Live Vaccines

[Meri T.]

Need to clear something, please help:

I have an important medical check tomorrow, and will need to get live vaccines, namely measles, mumps, rubella and varicella if I can't produce records that I have had them (and I don't have ANY immunization records).
I can choose to do antibody tests for MMRV, but if any comes out negative, I will need to be vaccinated.

I read all over the net that MDS patients should not get live vaccines. However, my hematologist gave me a "Medical Report" for the medical check tomorrow, and in there he stated "Getting live vaccination is acceptable in the current medical status".

What the ...!? So I'm in a bind here. I want to get a waiver for the shots tomorrow, but my doctor hasn't given me a get out of jail card, but just the opposite.

Most of the threads in this forum deal with getting shots after a STC. Has anyone out their got their shots before? Or during treatment?
Any suggestions?
Meri

[Neil Cuadra]

Meri,

A similar question was covered some years ago in the newsletter of the Aplastic Anemia & MDS International Foundation (AA&MDSIF). In their Fall 2006 issue they said

In general, live vaccines should not be administered to individuals who are immunosuppressed.

Quoting an even earlier newsletter they said

Generally, patients with active disease should not get immunization shots nor flu shots since this may cause worsening of blood counts. Patients should not be exposed to another family member who has received shots for 2-3 weeks if this is practical.

There is information about specific vaccinations in their Fall 2003 newsletter and their November 2007 eBulletin.

An article at UpToDate says

Vaccinations and antibiotics -- Vaccines are especially important for people with MDS. People with MDS are at higher risk of infections than other people, and vaccines help prevent infections. Only some vaccines are safe and appropriate for people with MDS.

People with MDS should have yearly influenza vaccines and a pneumococcal vaccine every five years. In general, people with MDS can get "inactivated vaccines," which are vaccines that contain dead copies of a virus. People with MDS usually should not get "live attenuated vaccines," which are vaccines that contain live but weakened copies of a virus.

If you are immunocompromised or immunosuppressed then it may be worth having the MMRV antibody tests to determine your status, but then talk again with the doctor before getting any vaccinations, to weigh that risk against the risk of not being vaccinated.

[lisa3112]

Its totally up to you if you get the mmr vaccine isnt it? If you're worried why not wait?

[Meri T.]

Lisa,
It's one of those visa procedures that can't wait. Trust me, I would wait if I could. Thank you for your concern.


Neil,
Thanks for the links. I printed them out and showed the doctor. The doctor was sympathetic but he stated that the hematologist's letter trumphed all. And as it stated very clearly that I could take the live vaccines, then no waiver, sorry. He suggested the antibody tests first, so we will have the results in a few days. That should buy me some time as I am seeing my hematologist this Thursday.

The doctor mentioned that should my hematologist change his mind, and decided that live vaccines would be a no-no for me, then I could get a blanket waiver for the shots. I guess I'll present my case to my hematologist again and get a new letter if possible (sigh!).

(Sigh again!) Can you believe it took over 2 weeks for the old letter!! I prepared the layout, my hema just needed to fill in the blanks, but it took 2 whole weeks because they don't do English over here. I'm at one of the best hospitals in Tokyo, the best in cord blood transplant, and a very famous transplant team to boot. It's where all the government hotshots get their physical, but it takes 2 whole weeks for a statement in English! They said I was lucky because my hematologist could do English, so it was only 2 weeks, sometimes it could take as long as 6 months if the hospital translator was away on business! And that's just in the admin corner, don't get me started on other stuff!
Okay, rant over. Really sorry, but just had to get it out of my system

[lisa3112]

Oh ok didn't realise it had to do with visas. In Aus we start immunisations at 6months and mmr at 2 yrs. Regardless of anything! Its a set schedule. Good luck.

[Meri T.]

And I had the talk about live vaccines with my Hematologist. He explained that with my current health status, specifically looking at my differentiated white blood counts, the ones in charge of protecting me against the live viruses were still at an acceptable mark.

Well, that's good to know. But the best part is that the anti-bodies check came out ALL positive for MMRV, so I'm exempt from getting the shots!