I'm an SLL patient, 55 years old, now about 2.5 years into remission after 6 FCR treatments. I just recovered from a recent (and thankfully mild) bout of shingles. My shingles was so mild that my GP wasn't convinced it actually was shingles! She had me tested for herpes zoster antibodies, and for good measure, also checked for MMR antibodies/titers, given the recent uptick in measles in the community (we're in Canada).
My results came back: it was indeed shingles. It also turns out that I am immune to mumps but have lost immunity to measles and rubella. I've been reminded by my GP and haematologist that I cannot get an MMR booster and will need to "be careful out there." (A big shout-out and hearty thanks to all the antivax idiots.)
My wife, curious about her immunity status, went to get her titers checked, too: she's immune to measles and rubella but has lost her immunity to mumps.
She's considering getting an MMR booster but we're unsure if I will be put at undue risk. I've searched this forum before posting and can only say that the guidance is inconclusive. Given that my wife is immune to measles & rubella, will she be shedding measles & rubella virii in a high enough concentration to put me at risk?
Is this nothing to worry about, or should one of us isolate after her booster? What would "isolation" mean? Separate beds? No contact?
Thanks in advance for your insights and collective wisdom!
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xpro3
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This is a question for your doctor, I think. I do know that kids with HIV disease are recommended to get live, attenuated vaccines if their T cell counts are above a certain level. So IMO *your* level of immune dysfunction would largely play a part of your personal risk.
There have been people here reporting that doctors have advised them to completely avoid children who have gotten live vaccines for brief periods. I think the most common recommendation was a week, if I am remembering correctly. So the safest thing would be for your wife to plan to stay elsewhere during any recommended time.
"The decision to use or avoid a live vaccine in people with weakened immune systems is based largely on the degree of immune suppression. The benefits and risks must be weighed on a case-by-case basis.
For example, it is now recommended that children living with HIV receive the MMR, Varivax, and rotavirus vaccines. But this depends on their immune status, measured by the CD4 T-cell count.17"
This reference below mentions avoiding a person for "days" but isn't specific.
The physician CE material on MMR states "post exposure prophylaxis" in severely immune compromised people is an immune globulin dose 6 days after exposure. So I am thinking this is where the "stay away from the vaccinated person a week" is coming from.
Immune globulin bolus for you 6 days after her vaccination is another consideration. It's what is recommended for severly immune compromised after exposure. The measles component appears to be the part clinicians are most concerned about. And instead of automatically getting the second shot in the series, do a titer to see if's it's needed.
Immunoglobulin (400 mg/kg) can be administered six days after exposure. The intent is to prevent or reduce the severity of measles, but it is not given to immunocompetent persons who have received one dose of MMR after 12 months of age. This type of post-exposure prophylaxis is only for patients exposed to measles who have an increased risk of complications and also have a contraindication to MMR vaccination. This group includes patients:
Severe immunodeficiency, regardless of immune status or immunization
After a bone marrow transplant, up to at least 12 months after the end of immunosuppressive therapy or longer if there is a graft-versus-host reaction
Treated for acute lymphoblastic leukemia until at least six months after the end of immunosuppressive chemotherapy
Infected with HIV and a percentage of CD4 cells less than 15 percent (all age groups) or CD4 cell counts below 200 cells / mm^3 (age over five years) and patients. They have not received the MMR vaccine after receiving effective antiretroviral therapy."
I would probably contact your doctor, if you are being seen by an immunologist even better - speak to them. My own immunologist confirmed that when my 3-year old needed a MMR booster, it was safe for me to be around him (even while being on treatment at the time) - he explained that there was no risk from the MMR vaccine. The live flu vaccine - delivered through the nasal spray - was not recommended on the other hand and my kids had the flu jab instead. Different live vaccines pose different levels of risks it seems.
Thanks to everyone who responded. We will certainly be talking to our doctors tomorrow about this, but I suspect they will refer to the guidance I just discovered from Health Canada on the subject (canada.ca/en/public-health/...
"Vaccine viruses in MMR vaccine are not transmitted to contacts. Transmission of varicella vaccine virus from people with post-varicella vaccine rash occurs but is rare..."
As a precaution we're probably going to use separate beds for a week to 10 days but aren't going to go full Covid protocol in the house either.
You may want to reconsider "going full Covid protocol". I think the main reason the literature states that the measles component is of the most concern, is because measles is extremely contagious.
Measles is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected.
Infected people can spread measles to others from four days before through four days after the rash appears.
Measles virus can live for up to two hours in an airspace after an infected person leaves an area."
The R naught for measles is estimated to be 12-18. Covid's varies now that there are numerous strains, most everyone has been exposed, and in some places people aren't testing for it. It was thought that BA.5's R naught was somewhere around measles, but the studies aren't good.
Covid is still considered to be somewhat more infectious than the flu, whose R naught varies from 0.9 to 2.1
Remember that the reference from your government is for immune competent people. If you don't know for sure what your T-cells and immune globulin levels are, why risk it? I know some of us here have had mild Covid cases, others haven't. You likely will not have a problem, but is it so hard to do "full Covid protocol" for 10 days?
I am urging more caution especially after the recent death of GardenerGirl, it's affected me greatly. I don't think one should be fearful, or avoid everything forever after, just, if a small amount of annoyance can be tolerated for a short time period, I would.
I don’t have advice to give you about what to do regarding your main question as I feel others have answered and Sofia’s reply resonates most with me.
I did want to take a moment to comment about this part of your post: “I've been reminded by my GP and haematologist that I cannot get an MMR booster and will need to "be careful out there." “
So, did they happen to mention any ways for you”to be careful out there?”
Since measles is airborne— like SARS2 and TB (another infectious disease with recent upticks) one of your best ways to “be careful out there” is to use a well fitting respirator of N95 or above or equivalent.
One thing that measles also is known for is immune amnesia— that is it resets the individual’s immunity back to zero and wipes the slate clean. It can do a lot of other damage, but immune amnesia is another good reason to avoid it.
Yeah... "be careful out there" struck me as vague, dismissive and ableist. Just like most Covid-era public health guidance! The aged and/or immunocompromised would appear to be disposable these days...
"Being careful" in the words of my doctor means avoiding large gatherings of children, as they're the most likely to be susceptible to measles these days (all the outbreaks seem to be in schools right now).
It also means masking up which is something I still do. I'm often the only freak in the grocery store with a mask these days. KN95 out and about in shops, N95 (3M Aura) when visiting medical facilities of any kind or in public transit, including airplanes.
I'm so tempted to move to a cabin in the woods and live like a hermit...
Agree— telling one to be careful out there but without sharing what that looks like, what measures can be taken, isn’t particularly helpful and kind of falls into the realm of magical thinking.
You’ve got their number — vague, dismissive and ableist.
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