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PEDIATRICS Vol. 109 No. 1 January 2002, pp. 172
MMR—Separate Administration—Has It Been Done?
To the Editor—I am writing in response to an abstract from the report that was published in the May 2001 issue of Pediatrics.1 The second sentence in the last paragraph under "Conclusions" is unsupported and misleading. It states:
"Separate administration of measles, mumps, and rubella vaccines to children provides no benefit over administration of the combination MMR vaccine and would result in delayed or missed immunizations."
Have separate administration and combined vaccination been directly compared in a large trial, with results supporting the authors’ conclusions, or is this the authors’ unproven assumption? Do we also know that this would result in delayed or missed immunization, or is this also an assumption?
I believe that parents should have the choice of separate or combined administration until the issue is definitively decided. Granted it may take more work to provide separate administration, but the first objective is to "do no harm."
Robert Leitch, MD
REFERENCE
- Halsey NA, Hyman SL, and the Conference Writing Panel. Measles-mumps-rubella vaccine and autistic spectrum disorder: report from the New Challenges in Childhood Immunizations Conference Convened in Oak Brook, Illinois, June 12–13, 2000. Pediatrics.2001; 107(5) . Available at: http://www.pediatrics.org/cgi/content/full/107/5/e84
In Reply—
Dr Leitch questions the supporting data for the panel’s conclusion that separate administration of the component vaccines provides no benefit over MMR and that separate administration would result in delayed or missed immunizations.
The detailed panel report carefully addressed the hypothesis that separate administration might offer a benefit; no evidence was found to indicate that separate administration is safer or more effective than combined administration of these vaccines. Large-scale randomized trials involving millions of participants are not indicated in the absence of scientific evidence to support the need for such a trial.
Combined administration of vaccines provides significant benefits to children including fewer injections, less pain, lower cost, and more rapid induction of protection against the 3 diseases. If the vaccines were administered separately at different times, multiple visits would be required, which would lead to delayed protection against the diseases.
The amount of delay would depend up the scheduled interval between doses and the willingness and ability of parents to bring children back for at least 2 extra clinic visits. Increasing demands on parents’ time, competing priorities, and intercurrent illnesses in children would almost certainly lead to delays of more than the minimum 2 months of extra time to complete the immunizations. Studies have demonstrated decreased immunization coverage rates with increasing age of children and the need for extra clinic visits.1,2
One clarification is indicated in our discussion of genetic disorders that may be comorbid with autistic spectrum disorders. We stated that Down syndrome is less commonly associated with autism than other genetic disorders such as tuberous sclerosis. This does not mean that Down syndrome is protective. The prevalence of autistic spectrum disorders may well be increased in people with Down syndrome, but not to the degree that autism should be considered in the assessment of all children with Down syndrome, or that chromosome 21 is a likely site of candidate genes for autism.
Neal Halsey, MD
Institute for Vaccine Safety
Bloomberg School of Public Health
Johns Hopkins University
Baltimore, MD 21205, USA
Susan L. Hyman, MD
Children’s Hospital at Strong
University of Rochester School of Medicine and
Dentistry
Rochester, NY, USA
PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics
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