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Is another dose of MMR really needed if the first one was 19 days before 12 months?
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LDuncan posted:
My daughter is 18 months old and we visited the doctor's yesterday for the usual wellness check-up. I was very surprised to be told that she needed another dose of MMR as the first one was given too early (exactly 19 days before her first birthday). The reason it was given early was because we were leaving for our summer vacation (which included a trip to Nicaragua), but I was never told that this 2nd dose would be necessary. When I requested more information she went to consult someone else who confirmed that if the child was given the first MMR dose more than 7 days before their 1st birthday then they would need another one as it "would not count". Is that really true?
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youtalktoomuch responded:
do not consider nineteen days too early to stop the effectiveness of the vaccine. personally, i would request that they perform a titer test, which will detect the antibodies that should be present if the vaccine took effect, before agreeing to a second vaccination. this will allow you to know for certain if it is needed, and i really cant believe they did not suggest this. might be time to shop for a new doc lol. dont be intimidated, this is your child and your rights.
 
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Roy Benaroch, MD responded:
Yes, this is really true, and this is following the established guidelines. The mistake they made was in not communicating this to you clearly, but what was done was correct.

Two doses of MMR should routinely be given, the first on or after the 1st birthday, the second traditionally at school entry. however, for travel to areas with high rates of measles, giving that first dose early is recommended to provide protection from this disease (and also to prevent a child from bringing it back here.) However, vaccination prior to the 1st birthday doesn't reliable, lasting immunity. So that early dose, if given, is supposed to be "ignored"-- the child still needs another dose at 1, and another dose at 4.

This extra dose provides the benefit of disease protection, with no extra risk beyond the very small risk of any vaccine.

Doing titers is expensive and painful, and often gives equivocal results (meaning you'll still end up getting another dose of MMR to make sure your child is safe). Still, if that's what you want to do, discuss that option with your pediatrician.
 
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LDuncan replied to youtalktoomuch's response:
Thanks for your comments.
 
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LDuncan replied to Roy Benaroch, MD's response:
This is very helpful information, thank you. I just needed to hear another opinion. We looked it up on the cdc.gov website which said the same thing. I was frustrated that we were not informed properly, that's all. I will contact the doctor and arrange for a second MMR. I do not want to put her through a painful test that will just confirm the necessity for another shot! We are going to emigrate to Sri Lanka in July so it would be good for her to be as protected as possible.

Will she then need another one at 4?

Thanks for your advice!
 
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Olivetre replied to LDuncan's response:
If I understood the last sentence in para 2 from Dr. Benaroch she would need a shot at 4 also.
 
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Roy Benaroch, MD replied to Olivetre's response:
Correct. Child needs dose now (which will "count" as dose #1), and also needs another dose, traditionally given at age 4-5.

However, that final dose of MMR can be given at any time 4 weeks or more after the first valid dose, and it will "count."

Also, for travel to Sri Lanka, I would make sure child got at least 1 dose of Hep A vaccine. Additional travel health info can be found at cdc.gov/travel

best of Luck!
 
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LDuncan replied to Roy Benaroch, MD's response:
Thanks so much!


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