Friday, February 6, 2015

More about the measles. Is your child protected?

A lot of our families are understandably quite worried about this current measles outbreak. It is not a surprise that our phones are ringing off the hook with questions about our patients' vaccine status. Here is the scoop.

If your child is under 6 months, it is too early to give them the shot. Luckily these babies do have some maternal antibodies protecting them (based on the assumption that most moms are actually immune.) Of course it is a good idea to avoid crowds when given the choice, but do keep in mind that your baby has a bigger risk of getting the Flu or RSV than they do of contracting the measles. Either way, crowds this season are best avoided if you have a young, vulnerable infant.

If your child is between 6 months and 12 months, then we are in a bit of a gray area. If you feel strongly that you want it, call for an appointment and we will give the MMR to any of our patients who are requesting it. But here are some things to consider. This will likely NOT be covered by insurance. It also does NOT count towards the two MMR doses that must be given after the age of one year. Every case is a little different. I am not currently advocating automatically doing the shot early. There haven't been studies done for this age group. I have no hesitation about the safety of the shot, but am reluctant to give an extra dose of anything unless I am convinced it is really necessary.

It takes about 10-14 days to get any significant protection from the first MMR. For instance, getting an MMR for a 7 month old to protect them from a travel situation the same week is not going to do much of anything. If you are planning well in advance it might be worthwhile prior to airplane travel.

The Measles outbreak is a bit like fire. There are embers out in the community. It is NOT a wildfire yet. Don't panic! A few hundred cases is a few hundred too many, but that does NOT mean there is a child with measles standing on every street corner. The next couple of weeks will be very telling. It is possible that the numbers of infected patients will spread dramatically. It is also possible that the infected individuals have been identified and quarantined and we can all breath a little easier.
If we start getting cases in San Francisco, or continuing to see a rapid spread, then  I am going to become more aggressive in protecting the 6-12 month olds.

If they are over 12 months old let's get them protected now. All Noe Valley Pediatrics families can feel free to call and schedule an appointment to get the first MMR ASAP if your child is over 12 months and they haven't gotten it yet. Prior to this recent outbreak, It was fairly common to wait until the 15 month exam for the MMR, so your one year old may not have gotten it at the one year checkup. Call the office to ask about  the vaccine status if you aren't sure.

The second dose is routinely given after the age of four. This dose is thought to bump up the protection from 95% to 99%. It is safe to give a second dose any time, as long as it is at least 1 month following the first dose. We are pretty comfortable with the protection from that first dose and are not spending much energy trying to get the second dose early.
If you do opt to do it on the early side, and they have had the first dose after a year, the second dose will count regardless of how early it is given and the series will be considered complete. It is possible that some insurance companies may give trouble to folks giving it outside of the routine schedule recommendations. I went through the motions of trying to get a pre-authorization done for one of my families who wanted to get it done early. I did 10 minutes of automated hell, 20 minutes of holding; when I finally got the human voice I was told to submit a letter. The response to the letter was essentially they may pay, they may not. Ugh.

We are going to do our best to make sure that we don't have a measles patient walk into our office. If your child is over 12 months and has not been vaccinated, we will need to take extra precautions if they have any fever over 102 along with a cough. You will need to speak with the nursing staff before being given an appointment.

My mom is one of my loyal readers. When I updated the post about measles a few weeks ago she told me that it vividly reminded her about how frightening measles was when I was a young child. In the early 60's my family had traveled and she had seen a child with measles encephalitis. She was terrified that we might have been exposed. We were the first in line as soon as the measles vaccination became available. These diseases were very real to the parents back then and they couldn't wait to protect their children. Everyone knew someone who had died or became disabled from this illness. Parents in this country today are fortunate that the reality of these diseases has not really impacted them on a daily basis.

It is never my intent to shame parents who make the choice not to vaccinate. Some parents hold off because their child can not get the shot for a variety of valid medical reasons. Other well educated parents are opting to not get it, citing other reasons that they firmly believe to be valid. Over the past decades, the refusal to vaccinate did not put their kids at too much risk because the numbers of actual cases were down. That is now no longer the case. Unvaccinated kids are at risk. I hope that parents who are still reluctant to vaccinate will reconsider. Some parents of vulnerable children don't have the option.

One of my adult friends said to me the other day,  "we all got measles and survived, what is the big deal" My response was, "It is true enough that the vast majority of folks who get measles will recover intact and have lifelong immunity. However, one to two kids out of 1000 will die, more than that will be permanently damaged. That is too many when we are talking about something that can be prevented. That 1 child out of 1000 matters."

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