The Vaccination Saga Continues

Yesterday, after weeks of not hearing back from the dr.'s nurse regarding her ability to get the mumps vaccine, I called. Of course, I have to leave a message for her to call back. I give RJ's cell phone as the call back number - I thought I was giving mine at the time, but I call his all the time and never call mine, so I just mindlessly said a cell number. Anyway, she left a voice-mail saying, "we tried to order the mumps vaccine, but we couldn't - call if you have any questions". Whatever. Seriously. Sure, if she called Merck and asked if they could order 1 mumps vaccine - the answer was no and we told the dr. the answer would be no. We told him you have to order a batch of 10. We discussed how his practice would have to decide if they want to do that. So, for the nurse to say they tried to order it but couldn't is really non-information and indicates a real lack of willingness to work on this, in my opinion at the time.

So, now I decide to call around to different pharmacies in town to see if they stock it or will order a batch. If I find one, then I have to get the dr. to write a prescription. Maddening. I called around and finally called a locally-owned compounding pharmacy. The person who answered was relaying my questions to the pharmacist and the answer came back - we can only order the combination vaccine. So, I asked if I could talk to the pharmacist. She got on the phone and I said, "I'm trying to get the individual mumps vaccine and I'm having trouble - can you tell me what the problem is". So she says, "well it says that the single-dose is drop-ship only and that usually means only a dr.'s office can order it, but call back tomorrow and ask to talk to Melissa. Tell her that I told you to call her and that she should call Merck and ask if they can order a single-dose of Mumpsvax." - GREAT! At *least* someone explained the problem AND at *least* someone is willing to call Merck and ask some questions! I *think* drop-ship means a Merck rep will drop it off - and they may only do that for a dr.'s office. But, we'll see. I have hope.

Today, I decide to call Merck while I'm waiting for my pharmacy contact's pharmacy to open...Merck is on the East coast. I figure *maybe* they'll tell me what, if any, local health care people have ordered Mumpsvax recently - so I can call those people. No, they don't really know that. Merck pretty much sells to wholesalers and the drs. and pharmacies order from the wholesalers. Ok, fine. So, I call Melissa at the pharmacy. She was super-nice and told me she would make some calls and call me back. She called back within 10 minutes. She said that Mumpsvax is only available in units of 10 and that would cost about $300.00. Ok, so we would have to decide if we want to spend $300.00. BUT, she says that Mumpsvax is on back order from the manufacturer (Merck) until early 2009. So, she can't get it. She says there are other wholesalers, but she would imagine that Mumpsvax is something they don't keep in stock (due to lack of demand compared to the combo, that it requires refrigeration, and it expires) - the wholesalers likely order it from Merck when they get a request. Basically, she thinks the only way we'd be able to get it is from a dr. or pharmacy that has it in their inventory right now...they wouldn't have to order it. So, maybe the nurse wasn't so off after all...she checked and they couldn't get it. She could have said it is on back order!

I haven't checked for measles or rubella - since mumps is first on my list. At this point, I have to talk to RJ, who I'm sure will not want to give up the quest yet, but I'm seriously leaning to just forgetting about the mumps for a while. I'm fine with the MMR when PJ is older (like 4) and I'm really not concerned with him getting the mumps. I doubt he will, but if he does - I think he'll be ok.

Later, in doing some research I found a 2002 Medicaid newsletter from Alabama where they talk about the monovalent injections being in short supply as Merck is using those in their prioritized MMR combo vaccine. So, in short, it seems like the manufacturer is focused on the combo and is not using its resources to manufacture the singles. I'm sure, in general, it is more cost effective as the vast majority of people get the combo vaccine - and they now have a MMRV - that includes varicella, as well. I'll go with the cost effective part because it is *almost* like they are trying to FORCE the combo on us so we'll "get over" being concerned about the combo...but I really think it is an economic decision. Well, for me - it is just going to keep me from getting the vaccine at all. The one that seems most easy to get - not from my experience, but from my research, is Rubella...which is the one I'm really most concerned about. So, if I can get Rubella, I will, but if not - I won't.

So then, I decide I'm going to write a question about it to Dr. Bob Sears on his thevaccinebook.com website. I didn't have to ask a question...Here is what Dr. Bob says and Maybe I should read his website more often?!?!

Plain Mumps Vaccine Shortage - Should Babies Just Get the Full MMR?
Friday, June 20, 2008
Some parents are choosing to split the 1 year MMR vaccine into three separate shots. Although we don't know if this precaution is necessary, some worried parents prefer the choice of getting plain Mumps vaccine at 1 year, Rubella at 2 years, and Measles at 3 years.With a shortage of the plain Mumps vaccine expected to last the rest of 2008, parents may not be able to get the Mumps vaccine for their babies for a while. I would suggest getting a rubella vaccine at 1 year, and then Mumps at 2 years (by the time any current one-year-olds are two, the shortage will hopefully be over).Some parents are wondering if they should get the full MMR vaccine at age 1, not just to get coverage for mumps now, but also to get measles coverage in light of the recent increase in measles outbreaks. I think that this is a very valid choice to consider, especially for infants who are entering childcare or early preschool. For children who are not going to be in daycare or school until age 3 or 4, delaying the measles vaccine is less of a worry

So, RJ comes home and I relay all of the above to him. We decide to delay MMR until age 4. That's it. If school requires 2 at entry - we'll do the blood titer to show immunity and I'm pretty sure PJ will have the anti-bodies because he'll have just gotten the vaccine a year earlier. I'll probably blog next week about PJ's case of mumps, but we'll see!

Interesting note: When I called Merck's, I called the main number and talked to a lady who told me to call customer service...the original lady said "we get this question all the time and someone in customer service can help you" - which they couldn't, but...I would imagine they do get this all the time...and they will be getting it more and more.