Maine anti-vaccine legislation appears again – flawed and misleading

On 4 January 2019, the Maine Coalition for Vaccine Choice – a Maine anti-vaccine organization – posted an article about a proposed bill that they called “The Maine Vaccine Consumer Protection Program.” As with the coalition’s previous attempt to pass such a bill, in 2015, the proposal is ill-founded. The premises it is based on are flawed, and the proposals themselves range from directly misleading to not very meaningful. Continue reading “Maine anti-vaccine legislation appears again – flawed and misleading”

Getting the adult HPV vaccine – Dorit Rubinstein Reiss’ story

adult-hpv-vaccine

On 5 October 2018, the FDA expanded the licensing Gardasil 9 – currently the only HPV vaccine marketed in the United States – to men and women up to the age of 45. If up till now getting the adult HPV vaccine was not a realistic option for me, now it was. But at this point, the vaccine is not yet recommended for my age group – the Advisory Committee on Immunization Practices has not made any additional recommendations after licensing. Which raised the question: should I get it?

On one hand, I am in a committed monogamous relationship. I am a married mother of two young children, I have no plans of changing partners, and I’ve already probably been exposed to anything my husband had. I have never had an abnormal pap smear. That means that I am likely pretty low risk for getting a new HPV infection and that I have cleared any I ever had (almost all sexually active people in the United States have had HPV). If you are in a relationship, including marriage, and if you had children, you likely had sex at some point.

So the benefits of the adult HPV vaccine for me are low – but not non-existent. You never know what will happen, and while I hope to stay with my partner forever, bad things can happen – like death or sexual assault. One hopes for the best, but it’s reasonable to also plan for the worst (for example, while we do not plan to die, we have a will written out with provisions for caring for our kids if we do) – and the vaccine is age-limited. There are nine cancer-causing HPV strains in the vaccine, and I am fairly certain that I have not been exposed to all of them. 

The risks of the adult HPV vaccine are extremely minor. I’m likely to get a sore arm, may get other mild reaction like fever, and have a theoretical reaction of an allergic reaction (or fainting, though not being a teen, I think that’s unlikely). Studies pretty much rule out other risks.

In spite of anti-vaccine claims, getting the vaccine after being exposed to HPV does not increase your risk of cancer (but the vaccine won’t protect you against strains you were already exposed to).

So the adult HPV vaccine has low benefits but minuscule risks, at least for me. Still, it seemed to me to make sense to go for it, if possible. Especially because I speak up about HPV vaccines and encourage others to go for them, I thought it’s fair to get them myself, too. Show I mean it when I say that they are safe. 

To be sure, I emailed Dr. Paul Offit, who I trust completely on vaccines. He recommended going for it. 

I did not know, however, if my provider will give me the vaccine or if my healthcare insurance will cover it at my age (most health insurance in the USA does cover all vaccines, including the HPV vaccine, for children). In spite of what anti-vaccine people believe, I do not have secret ties to pharma or special access to vaccines. 

So I emailed my doctor:

Dear Dr. X,

Since the FDA approved HPV vaccines for people up to 45, I would like to get the vaccine, if possible.

I emailed Dr. Paul Offit, a vaccine expert,  for his opinion, and he recommended getting it.

Can you help me do that?

Best,
Dorit.

My doctor said: “Sure, let me see what our protocol is here and get back to you.”

After I did not hear back for over a week, I emailed again. My doctor answered:

Sorry that I could not repond in a timely manner.
I had forwarded your request to Dr. Y [details omitted to preserve my providers’ – and my own – privacy] but did not hear from them. I have ordered the shots. You can call your … health plan to see if it will be covered just to be sure.

You can go to ### injection clinic Mon-Fri 9am-12pm, 1:30-4:30 pm for the shot (ordered already).

Okay. All that was left was to actually get the vaccine. I wanted a picture – so I asked my eight-year-old son if he will act as photographer and come with me. He agreed. We went together, waited, and went in. I told him to take a lot of pictures all through, and he did. 

Dorit adult HPV vaccine

The nurse asked if I was feeling okay, if I ever had a reaction to a vaccine, if I was allergic to latex or anything else I knew of (yes, no, no). She explained what the shot was, and gave me the Vaccine Information Statement. We also wrote out the schedule for the next two doses. Then she cleaned the area, told me to take a deep breath and let it out, and done. I barely felt the needle. 

She told me my arm will hurt for a day or two. It didn’t, actually. Not complaining. I’m okay with less pain. But I would have been okay (not happy, but okay) with a sore arm for a few days, too. 

My son did a great job taking a lot of pictures. I posted several of those pictures on Facebook and Twitter, because, again, I think it’s important to make it clear I stand behind what I say on HPV vaccines specifically, and vaccines generally. 

So that’s my adult HPV vaccine story. One dose down, two to go. Maybe my arm will hurt next time. 

Vaccine coverage in USA remains high, but refusal has increased

vaccine coverage

Annually, the US Centers for Disease Control and Prevention publishes reports on vaccine coverage in the country. This year, they produced two reports – one describing vaccine coverage for children 19-35 months old, and a second one discussing vaccination coverage for children entering kindergarten.

Although vaccine coverage remains quite high across most vaccines and hasn’t changed much over the past few years, there is a bit of troubling news. A tiny, but increasing number of children in the country are not getting some or all of their recommended vaccines as a result of parental refusal to vaccinate their children. In fact, the percentage of children under 2 years old who have received none of the recommended vaccines has quadrupled since 2001.

Vaccine coverage – 19-35 months old

The first study by Holly A Hill, MD Ph.D. et al., published in the Morbidity and Mortality Weekly Report, examine vaccine coverage for Advisory Committee on Immunization Practices (ACIP) recommended vaccines in children born in 2015.

For some of the vaccines, the vaccination coverage exceeded 90%:

Unfortunately, for some ACIP-recommended vaccines, the coverage lagged:

There are a few key observations about this data. First, despite the false claims about the MMR vaccine being linked to autism, the vaccine coverage for MMR remains at historically high levels. On the other hand, hepatitis B vaccine coverage, especially at birth, is too low, despite that the fact that these vaccines are important for cancer prevention.

Vaccine coverage by state also showed some interesting information – Massachusetts has the highest vaccination rates for children born in 2015 of all states. The City of New York, considered a “state” for the purposes of this study, had the lowest rate.

However, it is troubling that, even though the proportion of children who received no vaccines by age 24 months, it has increased from 0.3% for children born in 2001 to 0.9% for children born in 2011 to 1.3% for children born in 2015. This works out to be over 100,000 children born in 2015 who aren’t vaccinated against 14 dangerous and deadly diseases. This is worrisome.

Although I do not want to give credit to the anti-vaccine religion for causing this troubling increase in vaccine refusal. The internet is filled with ignorant and scientifically inaccurate information about vaccines. Quora, where individuals can ask questions about almost anything, is filled with individuals asking questions about vaccines in good faith. Although 95% of the answers are scientifically and medically accurate, there are many individuals who use misinformation, ignorance, and outright lies to scare people about vaccines.

Eventually, this can lead to the point, where the overall vaccine coverage will drop below the level to maintain the herd effect. At that point, there are insufficient numbers of immunized people to block the spread of an outbreak or epidemic of these vaccine-preventable diseases.

On the other hand, the study points out that part of the lack of vaccination may be a result of an ongoing issue with the USA – the lack of universal health insurance, especially for the poor. This study showed that 17.2% of unvaccinated children were uninsured compared to 2.8% of all children. Looking at the data from another direction, over 7% of uninsured children were unvaccinated compared to only 1.0% of children on Medicaid and 0.8% of children on private health insurance.

This is one of the great moral failings of the country. However, there really are no reasons why any child in the USA is denied vaccines. The Vaccines for Children Program provides free vaccines for all children in the USA who otherwise have no insurance coverage. The program has saved hundreds of thousands of lives over the past 20 years.

Vaccine coverage – kindergartners

A second report, by Jenelle L Mellerson et al. and published in the Morbidity and Mortality Weekly Report, examined vaccine coverage for children entering kindergarten in 2017. The good news is that, despite somewhat lower vaccination rates in states like DC, Idaho, and Colorado, the overall vaccine coverage for the major vaccines is well over 90% for kindergartners.

The researchers found that the exemption rate was low, about 2.2%. Unfortunately, it was the third consecutive school year that a slight increase noted. The 2.2% exemption rate during the 2017-18 school year was up from 2.0% in 2016-17, and 1.9% in 2015-16.

The study does not provide a breakdown between medical (where there is a valid medical reason to not vaccinate a child with one or more vaccines) and non-medical exemptions. The non-medical exemptions, often called “personal belief” exemptions are simply refusing to vaccinate a child because of a variety of reasons – religious (no religion is opposed to vaccines) or because “we don’t like vaccines.” Most exemptions are of the non-medical variety.

Only a few states disallow these personal belief exemptions – California, Mississippi, and West Virginia. Unsurprisingly, California and Mississippi have the lowest non-medical exemption rates in the USA, at less than 0.1%. Unfortunately, California has an issue where unethical physicians are giving out (or even selling) non-medical exemptions for parents who want to put their children in danger of vaccine-preventable diseases.

Summary

These two studies show us two dangerous trends – first, too many very young children are going unvaccinated because of parental ignorance or lack of health insurance. And second, too many parents are putting their children at risk of vaccine-preventable diseases by requesting non-medical exemptions.

However, despite the pseudoscientific lies of the hysterical anti-vaccine religion, nearly 95% of children are vaccinated before they enter school. Unlike the anti-vaccine zealots, who seem to dismiss a few thousand cases of cancer or deaths from measles as unimportant or trivial, most of us on the pro-science side of vaccines want all children protected from dangerous and deadly diseases. That’s why we fight to make sure every single child is vaccinated.

Why aren’t you making sure that your children are protected from vaccine-preventable diseases?

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FluMist vaccine recommendation – CDC gets the science right

FluMist vaccine recommendation

There are a lot of anti-vaccine tropes about the CDC (Centers for Disease Control and Prevention), none of which make a lot of sense. There’s the conspiracy theories that the CDC is bought off by Big Pharma. Or the CDC whistleblower meme that they hid evidence that vaccines cause autism. However, the CDC usually gets the science right, like they did with the recent FluMist vaccine recommendation.

The CDC, a federal government agency made up of scientists, physicians, and public health officers, who come from civilian and military backgrounds, are the first responders to almost any infectious disease outbreak across the world. They are the front line of science against disease.

They use scientific data, gathered through clinical trials or lab experiments, to make public recommendations about diagnosing, treating and preventing diseases. They’re impartial about their recommendations – they go where the data leads them.

So what’s the story behind the FluMist vaccine recommendation, better yet, non-recommendation? It’s not all that complicated, and it’s clear that the CDC got the science right. Continue reading “FluMist vaccine recommendation – CDC gets the science right”

Why we immunize against the flu–save healthy children’s lives

flu 20shotIf you break your arm, go to an emergency department, you see that medicine has an effect. Your fracture is set (very painful), and then you have a cast (very itchy). You can observe, without much bias, that a physician and his medical knowledge has fixed you. And you can show everyone else your cast, get it signed, and tell everyone how brave you were!

On the other hand, vaccinations can seem like they really don’t do anything. We get vaccinated, and it keeps us healthy–but it’s really hard to see that it does anything. Basically, vaccines maintain your default standard of health (at least what you think is the standard), so showing off your post-vaccination bandage doesn’t have the same effect. The cause and effect is just not there.

But there are real stories of tragedies for adults and children who aren’t vaccinated.

For example, there is one vaccine that seems to be ignored or outright avoided, even by seemingly rational people who get vaccines for everything else–the flu vaccine. Many people seem to invent myths about this vaccine, or accept those myths more readily than they do for other vaccines, all of which are easily dismissed and debunked.

I don’t know what causes this one vaccine to be so easily rejected by so many people, but it could be that the central myth of the flu itself is that it isn’t dangerous. People really believe that no one gets hurt from the flu. Especially themselves.  Continue reading “Why we immunize against the flu–save healthy children’s lives”

New York State updates vaccine schedule for children

If we don't vaccinate, wards of iron lungs.
If we don’t vaccinate, wards of iron lungs.

As you may be aware, there was a relatively large measles outbreak in New York City (pdf), hitting 26 individuals according to the New York City Department of Health. Some have stated that the outbreak was small, but compared to the historical average of around 60 measles cases per year for the whole United States, and when it was thought that we had “defeated” measles in the USA, 26 is a surprisingly large number.

New York City also had a 2011-12 outbreak of whooping cough (Bordetella pertussis), which was infecting individuals at nearly 4X the historical rate.

In light of these outbreaks, the New York State Department of Health (DOH) announced that it has updated its immunization requirements for school attendance to meet the revised standards recently published by Advisory Committee on Immunization Practices (ACIP), which is a group of medical and public health experts that have developed vaccine and immunization recommendations to reduce the incidence and prevent disease amongst America’s children. The goal of these recommendations is to reduce the incidence of vaccine preventable diseases.

The new 2014 standards did not add any new vaccines for school entry; however, they did update the number of doses required and the minimum intervals between doses. Generally, ACIP makes several recommendations a year, and state health departments “catch up” with the newest recommendations when they set the standard for the upcoming school year.

According to said Acting State Health Commissioner Howard Zucker, MD, JD, “immunizations protect children from serious childhood diseases, like whooping cough and measles, and have an excellent track record of safety and effectiveness. I encourage parents to talk to their children’s healthcare provider and work with their school’s health services to ensure that all immunizations are up-to-date.”

New School Immunization Requirements

The new requirements, which apply to daycare, head start, nursery, pre-kindergarten and grades kindergarten through 12, represent the best evidence and data available to public health researchers, and is the first update to the New York State requirements in over a decade.

  • Students entering kindergarten or 6th grade in the 2014-2015 school year will now be required to have two doses of the varicella (chicken pox) vaccine and 3-5 doses of poliomyelitis vaccine. The updated varicella and polio vaccination requirements will be phased in over the next seven years and will be required for all grades by the 2020-2021 school year.
  • For all other required vaccines, students in day care, head start, nursery, pre-kindergarten and grades kindergarten through 12 will be required to have age-appropriate doses in accordance with the ACIP schedule (pdf).
  • A student who is in process is defined as one who has had the first dose of vaccine in all of the required immunization series and has appointments to complete the series in accordance with the ACIP catch up schedule.
  • Students may present proof of immunity by serology (blood test) for the following immunizations: measles, mumps, rubella, hepatitis B, varicella, and poliomyelitis.
  • Medical exemptions to immunizations must be reissued annually. The written exemption must identify the immunization exempted, the medical contraindication for the exemption, and the length of time the immunization is contraindicated. A sample medical exemption form is available one the website.
  • Any child who has been vaccinated according to the ACIP recommendations, which are followed by most health care providers, should not need further vaccinations in order to attend day care or school.
Line of New York City children receiving vaccines during World War II.
Line of New York City children receiving vaccines during World War II.

New York State and City allow for legitimate medical exemptions to some or all of these vaccines, but they require certification and renewal each year. The state and city also allow religious exemptions, but recent court decisions (also here) have empowered school administrators to restrict or disallow those exemptions.

I cannot be sure that the New York State Department of Health was responding to outbreaks of measles and whooping cough to re-examine its  vaccine requirements, but it would make sense. And hopefully it, along with the reduction or elimination of nonsense religious exemptions (there are simply no legitimate anti-vaccine religious groups), will reduce or eliminate outbreaks of vaccine preventable disease.

Use the Science-based Vaccine Search Engine.

Cocooning the family to protect infants from whooping cough

Infant being treated for pertussis infection. ©CDC, 2012.

Over the past year or so, there have been several outbreaks of whooping cough (Bordetella pertussis), including one that reached epidemic levels in Washington state, which has been considered one of the worst pertussis outbreaks in the USA during the past several decades. The disease lead to 18 infant deaths in the USA during 2012.

The original DTP vaccine (diphtheriatetanus and pertussis) became available in the USA in 1948 and was critical to dropping the number of cases of whooping cough from 260,000  in 1934 to less than a few thousand per year in the 1990′s. The Advisory Committee on Immunization Practices (ACIP) recommends (pdf) that children should get 5 doses of DTaP (the replacement for the original DTP vaccine), one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. Those children who are not completely vaccinated according to these ACIP recommendations for pertussis are considered to be “undervaccinated.” 

Whooping cough is a serious disease that has significant complications for children:

  • 1 in 4 (23%) get pneumonia (lung infection)
  • 1 or 2 in 100 (1.6%) will have convulsions (violent, uncontrolled shaking)
  • Two thirds (67%) will have apnea (slowed or stopped breathing)
  • 1 in 300 (0.4%) will have encephalopathy (disease of the brain)
  • 1 or 2 in 100 (1.6%) will die

Even in adults, there are substantial complications, such as broken ribs from coughing, that can have a significant impact on the overall health of the individual.

One of larger concerns with recent outbreaks of pertussis has been that adults with lapsed immunity or unvaccinated older children may pick up the infection, then pass it to these unvaccinated or partially vaccinated infants (usually less than 1 year old). 

Continue reading “Cocooning the family to protect infants from whooping cough”

Infant in North Carolina dies of whooping cough

whooping-cough-coccoonThe North Carolina Department of Health and Human Services reported that a three-week old child died of whooping cough (Bordetella pertussis) last week.

As the report states, a child cannot be vaccinated with DTaP (the vaccine for diphtheriatetanus and pertussis) until they are about 2 months old. However, because infants are susceptible to whooping cough, all adults, children, friends, relatives, everyone, who is in contact with that child should be vaccinated against pertussis, a process called cocooning.

When an antivaccination militant says “my unvaccinated child won’t hurt your child”, this is where their lies are uncovered. For example, an unvaccinated older child may have whooping cough, and the parent take him or her to a pediatrician for the horrible cough, and that infected child passes it to other children.

In this case, the NC Department of Health and Human Services has not reported how the child may have contracted the deadly disease, so we can only speculate. Continue reading “Infant in North Carolina dies of whooping cough”

Undervaccinating against pertussis puts children and community at risk

whooping_cough-babyOver the past year or so, there have been several outbreaks of whooping cough (Bordetella pertussis), including one that reached epidemic levels in Washington state, which has been considered one of the worst pertussis outbreaks in the USA during the past several decades. The disease lead to 18 infant deaths in the USA during 2012.

The original DTP vaccine (diphtheriatetanus and pertussis) became available in the USA in 1948 and was critical to dropping the number of cases of whooping cough from 260,000  in 1934 to less than a few thousand per year in the 1990′s. The original vaccine contained what was called “whole-cell” pertussis, which includes all of the antigens of the pertussis bacterium, partially because it wasn’t understood (and to some extent still not fully understood) which antigens on the bacteria actually induce the proper immune response to have the body destroy a pertussis infection. In the late 1990’s, the Advisory Committee on Immunization Practices (ACIP) recommended that the USA switch to the acellular form of the vaccine, known as DTaP (a pediatric vaccine to immunize against diphtheria, tetanus and pertussis) or Tdap (the older children/adult version of same vaccine). Continue reading “Undervaccinating against pertussis puts children and community at risk”

Updated: make religious vaccine exemptions more difficult to obtain

flu church vaccineA recent report indicated that US state legislatures are beginning to pass laws that make it more difficult for parents to obtain so-called personal exemptions to vaccinations before children attend public schools. According to the author, Tara Haelle, “Each US state sets its own vaccination policies, and most will not generally allow children to attend public school unless they have been vaccinated against diphtheria, tetanus and pertussis (whooping cough)hepatitis B; the Haemophilus influenzae bacteriummeasles, mumps and rubellapolio; and varicella (chicken pox).” In general, most states require that students meet the Centers for Disease Control and Prevention schedule (pdf) for children between 0 and 6 years old, which is set by the Advisory Committee on Immunization Practices.

All states allow legitimate medical exemptions from the immunization schedule before a child enters school, because of certain medical conditions that might make vaccinations problematic for young children. Some of these medical issues are: allergies to some of the components in the vaccines, immunocompromised conditions, family history of seizures, and other issues outlined in the General Recommendations on Immunization of the Advisory Committee on Immunization Practices. These medical exemptions are extremely rare, but are very important. A licensed medical doctor is the only one that should provide this exemption. Continue reading “Updated: make religious vaccine exemptions more difficult to obtain”