Measles!! No MMR #2 advice

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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

11 hours ago, ruby_jane said:

"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.

No GB but blistered head to toe, they thought she may have gotten measles from it. Mom said she was quarantined for days at the hospital and infectious disease docs were baffled. That’s just what I got from the parents.

Specializes in ICU/community health/school nursing.
12 hours ago, schoolnurse1118 said:

No GB but blistered head to toe, they thought she may have gotten measles from it. Mom said she was quarantined for days at the hospital and infectious disease docs were baffled. That’s just what I got from the parents.

It is not beyond the realm of possibility that she got the measles, then. But surely those docs would have titered her or something. At any rate...titer will prove forever she had it. Medical exemption yearly can exempt her as well. My least favorite option here is the conscientious exemption becuase the parent will not have to think through it every year.

Specializes in School Nursing.

I would ask for medical documentation that she can't have the second dose. "terrible reaction" could mean anything in parent speak. Without documentation, I would require she get the second dose prior to starting school.

I'm just eavesdropping on this thread. But I feel with the parents here, I had a reaction to the MMR vaccine both of the 2 times I have had it in adulthood. My face and tongue got numb and itchy. I am sure that for the parents the negative reaction they saw (and WAS documented to a point) scared them enough away from it. I don't blame them. I think the reaction they saw was severe enough if it required hospitalization.

1 Votes
On 2/15/2019 at 8:02 AM, lifelearningrn said:

I would ask for medical documentation that she can't have the second dose. "terrible reaction" could mean anything in parent speak. Without documentation, I would require she get the second dose prior to starting school.

Yep, this. We all know that "quarantined in the hospital" happens in all kinds of situations where ultimately a non-infectious cause is found (you've got a headache and a stiff neck in the ER, everyone's masking up in case it's Neisseria meningiditis, until the results of the LP come back ). And "baffled infectious disease doctors" could mean "they were consulted along with neuro and derm and half of the other specialists, and they didn't find anything."

1 Votes
Specializes in Pediatrics; School Nurse.

I had a similar situation at a private school in Oklahoma. I contacted parents regarding the 2nd dose being due before school started. They reported that the student had history of reaction to the first dose. After discussing it, the parents talked with their pediatrician, titers were drawn and results showed immunity. Problem solved. I wish it was always that easy.

1 Votes
Specializes in pediatrics, School LVN.

I think it would be pretty easy to get medical exemption from the doctor if the 2nd dose is contraindicated or if the student has titers drawn indicating immunity. If the doc says she's ok to get second dose then you have to go by state and school policy. You might be able to contact the health department to see what they recommend, with a measles outbreak in Texas right now it's a bit scary to have a student with questionable immunity.

Specializes in ICU/community health/school nursing.

This weekend I remembered something: Stevens Johnson rash sometimes presents itself with viral infection. And that stuff is terrible to behold. But that would assume it was a case of the measles....

On 2/14/2019 at 7:47 PM, schoolnurse1118 said:

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?

Yes - kids in Texas can go to school without immunizations - just need the proper paperwork on file - either the medical exemption from doctor's office or the Affidavit from the State.

I personally am not a fan of it but it is what it is. As long as I have the proper documentation on file I don't question parents reasons nor care to get into debates with them about it.

3 Votes
Specializes in Cardiology, School Nursing, General.
29 minutes ago, AdobeRN said:

Yes - kids in Texas can go to school without immunizations - just need the proper paperwork on file - either the medical exemption from doctor's office or the Affidavit from the State.

I personally am not a fan of it but it is what it is. As long as I have the proper documentation on file I don't question parents reasons nor care to get into debates with them about it.

Pretty much this. But you rarely see medical or religious. I see more Affidavit from the State. I am in Texas and in my tiny school of 522 kids, I only got 2 of them with affidavits.

1 Votes
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