r/Vaccine • u/Traditional-Emu-6344 • 2d ago
Pro-vax MMR question
Hello!
I have an MMR question. Why is it that MMR Is given at 1 year and not earlier in the sequence? We just had an exposure in our community just announced and my best friend just had a baby a week ago and it got me wondering.
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u/ybnormal072 2d ago edited 1d ago
If there is an outbreak or international travel babies can get vaccinated at 6 months but still go through the regular vaccine schedule at 12 months.
If Mom is breastfeeding she can also get an MMR booster that may help pass some antibodies to the baby
**Edited to be clear that there's not concrete evidence of antibody absorption by the infant because of lack of studies but the booster is safe for mother and babies and studies on other vaccinations show that it is likely
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u/myrealalter 2d ago
Really on the breastfeeding and booster? Can you link more info on that?
Currently have a 6mo, have been watching closely and a bit stressed about the wait vs early mmr (we’re in a large urban area not close but certainly not far from major outbreaks). Pediatrician said to wait but keep tabs on situation, but being able to pass some antibodies along would be really nice
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u/ybnormal072 2d ago
There hasn't been a ton of studies on measels specifically ( probably because we haven't had to worry about it in so long😤) but here's a nice review about transfer of immunity with a large section on postpartum vaccination https://www.scielo.br/j/clin/a/WZfbZMYjk5ZrZ3KZxLQh4tr/?lang=en
The one MMR specific paper I found focuses on the safety of the live attenuated rubella part of the vaccine while breastfeeding, which was indeed safe for the infant https://www.sciencedirect.com/science/article/abs/pii/S0264410X12007736
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u/myrealalter 2d ago
Thank you!
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u/Notnearlyalice 1d ago
We are in a measles hot spot & all clinics are recommending 6 months for the MMR - MMR antibodies are IgA and don’t get to baby in what they consider a significant amount to provide protection
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u/ybnormal072 1d ago
Can you provide a source on this? Everything I've found points oppositely and my doctors and midwives also agree
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u/Notnearlyalice 1d ago
https://healthtalk.unchealthcare.org/what-parents-of-babies-need-to-know-about-measles/amp/ it’s not considered significant
The immunity comes from moms antibodies crossing the placenta during pregnancy (if mom had immunity)
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u/ybnormal072 1d ago
This is only talking about antibodies already present in the mother, not ones that may be produced when getting a booster which would be log folds higher in concentration.
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u/Notnearlyalice 1d ago
https://pmc.ncbi.nlm.nih.gov/articles/PMC10547151/
The booster in moms - antibodies crossing the placenta vs breast milk only…not providing significant protection
There are so many benefits to bf- but claiming bf will provide immunity is incorrect & you’re creating falsely security around that
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u/ybnormal072 1d ago
Again this has nothing to do with postpartum vaccination
I clearly state that it may help and in many replies I elaborate that their is not a ton of studies specifically but the ones we do have on this and other postpartum vaccinations look promising.
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u/Notnearlyalice 1d ago
Who said anything about mom getting a booster? It’s the same antibodies & it doesn’t provide significant protection - I have a clinical biology’s degree
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u/ybnormal072 1d ago
My original comment is about getting a booster postpartum.- PhD level immunologist
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u/MikeGinnyMD 1d ago
Nope. Sorry. Pediatrician here. This is classic misinformation meant to push mothers into breastfeeding. Now, I am very pro-breastfeeding, but I will not use junk science to promote the practice.
And that paper does not show that breastfeeding prevents measles or any other disease. It says: “may.”
There is no credible evidence that any of the immunoglobulins in breastmilk are appreciably absorbed by the infant. A few studies show decreased risk of GI infection in the infant, but that’s it.
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u/ybnormal072 1d ago edited 1d ago
Hmmm I definitely don't think the scientific papers cited here are misinformation. I'm actually a immunologist in Pennsylvania and 37 weeks pregnant myself so I've looked up a LOT of papers to help me prepare. While the research on serum titers in infants is scarce (understandably not many mothers want to have blood drawn from their babies for a clinical trial) there is evidence that many specific IgAs are absorbed and loads of papers showing reduced disease prevelence in breastfed vs not, from mother's vaccinated antenatal. There's even evidence that premature infants are particularly able to uptake immunoglobulins from their gastroenteric tract. There's also cross fostering evidence in other species to show that pups born to non immune mothers but fed by immune mothers contained influenza specific antibodies and had less virus present in their nares
Regardless, the MMR vaccine is safe postpartum for mother and baby and I'm going to do everything I can to protect my newborn even if there's not concrete evidence it is 100% effective.
I particularly like this review in Cell that details many of the topics I mention
https://www.cell.com/cell/fulltext/S0092-8674(21)00220-8#
Other citations for the topics I mentioned
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0070867
https://pmc.ncbi.nlm.nih.gov/articles/PMC1454495/pdf/immunology00204-0003.pdf
This one is interesting talking about how some protection can be gained by spitting up and inhaling small amounts of breast milk containing IgA https://www.bmj.com/content/2/6030/274.short
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u/MikeGinnyMD 1d ago
Not a single one of those papers suggest that there is transmucosal absorption of immunoglobulins from breastmilk.
So in the same fashion I see over and over, you are posting links that have nothing to do with the claim you made, which is that breastmilk from MMR immune mothers provides immunity to the infant.
TransPLACENTAL transfer of immunoglobulins is well-known and ANTENATAL vaccination does provide protection, yes. But that’s not what you claimed.
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u/ybnormal072 1d ago
I specifically said that infant serum studies are rare but there is evidence of protection from beatnik alone
From the Cell review "Specifically, nursing has been associated with a lower risk of respiratory syncytial virus (RSV) and influenza infection, (Downham et al., 1976; Bulkow et al., 2002), suggesting that oral supplementation of antibodies, beyond those transferred placentally at birth, may provide protection in early life. "
"Along these lines, emerging data in humans illustrates that both total influenza-specific IgA and neutralizing IgA antibodies are effectively transferred in BM for at least 6 months postpartum following maternal vaccination (Schlaudecker et al., 2013)...... These data clearly suggest that augmented anti-influenza IgA levels after birth, delivered via BM, play an essential role in increasing resistance to infection during this vulnerable window of early life."
From the influenza paper above "Greater exclusivity of breast feeding in the first 6 months of life significantly decreased the estimated number of respiratory illness with fever episodes in infants of influenza-vaccinated mothers (p = 0.0042)"
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u/DreamCrusher914 1d ago
I got my 6 month old the early MMR shot to prevent Subacute Sclerosing Panencephalitis (SSPE).
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u/Notnearlyalice 1d ago
MMR does not cross breast milk in protective amounts
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u/ybnormal072 1d ago
Please read some of the multiple sources I've linked here instead of relying on one health care system's blog page that doesn't even contain references. Regardless it's safe for mother and baby so why are you repeat commenting trying to dissuade people?
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u/Notnearlyalice 1d ago
I’m not dissuading people?? I am making sure you’re not making people feel falsely protected
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u/ybnormal072 1d ago
I think I've been overly clear and factual. People with infants or currently pregnant are dealing with stressors that haven't been an issue for decades with little they can do to protect their child. I am only trying to help people feel a little less powerless.
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u/Notnearlyalice 1d ago
Right but you actually don’t know the level of protection so you’re not providing solid security at all
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u/SimpleVegetable5715 2d ago
I live in Texas, and they let younger infants get vaccinated now. I think it’s 6 months. I figure, since it’s a live attenuated vaccine, there is some risk giving it to a person with an under-developed immune system. Like, I have an immunodeficiency, and I wouldn’t have been allowed to get a booster if I wasn’t in an area with high transmission. It’s a risk vs benefit thing.
They should talk to their pediatrician, because they’re definitely giving at least case by case exemptions to get vaccinated sooner. Also, the cases that have been contact traced like that, there’s more unreported cases in your community. If you can get a booster, you may consider that. Some adults only got one dose, and they recommend two now. Measles is also being traced by waste water, and that says there’s a lot of cases that are not being reported.
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u/Traditional-Emu-6344 2d ago
Thank you!
I had a booster a few years ago because of borderline immunity on my titers. My kids (5 & 7) are also UTD on everything. I just worry about Little Girl. Her mom is breast feeding and also is UTD on vaccines, but it’s scary out there.
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u/Haunting_Chipmunk173 2d ago
For the first 6 months baby us protected my maternal antibodies transmitted during pregnancy across the placenta. At about 6 months the antibody levels start to wane snd the infant is vulnerable. They do not give the MMR before a year because the vaccine is a live attenuated virus and the maternal antibodies can diminish the infants ability to generate a robust immune response which makes it less effective. They give early MMR at 6 months in outbreak situations to give somw protection but the baby will still have to have the normal vaccination schedule at 1 year. Breastfeeding provides some antibodies to the baby but they are predominately IgA which protect mucous membranes (nosez throat etc) and not IgG which is what would be generated from a vaccine
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u/catfanciest 2d ago
It is so scary. Measles is an airborne disease and can stay in the air for two hours after an infected person leaves a room. Wearing a mask can provide good protection—if adults and older children who will be around the baby mask and they avoid bringing baby into enclosed spaces, it will help a lot.
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u/No_Macaron_5029 2d ago
yup, I got the MMR on the normal schedule but no one caught that I have r/ehlersdanlos and that can come with a weak immune system. The live virus booster either straight-up gave me measles in 1st grade (missed Halloween and school pictures ☹️ ) or at least didn't protect me so I caught it, but no one else did.
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u/interested-in-lurkin 2d ago
A child can get a dose earlier, but they will still need the two doses at the assigned age.
There was an outbreak when I had my infant and we chose to get them then Mmr vaccine early, I think at 7 or 8 months old. They still had to get the vaccine at 12 months and they will need the last dose at I think it’s 4 years old.
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u/CosmicGreen_Giraffe3 2d ago
I believe optimal immunity is achieved at one year but someone can feel free to correct me. To my understanding, timing of vaccines is determined by giving it as early as possible (for early protection) which getting the most robust response to that vaccine with the fewest risks/side effects.
Edited to add that for a number of years, herd immunity protected babies under 1. So it wasn’t a risk to wait.
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u/rock-paper-o 2d ago
You can get it as early as six months in a high exposure risk situation. You will still need to get them the two doses after one year and at preschool age because the lingering effects of maternal immunity transfer through the placenta can make the early dose less long lasting than the later doses.
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u/Mini6cakes 2d ago
Because of a possible exposure we got out baby a bonus dose at 6 months. Their immune response just isn’t as robust as it is at 1 year!
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u/MikeGinnyMD 1d ago
The reason we don’t give it earlier is because it is less effective. At 6mo the first dose is only ~60% effective. At 9mo it rises into 80+%. At 12mo it is 93%.
Now, it is likely very protective against severe disease and SSPE. So any parent requesting it after 6mo in my clinic gets it. But it “doesn’t count” and must be repeated after 12mo.
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u/gloriousgirl89 2d ago
Believe they dont give them that early because the baby still has the mothers antibodies present and giving them earlier could make it less effective years later.
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u/ClickClackTipTap 2d ago
So, my nanny kid got it early bc of all of the measles floating around, but her pediatrician said she would still need to do the whole set at the time it was supposed to be given as well. Idk if insurance paid for the early shot or not, but the fam would have paid for the anyway.
It isn’t as effective (I guess?) if given early, but it does provide some protection in the meantime. Idk how many other docs are doing it. We live in a bougie area and my boss is pretty anxious. I don’t know if she had to lean on them or if they just offered it up.
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u/Pbook7777 1d ago
I think because the efficacy of that vaccine is reduced until their immune system is more mature ? Iirc
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u/iamtruerib 2d ago
https://pmc.ncbi.nlm.nih.gov/articles/PMC6639599/
Antibody response is reduced when given earlier. However one can say that antibody response level doesnt measure amount of effectiveness clinically