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When to Say No to MMR Vaccination


Even when a parent begs, you may still have to say “no” to MMR. Which of these 4 children should not receive the vaccination?

Editor's note: this is an updated version of the original article which appeared in March 2015, shortly after the outbreak of measles traced to a Disney them park in Orange County, CA.

The old adage that “every cloud has a silver lining” certainly applies to the current United States measles outbreak. The dangers of the antivaccine movement have been printed on front pages across the country and raised new awareness of the importance of herd immunity. While no measles cases have been reported in North Carolina where I practice, I get questions from parents almost daily about whether their children are protected against measles or whether they can get their MMR vaccination early? Having had to cajole and plead with some parents to vaccinate their children against measles for so long, it is a refreshing change to have parents demand the vaccine for their child.

Sometimes, however, the health care provider has to “just say no.”

There are 2 broad reasons that preclude the use of live vaccines. First, the live vaccine may prove a risk to the individual receiving the vaccine. The second is that the vaccine may not result in protection against the disease it targets.  

Looking at the first reason to withhold live vaccine, in which of the following scenarios does the administration of the measles vaccine pose a risk to the recipient? 


Which of these 4 children should NOT receive the MMR vaccine?

A. A 12-month-old child comes to your office for his well-child visit. Ten weeks earlier, he was in a motor vehicle accident that resulted in removal of his spleen. He seems to be fully recovered.
B. A 5-year-old boy comes to your office for his kindergarten shots. His past medical history is significant for a 2-day hospitalization for encephalitis diagnosed 4 weeks after he received his 12-month shots including an MMR, Varivax, Prevnar, and HIB vaccines. No etiology was found, but mom says the doctors told her it was probably a virus.
C. A 5-year-old girl with spina bifida and anaphylactic allergy to both egg and latex needs her second MMR.
D. A 5-year-old boy needs his second MMR. His past medial history is significant for two ICU admissions for asthma with intubation. He weighs 25 kg and has been on 25 mg of oral prednisone daily for the past 6 months.


Please click on the links below for the next installments of thhe Patient Care Pediatric Vaccines Special Report:

"How to Pump up the Volume on Gardasil" and "Gardasil vs Meningococcal Vaccine: A Lesson for Anxious Parents"


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