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Measles!! No MMR #2 advice

School   (1,616 Views 22 Comments)

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Hi guys,

 

I just wanted your take on this. I work at a private school in Texas. To some extent I know we make our own guidelines, but obviously follow state law. 

I have a 6 year old trying to enroll for second grade next year. The girl apparently had a terrible reaction to her MMR at her one year checkup. She hasn’t gotten the second dose. She had been hospitalized, infectious disease met with her, etc. 

Would your school allow her to be exempt from the shot or is it mandated she get it prior to beginning school?

Also........how susceptible is she to getting measles? I’ve heard with just the first shot you’re around 94% protected?

Just wanted to hear your thoughts on the matter. Thanks!!

Maggie 

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laflaca has 5 years experience as a BSN, RN.

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Former Epidemiology nurse and current (brand new) school nurse here....it really does totally depend on your state law.  Here in Arizona, where our state law makes poor choices related to vaccines, her parents can just sign a "personal belief" exemption for any old reason, and voila!  Exempt!  Why even bother with doctors and reasons?

If someone's asking for a medical exemption, you can see Texas' dept of state health services guidance here:  https://dshs.texas.gov/immunize/school/exemptions.aspx   Seems pretty typical of laws about true medical exemptions:  you've gotta have a letter from an MD or DO stating it's medically contraindicated, not just an anecdote about a hospital stay.  

It's true that the MMR has a decent level of protection with just the one dose BUT in the county where I work, she would not be considered vaccinated with one MMR.  In an outbreak situation, our county public health department would require us to exclude her from school.  I tell this to every parent who requests an exemption.  

Your mileage may vary... I've never worked in a private school and Texas sometimes has its own ideas  🙂  

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SaltineQueen specializes in School Nurse, past Med Surge.

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We would require a doctor's verification and allow it as a medical exemption.

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2 Followers; 5 Articles; 4,084 Posts; 34,839 Profile Views

Check state laws.  I am not sure if private schools are excluded by and large from adhering to immunization standards.  In my state, i do not believe they are - i believe they are audited just the same.  At least that's how it was when i worked at one ages ago.  

Because of the reaction, the child may qualify for a medical exemption.  If i were looking to avoid this vaccine due to concerns of reaction, that would be the first thing I'd try.  Again, i'm in a different state.  Medical exemptions need to be reviewed and renewed regularly here.  That may differ by you.  Second idea may be to get MMR titers drawn.  If your state accepts that in lieu of 2nd dose and the levels are good,  then the kid's all set.  Finally, some states do allow for philosophical objection.  Since the parent is claiming there was a reaction, then I'd say medical exemption sounds more appropriate, but it may be a possibility.  

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ruby_jane has 10 years experience as a BSN, RN and specializes in ICU/community health/school nursing.

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"Terrible reaction" means what? I have seen febrile seizures in kids who were predisposed to such AND who had the MMRV at 12-18 months. As in...two kids, out of the hundreds I vaccinated. At this time I think we don't do MMRV for that dose.

If she got Guillaine-Barre or such - sure, not a good thing. My "terrible" and really terrible are probably up for interpretation.

As to the odds of her getting measles (or mumps or varicella) -that depends on a lot of variables. I'd insist on a medical exemption that has to be renewed YEARLY if you proceed.

 

 

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SchlNrsKrn has 26 years experience.

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3 options (I'm in Texas too):

Get titers drawn: if good, this would take care of it forever

Medical exemption: letter from MD stating medical reason student can't have immunization, must get new letter every year unless letter states "lifelong exemption"

Conscientious Exemption: request form from DSHS. Redo every 2 years

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1,147 Posts; 9,476 Profile Views

Just have parents get the Conscientious Exemption form and be done with it.  

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KeeperOfTheIceRN has 4 years experience as a ADN.

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2 hours ago, SaltineQueen said:

We would require a doctor's verification and allow it as a medical exemption.

This for us too. If they don't want to do that (and it wouldn't be hard if it were true), then they can just do a Vaccination Waiver. I'm located in Texas as well and they make it very easy to opt out.

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SaltineQueen specializes in School Nurse, past Med Surge.

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36 minutes ago, KeeperOfTheIceRN said:

This for us too. If they don't want to do that (and it wouldn't be hard if it were true), then they can just do a Vaccination Waiver. I'm located in Texas as well and they make it very easy to opt out.

It's too easy for us here in Indiana, too.  Indiana doesn't recognize personal exemptions so people just claim religious.  🙄

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Jedrnurse has 25 years experience as a BSN, RN and specializes in school nurse.

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35 minutes ago, SaltineQueen said:

It's too easy for us here in Indiana, too.  Indiana doesn't recognize personal exemptions so people just claim religious.  🙄

"Claim religious" - so they just pray their kiddos don't get sick...?

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kidzcare has 5 years experience.

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6 hours ago, SaltineQueen said:

We would require a doctor's verification and allow it as a medical exemption.

This is how it works in Illinois as well. The state allows medical or religious exemption. However, I believe in the case of an outbreak, this student would be excluded for the duration of the measles incubation period (10-12 days) to avoid their potential exposure. 

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3 Posts; 157 Profile Views

Thanks for the replies everyone. 

I should have mentioned it’s a Catholic private school. We don’t accept religious exemptions since vaccines don’t go against Catholic teachings. 

I was just curious how it was for everyone else. 

I guess I’m wondering if kids can go to school without their immunizations....why would anyone be surprised if there was a measles outbreak and that child had it? 

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