Thursday, March 6, 2014

Measles in California

California has had a lot of bad press in 2014 as vaccine-preventable diseases wreak havoc on citizens. As flu season is coming to a close, California has reported 278 deaths from the flu.

Now, measles, a highly contagious respiratory disease caused by a virus, has arrived in the state. As of late February, fifteen Californians have been diagnosed with measles. Almost half of the cases did not receive a measles childhood vaccine. To date, six counties have reported cases of measles. Last year, there were only two reported measles cases in California.

Health officials are worried that many people could be exposed to the measles virus by one of the sick people. Measles had been eliminated in the United States in 2000, but people can still contract it by visiting a country where it hasn’t been eliminated. In the case of the recent outbreak, three of the measles patients had recently been in the Philippines, two had recently traveled to India, and two had contact with travelers.

“A myth persists among many parents that the measles vaccine is dangerous,” stated California state epidemiologist Dr. Gil Chavez. “These illnesses continue to make a comeback because we have people who refuse to be vaccinated. There’s a tremendous burden to the counties and society.”

Thousands of people who ride the Bay Area Rapid Transit were warned they may have been exposed to measles after an unvaccinated UC Berkeley student contracted the disease on a trip to the Philippines and then rode public transportation.  Symptoms of measles include: rash, fever, runny nose and cough. If it isn’t treated, measles can cause: pneumonia, neurological damage, and birth defects in children if contracted by pregnant women.

It’s important to consult your physician when making vaccination choices. Measles and other diseases are serious threats to public health. When a parent chooses not to vaccinate their child, the choice can also have implications on the health of others.

Monday, March 3, 2014

The Worrying Rise of the Anti-Vaccination Movement

One of the top stories on The Week today is about the worrying rise of the anti-vaccination movement. The sub-titlte reads: "With vaccination rates falling, diseases that once were nearly eradicated are making a comeback."

Here is the article:

Why are vaccination rates falling?
Since the late 1990s, a growing number of American parents have become convinced — against all scientific evidence — that the risks of immunization outweigh the benefits. Their fears are rooted in a now-discredited 1998 study by a British doctor, Andrew Wakefield, who claimed that the onset of autism in 12 British children was linked to their being vaccinated for measles, mumps, and rubella (MMR). But subsequent studies failed to replicate Wakefield's findings, and an investigation found that his study was "an elaborate fraud," with deliberately falsified data. Nonetheless, Wakefield's bogus study started a wave of apprehension and confusion that continues to spread. In some states, from 5 to 8 percent of parents got a "personal belief" exemption to prevent their children from being vaccinated in 2012. Overall, more than 10 percent of parents are either delaying when their children are vaccinated or not getting the shots at all. "Every year, the number of kids getting exempted [from vaccines] grows," said Dr. Lawrence Madoff, director of epidemiology and immunization for Massachusetts. "When immunization rates fall, it doesn't take long, even in a developed country, for diseases to resurge."


Tuesday, February 18, 2014

The Flu Vaccine Works

Duke University Medical Center released a study a couple of weeks ago that showed 91% of patients who are in the intensive care unit (ICU) with influenza this season did not have a seasonal flu vaccine. Another 67% of those admitted to the hospital with less severe cases of the flu also weren't vaccinated. The bottom line is, the flu vaccine works.

The study examined only 55 patients who were admitted to the Duke Medical Center between November of 2013 and January of 2014. But, the cases were well documented. 47% of patients were Caucasian, 42% were African-American and 6% were Hispanic. 49% of patients were in the 18-49 age range, with the median age at 28.5. 33% of the patients were ages 50 to 64.

Duke's numbers are consistent with the national trend this year, that the flu is affecting young or middle aged adults more than infants, toddlers and seniors, who are always at high risk. Patients who were vaccinated but still had the flu had disorders that rendered them immunocompromised, therefore causing the vaccine ineffective.

Cameron R. Wolfe, M.D. was co-author of the study and stated: "Even if you get influenza, the vaccine reduces the likelihood of truly serious disease. These people on the intensive care unit are very sick. If you end up there, you're going to be battling a month or more of hospitalization." Five of the 22 ICU patients had died by the time the study was published.

It's not too late to get a flu vaccine. The FluView shows the states that are still having high flu activity levels. The vaccine generally takes 10-14 days to become effective. Vaccine Watch encourages people with questions and concerns to consult their physician about the flu vaccine options available.

Tuesday, February 11, 2014

High Rate of Adult Deaths from Vaccine Preventable Diseases

The University of Colorado School of Medicine recently released the results of a study showing that adult vaccination rates for vaccine preventable diseases are remaining low. This news came after the report that adults make up 95% of the annual death rate for vaccine preventable diseases. The death rate is currently at 30,000 people per year. These facts represent a growing public health concern.

Laura Hurley, MD, MPH is an assistant professor of medicine at the CU School of Medicine and was the lead author. “Our study suggests that missed opportunities for adult vaccination are common because vaccination status is not being assessed at every (physician’s) visit, which is admittedly an ambitious goal. Also, most physicians are not stocking all recommended vaccines.”

There are eleven recommended adult vaccines. Estimates have shown that only 62-65% of adults over age 65 received a pneumococcal or influenza vaccine. A dismal 20% of high-risk adults between the ages of 19 and 65 received a pneumococcal vaccine and only 16% of those 60 or older got their shingles vaccine.

“Physicians reported a variety of barriers to vaccine stocking and administration, but financial barriers dominated the list,” Hurley continues. “Physicians in smaller, private practice often assume more risks from stocking expensive vaccine inventories and may be particularly affected by these financial barriers.” Physicians also struggle to get reimbursed by insurance companies, a problem that discourages them from stocking vaccines. Physicians choose to refer patients to pharmacies or public health facilities for vaccination.

“I feel we need to take a more systematic approach to this issue,” Hurley concludes. “As the population ages this could easily grow into a more serious public health issue.”

Vaccine Watch recommends all adults speak with their physician about recommended vaccines and take the necessary steps to insure they are protected from vaccine preventable diseases.

Wednesday, February 5, 2014

What is the Alternative Vaccine Schedule?

This article was originally published by WebMD.

By Katherine Karn
WebMD Feature

Experts debate the pros and cons of the alternative vaccine schedule and what it means for parents.

When pediatrician Robert W. Sears, MD, FAAP, wrote The Vaccine Book: Making the Right Decision for Your Child, he envisioned giving parents more choices on how to vaccinate their children if they were concerned about a vaccine’s side effects or ingredients or the large number of shots that kids receive today.
 “A lot of parents don’t really trust the vaccine system,” Sears says. “I felt that if I could give parents a better understanding of vaccines -- as well as an alternative way to approach giving vaccines -- then these families who otherwise might not vaccinate could go ahead and feel comfortable with vaccinating.”
Sears, who practices in San Juan Capistrano, Calif., says that he isn't against vaccinations. Instead, his book suggests an untraditional “alternative” schedule that delays shots or spaces them further apart. If parents are skittish about any shots at all, he offers a separate “selective” schedule to encourage them to give their kids at least the "bare minimum" of vaccinations.
But public health officials say that those approaches leave too many kids unprotected for too long and aren’t backed up by science.
“These altered schedules have not been studied at all,” says Meg Fisher, MD, a pediatric infectious disease specialist and medical director of the Children’s Hospital at Monmouth Medical Center in New Jersey and chair of the American Academy of Pediatrics' section on infectious diseases. "I would rather stay with what we know is the most likely to protect the most people."

Regular, Alternative, Selective Vaccine Schedules

The regular vaccine schedule for children aged 0-6 is approved by the CDC, American Academy of Pediatrics (AAP), and the American Academy of Family Physicians.
It recommends 25 shots in the first 15 months of life. The shots immunize against whooping cough (pertussis), diphtheria, tetanus, mumps, measles, rubella, rotavirus, polio, hepatitis B, and other diseases.
The alternative and selective vaccination schedules aren't reviewed or approved by the CDC or other public health group. They come solely from Sears.
Sears’ alternative vaccine schedule spreads the shots out over a longer period of time, up to age 5-6 years. For instance, he recommends not giving kids more than two vaccines at a time. It also changes the order of vaccines, prioritizing what Sears believes are the most crucial vaccines to get, based on how common and severe the diseases are.
As Sears writes, “If some of the theoretical problems with vaccines are real, this schedule circumvents most of them. If the problems aren’t real, then the only drawback is the extra time, effort, and cost for the additional doctor’s office visits.”
For parents who are the most reluctant to vaccinate, his selective vaccination schedule includes what he calls the "bare minimum" vaccinations against serious and common diseases, such as whooping cough and rotavirus. It also omits some vaccines, including the one for polio.

Vaccine Watch encourages parents considering the alternative vaccine schedule to consult their pediatrician.

Wednesday, January 29, 2014

Pediatrician & Mother Talks About Flu Vaccine

This was originally posted on The Mom's Guide to San Diego and was written by Dr. Jaime Friedman.

As a local pediatrician, and part of the medical group that partners with the Mom’s Guide to San Diego, I felt it was very important to respond to a recent thread of posts on the Mom’s Guide Facebook page regarding flu vaccines. The media often highlights extreme medical cases for the sake of the “story”, sometimes without providing thorough information on the topic for the viewer to come to their own educated conclusion.

Every year many thousands of people become ill with influenza.  Of those, hundreds to thousands die.  Unfortunately, while the very old, very young and chronically ill are most severely affected, many who die of influenza are perfectly healthy.  Influenza should not be confused with the common cold or a viral illness causing vomiting and diarrhea.  It is more severe, causing sudden onset of high fever, body aches and fatigue.  Many people also experience a cough, headache, sore throat, or diarrhea. The illness is very uncomfortable and can result in pneumonia, bronchitis or sinusitis.  It also can exacerbate chronic illnesses including asthma.  Most people are sick for 1-2 weeks.

The best ways to prevent the flu are good hand washing and vaccination.  The vaccine was first introduced in the 1940s for the military.  Since then it has repeatedly been perfected and proven to be safe and effective.  In fact, each year the vaccine is altered to keep up with the mutating virus.  The vaccine works by introducing proteins from the surface of the virus into the body so that the individual can make their own antibodies to the virus.  The injected vaccine is NOT a live virus and one cannot get the flu from the vaccine.  Because the vaccine is given during respiratory virus season many people develop other illnesses around the same time as vaccination and mistake that illness for “getting the flu from the shot”.  Also, it takes 2 weeks for the vaccine to be effective so exposure to the virus around the time of vaccination can still result in illness.  Some common side effects include soreness at injection site, feeling achy and low grade fever for 1-2 days.  These symptoms are far less severe than actually having an influenza infection.  There is also a live attenuated vaccine available that is sprayed into the nose. While this is a live virus it is weakened so that it does not cause infection.  However, side effects may be more prominent than injection, including runny nose, headache and wheezing.  It should not be given to people with a history of asthma.  

While serious reactions, such as allergy or anaphylaxis, are rare they do occur.  Do not get the vaccine if you have had a reaction in the past or if you have a severe allergic reaction to eggs.  Signs of a severe reaction include hives, paleness, dizziness, difficulty breathing and racing heart rate.  The number of severe reactions to the vaccine is far less than the number of severe infections that occur every year.  

Here at Children’s Physicians Medical Group we believe that vaccination is safe and the best way to prevent infection.  Our doctors offer the vaccine to children 6 months and up.  For more information, and to determine which type of flu vaccine is best for your child, please contact your pediatrician or go to the CDC website  

Thursday, January 23, 2014

Map Shows Vaccine Preventable Outbreaks

The Council on Foreign Relations released an interactive map in October 2011, and it gained a lot of attention earlier this week. The map is regularly updated and shows worldwide vaccine-preventable outbreaks from 2008-2014.

There are a few important things to note about the map. The red dots represent measles, and it’s covered the United Kingdom and is showing up in the United States as well. Mumps (dark green dots) are also completely covering the United Kingdom, and showing up in the United States; both of these are part of the MMR vaccine.  Whooping cough (bright green dots) has really only been a problem in the United States, and there is quite a bit of it.

Michael Hiltzik of the Los Angeles Times wrote an article about the map, and commented:

“The lesson of all this is that vaccination is not an individual choice to be made by a parent for his or her own offspring. It’s a public health issue, because the diseases contracted by unvaccinated children are a threat to the community. That’s what public health is all about, and an overly tolerant approach to non-medical exemptions – and publicity given to anti-vaccination charlatans like Wakefield and McCarthy by heedless promoters like, sadly, Katie Couric, affect us all.”

The map highlights the imperative need for parents to vaccinate their children. All parents should consult their pediatrician when making vaccination decisions that will impact public health.

Thursday, January 16, 2014

A Positive Spin on Vaccines

Negative stories about vaccines dominate the news, as activist groups continue to spread misinformation. But, vaccines are important to our health and safety, and many are speaking out about their positive effects.

NASCAR driver Jeff Gordon joined the Sounds of Pertussis campaign with the March of Dimes and Sanofi Pasteur. The campaign is a national education program educating adults about the importance of getting an adult Tdap (tetanus, diptheria and acellular pertussis) vaccination. The booster vaccine prevents adults from contracting pertussis and passing it along to unvaccinated infants, who will receive the vaccine at two months of age.

The Centers for Disease Control and Prevention (CDC) reported there were more than 41,000 cases and 18 deaths reported in 2012 for pertussis, the largest outbreak in fifty years.

“Eighty percent of the time…these young infants are getting it from family members so it’s really about prevention (efforts),” Gordon states. “Prior to the baby being born, family members, when they come to the hospital, when they come to the home to visit, you know they need to make sure they’re protected.”

Gordon is not the only person speaking in favor of vaccines.  Jeanne Sager wrote an impassioned blog post for The Stir about the importance of vaccines. She asks parents to also consider all of the diseases that vaccines prevent, rather than just focusing on vaccine safety.

Sager references Amy Parker’s story on Voices for Vaccines. Parker grew up un-vaccinated in a “health nut” family. Parker states:

As healthy as my lifestyle seemed, I contracted measles, mumps, rubella, a type of viral meningitis, scarlatina, whooping cough, yearly tonsillitis, and chickenpox, some of which are vaccine preventable. In my twenties I got precancerous HPV and spent 6 months of my life wondering how I was going to tell my two children under the age of 7 that mummy might have cancer before it was safely removed...

If you’ve never had these illnesses you don’t know how awful they are -- I do. Pain, discomfort, the inability to breathe or to eat or to swallow, fever and nightmares, itching all over your body so much that you can’t stand lying on bed sheets, losing so much weight you can’t walk properly, diarrhea that leaves you lying prostrate on the bathroom floor, the unpaid time off work for parents (and if you’re self employed that means NO INCOME), the quarantine, missing school, missing parties, the worry, the sleepless nights, the sweat, the tears and the blood, the midnight visits to A and E, sitting in a doctor’s waiting room on your own because no one will sit near you because they’re rightfully scared of those spots all over your kid's face.

Dr. Daniel Gilstrap of Durham, North Carolina notes that, “The list of vaccines for adults has expanded quite a lot in the last few years. Not only that, the knowledge of the safety of these vaccines has increased.”

Vaccination efforts have enabled entire generations to grow up without knowledge of the severity of
polio, measles, whooping cough, and others. Gilstrap and other physicians are working to educate people on the importance of vaccines because they don’t know how bad the diseases can be.

Finally, Lisa Murakami wrote a blog post last September, Vaccination: A Layperson’s Perspective. Her post generated 482 comments and tackles all of the vaccination myths.  Her husband is a medical resident at Dana Farber.

She notes, “That means, he has 14.5 years of grueling medical training that I don’t have. And – conservatively estimated – 28,160 hours. My father has infinitely more; he’s seen tens of thousands of patients over the course of his forty-year career as a pediatrician. Clearly, I can’t run a Google search on a complex medical topic and eventually cobble together a better answer on it than these two can.”

Murakami concludes by noting that she can’t link to many of the sources she used when debunking vaccine myths because you have to pay for a subscription to major medical journals and other legitimate scientific sources. She has subscriptions to these sources, but the average person does not. The best information on vaccines isn’t available by Googling the Internet, however the worst information is available.

Those with questions about vaccines should consult their pediatrician. The Internet and other sources is not a substitute for years of medical training, and the diseases are much worse than the vaccines.

Tuesday, January 7, 2014

Vaccines: Where are the facts?

Parents are barraged with a lot of anti-vaccine materials through the Internet and media, and it’s hard to sort out what the facts are, and which stories are myths and conspiracy theories.

“I think vaccines have become a scapegoat for our fears about medicine, the government, and mistrust of authority,” Dr. Julia Getzelman states. Her pediatric practice in San Francisco attracts vaccine skeptics, and some of her patients follow an amended vaccine schedule in an effort to increase vaccination.

A recent article in Forbes magazine supported Dr. Getzelman’s statement. A study showed that climage change deniers, anti-GMO activists and vaccine conspiracy theorists all overlap each other on a tendency to believe in conspiracies.

Another study refutes this and showed that Americans reluctance towards vaccines isn’t from a distrust of science or misinformation, but from divisive forces that turn scientific findings into uninformed politically charged controversies. Dan M. Kahan of Cultural Cognition Project at Yale Law School argues: “The problem isn’t media sensationalism. Uninformed and counterproductive risk communication is the inevitable byproduct of the absence of a systematic, evidence-based alternative.”

For many spooked parents, data and studies don’t ease their fears. Instead, pediatricians like Dr. Jane Finlay in British Columbia are using humor, validation and compromise to work with parents. Finlay can’t acknowledge these parents beliefs as true, but she will work with them to adapt the vaccine schedule because it is in the best interest of the child to get their vaccinations.

According to Noni MacDonald, a professor of pediatrics at Dalhousie University in Halifax, just spending 5 to 10 minutes on an anti-vaccine website can influence a parent to opt out of vaccines. Doctors are pushing for more regulation on websites that push anti-vaccine messages. The Australian government is working to force the Australian Vaccine Network to run a consumer-warning banner stating it has a misleading name.

“We all like to think we make our decisions based on incredible evidence and we weigh it out. Well, we don’t. A lot of our decisions are based on our beliefs at the unconscious and subconscious level,” MacDonald states.

Finlay and MacDonald recommend that pediatricians work with parents on a vaccine schedule, use a non-confrontational tone, hear parents out, and not assume that all parents have the same concerns.

“They’re doing what they feel is honestly the best thing for their child,” Finlay points out. She further recommends that pediatricians combat Jenny McCarthy-style stories with compelling information on children damaged or killed by vaccine-preventable diseases.

Lessley Anderson wrote a blog post about vaccine deniers for the Verge in October, and focused on the San Francisco Waldorf School, where only 35% of incoming kindergarteners are up to date on vaccinations. “But if I decide not to vaccinate my kid, I make him a potential carrier. He may be able to fight off measles, mumps, rubella, and other illnesses — but what if he spreads a disease to somebody who, for whatever reason, isn’t so lucky?”

Vaccine Watch encourages parents with concerns about vaccines to talk with their pediatrician and about their concerns. Vaccines are the best invention of the twentieth century, and as recent outbreaks of measles and other preventable diseases have shown, very necessary to public health.

Wednesday, January 1, 2014

Pregnant Nurse Fired for Refusing Flu Vaccine

Photo: Miller, Los Angeles

Horizon Healthcare Service in Lancaster, Pennsylvania has fired a pregnant nurse who received a company mandated flu vaccine. Dreonna Breton was three months pregnant when she refused the vaccine, and after suffering two miscarriages in the past, did not want to take any chances with her pregnancy.

The company requires all workers to be vaccinated to protect patients and other employees from catching the flu. Horizon Healthcare Services stated: “Like our requirements for TB skin testing and MMR (measles, mumps and rubella) vaccination as a condition of employment, mandatory flu immunization protects our patients, employees, and community from getting this potentially serious infection.”

“Not only does the flu shot offer some protection to the pregnant woman, but there is a bonus – the pregnant woman can pass some of that prevention into her newborn baby,” notes William Schafner, an infectious disease doctor at Vanderbilt University.

The American College of Obstetricians and Gynecologists also advises all pregnant women be vaccinated against the flu, calling it an essential element of prenatal care. There have been no adverse consequences of flu vaccine in pregnant women or their offspring.

Reports on flu outbreaks from the Centers for Disease Control and Prevention (CDC) for the week of December 21, 2013 say the flu is now widespread in Alabama, Alaska, Kansas, Louisiana, Massachusetts, New York, Pennsylvania, Texas, Virginia and Wyoming.

Flu activity is also picking up in Tennessee, the CDC report notes. They further state that 1,156 flu-associated hospitalizations have been confirmed since October 1st, but that many hospitalizations could be prevented by vaccination.

“Nationwide, seasonal flu causes an average of 250,000 hospitalizations and up to 36,000-49,000 deaths in a severe influenza season. Typically, flu season increases in January and peaks in February or early March,” states Anne Roche, a spokeswoman for the Massachusetts Department of Public Health.