Separate Measles, Mumps, and Rubella Vaccines No Longer Available? What Can Parents Do? Thursday, January 22, 2009 One of the most challenging and controversial parts of the alternative vaccine schedule is splitting up the MMR into three separate shots, spread out over a few years. The reasoning behind this idea is to expose a child to only one live viral vaccine at a time to allow the child’s immune system to better handle each vaccine and possibly experience fewer side effects. Although there is no medical evidence that this precaution is necessary or even useful, some parents, long before my book came out, have been skipping the MMR over fear of side effects. Some of these parents are more open to getting the separated vaccines. I present this option as a way to allow such families to vaccinate for these diseases. I don’t claim that it is the best way to go. I simply acknowledge it as an option. Now, however, it seems that this option has been taken away from these families. The official word on Merck’s website is that these vaccines are not available for order. I’ve called Merck to ask if they are planning to start making more, but I can’t get anyone from the company to call me back. I have heard from numerous people and some news reports that Merck isn’t currently making the vaccine. I haven’t heard that they’ve decided to stop permanently, just that they aren’t producing any at this time. So, it’s pretty clear that, at least for the time being, there is no more to be had. It is probably safe to say that there won’t be any more for at least 6 months to 1 year. It is also possible that they won’t ever make the separate vaccines again. This puts many parents in a difficult position. Some children have already received part of the series and are now left without a way to finish it without getting the entire MMR (and thus accepting extra doses of some components). Part of me wonders if Merck has stopped production as a way to force parents into an all-or-nothing decision. The AAP and CDC continue to insist on a “one size fits all” approach to vaccinating, without offering any suggested alternatives. Is this their way of forcing parents into the full MMR? I don’t know. The official word from Merck is that they need to devote all of the manufacturing capabilities to the full MMR and Chickenpox. They also state that the demand for the separate vaccines is so low that it doesn’t justify its production. One news story stated that the separate components only make up about 2% of the total MMR demand. Well, with 5 million babies being born each year in the U.S., that could be as many as 100,000 families searching for the separate vaccines each year. That would be a lot of unvaccinated children if these parents refused the full MMR. One issue that I don’t understand is that the separate rubella vaccine is routinely used for adult women after they have a baby. Any new mom who doesn’t have rubella immunity is given the vaccine. If Merck stops making it, such women will have to get the full MMR, even if they still have good measles and mumps immunity. The separate mumps vaccine also has its usefulness. During the outbreak of 2005/2006, many teens and adults needed a mumps booster to help contain the disease. If separate mumps vaccine isn’t made available for such events, the full MMR will have to be used. The same would be true if a measles epidemic occurs. So, what can parents do? Parents hate to give their children an extra dose of a vaccine if it isn’t needed. You’ve gone to all the trouble to try to split it up, and now you are faced with having to give it all together anyway. I know it’s frustrating. One note of encouragement is that there is no known harm in getting an extra dose, other than the fact that you are taking the small risk of a side effect an extra time and the frustration of knowing the separate shot you gave earlier was all for naught. If a child already has some immunity to one of the diseases from a previous vaccine, I’ve never seen any research that shows a child is any more likely to react to a second dose compared to anyone just getting their first dose. I’ve seen no evidence that getting an extra dose is dangerous. I know it’s very small consolation, but I just mention this so that parents aren’t afraid to get any extra components of the MMR if they decide to. Part of me wants to rally the nation’s parents in a campaign to insist that Merck begin making the shots again. Write your Senators, email Merck (politely!), refuse to get the full MMR! But that just isn’t responsible. Skipping the shots altogether leaves children at risk, the riskiest disease being measles. Of course, parents do have the option to skip the vaccine altogether. Even in states with mandatory vaccines laws, parents can still exercise a religious exemption (except for West Virginia and Mississippi). But for those of you (which is most of you) who do want MMR protection, I will offer you some choices. There isn’t one right choice here. When it comes to MMR there is so much controversy that I don’t believe there is one clear option. So, I will lay out all the choices so you can think it through. Most people who are very pro-vaccine feel my MMR recommendations should more closely reflect the standard American vaccine schedule. Now that the separate M-M-R vaccines are no longer available, most such vaccine advocates are hoping that I will now begin recommending the MMR at the standard ages of 1 and 5 years. To these people I would like to point out that I don’t make absolute recommendations. I present options. That’s what I’m going to do here. Here are all the options, depending on whether or not your child has received some of the separate components: CHILDREN WHO HAVE NEVER HAD ANY MMR COMPONENTS - Parents who feel confident in the safety of the MMR vaccine should go ahead and vaccinate at the recommended age of 1 and 5 years. - Parents who were planning to do it separately because they have some worry about side effects should wait until a later age to get the full MMR. I suggest waiting until a child is either 4 years of age or enters school, whichever comes first. The reason for the 4-year recommendation is two-fold: 1. Many kids don’t enter school until age 4, so their risk of catching measles, mumps, or rubella is very low, and the risk that they would expose other kids if they got sick is very low, and 2. Most states only require one dose of mumps and rubella if that one dose is given at age 4 or older, because the vaccine works much better for older kids like this. Some states do require a second dose of measles, however. See the State Requirements section below. - Parents who don’t feel comfortable leaving their children susceptible to these three diseases until age four, but want to delay it for at least a little while, can get the MMR at whatever age you feel most comfortable. If your toddler or young child is entering early preschool at age 2 or 3, you may want him to have the disease protection. If you get the MMR before age 4, your child would need a second dose around age 5 according to the regular vaccine schedule. This second dose is given because a small percentage of kids lose their immunity from the first dose and need a booster. From a health care cost perspective, it isn’t economical to test every child’s blood at age 5 to see which kids need a booster, then only give those kids a booster. So, the routine practice is to just give the two doses to everybody. If you don’t want to simply follow this routine 2-dose schedule, and instead want to try to get by with just one dose, you can do the one dose at any age, then get a blood test around age 5 to check immunity, then repeat the MMR if needed. - When you do get the MMR, I would suggest getting it alone, without any other shots. You can pick any time in the vaccine schedule to do it. There is no exact time that I would place it into my Alternative Vaccine Schedule. It’s an individual choice for each parent. If you get the shot at 1, 2, or 3 years of age, you can then either get the booster at 5, or do blood testing to confirm immunity and skip the booster if your child is still immune to all 3 diseases. There is also the possibility that in a few years we will have separate M, M, R component vaccines again, and you can give a booster shot for only those diseases your child needs a booster for, based on the blood immunity results. If the separate shots are not available, and 1 or 2 parts of the first shot (but not all three) have worn off, it’s okay to get the full MMR again. Or, you could just leave your child susceptible to a disease. The choice is yours. The risk of skipping or delaying the MMR Although these diseases are rare, outbreaks can occur. I encourage you to re-read the MMR chapter to refresh your memory on these diseases. The riskiest disease is probably measles. While most kids weather the disease without problems, occasional complications do occur. The risk of suffering a fatality from measles is about 1 in 1000 to 1 in 3000 cases. The risk of suffering a non-fatal complication that requires hospitalization (such as pneumonia, dehydration, and a variety of others) is unclear, but is probably 1 in 100 to 1 in 300 cases. Many years have gone by in the U.S. without a measles fatality. I pray it stays that way. CHILDREN WHO HAVE ALREADY HAD ONE DOSE OF ALL THREE MMR COMPONENTS EITHER SEPARATELY OR TOGETHER This decision is easy. Either get the 5 year booster of MMR, or do a blood test around age 5 to check immunity and don’t get any more MMR if immune to all three diseases. If your child is only immune to 1 or 2 diseases, but not all, it’s OK to get a full MMR. Or you can wait for the separate vaccines to come out again. CHILDREN WHO HAVE ALREADY HAD 1 OR 2 COMPONENTS OF THE SEPARATED MMR VACCINES Those of you who have already begun the process of separated MMR vaccines, you probably did so with two things in mind: You at least had some concern about MMR safety, and you felt comfortable to some degree with leaving your child susceptible to some of these diseases during the early years until all three doses were given. But now what do you do? - If your child has already received 1 dose of rubella (but no mumps or measles yet), you either have to get the full MMR now or wait until 4 years of age and get it then. It all depends on how comfortable you are with leaving your child susceptible to mumps and measles. You can review the book information on mumps and measles to refresh your memory. Leaving a child open to measles is probably the riskiest of the three diseases. If you get the MMR at 4, you can verify mumps and measles immunity with a blood test about 6 to 12 months later if your state requires it, since your child only received one dose. If your state doesn’t require it, I wouldn’t bother with an immunity check since most kids get full immunity after just one dose given this late. See State Requirements below. - If your child has already received 1 dose of mumps (but no rubella or measles), the same information applies as the previous paragraph. Rubella is extremely rare, and harmless to young children. Review the disease information in the book to remind yourself of the risk to pregnant women. - If your child has received 1 dose of measles, but not mumps or rubella, then I suggest you wait until age 4 to do the full MMR. That will give your child the required 1 dose of mumps and rubella, and 2 doses of measles. I wouldn’t bother checking blood immunity levels in this instance – you are pretty well covered. Since rubella is harmless to young children, and mumps is virtually always harmless, it is generally safe to remain susceptible to these until 4, especially if not in school yet. However, you should fully inform yourself about the personal and public health risks of delaying these shots by reviewing those pages in the book. - If your child has received 2 out of the 3 components already, it is not worth getting a full MMR prior to age four just to get protection from the third disease now, only to have to get another booster dose at age 5. Just wait until age 4 or 5 to get the full MMR, as long as you feel comfortable with the disease risk for a couple years for whichever vaccine hasn’t been given yet. See State Requirements below if you worry that your state laws may require you to get the shot sooner. If the third disease that you haven’t gotten the shot for yet is measles, I would just wait until 4 to get the full MMR dose. - Technically you can get the full MMR as close as only 1 month after any doses of the separate vaccines. However, as a precaution I would suggest putting at least a few months between them if you move on to the full MMR MEETING STATE REQUIREMENTS If you live in one of the 20 free states (these are listed on page 218 of the book) that allows parents to skip a vaccine for personal beliefs, and you chose to skip the MMR during infancy, I would suggest getting the MMR around age 4 or 5 when your child is going to have more exposure to other children and the general public. I wouldn’t bother with immunity blood testing – this one shot works very well in virtually all kids who get it late. If you want to skip the shot until the pre-teen years, it may be useful to check blood immunity around age 10 prior to the shot, since by that time your child will have been around many kids for many years and might have acquired some natural immunity. If your child does not have immunity to one or more diseases, you can either get the full MMR or separate components if they are available at that time. If you live in one of the 30 states that have mandatory vaccine laws, and you don’t want to claim religious exemption, realize that this doesn’t mean you absolutely have to get the MMR at age 1 and 5 years. You only have to meet the state requirements by the time a daycare, preschool, or kindergarten is going to enforce it. So, this means that if you are worried about the MMR, you can delay it for a year or two (or more) until your child enters school. Most states only require one dose of mumps and rubella if given at age 4 or older (since getting the shot at this later age works much better). Most states, however, will require either 2 measles vaccines, or a blood test to verify immunity from just the one dose. I suggest getting a blood test 6 to 12 months after the shot to prove this immunity. If not immune to measles, a second dose may be required by your state. This may mean another full MMR if the separate shots aren’t being made yet. If you do need (or want) to get the full MMR at an earlier age (between age 1 and 3 years), I suggest you do it alone, without any other shots. SUMMARY In the vaccine book I clearly state that vaccines are important, and that I believe the benefits outweigh the risks. Each vaccine can have a serious side effect, but in most cases this is rare. The MMR, however, is unique in that it is a triple live virus vaccine, and therefore has a more extensive list of possible reactions. These reactions mimic what the actual disease complications can be. Some of these reactions are very serious. Yes, the serious reactions are extremely rare, but it is a risk nonetheless. However, vaccinating for the MMR diseases is also a very important individual and public health concern. Measles will continue to increase if parents don’t vaccinate. Rubella may come back. The more people that don’t vaccinate, the more likely this is to happen. I have presented the options here. It’s not based on what the right or wrong decision is. It all comes down to what you as a parent and individual believe about the safety of the MMR and the risks of the three diseases. Remember, my alternative vaccine schedule isn’t a reflection of what I believe all parents should do. It is a suggestion for parents who are more worried about vaccines than the average person, and want to vaccinate their child more carefully. Splitting the MMR was part of that approach, but now it’s not an option for the foreseeable future. If I was to have written my alternative vaccine schedule without the separate vaccines, it would probably look something like this: MMR at age one and five, with an asterisk that says if you are worried about a reaction to the MMR, wait until age 4 to get the first (and only) dose, or get it sooner if your child will be entering early preschool (and possibly need a booster dose around age 5 or 6). LOOKING INTO THE FUTURE – WILL WE HAVE SEPARATED DOSES AGAIN? I think that one of two things are going to happen: 1. Many angry parents are going to delay or skip the MMR vaccine (either out of protest against Merck or out of worry over side effects), and once the government notices this (as measles increases or reports on non-compliance grow) they will ask Merck to begin producing the separate doses again. Post-partum moms who need a Rubella shot, but refuse the full MMR, may add to this campaign. When outbreaks of measles and mumps do occur (and they will!), and the parents of any unvaccinated children refuse the full MMR (but make it known they would happily accept the single component vaccines), the government might take notice. OR 2. Only a small minority will skip the full MMR. Most parents who wanted the separate shots will go ahead with the MMR at the recommended age of 1 year, and enough children will be vaccinated so we don’t see any appreciable rise in measles, mumps and rubella. Merck won’t begin making the separate shots again. Labels: Vaccine News posted by Dr. Bob Sears @ 1:29 PM   117 Comments: At January 23, 2009 2:39 PM ,  Jody said... Dr. Sears, Do you know of an email address with which to contact Merck and politely express our opinions? I looked at their website and could only find a mailing address. Thanks.   At January 23, 2009 4:48 PM ,  Anonymous said... I live in Michigan and no hospitals offer the single Rubella vaccine for moms w/out immunity, they only offer the full MMR. Just an fyi   At January 23, 2009 5:21 PM ,  Dr. Bob said... Jody - good question, but I don't know.   At January 23, 2009 6:18 PM ,  Her said... Ugg. Well then their ya have it.Thank you Dr Bob for taking time to write this up. Sister   At January 24, 2009 1:01 PM ,  Anonymous said... Dr. Bob, You said: "and once the government notices this (as measles increases or reports on non-compliance grow) they will ask Merck to begin producing the separate doses again" do you mean to say that the government dictates what vaccines are made and they could offer them but are chosing not too?   At January 25, 2009 7:39 AM ,  Anonymous said... Anonymous.... It certainly sounds like a government conspiracy doesn't it? I wouldn't doubt it for one moment! Tara   At January 25, 2009 9:58 AM ,  Dr. Bob said... Merck, and other companies, have the right to make such decisions themselves. But they do consult with the government as well. I don't know who is responsible for THIS decision. It's very possible Merck made this decision solely based on the need to use all their manufacturing ability for the full MMR. It's also possible Merck decided to stop the separate shots in order to take away choices from parents that take them outside the regular schedule. Whether or not the government or the AAP had a role in this decision is hard to say. But you can probably be sure that this decision wasn't made without everyone discussing it, and the reasons and implications behind it.   At January 25, 2009 10:45 AM ,  Anonymous said... I think that the independent pharmacies complained because they couldn't handle the intake of calls and requests for the individual shots, this new wave took them off guard. But if doctors offices could off them or make it more of the structure to split and the full MMR an option it might work better. My children both received the full MMR w/out incident but I'm glad I'm not one of those poor parents who are midway throught the single series!   At January 26, 2009 10:02 AM ,  Science Mom said... ”This puts many parents in a difficult position. Some children have already received part of the series and are now left without a way to finish it without getting the entire MMR (and thus accepting extra doses of some components).” No actually Dr. Bob, it would be recommendations like yours that put parents in that position. ”Part of me wonders if Merck has stopped production as a way to force parents into an all-or-nothing decision. The AAP and CDC continue to insist on a “one size fits all” approach to vaccinating, without offering any suggested alternatives. Is this their way of forcing parents into the full MMR? I don’t know. The official word from Merck is that they need to devote all of the manufacturing capabilities to the full MMR and Chickenpox. They also state that the demand for the separate vaccines is so low that it doesn’t justify its production. One news story stated that the separate components only make up about 2% of the total MMR demand. Well, with 5 million babies being born each year in the U.S., that could be as many as 100,000 families searching for the separate vaccines each year. That would be a lot of unvaccinated children if these parents refused the full MMR.” You have got to be joking. If producing the monovalents was a profitable venture then don't you think that Merck would continue doing so? The low demand doesn't justify its production in spite of your creative attempt to do so. That is 100K children all on different M, M and R schedules spread across the country and you are insinuating that Merck had better cater to them else it's their fault if the children are left unvaccinated. ”The separate mumps vaccine also has its usefulness. During the outbreak of 2005/2006, many teens and adults needed a mumps booster to help contain the disease. If separate mumps vaccine isn’t made available for such events, the full MMR will have to be used. The same would be true if a measles epidemic occurs.” Well if the uptake of 2 doses of MMR is high enough then we don't have to worry about this right? Because that was the problem identified in that mumps outbreak and the 1989-1991 measles outbreak. ”Part of me wants to rally the nation’s parents in a campaign to insist that Merck begin making the shots again. Write your Senators, email Merck (politely!), refuse to get the full MMR! But that just isn’t responsible. Skipping the shots altogether leaves children at risk, the riskiest disease being measles. Of course, parents do have the option to skip the vaccine altogether. Even in states with mandatory vaccines laws, parents can still exercise a religious exemption (except for West Virginia and Mississippi).” Oh that's a good plan. I'm all for being informed of exemptions but to use them as a weapon is really irresponsible and self-defeating. Senators have absolutely nothing to do with such a business decision by Merck and with a war, the worst economy since the depression, and a healthcare coverage crisis, just to name a few, their plates are rather full so I really don't think that is a productive recommendation. ”Parents who were planning to do it separately because they have some worry about side effects should wait until a later age to get the full MMR. I suggest waiting until a child is either 4 years of age or enters school, whichever comes first. The reason for the 4-year recommendation is two-fold: 1. Many kids don’t enter school until age 4, so their risk of catching measles, mumps, or rubella is very low, and the risk that they would expose other kids if they got sick is very low, and 2. Most states only require one dose of mumps and rubella if that one dose is given at age 4 or older, because the vaccine works much better for older kids like this. Some states do require a second dose of measles, however. See the State Requirements section below.” Did you learn nothing from the last 2 outbreaks of measles and the last mumps outbreak? The index case of the last outbreak gave it to 4 children in his paed's office, 3 of them were infants less than 12 months so how can you say that it is rare especially when you are encouraging parents to 'hide in the herd' and take advantage of it without contributing to it. Two doses of MMR have been shown to be effective for increasing the immunogenicity and duration of immunity and yet your very non-scientific recommendation is for parents to ignore these facts and do the bare minimum, based on a school recommendation, even though it means that their children may not be adequately protected. ”If you get the MMR before age 4, your child would need a second dose around age 5 according to the regular vaccine schedule. This second dose is given because a small percentage of kids lose their immunity from the first dose and need a booster. From a health care cost perspective, it isn’t economical to test every child’s blood at age 5 to see which kids need a booster, then only give those kids a booster. So, the routine practice is to just give the two doses to everybody. If you don’t want to simply follow this routine 2-dose schedule, and instead want to try to get by with just one dose, you can do the one dose at any age, then get a blood test around age 5 to check immunity, then repeat the MMR if needed.” Where are you getting this from? You have been repeating this in spite of much evidence to the contrary. By most school requirements, 2 doses of rubella and measles are required, 1 being administered between 4-6 years old. Recommending titre checks may be accepted by some school districts but you are forgetting, conveniently, the fact that just because a 5 year-old child may have adequate titres, doesn't mean that s/he will have that level of immunity at 10 or 20 years old. ”Many years have gone by in the U.S. without a measles fatality. I pray it stays that way.” Why pray? We have a very effective vaccine with a good safety profile that will prevent nearly all cases. But then again, prayer might be a viable option if too many parents follow your recommendations. CHILDREN WHO HAVE ALREADY HAD 1 OR 2 COMPONENTS OF THE SEPARATED MMR VACCINES This entire section is completely lacking of any science-base; you are more concerned with convincing parents to do the bare minimum for school rather than what is best for their children immunologically. ”In the vaccine book I clearly state that vaccines are important, and that I believe the benefits outweigh the risks. Each vaccine can have a serious side effect, but in most cases this is rare. The MMR, however, is unique in that it is a triple live virus vaccine, and therefore has a more extensive list of possible reactions. These reactions mimic what the actual disease complications can be. Some of these reactions are very serious. Yes, the serious reactions are extremely rare, but it is a risk nonetheless. However, vaccinating for the MMR diseases is also a very important individual and public health concern. Measles will continue to increase if parents don’t vaccinate. Rubella may come back. The more people that don’t vaccinate, the more likely this is to happen.” No Dr. Bob, the serious adverse reactions to the vaccines do not mimic the actual diseases if you care to review or possibly even take a first glance at the literature. There are some reactions that are the same but do not occur at nearly the rate of the natural infection. As for the rest of this paragraph, you are speaking out of both sides of your mouth, “I'm pro-vax, really I am but I am going to feed into your irrational fears about vaccines nonetheless”. You don't seem to fully understand the ball that you have set in motion; there is no reason why you can't address parental fears about vaccines, allay them with rational, layman's explanations of the actual scientific evidence and still offer selective/delayed schedules that do not leave such gaps in individual and herd immunity. ”1. Many angry parents are going to delay or skip the MMR vaccine (either out of protest against Merck or out of worry over side effects), and once the government notices this (as measles increases or reports on non-compliance grow) they will ask Merck to begin producing the separate doses again. Post-partum moms who need a Rubella shot, but refuse the full MMR, may add to this campaign. When outbreaks of measles and mumps do occur (and they will!), and the parents of any unvaccinated children refuse the full MMR (but make it known they would happily accept the single component vaccines), the government might take notice.” This sounds more like a threat and some foot-stomping because Merck threw a monkey wrench into your vaccine schedules than anything productive. I, sadly, predicted that your MMR recommendation would become more ludicrous should the monovalents cease to be available and you delivered. You had the opportunity to contrive a firm, realistic and evidenced-based recommendation in light of this but instead, you have chosen to tell parents that it's OK to leave their children susceptible to nearly eradicated diseases that are increasing in prevalence due to recommendations like yours and that free-riding on dwindling herd immunity is acceptable as well. You may have the market on compassion for concerned parents by telling them what they want to hear but I certainly do hope that they question the soundness of your recommendations for you are putting children and adults at risk. Where is your responsibility to your own patients? The ones that are coming into your waiting room with infants that have a much higher likelihood of sitting down next to a 4 or 5 year old child infected with measles whose parents were following your schedule? You are doing nothing more than encouraging gaping holes in herd immunity and a potential backlash against parents that are opting out of vaccinations or delaying them for years.   At January 26, 2009 10:56 AM ,  Jennifer said... Dr. Bob, I'd love to hear you answer to the previous post by Science Mom. Why do so many who are shocked by your recommendations want to completely dismiss the justifiable fears that some parents have with the MMR? The bottom line is that many parents have VALID concerns, ESPECIALLY with autism and other disorders already in their family. It seems like you are trying to address those fears...there is not enough research to solidly say that the MMR carries no risk. It seems like you are trying to help people who would otherwise decline the MMR, to at least get it at some point. Why do people like Science Mom not understand this point?   At January 26, 2009 11:15 AM ,  Science Mom said... The bottom line is that many parents have VALID concerns, ESPECIALLY with autism and other disorders already in their family. It seems like you are trying to address those fears...there is not enough research to solidly say that the MMR carries no risk. It seems like you are trying to help people who would otherwise decline the MMR, to at least get it at some point. Why do people like Science Mom not understand this point? Jennifer, From your perspective I don't 'get the point' but nothing could be further from the truth. I do understand the parental fears but I also understand what they are based upon and what Dr. Bob refuses to acknowledge. They are founded upon the pseudo-scientific drivel of Dr. Andrew Wakefield et al. Ask yourself Jennifer, if Wakefield was able to find that many children with MMR-associated autism for his and a subsequent 'study', then where was the massive eruption of neurological disorders in the infant population when MMR was introduced more than 30 years ago? Also ask yourself why other countries, with different vaccine schedules have the same if not higher ASD rates as the U.S. The entire theory is based upon very bad science that has been debunked by numerous scientists that have a far better concept of scientific principles than Dr. Bob. And you clearly didn't read my comment as I am not dismissive of fears, I am suggesting that Dr. Bob can acknowledge but allay those fears with the research and stop feeding them with recommendations that are going to put children at a real risk of disease as opposed to the completely unfounded 'risk' of autism. So when you can see things for what they really are, you will get it.   At January 26, 2009 11:44 AM ,  Catherina said... Science Mom! Thank you, you have summed up my thoughts exactly!   At January 26, 2009 11:47 AM ,  Jennifer said... To Science Mom...what makes you believe that there is enough research to debunk all possible theories of risk assessment with the MMR? I sure would love to hear Dr. Bob's answer on this one. Perhaps he is unable to allay all fears, as you say, because maybe he has his doubts as well. The MMR is still HUGELY debated, and I hardly believe that all answers have been found. Where there's smoke, there's fire...it might just take awhile to find the fire.   At January 26, 2009 11:55 AM ,  Catherina said... Jennifer, look for the fire where lawyers paid Wakefield to say that MMR causes autism.   At January 26, 2009 12:49 PM ,  Science Mom said... To Science Mom...what makes you believe that there is enough research to debunk all possible theories of risk assessment with the MMR? I sure would love to hear Dr. Bob's answer on this one. Perhaps he is unable to allay all fears, as you say, because maybe he has his doubts as well. The MMR is still HUGELY debated, and I hardly believe that all answers have been found. Where there's smoke, there's fire...it might just take awhile to find the fire. Jennifer, This is what makes me believe there is enough research: http://www.ncbi.nlm.nih.gov/pubmed/18769550?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum http://www.ncbi.nlm.nih.gov/pubmed/18252754?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum http://www.ncbi.nlm.nih.gov/pubmed/16865547?ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum http://www.ncbi.nlm.nih.gov/pubmed/16555271?ordinalpos=28&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum I urge Dr. Bob to access this one: http://www.ncbi.nlm.nih.gov/pubmed/15819183?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVCitation http://www.ncbi.nlm.nih.gov/pubmed/15877763?ordinalpos=45&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum http://www.ncbi.nlm.nih.gov/pubmed/15364187?ordinalpos=56&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum http://www.ncbi.nlm.nih.gov/pubmed/12421889?ordinalpos=107&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum ftp://autism.uscfc.uscourts.gov/autism/cedillo.html And this is just a sample. Now, compare the quality of these studies and the experts testifying to the OAP to those of Wakefield et al.'s and it isn't hard to see what the reality is. The fire has been looked for and can't be found save a small group of sleazy, agendised physicians and scientists; that speaks volumes to me but then again, I read with a critical eye, not with a decision rendered in advance. The debate only rages on in the empty minds of celebrity-based medicine purveyors, not for the rest of us that care to see where the real evidence is. The more evidence that comes to light that debunks the MMR-autism hypothesis, the more some dig their heels in when it should be just the opposite; goes to show that they are not interested in empirical evidence, just vacuous, emotional anti-vax rhetoric.   At January 26, 2009 1:30 PM ,  Dr. Bob said... Catherina and Science Mom: When you look at this issue purely from the point of mainstream medical science, you are both 100% completely right. The problem is, many parents don't completely trust mainstream science when it comes to vaccines. The main reason some parents don't trust it is that some (not all, some some, or most) vaccine research is funded by the companies that make the vaccines. In addition, most (not all) research that is done by infectious disease specialists regarding vaccine-preventable diseases is funded by vaccine manufacturers. I'm not saying that this negates the research findings. But it certainly is not an ideal system for instilling faith in doubting parents. So, I'm not sure why it surprises the two of you so much that parents don't always trust it. A couple of reassurances that should make this system more trustworthy are 1 - governmental oversight (which probably also has some trust holes in it since the vaccine manufacturers could influence politics through financial donations), and 2 - the faith that, despite where the research money comes from, most doctors would hopefully remain unbiased in their work. THIS IS THE BOTTOM LINE. Parents won't always trust science that is funded by the people who have a financial or political stake in the outcome. Why does that surprise you? So, what I attempt to do is take ALL available information and put vaccine recommendations that hesitant parents can feel better about. All the science in the world isn't going to convince every parent to get the MMR at age 1 and 5. So, instead of bailing on such parents, I show them how the CAN get it. I don't expect you two to agree with this post. My recommendations aren't designed to convince everyone - they are designed to help parents who are worried about vaccines and still want to vaccinate. Why is this is so hard a concept for you to grasp? Dr. Bob   At January 26, 2009 1:47 PM ,  Catherina said... Bob, it is NOT the government that is responsible here - it is you. The government has nothing to do with your gut feeling - the only thing supporting your audacious practise to delay the MMR for your patients. Read SM's post again - slowly. She is right about everything, also the "speaking out of both sides of your mouth". Given that you get called upon your stance (both from parents who are expecting definite guidance, and by colleagues - see Offit and Moser's article and the comments of Drs Mason and Lerner here for example) you cannot have it both ways: there is only one science - not "mainstream science" and "Dr Bob's gut feeling science". So if science supports the AAP recommendation to vaccinate MMR at age 12 months, then maybe you should try and explain that to parents rather than to increase their fears by suggesting they delay the MMR until the age of four.   At January 26, 2009 3:45 PM ,  Anonymous said... Catherina, Please post YOUR advice to parents regarding MMR for those reluctant and doubting parents. I would like to see a recommendation from you. Give it your best shot. Let's see if what you come up with is convincing enough for parents to vaccinate with MMR at 12 months rather than delaying or foregoing the vaccine. Go on. Use everything you got. Your deep and vast knowledge, your background, your convictions and your science. What can YOU offer fearful parents?   At January 27, 2009 7:47 AM ,  Science Mom said... "When you look at this issue purely from the point of mainstream medical science, you are both 100% completely right." What other way is there to look at it? The pseudo-scientific way? "The problem is, many parents don't completely trust mainstream science when it comes to vaccines. The main reason some parents don't trust it is that some (not all, some some, or most) vaccine research is funded by the companies that make the vaccines. In addition, most (not all) research that is done by infectious disease specialists regarding vaccine-preventable diseases is funded by vaccine manufacturers. I'm not saying that this negates the research findings. But it certainly is not an ideal system for instilling faith in doubting parents." Dr. Bob, that is simply not true; look at the key articles I posted, name one that was funded by Pharma. Look at the literature, how many articles examining the MMR-autism hypothesis are funded by Pharma? It's one thing for parents to believe this, it's quite another for you to be disseminating this complete fabrication, quite disingenuous. "A couple of reassurances that should make this system more trustworthy are 1 - governmental oversight (which probably also has some trust holes in it since the vaccine manufacturers could influence politics through financial donations), and 2 - the faith that, despite where the research money comes from, most doctors would hopefully remain unbiased in their work." I don't think you are familiar with how funding institutions work are you? "THIS IS THE BOTTOM LINE. Parents won't always trust science that is funded by the people who have a financial or political stake in the outcome. Why does that surprise you? So, what I attempt to do is take ALL available information and put vaccine recommendations that hesitant parents can feel better about. All the science in the world isn't going to convince every parent to get the MMR at age 1 and 5. So, instead of bailing on such parents, I show them how the CAN get it." Emphasis mine. But they and you will trust a poorly executed study by Wakefield et al. whom was paid by attorneys to find an MMR-autism link? Not to mention unethical medical procedures performed on children well after the study in order to try and exonerate himself. And you reject high-quality, independently-funded studies that cannot find any association. Yes, that surprises and disappoints me. You do not attempt to take ALL the information for alternative vaccine schedules. Anyone can look at your resources and see that you have not cited a single study that I linked to, instead have used pseudo-scientific rubbish from Medical Hypotheses, Medical Science Monitor and Journal of American Physicians and Surgeons. It is clear that you have an agenda that does not reside in the realms of empirical evidence. "I don't expect you two to agree with this post. My recommendations aren't designed to convince everyone - they are designed to help parents who are worried about vaccines and still want to vaccinate. Why is this is so hard a concept for you to grasp?" I don't think it is we that have a difficulty grasping for we have reviewed the relevant data and can see the MMR-autism hypothesis for what it is. You can still address parental fears by presentation of the actual evidence and justification and reassurance for giving their children MMR between 1 and 1.5 years, even 2 years if the uptake is high enough. But what I think is that you have painted yourself into a corner with your 'trademark' MMR recommendation and that you have too much ego invested in a later recommendation that that precludes you from critically examining the facts and forming an evidenced-based recommendation.   At January 27, 2009 3:57 PM ,  Megan said... Dr. Bob: I am traveling to Europe with my 17 month old in March. Since the most recent Measles outbreak came from a visit to Europe, I have located a Measles-only vaccine locally and was planning on giving it to my daughter on Thursday. Does this make sense now, given the fact that the mumps and rubella separate vaccines are no longer available?   At January 27, 2009 6:33 PM ,  Dr. Bob said... Megan - Here's how I feel about travel - vacation travel that doesn't involve your family mixing with other native children is fairly low risk. The family that brought measles back from Europe was visiting their family there and mingled with local children. If you think you'll mingle, or you don't want to take any chance with measles, then yes - vaxing now would make sense. But that would mean not getting any mumps or rubella vaccine until you perhaps get the full MMR at age 4 or 5.   At January 27, 2009 6:44 PM ,  Dr. Bob said... SM - thanks for listing all those studies - I've looked thru them all in the past, but will review again. It WOULD be nice for me to add a complete review of all the science in the next book edition, so thanks!!!!!!! A lot of my opinion on this issue stems from an article in Vaccine - http://www.ncbi.nlm.nih.gov/pubmed/12922131 It's a review of ALL available research, and appears in the back of my book. It does dispel the connection between MMR and many chronic diseases. However, at the end of the abstract, these words appear: The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate." How do you interpret this statement? My interpretation was that this group of researchers feel that there is a lack of adequate study on the side effects of MMR. That there needs to be better safety research on the MMR. Am I interpreting this wrong? Your thoughts?   At January 27, 2009 10:43 PM ,  Catherina said... Megan, I completely disagree with Dr Sears' assessment that the risk is low if you are not visiting family. No close contact is necessary for the transmission of measles. I would get the MMR. It is not more "dangerous" than the measles only vaccine. Separating the MMR is not backed by any science and leaves children vulnerable longer than necessary. Have a wonderful trip!   At January 28, 2009 10:35 AM ,  Megan said... Dr. Bob: Thank you for your advice. Catherina: I actually disagree with you. A very good friend of mine's daughter was adversely affected by her MMR at 12 months. My friend noticed the change immediately. Her daughter is now 8 and has high functioning austism. She has undergone years and years of therapy and diet alterations in order to get her to where she is today. My friend has chosen not to vaccinate her four year old as a result of her experience with her eight year old. The CDC schedule is just too heavy-duty for me to be comfortable. I am taking the vaccinations very slow. Best regards.   At January 28, 2009 12:11 PM ,  Catherina said... Megan, fair enough and nothing wrong with that as long as you stay in the US. I don't know where you are going, but much of Europe is a high risk environment for measles and there is NO data (as in squat, nada, zero) saying that measles only vaccine is any safer than the MMR. That is entirely made up following the financial interests of a group of greedy lawyers. As said - have a nice trip - Catherina   At January 29, 2009 8:40 AM ,  Anonymous said... Dr.Bob; Thank you for posting your MMR blog. While some refuse to admit it, there IS a "vaccine debate" whether they recognize its validity or not and parents are demanding options. I thank you mostly for recoginizing that. I have worked for a US pharmaceutical company and know there is definite corruption and to think that vaccines would be excluded from that (on some moral grounds?) is naieve. There is also most certainly a huge government influence and anyone who thinks otherwise is naieve to the system at best. Science Mom; You have way too much time on your hands.   At January 29, 2009 9:09 AM ,  SM fan said... Science Mom; You have way too much time on your hands. and she is putting it to such good use :)   At January 30, 2009 7:06 AM ,  Happy Dad said... I don't see any scientific explanation at all as to why these whitecoats are exposing innocent and non-diseased babies and children thru the inoculation of pathogenic microorganisms in the body. Why would they assert that vaccines will protect them from such diseases when in fact, their non-diseased state has already been infiltrated and contaminated by way of vaccination. Nonsense.   At January 30, 2009 11:50 AM ,  Anonymous said... I live in Canada and for the most part I've been following our typical vax schedule with both my children until now when the nurse suggested to inoculate my 13 month old daughter with MMR, varicella, hep B, meningococcal, and influenza all at once. I thought that was way too much in one day. Instead I opted for my daughter to receive her first dose of MMR and meningococcal (because we have 3 reported cases in our city). So far so good and no adverse reaction. I've scheduled to have the varicella and her third hepB shot 14 days later. Because we plan to travel to Paris, France in mid-May the public health nurse recommended our daughter get her 2nd MMR prior to travelling opposed to waiting until age 4. From my internet research I understand that this is okay so long as the second dosage is given at least when she's 15 months old and 28 days after the first dose. Dr. Bob, what do you think of this recommendation for the second MMR? Chances are our children will be exposed to local kids in the parks, Disneyland Paris and most of all 12 hours each way on the airplane breathing recycled air. What are your thoughts? Thank you in advance for your advise and sharing information with active parents who want to make their own informed decision.   At January 31, 2009 12:48 AM ,  Catherina said... Hi Canadian mom, not Dr Bob, but I can tell you that the official German schedule is recommending the first MMR at 11 to 14 months and the second at 15 to 24 months. Apparently, it is working well and adverse events (apart from the usual ones) have been associated with this schedule. Have a great trip! My DD is going to be in Paris this Summer with her school. I so want to go too :)   At January 31, 2009 7:50 AM ,  Catherina said... duh - NO extra adverse events have been noted.   At February 2, 2009 8:04 PM ,  Dr. Bob said... Anonymous - In the U.S. we wait at least 30 days to give Varicella vaccine after the MMR. IF you give it sooner, the immune system won't recognize it as well (because it's still working on the MMR). So, I would wait LONGER than the 14 days - wait at least 30 days. As for the second MMR, I see no reason for you to get it sooner than the recommended age. Getting a second MMR prior to age 4 for travel purposes is NOT an official recommendation, NOR is it advised by any travel vaccination schedules. The one dose is thought to work just fine.   At February 3, 2009 4:05 PM ,  Bill said... Science Mom/Catherina, As for me, I vaccinate my children on a delayed schedule, and have done so since before Dr. Bob's book came out. I plan on vaccinating them to the requirements of the law in my state with two exceptions. I will not give either of my girls Varicella or Hep B before they reach middle school age. If they do not get Chicken Pox before that then they will need it to prevent the more serious potential issues in later life from varicella related diseases. Hep B is unnecessary while they are not sexually active. If for some reason they decide to engage in sports where there is a reasonable chance of blood/body fluid exchange before puberty, then I will reconsider. All of the other vaccines I am giving per Dr. Bob's schedule. I actually HAVE single antigen Measles and Rubella for both of my girls stored in the fridge ready to go as we speak. I got the Rubella vax in September when Merck released it, and the Measles vax in December. Both came through Hopewell Pharmacy in NJ. My only exposure is Mumps for my youngest daughter, and if necessary I'll give her the MMR AFTER age 4... You obviously will never agree with anything that Dr. Bob has to say. Therefore, I suggest that you recuse yourselves from these discussions as you are firmly on the side of the AMA & Big Pharma, whose opinions and recommendations we are clearly familiar with. We just don't agree with them! Go drink your Kool-Aid elsewhere...   At February 3, 2009 4:28 PM ,  Bill said... Dr. Bob, Thank you for your efforts to assist those of us who are hesitant and worried about vaccines. Your book is a resource for me, and I have a copy to give to my girls' pediatrician for his reference. We are using your schedule with the exceptions I described in my earlier post. As I said before, we were able to get fesh single antigen Meruvax in September, and Attenuvax in late November/December from Hopewell Pharmacy. This was somewhat after the availability schedule that Merck was publishing, but the did release them. I was actually able to speak with a representative from Merck by phone early last year, and he gave me a late-summer '08 timeline for those vaccines. They missed it by a couple of months, but they did deliver. As for the Mumpsvax, they gave me no timeline when I talked to them, but Hopewell has an estimate of 06/2009 in their latest update from Merck, which was in November. I hope that they will hold to that, but if not I can live with one MMR for my youngest after age 4. We live in PA, where the requirement is 2 Measles, one each Mumps and Rubella, so my older girl is covered by the singles we were able to get in the past and recently. Thanks again for understanding that there are rational, intelligent, free-thinking people who actively question the information disseminated by mainstream medicine and research. We are not cranks who blindly play roulette with our children's health. We hold the institutions that would require us to vaccinate our children on their schedule to the high standard of proving beyond any doubt that what they would force upon us is safer and healthier than any other alternative. When they derive their funding from the companies that make and market the 'cure', and they are represented by the very policy-makers in government who are supposed to have our well-being in mind, (I'm talking to YOU Tom Daschle) then reasonable people are perfectly justified in asking them to prove their assertions conclusively. With Best Regards, Bill Finch "Primum non nocere, secundum succurrere"   At February 3, 2009 4:53 PM ,  Sheri said... Dear Dr. Bob, I am left unsdure what to do. I have a five year old and the first two years of his life I followed the regular vaccine schedule. I started worring about giving him the booster MMR. He has been in speech, OT and PT since he was 2. He has some sensory and vestibular issues ( not Autism). Also when he had his first MMR at 12 months, he had a reaction(a high fever of 105 and a rash all over his body). So I was scared to give him the booster, so I just recenty decided to get it seperate and just gave the measles vaccine last month. What do I do now in your opinion? Thanks, Sheri   At February 3, 2009 5:31 PM ,  Carmen said... Thank you Dr. Bob for your insightful information and for always presenting options. I will be vaccinating but using a selective and alternative timeline. I'm one of those people who was planning to vaccinate MMR seperately, but now I have to rethink things. Regarding the MMR, yes, there are no studies that PROVE a link to Autism, but there is also nothing that has DISPROVEN it either. I have worked in politics for 11 years. Much of the information we trust and the policies that are made (ie: even the AAP vaccine recommendations), are influenced by interested parties. Sure sounds like Science Mom and Catherina have an agenda of their own... Thank you Bill for your refreshing comments.   At February 3, 2009 8:03 PM ,  Anonymous said... Is it possible to get the separate MMR oversees anywhere.   At February 3, 2009 8:06 PM ,  Kacey said... Dr. Bob, there are also some of us who are Catholic, who cannot give our child the MMR, because they use aborted fetal cell lines. Merck's separate dose for rubella, Meruvax, uses aborted fetal cell lines and taints the entire MMR II vaccine. The separate doses of Attenuvax (measles) and Mumpsvax (mumps) use chick embryo. Without these separate doses for measles and mumps, there will be no moral alternative for parents! It's a tragedy.   At February 3, 2009 11:18 PM ,  allinplass said... I am furious that the option of separate vaccinations has been taken away from me. My twins were born three months premature and my son had major life threatening intestinal issues at birth. He is now a thriving 18 month old...and has not received the MMR vaccine. I was planning to do separate vaccines and hold off on measles. Once that shot is given, you can't take it back. The unknown of how the triple vaccine could impact my son is a risk I'm not willing to take.   At February 4, 2009 9:46 AM ,  JewelyaZ said... We will not be getting my April 2008 son the full MMR... way to go, Merck! My January 2000 daughter did get the separated measles shot. She got rubella naturally and I don't care about mumps for girls. I will be writing my senators and Merck, politely, but with vigor. I am just not EVER willing to administer the whole MMR to my kids.   At February 4, 2009 12:36 PM ,  Science Mom said... A lot of my opinion on this issue stems from an article in Vaccine - http://www.ncbi.nlm.nih.gov/pubmed/12922131 It's a review of ALL available research, and appears in the back of my book. It does dispel the connection between MMR and many chronic diseases. However, at the end of the abstract, these words appear: The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate." How do you interpret this statement? My interpretation was that this group of researchers feel that there is a lack of adequate study on the side effects of MMR. That there needs to be better safety research on the MMR. Am I interpreting this wrong? Your thoughts? Yes, you are interpreting it wrong as you are not considering the entire body of evidence. Incidentally, it is not a review of ALL the evidence. You should also refer to the Cochrane Systematic review, with some of the same authors as well: http://www.ncbi.nlm.nih.gov/pubmed/16235361?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum which states: The range of differing study designs used by authors are partly a reflection on the lack of control children not exposed to MMR, due to the population nature of vaccination programmes. As MMR vaccine is universally recommended, recent studies are constrained by the lack of a non-exposed control group. This is a methodologically difficulty which is likely to be encountered in all comparative studies of established childhood vaccines. and also this: The safety record of MMR is possibly best attested by its almost universal use; its evaluation cannot be divorced from its effectiveness and the importance of the target diseases. As such, MMR remains an important preventive global intervention. In other words, the universal use of MMR simultaneously presents a difficulty for conducting a prospective study with a sufficiently large, non-vaccinated group but since it has been in use for so long and so many doses administered that it presents an opportunity for a natural experiment of safety which has been noted. Bill, Calling the brainy kids names to chase them out of the sandbox has been done already and to no avail. Furthermore, we are not offering opinions when we disagree with Dr. Bob's recommendations, they are objective interpretations of the best available data, not 'gut science' which sadly, some rely upon. Kacey, You may be interested in this: http://www.physiciansforlife.ca/html/conscience/articles/NCBQ_vaccines.pdf which essentially states that in the absence of an 'ethical' cell line, that the receipt of vaccines cultured on cell lines derived from aborted tissue is granted by the Vatican. In fact, they recommend the vaccines' benefits far outweigh the origin of the cell lines.   At February 4, 2009 4:27 PM ,  Bill said... Bill, Calling the brainy kids names to chase them out of the sandbox has been done already and to no avail. Furthermore, we are not offering opinions when we disagree with Dr. Bob's recommendations, they are objective interpretations of the best available data, not 'gut science' which sadly, some rely upon. Science Mom, You obviously did not read my post very carefully. I am not a 'dummy' who is belittling a more intelligent child to make himself feel important. I can read, and spell, and even count beyond my ten fingers and toes! I carefully and cynically evaluate everything that comes out of the published studies. I watch closely as segment after segment of healthcare research is bombarded with conflicting and sometimes contradictory study findings. Therefore, if the risk of an adverse reaction due to administering multiple vaccines to my child when they are too young too handle it is even one tenth of one percent, I WILL NOT TAKE IT! I also will not give my children vaccinations for diseases that they have virtually no chance of being exposed to until puberty or later simply because the CDC believes that parents are irresponsible and will not bring their children back for future vaccines after they enter school (This is the rationale used to justify the Hep B requirements). Thankfully I live in a state where I can choose which vaccines to give my child and decline or postpone the others on my own philosophical recognizance without the limitations imposed by 'proving' that I have a religious reason for declining or postponing vaccination. Otherwise the party-line opinion, yours, would be forced upon me. I fully intend to vaccinate my children, but I will not be bullied, shamed, or patronized into doing it one day sooner than I feel is appropriate. At the end of the day it is I who have to explain to my child why they are damaged for life if that should occur, not the politicians, physicians, or drug-peddlers. If you choose to follow them, that is your decision, and nothing I say will change that. Similarly, nothing you say, and no study or Pontifical opinion you cite will cause someone who does not trust the vaccine machine to do so. By the way, here is the direct quote from the Vatican work you cite: • As regards the vaccines without an alternative, the need to contest so that others may be prepared must be reaffirmed, as should be the lawfulness of using the former in the meantime insomuch as is necessary in order to avoid a serious risk not only for one’s own children but also, and perhaps more specifically, for the health conditions of the population as a whole—especially for pregnant women. • The lawfulness of the use of these vaccines should not be misinterpreted as a declaration of the lawfulness of their production, marketing, and use, but is to be understood as being a passive material cooperation and, in its mildest and remotest sense, also active, morally justified as an extrema ratio due to the necessity to provide for the good of one’s children and of the people who come in contact with the children (pregnant women). • Such cooperation occurs in a context of moral coercion of the conscience of parents, who are forced to choose to act against their conscience or otherwise, to put the health of their children and of the population as a whole at risk. This is an unjust alternative choice, which must be eliminated as soon as possible. I do not interpret this as a recommendation that "far outweighs" the origin of the cell lines. This is a stated case of the lesser of two evils and a "moral coercion of conscience", hardly a glowing endorsement...   At February 4, 2009 5:53 PM ,  Science Mom said... Bill, I did not say it was a glowing endorsement, didn't even imply that; strawman. You obviously did not read my post very carefully. I am not a 'dummy' who is belittling a more intelligent child to make himself feel important. Oh I read it just fine along with the pharma shill inferences. Doesn't that ever get boring? Although I think it may be your ignorance of me or just some pre-programmed response to science-types that precludes you from knowing that I do not tell anyone to vaccinate, nor do I pass judgment on them; that's not my 'thing'. I prefer to focus upon disemboweling the pseudo-science and the flawed reasoning that goes into vaccinating decisions, like some of yours for instance.   At February 5, 2009 7:55 AM ,  Anonymous said... Ah, Science Mom .... you come out with some good things, then you shoot yourself in the foot. While you may think that you do not tell anyone to vaccinate, it is always there below the surface. Unfortunately, I just don't think that you can see it.   At February 5, 2009 9:34 AM ,  Science Mom said... Anonymous, Please feel free to post anything that I have said or inferred with regards to telling people to vaccinate. Parents are free to choose what they think is best for their children and if that choice is not to vaccinate or on the fence then it serves no purpose for me or someone like me to wag my finger at them. I prefer to, as I have stated, to rebut the bad science with good, to refute the agendised, emotion-driven anecdotes and pseudo-science with facts so that parents may at least be given the opportunity to consider all the evidence. That is hardly a disservice to them but I can see why my approach would get under the skin of those that have decided they know all the answers.   At February 5, 2009 9:55 AM ,  Carmen said... Allinplass-I am in the same boat. I'm furious. I fully intend to vaccinate, but now that the seperate MMR is not available, I will not give the combined MMR. To this moment, I have yet to be convinced by any study that the MMR absolutely does not cause Autism and more. Until I see something that disproves the possiblity, I will not put my child at risk. I can only hope that Merck or another pharma company will begin production again. If they don't, then its no MMR shot, it's that simple.   At February 5, 2009 8:16 PM ,  Dr. Bob said... Bill - thanks for your thoughtful input. glad you've been able to follow the shot schedule you want. Sheri - In children with those types of minor developmental challenges that require therapy, I ask parents to consider holding off on any further vaccines. Since you just did measles, I wouldn't do a full MMR - I would just stay without the second Mumps and Rubella if you are OK with that.   At February 6, 2009 12:16 PM ,  Anonymous said... Dr Bob - I have a question, and I apologize if it has already been asked. I was able to find the separate Measles, Mumps & Rubella vaccines. Since I was aware of the Merck issue I did fill all 3 prescriptions at once. My daughter received her mumps vax in January, but the measles and rubella vaccines have expiration dates of January, 2010. In your book you recommend a 1 year spacing between these vaccines - if I compress the schedule to fit them all in within the year, have I defeated the purpose of giving separate shots? Thanks for this book and the time you spend to answer our questions.   At February 8, 2009 8:12 AM ,  Science Mom said... More bad news for Wakefield, good news for parents concerned with the MMR jab: http://www.timesonline.co.uk/tol/life_and_style/health/article5683671.ece   At February 8, 2009 1:38 PM ,  Catherina said... Re: seperate Measles, Mumps, Rubella vaccines. The year between shots has been entirely made up (as, see link above, Andrew Wakefield made up his other claims as well), it is not based on any science or evidence at all. So if you have all three vaccines ready, it would be silly to let one go bad based on a made up story/rationale for spacing. Let's look at it from a biomedical angle: When the vaccine virus enters the body, it has to infect some cells (about 4 days), replicate (3 days), the immune system detects it, mounts an immune response (9 days) and clears the virus (10 to 21 days). We know from rubella that it can be shed up to 3 weeks after injection. So if you go by that, the minimum spacing would be 4 weeks to make sure any two vaccine viruses do not encounter each other in the body. The maximum, if you want to get all three within a year, is obviously 6 months. Pick *anything* between 4 weeks and 6 months as it suits you. If I was to suggest anything then to wait until April when not so many sick children gather at the doctor's office and then space them maybe three months apart for your peace of mind. Like that your child will be covered by next Winter. If you are near a touristy spot, do measles first. San Francisco has a couple of imported cases at the moment, and the way measles are going strong in Europe, the US is going to see their fair share of measles this year, too. I hope this helps, and I am sorry for the snark in my post. It is not directed towards you, but towards the people who make up scary stories to fill their own pockets with lawyers' bribes or single vaccine administration fees. All the best!   At February 9, 2009 12:14 PM ,  Anonymous said... Dr. Bob, Thanks for the information. My prediction is the former -- parents will choose to skip the MMR altogether and we'll continue to see a growing repsonse in measles and mumps in the US. Merck's response to this is disgusting. It's government conspiracy at its finest. They'll see the outcome. And it won't be pretty. Thank you, again. It's nice to know we have support out there.   At February 9, 2009 1:53 PM ,  Science Mom said... Thanks for the information. My prediction is the former -- parents will choose to skip the MMR altogether and we'll continue to see a growing repsonse in measles and mumps in the US. Merck's response to this is disgusting. It's government conspiracy at its finest. They'll see the outcome. And it won't be pretty. I really have to address this. So you are going to punish Merck by foregoing the MMR jab for your children because you can't have the monovalent jabs? Wow! Yes, we will see an increase in measles, mumps and rubella in the U.S. and guess who the vast majority of those will contract them? If you would be so kind as to remove your tin foil beanie for just a spell to listen to this, there is no government conspiracy; it's all about money and don't you think if the monovalents were profitable for Merck they would be making them?   At February 9, 2009 1:55 PM ,  Catherina said... They'll see the outcome. And it won't be pretty. Translates into "first our children will die and then they'll be sorry." The responsibility to protect children from potentially devestating diseases lies with their parents, not some pharma company, or the government. If the government was going to react to a refusal of parents to adequately protect their children (and the children in the community), it would be through a more rigorous enforcement of the vaccine mandate. That would be my prediction.   At February 9, 2009 3:14 PM ,  Anonymous said... Science Mom & Catherina - Clearly you are well versed in the issues, and quite passionate, and that's all good. But why do you have to attack us parents? We are simply seeking additional information. Personally, my child will have all of her vaccines...I have chosen to space them out. That is my decision, and quite frankly, Dr. Bob's ability to communicate the pros and cons (whether or not you or your interpretation of the research agrees with them) in an easy to understand way convinced me that my child should have all of her vaccines. I cannot make sense of medical research on my own, the media puts a lot of scare out there, and I think we are all just trying to do the right thing in our own way. Is it so awful to question the motivations behind corporate and government decisions? Every other decision they make seems to be questioned. You shouldn't let your messages be so clouded by such hostility, this is not the place for it. And besides, I might be more apt to listen if you were not so darn mean.   At February 10, 2009 1:20 PM ,  DR. Bob said... Anon - to answer your question about having the separate MMR shots already, yes, you can speed it up. The 1 year spacing was just an arbitrary precaution, so doesn't have to be one year. I would go for about 6 months in between each.   At February 10, 2009 5:05 PM ,  Sheri said... Dear Dr. Bob, Sorry to bother you again. My name is Sheri and you were kind enough to answer my first question. I have the five year old son who had a reaction to the MMR at 12 months and has been it speech, OT and PT for some sensory and vestibuler issues and he has low muscle tone. Anyway I gave him the measles seperate a couple months ago and you told me that I shouldn't give him anymore vaccines right now. My question is I was able to get the rubella vaccine because they had some left at my hospital. They no longer have the mumps. I am now questioning if I should even be giving the rubella seperate to him. He is also due for polio and chicken pox. I was going to give them to him spaced out, but should I be because he has some minor developmental delays? I do not want to harm all the progress he has made over the last couple of years. He is finally starting to catch up to his age group in the motor skill areas. I would say he is still about a year behind in gross motor skills, but ahead in his age group acadamically. I don't want him to go backwards or stall his progress by giving him another vaccine. But I also know how important vaccines are. He received Dtap last summer. He is also allergic to peanuts and eggs. I also question if vaccines play a role in the increase of food allergies. Thank you for you advice. I really appreciate it, I know how busy you must be. Sheri   At February 11, 2009 6:24 PM ,  Janie said... Science Mom: ....brainy kids.... LMAO...seems someone has an inflated sense of self...it's hard to take you seriously after that comment...take a hike!   At February 12, 2009 12:11 AM ,  Catherina said... Janie: ...take a hike! that is really deep now...can we return to the matter at hand, i.e. the health implications of not getting the MMR?   At February 12, 2009 12:57 PM ,  Anonymous said... I just realized I posted this comment in the wrong thread, so I am reposting here. Sorry for the repeat. While this is totally hearsay, in October, I discussed the single dose MMR with my pediatrician. She told me that their Merck rep had recently informed her office that Merck was no longer producing the single shot. According to the Merck rep (as reported by my pediatrician, so we are now getting close to a game of telephone), the CDC requested that Merck stop producing the single dose b/c they felt like it was playing into parents' hysteria about the possible autism link. Merck was complying with the CDCs wishes despite the single dose shots being financially beneficial for both Merck and my pediatrician (I have no idea how financially beneficial was determined for either Merck or my pediatrician). I hesitate to post it b/c i have no way of verifying the info (and don't want to unnecessarily feed government conspiracy fears), but hopefully readers will evaluate with a grain of salt. Thanks for your approach to these complicated and emotional issues. I wish more individuals in this debate were including all the information(or as much as is reasonable), rather than just cherry picking the info that supports their argument. Clearly, there are a number of people who find the scientific studies adequate. For those of us who are on the fence as to whether the science is sufficient and whether overall public health concerns sometimes deprioritize the welfare of each individual child (e.g. vaccinating newborns against HepB while they are in the hospital), I am grateful for your critical consideration of different sides of the issues. For the record, I am trained in scientific methodology and am still choosing to be cautious. I'm vaccinating my child on a slower schedule than the CDC recommends, though she will ultimately have all of her vaccinations.   At February 12, 2009 2:25 PM ,  Science Mom said... I hesitate to post it b/c i have no way of verifying the info (and don't want to unnecessarily feed government conspiracy fears), but hopefully readers will evaluate with a grain of salt. For the record, I am trained in scientific methodology and am still choosing to be cautious. I'm vaccinating my child on a slower schedule than the CDC recommends, though she will ultimately have all of her vaccinations. And yet you chose to post that titillating bit of hearsay anyway. Really? A Merck rep would not only know this but casually let it be known to a lowly paediatrician? I daresay, if you are a scientist, then your ethics are on par with Wakefield's.   At February 12, 2009 2:49 PM ,  Anonymous said... Science Mom If this was a "peer-reviewed journal", I would not include it. However, this is a BLOG. Get a grip. Merck was not responsive to inquiries about this question (I tried as did several other people I know). Would anything besides a documented/notarized/taped conversation with a Merck executive or the CDC fit your paramters? You are obviously entitled to your opinion about my ethics, but given that I made the source of the information as clear as possible to allow others to draw their own conclusions, I believe I acted ethically. I agree with you that it is suspect that a rep would have factual knowledge about Merck's decision-making, though I don't believe that makes it impossible. I also don't agree with you that the rep would not have communicated his/her knowledge to a "lowly" pediatrician (considering they develop relationships through consistent contact). I support allowing free access to information, being clear about the source and letting people make up their own minds. In my opinion, any thing else is patronizing and starts to feel too much like information-regulation.   At February 12, 2009 4:40 PM ,  Science Mom said... If this was a "peer-reviewed journal", I would not include it. However, this is a BLOG. Get a grip. For anyone with an ounce of integrity, that is no excuse. Merck was not responsive to inquiries about this question (I tried as did several other people I know). So what? You just fill in the blank with something juicy? You are obviously entitled to your opinion about my ethics, but given that I made the source of the information as clear as possible to allow others to draw their own conclusions, I believe I acted ethically. Not even close. You are merely rumour-mongering; pandering to the questions that have been raised vis de vie, Merck's motives for discontinuing the monovalent jabs. Don't ascribe to conspiracy what can easily be explained by simple financial and practical considerations. I support allowing free access to information, being clear about the source and letting people make up their own minds. In my opinion, any thing else is patronizing and starts to feel too much like information-regulation. No, you're playing an irresponsible game and trying to attach some legitimacy to your claims by co-opting scientific knowledge. It is people like you that give honest and ethical researchers a very undeserved bad reputation.   At February 12, 2009 6:12 PM ,  Anonymous said... Science Mom I'm not interested in the style of discussion that you seem to be, so I'm not going to comment any further. Thank you.   At February 12, 2009 7:18 PM ,  Anonymous said... Wow. Really. Wow. I started reading these comments today (2-12-09) to get information, and all I saw was a bunch of over-bearing people trying their best to insult each other because of differing opinions. SM & Catherina - your opinions are duly noted and have been thoroughly covered. But, this blog was never intended for you. Instead it was intended for those of us who are concerned about MMR, which you clearly are not. Perhaps you should let the rest of us digest the information you have provided, as well as the information Dr. Sears has provided and let us form our own opinions. I respectfully request that you bow out so that this discussion can return to just that - a discussion. The attack-like nature of many of these posts, particularly the later posts is not helpful.   At February 12, 2009 7:54 PM ,  Anonymous said... There seems to be quite a few studies that attempt to indicate the safety of vaccines and the current vaccine schedule. Is there any reason to believe that Dr. Sears' alternate schedule is any less safe? What is the danger of following the alternate schedule? If such a schedule provides parents with peace of mind while still vaccinating the children, then what is the problem??   At February 13, 2009 12:26 AM ,  Catherina said... The concern is the delay in measles immunity. Pockets of non-immune children are a breeding ground for outbreaks. Leaving measles vaccine until age 3 would generate 13 million vulnerable children. Leaving MMR until 4 and to only get one after that, would generate 17 million non immune under 4 year olds, plus the 5% that are non immune after their one 4 year MMR adding a further 215000 non immune children to the tab per year. Outbreaks will occur, complications, disability, and death at a MUCH higher rate than the MMR is causing now. Dr Sears' MMR recommendations are absolutely irresponsible. What parents may not understand is that all assumptions they base their vaccine decisions on only hold as long as vaccination coverage is as high as it is now. Once 15% of all children are unvaccinated, the infectious risk increases tremendously for the youngest = most vulnerable. It may then not only be your own child that suffers from measles, but it may be someone else's baby that your vaccine decision kills (in 2000, one unvaccinated child infected 7 babies in a doctor's waiting room and two of them are now dying of SSPE and Germany "only" had about 3000 measles cases that year, so it does not take much for such catastrophes to occur). That is the problem - there is another one too, that I will describe later.   At February 13, 2009 9:04 AM ,  Anonymous said... RE: Dr. Bob's comment..."In children with those types of minor developmental challenges that require therapy, I ask parents to consider holding off on any further vaccines. Since you just did measles, I wouldn't do a full MMR - I would just stay without the second Mumps and Rubella if you are OK with that." Dr. Bob, I am sorry, but must disagree with this statement. As a developmental and behavioral pediatrician, (and as a parent of an autistic college student) I want to see the health of my children with special needs protected. With this statement, you move beyond the range of clinician providing information and guidance to parents who are hesitant about vaccinations to one of an advocate (without supporting scientific merit)who promotes a whole class of children as too fragile for vaccination. The management of a difficult and preventable illness in a child with a disability (such as a bad week with fevers, aches, poor sleep, need for difficult to administer comfort treatments (fever meds, etc.) is often a strain on both the child and the parents. I am concerned that this might drive a wedge between attempts to mainstream my patients, if parents, already worried about the heightened risk to their children from the unvaccinated children near them in school, started to see children needing some therapy as a health risk to their own kids. I strongly urge the vaccination of Dr. Bob's patients with developmental concerns and those in each primary care practice. Marc Lerner, M.D. Pediatrician   At February 13, 2009 12:15 PM ,  Catherina said... I agree with Dr Lerner! That is one of my concerns too. I don't know whether you saw it on the previous MMR blog, Dr Lerner, but you gave my daughter her first MMR (12 years ago) - thank you!   At February 16, 2009 4:39 PM ,  Dr. Bob said... Sheri - I can't tell you what to do here. I ask parents with a child who has delays to not just automatically get all subsequent vaccines. I don't tell them NOT to, I just tell them to think twice. This is not a scientific answer. It's just an opinion. You will have to look closely at each disease you are considering vaxxing for, decide which diseases could be bad if your child catches them, and then consider whether or not to vax for it.   At February 17, 2009 3:04 PM ,  mp said... Dr. Sears, I have an important question about Prevnar. Our son is 15 months old and has received 2 Prevnar shots - first at 2 months and second at about 6 months. We are going to get him one more of this particular shot. Is one more shot sufficient at 15 months (so that he only receives 3 total but the third at 15 months), or will he still need a forth? I cannot seem to find the answer anywhere (I know the last shot can be given at 12-15 months but what if one shot is still missing). Thanks!   At February 18, 2009 7:42 PM ,  Anonymous said... Dr. Bob, Thank you for the excellent post regarding a halt in production of separate Measles, Mumps, Rubella vaccines. I see that some people feel strongly about positioning their argument against separate vaccines (let’s call the separate vaccines M...M...R as opposed to the combined MMR, the dots representing a time pause of days or weeks between each component). MMR proponents focus on debunking Wakefield’s assertions, and I respect their position but I also ask respectfully that they consider that Wakefield is not the only reason that anyone would want an M...M...R. I have a different reason why I am cautious about our infant daughter getting the MMR--my personal experience with it. In this post I tell of my own experience, and near the end I propose an idea that might interest pro-MMR people as well as parents still concerned and cautious. I am generally pro-vaccines. I cannot say “completely” because of an incident in the early 1990’s when I was going back to grad school and they required that I get an MMR. I was very healthy and in-shape, I felt great that day, and I had no concerns about getting the vaccine. Within a few minutes of getting the shot my armpits started itching strongly, and within hours I began feeling ill. I was on the couch for days with a high fever, heavy sweating, and during the worst of it, shakes. When I called the clinic that administered the shot, they were quick to deny the shot could have had anything to do with my getting sick, and when I pressed further they fell back to what I now recognize as a common (and probably coached) response: “You must be allergic to eggs.” I see that these days there is plenty of documentation about the egg allergy problem, e.g. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1117843 In my case, I love to eat eggs at breakfast, and I have never had even the slightest problem. I’ll be the first to admit I’ve never even considered injecting scrambled eggs (or anything else for that matter), so I can’t rule out an allergy to intravenous eggs but I find it highly improbable. Anyway, at the time I got the shot and became ill, no one would discuss the matter further and so I gave up trying to find out anything more. The experience taught me that some people don’t care about or believe there’s a problem unless they experience it themselves. And that’s why all these years later I worry 1) that our 14-month old daughter has a non-zero probability of having a similar reaction, and 2) that if she gets the vaccine now and gets as sick as I did, it could cause something bad to happen (or conversely, something good NOT to happen) during a key developmental period in which she is beginning to say words and show similar leaps in cognitive development. I think that any credible scientist in my shoes would want to break the potential problem into subsets and look at each one individually, i.e. an M...M...R series. If our child does have a reaction, then it will be easier to determine which, if any, of the components caused the problem so that we know better how to treat the problem or at least learn from it. It would be nearly impossible to pinpoint the cause of a problem if the shots are bundled, hence my desire for an M...M...R. I can understand why the government and some healthcare providers might be comfortable saying “The MMR has been given to many patients without causing a problem.” For the majority of people in this world, MMR appears to be safe and effective in preventing the diseases. Even if health authorities knew MMR to be risky or harmful to a tiny subset of the population, they would probably still push vaccination because the number of lives impacted by vaccination is a relative few compared to the number who would be harmed if the diseases resurge in a growing population of unvaccinated kids. That’s the abstract logic of “protecting the herd”. I can understand the reasoning behind protecting the herd, but I am not a keeper of the herd--I am the father of a child. As I wrote this in frustration I had an insight. Maybe I should get the MMR shot to see if it still affects me adversely. I suspect there are other adults out there who have had a bad reaction to the MMR, and who are worried about their children getting the shot. If enough of us are willing guinea pigs, and IF a significant reaction is reproducible in people like me (I’ll admit, I don’t have any idea if it is), then would the government or Merck study us to see if there is a simple fix to the vaccine or a screening test that can detect kids likely to have the same bad reaction? Or is this a question of herd economics that no one wants to delve into? I would think that the pro-MMR crowd would support the idea of parents getting an MMR first (before their children), because if parents get it and feel fine, then they will be far less anxious about having their children vaccinated. Reduce the anxiety and this issue becomes a non-issue. As far as Merck is concerned, adults unnecessarily getting their MMR just means more revenue, so unless their capacity to produce the vaccines is inadequate or their margins are negative, then I can’t imagine why they would be anything but supportive of a “parent first” vaccination strategy. The government should love it if adults get the MMR because that means the herd is even better protected from disease. And parents like me will do it because either it will give us confidence in the MMR or it will clarify why our children may be at higher risk of a bad reaction. It does raise two questions: 1) Is there any reason a pediatrician would be unwilling to administer the MMR to a parent upon request? (assuming the parent signs a liability waiver). The reason for getting the MMR through the pediatrician is to demonstrate clearly that this is related to a parent’s worries about a child getting the combined vaccine. By counting adults getting the MMR this non-traditional way, then Merck can better assess the degree of concern. 2) If I do have a significantly bad reaction to the vaccine, then are there any steps I can take (e.g. testing) that can shed light on the reaction this time around? I hope that everyone on this forum, regardless of their stance, recognizes that we all want this issue put to rest one way or another. Does the proposed “parent-first strategy” satisfy both pro-MMR and pro-M...M...R groups? Thanks again Dr. Sears for providing a forum for people to discuss both sides of the issues. Best regards, John in Austin   At February 18, 2009 10:53 PM ,  Anonymous said... Wow, there are some really great questions and comments on this site. I very much appreciate Dr. Bob and his suggestions about vaccines since I am the mother of two boys and would like to hear the information from a real doctor, not some hot-heads who like to hear themselves talk (you know who you are). Please keep up the useful information, as objective as possible, and keep your jaded comments to yourselves. Thank you, Dr. Bob! I love your Vaccine Book! It has given me the information I need to make my own informed decisions.   At February 19, 2009 2:04 AM ,  Anonymous said... Dr. Bob, A million thanks for this insightful post. I went out of my way, but was able to get the "measles only" vax for my daughter last fall and just followed up with my doctor on the "rubella only" vax after reading your post. Turns out I'm just in time as they have three left -- one of which now has my daughter's name on it for her appointment scheduled in a month. Had I not read this, I likely would've been too late. I appreciate your blog; it's an excellent resource for parents. I continue to refer others to it. I'm pregnant now and will have to make new decisions for this child given the changes. It won't be easy, but I'll continue to look to you -- as well as others -- for insight, opinion and support. Thank you again.   At February 19, 2009 6:55 AM ,  Jennifer said... To John in Austin: EXCELLENT post! Thank you for your insights. I think you are right in saying that many "pro-MMR" opinions simply dismiss "pro-M...M...R" worries to that of the Wakefield study. I would like to maintain that Wakefield's input into this great debate is not the only angle to look at. Personally, I look at the thousands of parents who strongly believe they or their children have had "reactions" (if not also developmental delay triggers) due to the vaccine. Many will dismiss that and say that their memory is skewed and tainted because of public debate and fear over the MMR. But I believe that most parents KNOW their children in and out. They KNOW what behavioral or physical changes occur in their children, and they KNOW what may or may not have caused it. If this weren't the case, there would probably not be nearly as many vaccine reactions reported legitimately. For me, as long as those possibilities remain unanswered, I will always have some worry or concern. And I don't like people merely dismissing it to Wakefield. Yes, he was probably wrong...but that doesn't mean it's the only angle. Thanks again for your input.   At February 19, 2009 11:22 AM ,  anotherSherri said... THIS IS THE BOTTOM LINE. Parents won't always trust science that is funded by the people who have a financial or political stake in the outcome. What common sense to find in a day when this trait has almost vanished in our society! This has me sold on buying Dr. Sear's book! Dr. Bob, do you have a schedule of vaccines in your book for children that are over the age of 5? Thanks.   At February 19, 2009 12:54 PM ,  Dr. Bob said... AnotherSherri - no, I don't have a suggested older child schedule in the book for unvaxed kids. John in Austin - great post - NO, I don't test dosing parents is a good idea. 1. Adults generally react worse to vaccines, especially live ones, than kids (more autoimmune propensity). Thats one reason we don't give adults MMR boosters routinely (although that might change for women of childbearing age who need rubella). I think that an adult's reaction to the vaccine is NOT a good predictor of the child's reason - you are two different creatures. For you, I would NOT repeat this vaccine. I don't know of any testing that could be done to determine WHY you reacted.   At February 19, 2009 3:11 PM ,  Anonymous said... Dr. Bob, Thanks for your reply to my "parents first MMR?" post. I respect your insights. With our daughter just about to turn 14 months and our pediatrician unable to get M...M...R vaccines, I was doing my best to think outside the box. I had not considered that an adult immune system would not be similar enough to a child's. I guess it's time to cross my fingers that the pro-MMR crowd is right about the vaccine's safety, or at the very least, that the odds of the herd are with us. Lastly I do want to thank Science Mom, Catherina, and some of the others for the portions of your posts in which you provide solid science background and reasoning to back up your positions. There are also non-scientific portions of your posts that, in my opinion, could have greatly strengthened your positions had they been omitted or else stated differently. -John in Austin P.S. Thanks also Jennifer for the positive comments!   At February 20, 2009 1:44 PM ,  Anonymous said... Why does it have to be all or nothing? I can understand the controversy around the MMR-autism link. But I don't believe that's the only reason to allow for an M..M..R approach. I believe vaccinations are important but I see no reason to to overload my twin boys' immune systems with 3 at the same time. Most of my friends' children have had a reaction to MMR, from just a low fever to a very high (106) fever/rash/etc. So why must I put my kids through a strong reaction when there is (well, now was) an alternative? I'm not talking about causing a developmental injury--I still feel it's unnecessary to put their bodies through a "normal" reaction. I'd pay out of pocket 3 times as much (even more) for separating them vs MMR. I am upset I missed this option by a month (I was going to do measles at the 2 yr appointment). So now I have to rethink my approach and the lack of information about why production stopped is not helping (I have to imagine demand for separate measles is higher now than it has been in the past so I find the timing suspect). Parents should have choices--I can't believe anyone would argue against a different approach to the same end.   At March 19, 2009 9:15 AM ,  Anonymous said... Help! I need to find 16-19 families who want to give the M..M..R separately. I found two pharmacies who can get the two M's (can't find an R yet), but they won't order it for just me because it's being sold in a 20-vial case. Please email me at bwark@bellsouth.net if you're interested. We must act quickly!!!   At March 27, 2009 4:26 AM ,  Melonie said... To Jody - author of the first comment posted - as well as Dr. Sears and any other parents who would like to contact Merck and respectfully request that they continue manufacturing the separate M/M/R vaccines: Their website lists their corporate contact information on this page: http://www.merck.com/contact/ Additionally, they have patient/caregiver (ie U.S. consumers) specific phone numbers on this page: http://www.merck.com/contact/consumer.html It is possible that with enough phone calls (RESPECTFUL) they will reconsider this decision. After all, not vaccinating due to concerns about the MMR vax not only threatens public safety - it does ultimately affect their bottom line. Selling a product is still their business, in the end.   At March 31, 2009 9:23 PM ,  Anonymous said... Dear all, I received a flyer from my pediatrician today that had the Merck's service center line: 1800-672-6372 to request the company continue to make the MMR as separate vaccines. The more requests the better! Please call!   At April 1, 2009 10:02 AM ,  Anonymous said... I just contacted Merck this morning and was told that a final decision on future manufacturing has not been made yet - so if you're interested in making your voice heard, please contact them! I was given the following address: Merck National Service Center Merck and Company, Inc. PO Box 4, ZB-714 West Point, PA 19486-0004 Also the main address is: One Merck Drive PO Box 100 Whitehouse Station, NJ 08889-0100 Phone: 908-423-1000 I am also planning to write to the CEO: Richard T. Clark   At April 8, 2009 1:58 PM ,  Anonymous said... I've been struggling for months now since Merk stopped making the mumps only vaccine. I'm not comfortable with the full MMR at such a young age but I want to be socially responsible. I was so happy to find your alternative schedule. AND now so angry with Merk for messing it up and leaving me with my hands up in the air again. SO, I've thought about an option and wanted to understand your logic behind the order of the mumps, measles, rubella only shots in your schedule. I'm thinking of giving my son the rubella only shot now (16 months old) so we are not contributing to any birth defects/still births in society should there be a rubella outbreak. Then delaying and getting the full MMR right before kindergarten age. However, you had said you ordered these vaccines in order of their importance. Why is rubella "less important" than mumps if mumps is mild in children and not a major issue for causing societal disease like rubella does? Just making sure I am not missing something bigger by making this decision. Thanks   At April 14, 2009 12:52 PM ,  Amy said... Dr. Sears, I have a 27 month old daughter who has not yet received her MMR. We have the separate M...M...R shots refrigerated at the doctor's office. (Thankfully our pediatrician knew that Merck was gonna stop making them and had us get the shots beforehand). The expiration dates on the vaccines are between Nov. of 2009 and Jan. of 2010. When do you recommend that she receive each shot? And is that too close together? Thank you so much for the wonderful book and this site! If you have the time to answer my question, I'd really appreciate it!   At April 14, 2009 4:24 PM ,  Anonymous said... Amy - I had a similar question, here is what Dr. Sears kindly answered: DR. Bob said... Anon - to answer your question about having the separate MMR shots already, yes, you can speed it up. The 1 year spacing was just an arbitrary precaution, so doesn't have to be one year. I would go for about 6 months in between each. February 10, 2009 1:20 PM   At April 14, 2009 4:31 PM ,  Anonymous said... Amy - I just responded to your post, but had an additional thought that you might also want to read Catherina's Feb 8 post (in response to my Feb 6 post) for some additional scientific information. If you can get beyond what she admittedly called "snarkiness", it is interesting/helpful information. Personally, I want my girl to get her vaccines...just moderately spread out so I am going to do 3 month spacing. Good Luck!   At April 20, 2009 2:44 PM ,  Anonymous said... I called Merck today on 04/20/09since I found a pediatrician who would write the prescription and administer shots separately, and they told me that they will no longer be offering the shots separately. That was a definitive answer from their customer service. In fact, the "new" vaccine that will be offered instead is the MMRV vaccine that now combines 4 vaccines into one. I voiced my complaint and they said they would forward it. I HATE the fact that I cannot decide how to administer these vaccines to my children. I do not want to give my child 3 shots into one. I don't even get three separate vaccines administered together. Although I am not 100% convinced that the MMR vaccine does cause autism, I do not want to take a chance. I know too many people whose children have suffered side effects as a result of this vaccine and they can't disprove it 100% otherwise. The CDC and other organizations want to discredit shots are linked to autism because they want to you to get the shots, but you have to stop and wonder WHY autism and other disorders have increased so significantly since 20 years ago. Not only are we giving more shots than ever before due to the increase in illnesses, but we are also giving them all together. I had to fight to get my son's shots (and the delay of the MMR vaccine) even split up and spaced farther apart. The doctor said my insurance wouldn't pay for multiple visits and that shots (3-4 at a time) are given during wellness visits. More convenient for the doctors office too. I insisted and told them I didn't care what it cost me, and they finally consented to space apart his shots and delay his MMR. I would be less worried about him getting the MMR if it also was given separately, but now, they have taken that option away as well. So basically what aggravates me the MOST is that it is NOT about what is best for the kids, but what's CHEAPEST for the insurance companies and what is CONVENIENT for the doctors. By the way, it turns out my insurance company does pay for the separate visits, so the doctors office was wrong about that too.   At April 23, 2009 11:34 AM ,  daisy said... Hi Dr. Bob and Everyone, I just wanted to post the phone number for Merck customer service: (800) 672-6372 They are very polite and will register your complaint. I called to tell them I am extremely unhappy the separated MMR is no longer available. I am a mom who has vaccinated my baby using a graduated vaccine schedule. Years ago, as an 18 month old, I had a severe reaction to the MMR (paralysis which lasted several days), as did my younger sister. The thought of incurring a similar reaction (or worse) in my own baby is terrifying. I believe in vaccines, but the MMR is a doozy of a shot, and I wish the drug companies would work with parents on this one. A separated MMR would ensure more kids are vaccinated and that parents' concerns are addressed.   At April 28, 2009 8:01 PM ,  Anonymous said... Dr. Bob: Keep up the great work. Your knowledge keeps all of us mothers informed. Daisy: thanks for posting the customer service number. I am DEFINITELY going to call. thanks!   At April 29, 2009 9:06 AM ,  Kashababy said... I just called the Merck hotline (as previously posted in this blog) and was told that, if it deemed a viable operation to produce the monovalent vaccines, they will plan on resuming production in 2011. Apparently this is the update as of 4/28/09. This is encouraging news to me, since I live in Illinois and the vaccines are required for my son to enter school and he will not be 4 years old until 2012. My husband had some adverse reactions to the MMR as s child, so I definitely want to space them out for my son... How did the pp put it? M...M...R I am a scientist myself and beyond the possible reactions, it makes more sense to me to allow my son's immune system to handle one vaccine at a time. I know, logically, that the chances of my son coming down with measles, mumps and rubella at the same time from this shot is low, but as a mother who will take no chances with her son's health, I would rather handle one potential sickness at a time if he should happen to get it (the way his father did). right now, my son is completely caught up with his vaccines and thankfully, he has handled the one at time schedule beutifully. My instincts where my son's health are concerned have been spot on so far and I am trusting my instincts on this one as well. Something is telling me that something would go very wrong with my son if I let him get the combo vaccine. That may not sound very scientific, but the only two times I have NOT listened to my isntincts when they were this strong, I very much regretted the consequences. I learned my lesson there. That said, I think attentive parents who listen to their instincts where their children are concerned will have a better idea of what their individual child will be able to handle. I understand the blanket vaccination idea, but hate treating children as a group when they are so very much individuals in every way. I am currently seeking monovalent doses of teh M...M...R vaccines for my son from a reputable source. I am hoping to find some so that my pediatrician can use those on the timeline I already worked out for my son. If anyone is looking for someone to combine with for an order of monovalent vaccines, let me know! kashababy@aol.com   At April 30, 2009 8:34 AM ,  Anonymous said... My 10 ½ month old will be due for the MMR soon. I have >been following your > modified vaccine schedule for her whole first year, and >I am nervous that it > seems I will have no option but to get her the >combination MMR at 12 months. > We are from the U.S., but we are in Canada until she is >13 months old. Do > you know if Canada has any separate M, M, and R vaccines >available? Where > would I find this out? We will be moving to Mexico when >my daughter is > almost 14 months old.   At April 30, 2009 12:21 PM ,  Kashababy said... to anonymous; I am not sure about the availability in Canada, but I do know in Mexico the Measles and Mumps vaccines are commonly available on their own. I am currently working with a reputable DR in Mexico to see if this DR and my pediatrician can work together to make the monovalent vaccines available for my son. I'll be honest and say that as far as I've gotten for now, I don't know if this attempt will be successful for me, but then I won't be traveling or moving to Mexico. You will. Perhaps you will have more availability once you are in Mexico. good Luck!   At July 3, 2009 9:34 PM ,  Anonymous said... Should I fly on an airport through international airports here in the U.S. if he hasn't had MMR vaccine?   At July 10, 2009 10:30 AM ,  Anonymous said... Science Mom and others, Do you work for a drug company or some how connected to one? Dr Bob is simply offering options for parents to choose from. It's just common sense that most of the people that listen to him are those that are looking for options unlike Merck who have chosen to stop the seperate shots and give us no options. Remember, smoking was considered a safe thing to do. Vioxx was considered safe until a few years ago. etc. Do you have any options to present to the parents other than to take the MMR? He has already covered that in one of his options.   At July 14, 2009 9:28 PM ,  Anonymous said... I'm about to take my four week old son to the doctor tomorrow. I just don't know what to do about vaccinations. I've read the pro-vac books and the anti-vac books, research papers, and web-sites. I'm scared to do it and I am scared not to. So let me ask this...Are there children who have had the vacs that are doing just fine? I want to hear from the parents whose children are doing great with all of the recommended vaccinations.   At July 15, 2009 8:53 AM ,  Anonymous said... To Anonymouse on 07/14/09: I had no friends or family with small children when I had my baby in 2008. I did not know about the issues with immunizations until right before my child turned one. I got all of her shots on time and as scheduled. She made out fine. I did, however, research the MMR and requested that my child not get it until she is 18 months. It is recommended between 12-15 months with most doctors giving it at 12 months. I just have to squeak through daycare without getting "caught" until 18 months. My one year old looks like a 2 yr old (90th percentile for height and weight), if she was small for her age I would probably wait even longer if I could. Good luck with whatever decision you make.   At July 18, 2009 9:54 PM ,  Anonymous said... My son was administered Rubella when a monovalent vaccine was a choice where I live then when it was time for the Measles and mumps they were done with produciton. I researched everywhere. The only informative information I found was on Dr. Sears website. I emailed the news, tried to activate a network of doctors, and other ways but was just looked at like a looney who did not want to get my son vaccinated. I WANT MY CHILDREN TO BE VACCINATED. BUT IN A SAFE WAY! So my son turned two the other week. His doctor kept saying lets just wait and see if Merck starts making the shot. Well, it got to the time to make a decision. At this point Merck just doesn't seem to care. So we gave him a full MMR after the fact that he had a single Rubella vaccine. TWO DAYS LATER which is today- We are calling 911. He went from a ZOO birthday party to going in an ambulance. He was lethargic, eyes rolling back in his head, pale in the face almost blue, barely speaking to me. This is a healthy organic milk, meat, athletic talkative boy. Never sick, never the way he was today. I felt like I saw my son leaving this earth today. At the hospital the doctor gave me a look of egotistical scorn after I told him about the MMR and the "alternate schedule". I told him this was not the appropriate time for such a matter. My son is the matter currently! My son had a febrile seizure. Nonchalantly I was told they have one of those a day in the ER and he will be fine. Give him fever reducers. OK>>>> what about the MMR... oh noo.. that wasn't probably the problem. REALLY??!! Even though on the sheet at the pediatrician's office said seizure are rare but occur. THis was the first multi-vaccine my son ever received and it will be his last. He is a happy boy and I hope after this he will stay that way with no more seizures. On top of that- he started wheezing later today! We had to go back to the hospital. He had to get breathing treatment and meds for this. My son has never had a breathing problem in his entire life including wheezing. Our family has never had a history of seizures but I do have asthma for the record. I find it irresponsible of Merck and the FDA for not educating parents better, allowing monovalent vaccines and then taking them away, not properly instructing parents on how to properly deal with a child getting a double dose of a vaccine and instead wishing we go away. Welll guess what. MY son is my love and joy. I just went through a nightmare with myson. Please do not tell me that a febrile seizure is all too common and the MMR altogether is perfectly fine. If my son develops more issues, then believe me...This will become more public, it will become more noticeable, and you will see us in the trenches. I am an educated person with a science major. I come from a high economic background. I take care of my children. This is a topic that should not be so hard to find factual answers on. To only find it on this website is comforting coming from Dr. Sears but also weary on the mind about the situation in general.   At July 21, 2009 8:05 PM ,  Anonymous said... Dr. Bob, I am a bit confused as to the vehemence of the pro-vax group. If they believe vaccines are safe and effective, and they vaccinate themselves and their children, aren't their children protected from these diseases, whether or not other parents choose to vaccinate? What exactly are they worried about? Thanks for taking the time to help parents make the best choices for their kids. Sincerely, Mom of 2 of your patients   At July 23, 2009 7:06 AM ,  Anonymous said... To Anonymous posted on July 18: Your experience reminded me of Jenny McCarthy's book, Louder Than Words. I know many doctors and scientists gave her great critism over her book but she was only speaking from her own experience. I hope your son is ok now but if symptoms persist, you should read her book. Thank you Dr. Sears for your book and realistic options you present for parents. I am not a "conspiracy theory" individual but I do believe there is great denial from the medical community and pharmaceutical companies in looking at the possibility that vaccines do cause adverse reactions and autistic like symptoms in some children. My 9 month old son has been receiving his vaccincations on Dr. Sears schedule and now I am faced with the decision on how/when to give him the MMR vaccinations. I WANT to vaccinate him but stories like the post from July 18 scare me to death. Parents know their children and far too many have reported reactions such as this one. I agree that MOST children receive this and other vaccinations without any problems. But without a test available to determine if my son's immune system is strong enough to handle these vaccinations, I am forced to consider not vaccinating him for diseases that will surely resurface as more and more of us choose not to vaccinate. It is a vicious circle and those at the AAP should be ashamed of themselves for not acknowledging this issue other than insisting it is NOT an issue.   At July 25, 2009 10:03 AM ,  Anonymous said... Science mom, If you don't like what is being said in this forum, just go to a pro vaccine forum and put your opinion there. The people on this forum do not want to be bullied or made to feel guilty for questioning the regular schedule.   At August 8, 2009 9:19 PM ,  Anonymous said... my son is 3 1/2. can i start him on your delayed vaccination schedule or does it need to be amended at all?   At August 12, 2009 7:48 AM ,  ResearchMom said... Science Mom: Using a few scientific articles to scare people into thinking they should not question big business or government is ridiculous. Remember the 1970s: these same groups insisted that formula was better for babies than breast milk.   At August 18, 2009 11:27 PM ,  Anonymous said... Science mom: "That is hardly a disservice to them but I can see why my approach would get under the skin of those that have decided they know all the answers." This is the irony of your entire argument as you yourself claim to have all the answers. For me, it is your style of using insults, patronizing language, an angry tone, and this know it all attitude that destroys your credibility.   At August 18, 2009 11:59 PM ,  Anonymous said... http://vaers.hhs.gov/scripts/data.cfm The CDC has a vaccine injury reporting system. If vaccines NEVER caused any adverse reactions, this database would not exist. I don't think parents who ask about alternative vaccine schedules are all saying "if I vaccinate, my child will get autism" but rather, "how can I give my child the most protection from disease while minimizing the risk of an adverse event from the vaccine itself? (which can be quite dramatic as some accounts here describe.) And the side effects listed on medications and vaccines are derived from study participants. Though statistically determined to be "safe" in cited studies, some adverse reactions are undeniable. It is not "scientific" to ignore this reality.   At August 21, 2009 12:42 PM ,  Anonymous said... Dr. Bob, I am truly grateful that you have written your vaccine book and that you maintain your website and blog. It seems that everyone is so incredibly divided over this issue that it is wonderful to have someone looking at both sides and presenting options. I am so frustrated with Merck's actions to not offer these single vaccines, because it is forcing parents to either make a decision they feel awful about and then live with guilt, or just decide not to vaccinate, and unfortunately, most I know are deciding the latter. Merck and the AAP actually seem to be creating the opposite of their desired effect and causing so much distrust in the medical system. I'd really not rather wait until my son is 4 or 5 to vaccinate, but after reading all the available studies, which seem inconclusive, I'm just not comfortable with the MMR. My son has already had reactions to some of the vaccines he's received(although I just obtained a copy of his medical records which list no reaction to any vaccine, even though I called the office to report each time. I guess I'll start calling the CDC hotline mentioned above). My questions are: are the single dose vaccines offered in other countries, or are there places with "reserves" for those willing to pay? Is another company planning to start production? I'm really seeking another option here.   At August 25, 2009 2:57 PM ,  oberholser@hotmail.com said... Dr Bob, Thank you for your book and the very helpful updates. I wasn't thinking about getting MMR at all for my children; the only concern I really have with these diseases is that rubella could cause birth defects if my children were to contract it while I'm pregnant with another baby. So I was wondering, is it possible to get the MMR myself before I get pregnant, rather than giving it to my children? Thanks for your time, Rebekah   At September 1, 2009 3:33 PM ,  Fred said... "It is a vicious circle and those at the AAP should be ashamed of themselves for not acknowledging this issue other than insisting it is NOT an issue." The proverbial "hitting the nail on the head". "I don't think parents who ask about alternative vaccine schedules are all saying "if I vaccinate, my child will get autism" but rather, "how can I give my child the most protection from disease while minimizing the risk of an adverse event from the vaccine itself?" This is the category that my wife and I are in. But since sciencemom seems to enjoy including links with complete disregard for those concerned about ill effects (JUST like the CDC); how about this one? http://www.hrsa.gov/vaccinecompensation/statistics_report.htm That's "B" as in Billions, for us dummies.   At September 1, 2009 3:37 PM ,  fred said... Well, I was trying to be fair.....but "T" as in Trillions of you're looking at the far right column that includes the attorneys' fees.   At September 16, 2009 10:22 AM ,  Anonymous said... Quick Question Dr. Bob, This is in reference to their no longer being an option to seperate the MMR shots. Above, you listed an option to wait until age four or entering school (early pre-school, etc) to give the MMR shot but that would make your alternative schedule in your book at age 4 children recieving the DTaP, Polio, Flu, and MMR. Did I misunderstand your suggestion or did you want to move other shots around because of the loss of seperating the MMR shots?   At September 17, 2009 9:25 AM ,  Anonymous said... When Dr. Sears writes about vaccines he gives his opinion but also presents the other side of the argument. While he has his beliefs (and backs them up with relevant research), he doesn't force those beliefs on parents. This open-minded sharing of information earns my trust. I am a responsible, intelligent mom and feel like I should make all decisions regarding my children's health. I have chosen a pediatrician that agrees, but he can only do so much if Merck gets in the way. Reading that the seperate MMR shots have been discountinued, or reading the one-sided arguments of Science Mom are the things that breed mistrust for me. Why do Merck and Science Mom not want me to make decisions for my child, especially when my decisions do not pose a risk for anyone? I WILL vaccinate my children. I just want to do it at my own pace. Is it because Merck stands to make more money if they make the decisions? Is it to prove a point? This is where mistrust starts.   At September 23, 2009 9:18 AM ,  Anonymous said... Thank you everyone for your thoughts on this. My children's physician (a family physician in a rural area, but also a father and uncle to many small children) agrees with not giving too many shots at once (for one, why risk not knowing which your child had a negative reaction to to help you determine the need for boosters). My children have all received the MMR, but nothing else on that same day. Honestly, I wasn't even aware you could get these separately or I would have considered it. Ironically I'm not faced with my own anger at MERCK now that I realize these aren't available separately. I'm enrolling in nursing school and it turns out that although I was vaccinated for measles and rubella around age 5 (mid 1970's) I did not get a mumps vaccination at that time. When there was mumps (or was it measlees) outbreak in our state in 1989 I and a few other students were required to get an MMR. Now 20 years later it appears I either never obtained immunity to Mumps or it has worn off at 20 years and I need a Mumps booster. I don't like the one in several thousand side effects for my kids, but admittedly really hate the 1/4 side effect for adult women when receiving the rubella vaccine as adults (but hey it's only several weeks of inflamed achy joints... what mom who has kids, works and is going back to school can't handle temporary inflammatory arthritis... it rarely becomes chronic). Ironically, Merck, the CDC and the state health department all scoffed at me for my concern (just like I'm sure some others will) even after I could quote this is a KNOWN side effect for adult women quoted on the CDC website and in drug reference books. Sadly, those making the recommendations aren't even aware of the PROVEN side effects. And these are the people we are trusting that there are no unknown side effects for our kids. I consider myself someone who worries first about my family, but also the greater good. THerefore, despite the minimal risk of problems from Mumps for my daughter or Rubella for my sons, I've been happy to vaccinate my children knowing that their being vaccinated may not only protect them, but also helps protect those children and adults for whom the vaccination doesn't work for. However, it is scary as hell to have more blatant evidence that the people in charge have no clue and we're trusting our children's health to them. Despite that I've always been a vaccinator and basially on schedule, I completely sympathize and appreciate the opinion of everyone who feels otherwise. I've accepted the need for MMR, but save my argument for shots like varicella. They haven't even proven this provides long-term immunity. I'd much rather have my kids get this as a child when it's mild, then THINK they're immune and then get it when they're adults and it's more serious. Ditto with mumps, I may well have been immune after my vaccination 20 years ago... but not anymore. SCARY. Thank you Dr. Bob for your open-mindedness and allowing parents to care for their children as they should be able to. Jill   At September 30, 2009 12:38 PM ,  mamabear said... Dr. Bob, My family is wrought with auto-immune diseases: My mom and I have Lupus; my sister, colitis; my father, peripheral neuropathy. Based on a recent study on dogs that showed a difference in auto-immune diseases relative to vaccinations, should I be concerned about how I approach my babies' vaccinations?   At September 30, 2009 12:41 PM ,  mamabear said... Dr. Bob, My family is wrought with auto-immune diseases: My mom and I have Lupus; my sister, colitis; my father, peripheral neuropathy. Based on a recent study on dogs that showed a difference in auto-immune diseases relative to vaccinations, should I be concerned about how I approach my babies' vaccinations?   At September 30, 2009 12:41 PM ,  mamabear said... Dr. Bob, My family is wrought with auto-immune diseases: My mom and I have Lupus; my sister, colitis; my father, peripheral neuropathy. Based on a recent study on dogs that showed a difference in auto-immune diseases relative to vaccinations, should I be concerned about how I approach my babies' vaccinations?   At October 1, 2009 9:47 PM ,  Anonymous said... Thank you to all for this discussion, which has kept me up way too late! Science Mom and Catherina, I appreciate your perspectives and links to scientific data (I look forward to having a chance to actually read them)--but to Science Mom, I must echo the many comments that your hostility turns people off. I wish you could provide your arguments minus the attacks. Catherina wrote about the danger of delaying vaccination leaving more of the population vulnerable. This is certainly true in terms of gross numbers, but her implication that other people's unvaccinated infants are the most vulnerable does not jive with my research about measles and mumps. My reading suggested that these diseases are, like chicken pox, most serious for older children or adults. So, while of course any serious complications from the diseases themselves are tragic, they are not very likely in the youngest populations, and no more tragic than serious complications from vaccine adverse reactions. I have a question about MMR that I hope someone here might be able to address. I am not at all sold on the MMR-autism connection, but I'm also not convinced beyond a reasonable doubt that there is none at all. Anecdotal evidence alone is enough to give me pause about this (though I think it likely that many of the supposedly MMR-induced autism cases are a matter of coincidence, since autism often manifests for the first time around the same age as the first MMR dose on a standard schedule). I'm wondering if there is any breakdown in the data on adverse effects (particularly autism) based on age when receiving the vaccine? Are there claims out there that any five-year-olds, for example, became autistic shortly after an MMR shot? I've been delaying my daughter's MMR on the theory that if her immune system is more fully developed, she'll be less likely to have an adverse reaction. However, Dr Bob has said here that adults tend to have more severe reactions to vaccines--which would contradict my more-developed-immune-system theory. If anyone knows whether there has been an age-based breakdown of adverse reactions, please point me to where it is available. Thanks.   At October 19, 2009 7:09 PM ,  Traci said... I did not go back and look at all the articles posted, but I do see most of the abstracts as they are published. Most of the research I have read are all correlation studies. Which do not rule out causation for a certain child with predisposing factors. They are just generalizations. My fear is that my child may be the one, and if I can minimize that risk while still keeping her health, that is what I choose.   At November 4, 2009 8:45 PM ,  mc said... This subject has really been concerning me since my son is technically due for his MMR and Chicken Pox (2 seperate shots)(15 month) the end of this month. In my heart I really feel it is best to put the MMR vaccination off until he is at least 2 years of age. However, my question is, is it safe to put this off if I was to travel out of the US with him before he turns 2? Also what other vaccines would I need to give him if we were to go out of the country?   Post a Comment << Home   The 12 Childhood Vaccines Vaccine-preventable Diseases Boost Your Child's Immune System FAQs Parents Who Choose not to Vaccinate Current Outbreaks and Epidemics Vaccine Discussion Forum Read Dr. Bob's Online Interviews Updates & Corrections to The Vaccine Book Find a vaccine-friendly doctor near you Alternative Vaccine Schedule American Academy of Pediatrics 2007 Vaccine Schedule Vaccine News Vaccines and Autism Vaccines and their diseases

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