Thread by @bradrherrin

Week #5: #Measles & #MMR

Clear topic of the week was measles (so many convos w/ concerned parents this week!) so this week’s thread is on the MMR vaccine

#VaccinesWork #VaxFactsFebruary

@Dr_ScottK @PedsGeekMD @DrJaimeFriedman @DrPanMD

#PediatricTeachingTipsAndPearls

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Brief overview on #measles:

Highly #contagious - 90% of susceptible (i.e. non-vaccinated) persons will become ill if exposed

- Fever
- 3 C's (cough, conjunctivitis, coryza)
- #Koplik spots
- Rash (starts on face & spreads downward)

Sources for thread: @CDCgov & @WHO

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Complications from #measles:

Ear infxn (1 in 10) - can cause hearing loss
Pneumonia (1 in 20) - most common cause of death
Encephalitis (1 in 1000)
Subacute sclerosing panencephalitis (4-11 in 100,000)

1 in 4 will be hospitalized
1-2 in 1,000 will die

#VaxFactsFebruary

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Important dates for #measles vaccination:

1963 - 1st measles vaccine licensed
1971 - #MMR 1st licensed
1989 - 2 dose MMR schedule recommended
2005 - #MMRV licensed

#VaccinesWork #VaxFactsFebruary

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#MMR vaccine:

- Live attenuated vaccine

1st dose at 12-15 months:
- 95% of 12 mo develop measles antibodies
- 98% of 15 mo develop measles antibodies
- 2-5% fail to respond to single dose

2nd dose at 4-6 years:
- 99% of people will develop measles #immunity w/ 2 doses

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Early dose can be given for 6 to 11 mo but doesn’t count as 1 yo dose (only provides temp protection)—for infants at risk for measles exposure (incl international travel)

3rd dose of #MMR might be recommended in certain mumps outbreak situations (e.g. college campuses)

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MMR Contraindications

- h/o anaphylaxis to neomycin or MMR vaccine
- pregnancy
- immunosuppression and/or high dose steroids

MMR Precautions:
- moderate or severe acute illness
- recent blood tranfusion/blood products (specific interval varies)
- h/o thrombocytopenia

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Breastfeeding mothers can safely receive the MMR vaccine

Remember—No other live vaccines within 4 weeks but okay to give together (also true for TB skin test)

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Potential side effects:

- fever (5-15%) - occures 5-12 days after
- rash (5%) - occurs 7-10 days after
- transient thrombocytopenia (1 in 30,000-40,000)
- febrile seizure (see next tweet)
- arthralgias (up to 25% of adult women - due to rubella component)

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Febrile seizure risk

~5% of children will have a single febrile seizure in their life (most are not vaccine related)

There is a slight increase in risk of febrile seizure after MMR vaccination

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MMRV roughly doubles this risk (compared w/ MMR + VZV separately), resulting in 1 additional febrile seizure for every 2,300-2,800 vaccine doses

Not seen w/ 2nd MMRV booster at 4-6 yrs

PCV + flu & Dtap + flu also have small increased risk

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There is no convincing evidence that any vaccine causes autism

To the contrary, there have been multiple well-designed studies that have demonstrated that there is no link between the MMR vaccine & autism

See CHOP Vaccine Education Center: bit.ly/2QHqIx9

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Favorite measles fact:

Natural measles infxn appears to predispose children to other infxns for up to a few years by erasing immune protection to other diseases (so-called "immune amnesia")

When MMR is given, childhood deaths from other infectious diseases also decrease

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Bottom line:

#Measles can cause serious complications

#MMR is an incredibly safe & effective vaccine

Measles still kills >100,000 every year worldwide

Knowing #data & specifics is crucial in talking w/ families

#VaccinesWork #VaxFactsFebruary #HerdImmunity

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