Submitted by blackswan on Fri, 02/13/2015 - 02:59

Cases of measles have been very much in the news: 121 cases (as of today) reported in the US this year. To assess how much myeloma patients might need to be concerned or not, it is helpful to put this number of cases in perspective.

Since 2001 in the US, there have been up to 220 cases a year, according to the Centers for Disease Control and Prevention. During January through August 2013 (a year from which data have been analyzed), there were 159 cases, of which 157 were linked to exposures occurring outside the US (in particular, from Europe). Of note, since October 2014, there have been more than 300 measles cases in Germany linked to visitors and immigrants from Bosnia and the Middle East. In 2001, there were over 6,000 cases of measles in Germany. Other sources of measles are from China and the Philippines. The controversy in the US is that although the measles vaccination rate overall is 91%, “pockets” of unvaccinated children can lead to local clusters of cases.

As for myeloma patients, the vaccination rates are high. In fact during assessment for the measles virotherapy trial at the Mayo Clinic, in which a massive dose of engineered measles vaccine is administered to treat the myeloma, it was noted that a majority of myeloma patients have robust measles antibody levels in their blood and definitely do not need revaccination.

Cases of measles among myeloma patients are actually extraordinarily rare: I have never seen or even heard of a case. It thus seems that although the immune system of myeloma patients is compromised, measles is not a particular risk.

Anyone born in the US (or most developed countries) before 1957, which is the majority of myeloma patients, will have had the standard two or more doses measles vaccination. There is a 90-95% likelihood that myeloma patients will have 95-99% protection against measles. Since the measles vaccine is a live virus vaccine, revaccination is not recommended especially for patients on active therapy for myeloma. Anyone taking prednisone or dexamethasone should definitely not have measles revaccination.

So what is recommended? The main thing is to limit exposure right now in crowded places and also avoid visiting or spending time at any day care center where unvaccinated children can contribute to local clusters. The risks are very low for myeloma patients overall. So, be vigilant as always with regard to fever and any indication of infection – but most likely it is not going to be measles!

Dr. Durie sincerely appreciates and reads all comments left here. However, he cannot answer specific medical questions and encourages readers to contact the trained IMF InfoLine staff instead. Specific medical questions posted here will be forwarded to the IMF InfoLine. Questions sent to the InfoLine are answered with input from Dr. Durie and/or other scientific advisors and IMWG members as appropriate, but will not be posted here. To contact the IMF InfoLine, call 800-452-CURE, toll-free in the US and Canada, or send an email to [email protected]. InfoLine hours are 9 am to 4 pm PT. Thank you.

Tags: 
measles
virus
CDC
Mayo Clinic

Comments

Submitted by Vicki Jones on Fri, 02/13/2015 - 06:41.

Dr. Durie, if some inoculations have to be repeated after an SCT, how would childhood vaccination against measles be effected?

Submitted by Suzy Wahlborg on Fri, 02/13/2015 - 06:47.

Would you address the measles risk for recently (stem-cell) transplanted patients?
Thank you.

Submitted by Sarah on Fri, 02/13/2015 - 06:53.

Thanks for this article. Very helpful but curious as to whether a stem cell transplant may have wiped out the antibodies and immunity that once existed after vaccination as a baby. Thank you.

Submitted by Allan Willy on Fri, 02/13/2015 - 08:26.

I thought that Myeloma patients having a sct had their vaccinations set to zero and had to be revaccinated. My wife had this happen and we presume she was revaccinated for measles

Submitted by Sherry Bonds on Fri, 02/13/2015 - 08:35.

Dear Dr. Durie,

What about the stem cell patients who have had their vaccines wiped out and not been revaccinated for measles due to it being a live virus?

Also, as the spouse of a MM patient, I have been advised NOT to have a shingles vaccination since it is a live virus and might infect my husband. This is concerning me, as we are talking about health risks for 2 separate people. As long as my husband's MM is under good control with 5 mg Revlimie for 21 days and 20 Mg dex once a week; maintaining a .4 m-spike with all other labs looking great, do you think it would be a big risk for me to get this shot?
My husband takes 500 mg Valtrex daily as a preventative.
I am a type-1 diabetic, so I watch my health pretty closely.
Thanks,
Sherry Bonds

Submitted by Margaret Wilkins on Fri, 02/13/2015 - 08:38.

I was born in 1943, and as a child had a hard case of 3-day measles and mumps and chickenpox. However I never had the MMR vaccinations when they came along nor another case of the diseases. My two children had the vaccinations when they were children. In August 2012 I had an autologous stem cell transplant for Multiple Myeloma and am now on Valtrex and Revlimid 5 mg. (21days on/7 off). Do you recommend that I get the MMR vaccinations ?

Submitted by James L Cowell on Fri, 02/13/2015 - 08:55.

It would have been helpful if comments were included on thr risks of measles for myeloma patients who have had autologous bone marrow stem cell transplants.

Submitted by Barbara on Fri, 02/13/2015 - 09:31.

What is the official definition of Remission. Research data Patients and Drs throw around that word to feel better about the results....but if the patient is on maintenance drugs how can that be remission.???? Without the drug the MM will be back .. No remission! What numbers indicate remission? Ms pike Igg protein? Much confusion. Is it different for everyone. Sounds like remission really means stable.. Under control .
Your comment please

Submitted by Malcolm Coburn on Fri, 02/13/2015 - 18:42.

I am due for a vaccination for measles after my transplant. I thought all vaccinations were need. I was struggling with whether I should do it after the results autn Mayo Clinic. Can anyone clarify?

Submitted by Sarah Kelzenberg on Fri, 02/13/2015 - 18:47.

I am 16 years out from an allo transplant and never had any inoculations post transplant. I have had no symptoms for 13 years. Would it be wise for me to get my inoculations, especially measles, now?

Submitted by joyce newman on Fri, 02/13/2015 - 20:33.

Do these comments also apply to multiple myeloma patients who have recently undergone stem cell transplants?
Thank you

Submitted by Gary Walker on Fri, 02/13/2015 - 20:34.

Do measles antibodies remain post transplant?

Submitted by Marie Curry on Fri, 02/13/2015 - 22:29.

I see the issue was addressed for MM patients but was not addressed for those of us who have had a SCT. Should we or should we not get the vaccine? I know patients who have had and some have not and seems to depend on their doctor. What is the right way to go on this?
Thanks

Submitted by Marti Seidensticker on Sat, 02/14/2015 - 00:17.

My understanding is that after transplant that you need to be re-vaccinated when you are 2 years out from transplant. Is that correct?

Submitted by joanna jones on Sat, 02/14/2015 - 01:20.

what about post transplant patients? should we all get tested for measles immunity?

Submitted by MIKE LIOTTA on Sat, 02/14/2015 - 04:40.

What about vaccines for ASCT patients

Submitted by Mary Polancih on Sat, 02/14/2015 - 05:28.

Dr Durie failed to address a BIG concern for some of us...After ASCT we are without immunity for two years (CDC Guidelines) until we can get re-immunized. I just had my first MMR a few days ago. So what do I do...become a hermit until July when I can get the second dose? I'm not panicked, just concerned. My state just yesterday announced two suspected cases in quarantine, so there is a little time to find out, but folks like me need to have this part of the topic discussed very soon.

Submitted by blackswan on Sun, 02/15/2015 - 07:16.

Thank you for the several questions related to measles, measles vaccination and stem-cell transplantation. This is a very important aspect. Patients within the first six months or so post transplant still have a weakened immune system and do indeed need to be very careful about possible exposure to measles, as I commented. In addition, they are not good candidates for vaccination. Thus, being doubly cautious about possible exposure is essential. By one year after transplant, the immune system will have recovered enough that re-vaccination can be considered if that is the protocol for the transplant center. Some centers routinely re-vaccinate; others do not. The value and need for this re-vaccination remains unclear, so it is very important to follow the recommendation of your local doctor and/or transplant center. As I have said, the risk of actually getting measles seems to be quite low—but it is very good to discuss your personal situation with your doctor regarding the pros and cons in your case, and decide together what is best.

Hope this helps!

Submitted by Annette on Mon, 02/16/2015 - 06:13.

I have had smoldering myeloma for 7 years. I have had no therapy to date. I am a RN and during my orientation physicals over the past 18 years, found I am no immunity against the measles. I have had 2 booster inoculations and still test negative to immunity. What is your rational regarding this and should I try it again?
Thank you
Annette

Submitted by Thelma Garvin on Mon, 02/16/2015 - 22:43.

I had an autologous bone marrow stem cell transplant and after leaving the hospital I contracted measles 3 months later. And yes, I was vaccinated as a child.

Submitted by James Fisher on Tue, 02/17/2015 - 10:14.

Here is the advice I received from the Mayo Clinic when I inquired about whether to get the MMR vaccination. I was diagnosed with MM in Sept 2012 and am about 23 months post-ASCT. I am on Revlimid maintenance of 25 mg (21 days on and 7 days off).

"Research shows that it is contraindicated to give any live vaccines while a person is on chemotherapy due to immunosuppression and increased risk of the patient contracting that specific disease because of being exposed to a live vaccine. Our process is to withhold the MMR vaccine until chemotherapy is held/stopped and then administer the vaccine, whenever that may be. There is no way for our providers to know whether a patient will be on chemotherapy by the time the 24 month post-transplant vaccinations are due, so we give the schedule to all patients and if any modifications are needed, your provider will notify you. The MMR vaccine is the only live vaccine you will receive, so it is the only issue. We also advise that if anyone in your household/family/personal contacts is to receive a live vaccine (shingles or MMR), you should avoid contact with that person for 2 weeks to prevent exposure to yourself. I hope this answers all of your questions. Thanks! Kim Young, RN"

Submitted by Daniel R. on Mon, 03/30/2015 - 03:00.

Dr Durie,

In this article you made a couple of statements that I found confusing. Since I have a tendency to overlook what seems obvious to others, I have reread the article numerous times. I'm still confused, I'm hoping you can clarify for me.

You state: "As for myeloma patients, the vaccination rates are high." In the following paragraph he states: "Cases of measles among myeloma patients are actually extraordinarily rare: I have never seen or even heard of a case. It thus seems that although the immune system of myeloma patients is compromised, measles is not a particular risk."

Since I was told very specifically to avoid the MMR vaccination (all live vaccines) pre SCT and for 2 years post SCT, and I'm assuming that's a standard recommendation, how then can vaccination rates in Myeloma patients be high? Additionally, I'm just not clear as to whether you are linking the high vaccination rate to an "extraordinarily" low incidence of measles, or to some other factor?

Most confusing, by far, however, is the following statement: "Anyone born in the US (or most developed countries) before 1957, which is the majority of myeloma patients, will have had the standard two or more doses measles vaccination."

According to all the research I could find, the measles vaccine was not widely available until 1963. So how could those of us born before 1957 have been given the vaccine? What does appear clear to me is that virtually all of us born before 1957 have had the measles, and therefore had lifelong immunity to the disease, pre-SCT that is, since the Transplant process ostensibly removes all immunity.

Oddly, I was just (20 months post transplant) tested for MMR antibodies and was found to have robust protection against Mumps and Rubella, but none whatsoever to measles. So how can I have any protection at all? And why protection from Mumps and Rubella, but not to measles?

Thanks,

Daniel

Submitted by blackswan on Wed, 04/15/2015 - 22:25.

Dear Daniel, thank you for your comments. There are definite complexities involved regarding risks related to age, date of vaccination and exposures. In the US, older patients, prior to the time of the measles vaccination, had developed natural immunity (survived natural exposure ). With the start of vaccination, the population became immunized. So, all older populations in general in the US have protection. The recent issues stem from countries or regions where a significant number of individuals are not vaccinated. When they develop measles they become the source or reservoir of infection if, for example, they travel to the US. The caution about live vaccination for those with reduced immunity, such as myeloma patients, is appropriate. The good news is that despite low antibody levels in individuals such as yourself, measles is extraordinarily rare. Nonetheless, it is strongly recommended to studiously avoid any potential exposures from any unvaccinated or potentially infected individuals.

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