Measles epidemic – who should be vaccinated and with what?
Everything you wanted to know and did not dare to ask about the measles epidemic in Israel (and in the world ...).
Before we begin a brief explanation of the diseases measles, mumps and rubella.
Why also explain mumps and rubella in the chapter on measles?
Because the measles vaccine always includes measles and mumps vaccine (called the MMR vaccine or the triple vaccine, not to be confused with another triple vaccine given in the eighth grade), and sometimes chickenpox (MMRV vaccine, or the quadruple vaccine).
Viral disease (caused by a virus).
Its characteristics are high fever, cough, eye inflammation and runny nose.
Going forward its a typical rash.
A highly contagious and very unpleasant disease for its patients, and its complications include secondary bacterial infections (ear infections and pneumonia) and encephalitis (a prevalence of 1 in 1,000 patients) that can leave permanent brain damage.
What does the vaccine includes and what type is it?
The measles vaccine always includes a mixture of three viruses – measles, mumps and rubella. So called the triple vaccine or MMR. In addition, there is also a vaccine that also includes the chickenpox virus and then the vaccine will be called quadruple or MMRV.
This vaccine (triple or quadruple) is an active vaccine – that is, the vaccine contains antigens (proteins) against which our body produces antibodies and thus we get vaccinated (our immune system is active and produces antibodies). Sometimes after exposure to measles there is no time to give an active vaccine and a person will be given a passive vaccine (explanation below).
All routine vaccines in the State of Israel include only active vaccines.
The vaccine includes attenuated live viruses.
That is, the vaccine is active, live attenuated.
Where is measles vaccinated?
The vaccine is given under the skin.
This is an important benefit for me because most routine vaccines are given into the muscle.
A vaccine given under the skin is usually less painful than a vaccine given into a muscle.
What are the common and important side effects of the vaccine?
Each vaccine, like any drug, has infinite side effects listed in the leaflet.
Also for this vaccine.
However, the most common side effect is a local side effect such as redness and swelling at the injection site that usually occur during the 24 hours after vaccination.
A fever up to 39 degrees occurs in 5-15% of the vaccinated, about 5-12 days after vaccination, usually less in the second dose vaccine.
Is it possible to reduce the pain when injecting this vaccine (or any other vaccine)?
Actually yes. Pain can be reduced with any vaccine or injection by distracting the vaccinated child.
There is no age from which it works, much depends on the character of the child and the parents (and the patience of the injector).
I use a technique I call "funny coughs".
I ask the child to look the other way and cough 7 times (or 10 or 13, whichever comes first). If the child is calm and cooperates with me then one can be vaccinated during one of the coughs and many times the child will not feel vaccinated.
This technique can be used in all routine vaccines in children over a certain age who cooperate.
Is it possible to vaccinate this vaccine together with other vaccines on the same day ?
Definitely yes. Routinely in Israel the vaccine is given at the age of one year in addition to two other vaccines (pentagonal and Farbner).
The only caveat is that attenuated live vaccines can generally be given on the same day or at least a month apart between attenuated live vaccine and attenuated live vaccine.
This is especially important for those who want to split (see below) the measles / mumps / rubella portion from the chickenpox portion (both live attenuated vaccines).
There are subtleties in cases where children have received blood transfusions or passive vaccines. Recommends in exceptional cases and with specific questions to check with the attending physician or at the immunization briefing.
At what age are the measles vaccine in Israel?
In the country the vaccine for measles is routinely given in tipat halav at one year of age. A second dose is given in first grade. The vaccine at one year of age and in first grade also includes the vaccine against chickenpox.
In recent days (end of June 2019), an advisory committee recommended to the Ministry of Health on receiving the first dose of the vaccine at 9 months of age and advancing the second dose to one and a half years of age. We will see later whether and how the recommendation will be implemented.
When there is the quadruple vaccine (MMRV) that includes the vaccines against the four viruses in question, then it is given as a single injection.
It is sometimes difficult to get the quadruple vaccine and then the vaccine will be given separately for measles / mumps / rubella (MMR) and separately for chickenpox (V) on the same day.
Is there a benefit to any of the two vaccines or is it good to split this vaccine?
The quadruple vaccine (MMRV) has a clear advantage and is that no two injections are needed. The downside is that it has been proven in scientific work that there is a greater chance of heat and Fever convulsions After vaccination compared to the divided administration of MMR and V separately in the same session.
If you ask me then I would prefer MMRV in one shot but since that is not always available, two shots can be given separately or as the parents wish.
It is also possible to always split in terms of time, do measles / mumps and rubella (MMR) on time and after a month at least chickenpox (V).
After all, we said that vaccines can be given on the same day or at a distance of one month from each other.
I advocate less of this method because splits often cause vaccinations to be postponed beyond the time we thought we will delay them(many times after a month the child has a cold with 37.8 fever and the mother or nurse does not want him to be vaccinated and it is postponed and postponed until the bar mitzvah).
Who can not get vaccinated?
Since the vaccine is attenuated live then there are populations that cannot be vaccinated against it.
- Pregnant women.
- Immunosuppressed patients for example oncology patients or those receiving regular drugs that suppress the immune system.
- People who are aware of an immediate allergic, anaphylactic reaction to egg white should receive the vaccine in an appropriate medical setting.
- Children with a history of thrombocytopenia (decreased platelet count) within two months of a previous MMR vaccine.
There are other specific complex cases.
Again, shorten the canvas at this point to get into these subtleties.
In any case, it is exceptional to use the attending physician and the immunization briefing of the State of Israel.
Who is considered vaccinated against measles?
people who are considered vaccinated against measles:
- Has had the disease in the past including clinical and laboratory documentation of his disease.
- Born in 1956 or earlier (because he probably contracted the disease as a child).
- Those who are vaccinated with two doses over the age of one year at least one month apart.
- Anyone who has laboratory documentation on measles antibodies in a blood test.
From what year are two doses of measles given in the State of Israel?
From 1978 onwards, all children of the State of Israel were given two doses of measles vaccine and therefore people who were born after this year and received vaccinations as required are considered vaccinated.
So who in Israel is actually not properly vaccinated?
Since being properly vaccinated means that the person has received two doses of measles vaccine after the age of one year and at least one month apart, it can be understood that most of the unvaccinated in Israel are:
- Children who have not yet received the second dose in first grade.
- Adults born between 1957 and 1977 and receiving only one dose as children.
I recommend to these two populations to complete the second dose of vaccine as soon as possible.
Adults born between the years in question and vaccinated in only one dose have an alternative and that is to test for antibodies.
Is it possible to precede the second dose of the MMR or MMRV vaccine?
The second dose of the vaccine can be given about a month after the first dose and it elicits an excellent immune response in the child and is legitimate.
Moreover, in many Western countries the second dose is given to children aged three to four years and even before.
Therefore, one of my main recommendations for those who want to vaccinate their child properly for measles is to precede the second dose to any time before first grade and at least a month after the vaccination of the first dose.
Is it possible to precede the first dose of the MMR or MMRV vaccine?
During outbreaks, it is possible and appropriate to precede the MMR vaccine from the age of six months.
The chickenpox component (V) cannot be given before one year of age.
Vaccination of a child under one year protects him for a period of several weeks-months (it is difficult to know how many) but is not counted in the number of vaccines required.
An MMR vaccine dose given before the age of one year is not counted as a valid dose.
That is, those who are vaccinated before the age of one year still need to receive a one-year-old dose (and this will be counted as a first dose) and the first-grade dose (and this will be the second dose).
What do you do about adults? Who should get vaccinated?
Adults who do not meet the definition of vaccinated properly as written above should be vaccinated and complete the second dose of the vaccine (or the first, depending on the person).
This is mainly the population of people who were born between 1957 and 1977 and received only one dose in their childhood.
Is there another option for an adult (or child) who wants to check if they are vaccinated before deciding on a vaccine?
Sometimes there are people who have traveled abroad for more or less exotic trips and received a dose of the vaccine without remembering.
There are people who were born and raised in other countries in the world where the vaccination routine was different.
Moreover, many times adults who have received only one dose of vaccine develop an adequate response of the immune system.
Therefore, there is an option to test for measles antibodies at the HMO. Assuming and it is proven by testing the antibodies that a person has enough antibodies to measles, then he is considered vaccinated.
The problem with this approach for example is that a person may have developed antibodies to measles even after one dose of vaccine, but he is not vaccinated against measles.
So he can test antibodies against these diseases as well (mumps, measles and chickenpox if he does not remember getting sick as a child). It’s starting to get a little complicated.
Theoretically, children can also test whether they are vaccinated against measles after just one dose of vaccine.
I do not recommend this approach in children. i think it’s just worth giving the second course including mumps, rubella and chickenpox.
Is there any harm in getting another dose (maybe a third) of vaccine for someone who does not remember / know if he was vaccinated twice as a child?
it will certainly do no damage. The mild side effects I mentioned earlier.
Is it possible to stay close to family members after receiving the vaccine?
MMR vaccine – Although it is a live attenuated vaccine then there is no transmission of the live attenuated virus from the vaccine to a family member and there is no recommendation to stay away from a family member. This is also true if there is a family member who is vaccinated or a pregnant woman, there is no need to stay away from them after receiving the vaccine.
Chickenpox Ingredient (V) – Only if the vaccinated person has developed a rash (rare) then can he transmit the virus in direct contact. In practice, there is no recommendation to keep a family member away from a person who has been vaccinated with this vaccine.
What do those who did not get vaccinated or could not get vaccinated and were exposed to measles do?
Giving an active vaccine 72 hours after exposure can prevent disease.
Therefore, anyone who is not fully vaccinated against measles (see the definitions above) and there is no reason why he cannot be vaccinated, should be vaccinated as soon as possible.
If it is a person who has been exposed and cannot receive an active vaccine or alternatively if more than 72 hours of exposure have passed, the administration of measles antibodies (passive vaccine) may be considered even about 6 days after exposure.
In any such case the Ministry of Health should be contacted for further guidance.