Back to School - Time for Vaccines

As children and parents across the country gear up to go back to school, the Centers for Disease Control and Prevention (CDC) released a report showing high vaccination coverage among U.S. kindergarteners in the 2012-13 school year. Exemption levels remained stable in the report.

CDC used data from federally funded immunization programs to conduct their research. While optimistic about vaccination levels, the CDC did warn that even with high levels of vaccination, vaccine-preventable disease outbreaks can still occur among clusters of unvaccinated people at local levels in schools and communities.

“Vaccination exemptions have been shown to cluster geographically,” the CDC stated. “If exemption levels are high in a school or community, the number of unvaccinated kindergarteners might be sufficient to permit transmission of vaccine-preventable diseases, if introduced. Assessing and reporting school vaccination coverage at the local level is critical for state education and health departments to protect kindergarteners and the community from vaccine-preventable diseases.”

Health departments and schools are encouraged to use the data provided by CDC to develop health communication strategies based on the specific vaccine-preventable disease risk at a local school caused by low coverage or high exemption.

Illinois is now requiring all students in grades 6-12 to have a Tdap vaccination by October 15^th. The new rule was caused by the rise in whooping cough cases in Illinois over the last six years. Public health officials in Michigan are worried about their low immunization rate, citing philosophical waivers as one of the issues. The Michigan State Medical Society plans to organize more awareness events across the state.

Unfortunately, the number of teens vaccinated for HPV is not as high as the kindergarten coverage, with only half of U.S. teenage girls vaccinated. “We’re dropping the ball,” said Dr. Thomas Frieden, head of CDC. “This is a huge disappointment.” The CDC worries that family doctors aren’t encouraging patients to get HPV shots as forcefully as they recommend other vaccines.

A letter by Dr. David Horowitz in Contemporary Pediatrics recently stated that pediatricians are providing all the education they can to parents about vaccines and that educating parents isn’t sufficient. While there is a group of parents, known as the worriers, that education reaches; there are other groups of parents for whom education about vaccines will not be enough.

“The simple answer is that if simply educating patients about vaccines were sufficient, then we would not have a problem in the first place,” Dr. Horowitz states.

An earlier study done by researchers in upstate New York and published in Pediatrics cited community partnership as a way to increase vaccination rates in poor children. “Multi-component interventions aimed at increasing immunization coverage rates are more successful than single interventions, perhaps with the exception of patient reminder and recall systems,” researchers wrote. “The most successful interventions described allow families to explain their health concerns, address perceived barriers to vaccination, improve community awareness of services already available, and engage health care outreach liaisons.”

“Future programs should continue to focus on interactive vaccine education, with special attention on the risks of influenza infection and the benefit of influenza vaccination,” the study concluded.

As schools across the country get back into session, Vaccine Watch encourages parents to take necessary steps to protect their children. Education and talking to your child’s pediatrician, school nurse and other health officials is the best way to find reliable information about vaccines.

Lyme Vaccine

In the last fifteen years, concern over tick-borne diseases has begun to over shadow the enjoyment of recreational summer activities. The ticks that carry Lyme disease can be found in grassy areas like lawns, shrubs and woodlands.

Lyme disease in particular has become so wide spread in the United States that it is the number one vector borne illness. Public health experts are most concerned about children and adults who work or spend a lot of time outside and are urging the development of a Lyme vaccine.

“The fact that there is no vaccine for an infection causing some 20,000 annual cases of Lyme is an egregious failure of public health,” states emeritus professor of medicine Stanley A. Plotkin of the University of Pennsylvania.

Baxter International is currently developing a Lyme vaccine, but is moving slowly because of backlash earlier Lyme vaccines had from anti-vaccine groups. The Food and Drug Administration approved two Lyme vaccines in the 1990s, although only one of them made it to the market.

Lymerix was put on the market in 1998, but false claims were made that Lymerix caused arthritis. Anti-vaccine groups went so far as to claim that Lymerix caused Lyme disease. Although the claim was later proved wrong, the vaccine was pulled from the market in 2002 because of a class action lawsuit based on the false claims and declining sales.

Lorraine Johnson is the chief executive of LymeDisease.org, an advocacy group and states: “I’m cautious about vaccines. Everyone wants a good vaccine, but no one wants a vaccine that enriches researchers and harms patients like the last one.”

Meanwhile, a group at the University of Rhode Island (URI) is working to develop another vaccine. The group is using the protein from deer tick saliva to create the vaccine. After being vaccinated, anyone who is bit by a tick will have an itching sensation and their body’s immune system will be triggered to attack any pathogens the tick delivers.

With this previous history in mind, Baxter International and the group at URI continue to develop vaccines to combat this terrible disease. Their goal is to explain that the vaccine is safe and effective and will not cause Lyme disease, while helping thousands of people avoid this debilitating disease. Vaccine Watch encourages people to learn more about vaccines and speak with their doctors – especially if a vaccine has the potential to combat a terrible disease.

Voices for Vaccines

A group of parents has created an organization that advocates for vaccinating children. Voices for Vaccines provide information through a community of parents who are supportive of vaccination and discuss the benefits of on-time vaccination. Although the organization is parent driven, scientists, healthcare professionals and public health officials also support it.

One of the most compelling pages on the Voices for Vaccines website is the “Parents Who Vax” section, where parents explain why they chose to vaccinate their infants. Dr. Torre McGowan, MD is a practicing emergency physician in California and the mother of two little boys. She wrote an essay on the consequences of not vaccinating.  She states:

“I fully support parents’ rights to choose not to vaccinate, but there are consequences to that decision. I have had many conversations with parents in the middle of the night when their child has a fever and had to explain to them that because of their decision to not vaccinate, research indicates that their child is at a significantly increased risk for life-threatening diseases, and so will need invasive testing in the ER. It will take hours, and it will hurt their child. I tell them that the diseases we vaccinate against aren’t just nuisances; they kill and maim children every day, and they are almost completely preventable by vaccination.

I tell parents that I have worked in several developing countries, and I have seen children disfigured by diseases that we only read about in history books. I’ve seen babies die of diseases that in the U.S. we don’t even think about as a cause of illness because vaccination has nearly eliminated the illness. However, these illnesses are starting to make a comeback because of the anti-vaccine movement.

I also tell them that as a parent of two boys, I carefully research every vaccine and medicine that my children are given. I read the medical journals on the topic; examine the evidence for myself about all of the controversies about thimerosal and autism and invasive disease. Then I tell them that after many hours of studying the best research available, I am first in line to have my children vaccinated every time they are due.”

The parents at Voices for Vaccines aren’t alone. Nurses Who Vaccinate is a blog that advocates the safety and reliability of vaccines. Families Fighting Flu is a website that advocates for the flu shot to protect children from the flu.  Pfizer Australia created the smart phone app VaxiMate to help parents keep children’s immunization records organized and on time. The app is free and also includes the Australian immunization schedule and details on the diseases the child is being vaccinated against.

While there are numerous resources available on the Internet in favor and against vaccines, one of the best resources parents have is their child’s pediatrician. Vaccine Watch encourages parents to study all of the information, ask questions and make an informed decision for their child’s health and wellbeing.

Jenny McCarthy and The View

ABC News made headlines this week when they announced that anti-vaccine advocate Jenny McCarthy is joining the popular daytime show the View as a host in September. McCarthy has been linked to the anti-vaccine movement for over ten years, claiming a vaccine caused her son’s autism. 

McCarthy has been so outspoken on the topic that a website tracking the number of illnesses and deaths caused by the anti-vaccine movement has the domain name www.jennymccarthybodycount.com. With 1,170 preventable deaths between June 3, 2007 and June 22, 2013 and over 118,000 preventable illnesses, vaccine advocates are concerned about McCarthy’s new platform to spread her views.

The View caters to mothers and the credibility of host Barbara Walters and others influences the decisions many people make.  Over twenty studies have proven that there is no link between vaccines and autism. On the contrary, vaccines are the most effective instruments of public health. However, talented speakers like McCarthy can spread their scientific illiteracy through media quickly; McCarthy already has a book and will now regularly have television as another venue.

Michael Specter of The New Yorker states, “It is understandable that people would suspect vaccines are a cause of autism; parents often first notice developmental problems when their children are about eighteen months old, the same time they often receive several vaccinations. Causation and correlation are often confused, however as many studies have demonstrated. (Assuming that events that happen at the same time are connected can lead to serious misconceptions: over the last decade, for example the rise in the sales of organic food in the United States has mirrored the growth in autism rates almost exactly. No sane person would suggest that those facts are related.)”

“By preaching her (McCarthy’s) message of scientific illiteracy from one end of this country to the other, she has helped make it possible for people to turn away from rational thought. And that is deadly,” Specter concludes.

The anti-vaccine movement has been blamed for recent outbreaks of measles and whooping cough. Communities across the world are working to increase education and vaccination rates. Wendy Sue Swanson is a pediatrician in Seattle and believes it will take decades to recover from the anti-vaccine movement. “In the medical community, we’ll work to undo myths around vaccine safety for the rest of our lives, in part because of Ms. McCarthy,” she states.

Vaccine Watch encourages parents to make their decisions about vaccines with the help of pediatricians and sound science, not Hollywood.

Flu Vaccine Debate Continues

The anti-vaccine movement has been around as long as vaccines. While most people associate the anti-vaccine movement with the linking of vaccines to autism, this wasn’t the first protest of vaccines.

In the 1800s, countries began mandating smallpox vaccines for children. While many rushed to vaccinate their children, substantial numbers of people also refused to be vaccinated.  After a huge protest in Leicester, England in 1885 the Vaccination Act of 1898 gave parents the choice to conscientiously object to vaccines.

Evidence shows that vaccine laws increase the number of people that are vaccinated and decreases the rate of disease. After the measles outbreak in Wales, more people are arguing for mandatory vaccination. Others argue that in countries where vaccination rates are relatively high, educating and gently persuading parents to vaccinate their children may be a better approach.

Researchers from the UC Davis Health System, the Monroe County New York Department of Public Health, the University of Rochester Medical Center and the Centers for Disease Control and Prevention (CDC) found that elementary schools offering flu vaccination programs can increase the vaccination rate.

A 13.2 percent increase in vaccination rates was found in children who had access to school-located vaccination clinics.  Byung-Kwang Yoo of UC Davis was lead author of the study and noted, “Primary care practices may not have the capacity to vaccinate all U.S. children against seasonal influenza. If the CDC’s recommendations were followed, primary care offices would have to accommodate 42 million more patient visits during the five-month window for each flu season. Our goal is to find ways to ensure that the best prevention is as accessible as possible.”

Oregon State University conducted a study that found children in school and young adults do most of the flu transmission. Researchers noted there is a huge value in vaccinating more children and young adults for the flu by limiting the cycle of transmission. They also recommended vaccinating children at school.

In 2009, the Loyola University Medical Center in Illinois adopted mandatory influenza (flu) vaccination as a condition of employment. A multidisciplinary task force created the policy and presented their results at the 40^th Annual Conference of the Association for Professionals in Infection Control and Epidemiology in June. In addition to the new policy, educational materials like videos were also created for hospital staff and volunteers on the importance of vaccination.

Dr. Jorge Parada is a professor of medicine at Loyola and author of the study and has been working with the policy since 2008. “Near-universal flu immunization is achievable and sustainable with a mandatory vaccination policy,” Dr. Parada said. “Our employees and associates now understand that this is the way we do business. Just as construction workers must wear steel-toed boots and hard hats on job sites, healthcare workers should get a flu shot to work in a hospital. We believe that patient and staff safety have been enhanced as a result.”

Loyola was one of the first hospitals in the nation to adopt the mandatory flu shot policy and other hospitals have followed. Over 65 hospitals in North Carolina require doctors, nurses and vendors to be vaccinated for the flu. The vaccine debate will likely continue, and Vaccine Watch urges those with concerns to seek education from their primary care physician.

Vaccines and Social Media

Social media sites like Facebook and Twitter have far-reaching positive and negative effects on people’s lives. The influence of social media has extended to vaccines.

Dr. Emily Brunson, formerly of Texas State University in San Marcos, conducted a study that found parents make decisions about whether to vaccinate fully, vaccinate over a period of time or not to vaccinate their children at all based on their social networks. Pediatrics magazine published the results of the study.

Of the first-time parents surveyed, 126 conformed to vaccination recommendations while 70 didn’t. Twenty-eight of the seventy delayed vaccines, while thirty-seven partially vaccinated and five didn’t vaccinate at all. 95% of all participants surveyed stated that they got their advice from people they go to for information.

Parents who conformed to guidelines were more likely to get their information from friends, family, and healthcare providers. “Having those conversations with your sister, your parent, with your friends matter a lot more than we thought. If we want to improve vaccination rates, communication needs to be directed to the public at large,” Brunson says.

Researchers at the University of Texas at Austin conducted research on vaccine-related Twitter posts. 9,510 vaccination-related tweets during one week in January 2012 were analyzed and found to be mostly positive and reliable. The American Journal of Infection Control published the results of the study.

The original tweets were narrowed down to 2,580 that had been re-posted or shared. Of this smaller sample of tweets, 33 percent had a positive tone about vaccines, 54 percent were neutral and 13 percent were negative. 14 percent of the tweets contained medical information, and 66 percent of those were backed by scientific research.

Tweets covered many vaccine topics including: a potential children’s malaria vaccine, development of the NeuVax E-75 vaccine for breast cancer, the effectiveness of a herpes vaccine in women, a blog post discrediting the link between vaccines and autism, and many other topics.

Sources shared through twitter included: health specific sites like WebMD, national media like The New York Times, and medical organizations like American Medical Association. News and health organizations received more positive attention than political or advocacy groups.

Authors at The University of Texas stated: “In this sample, it appears that Twitter users share mostly reputable information and sources while actively mobilizing others to seek reliable health information. Results of the snapshot can help explain what social media content parents consume and respond to, as well as help determine directions for educational campaigns.”

While social media sites like Facebook and Twitter can be a great place to learn new information, it’s important to remember that your social network may not be providing you with all of the information you need. Vaccine Watch urges readers to consider a diversity of opinions and note the sources of information. It’s also important to maintain your general practitioner or child’s pediatrician as one of your sources.

Vaccines, Swine Flu and Paralysis

The H1N1 (swine flu) vaccine that was administered in 2009 received a lot of attention after a recent study linked it with a rare, paralyzing disease. People given the H1N1 vaccine had a small increased risk of developing Guillain-Barré Syndrome (GBS), a disorder that affects the peripheral nervous system. The disorder was originally linked to vaccines in 1976 with a vaccine created for a swine flu epidemic.  Doctors have stated that the benefits of the vaccine outweigh the risks.

GBS is a rare autoimmune response where a person’s own immune cells attack the protective coating on nerve fibers; specifically those that control movement and respiration. It’s characterized by symmetrical weakness, usually affecting the lower limbs first and then progressing to other parts of the body. It affects one person in every 100,000 and can lead to paralysis, but is usually temporary and 80% of patients have a full recovery.  Most GBS cases occur after a bacterial or viral infection and take a few days or weeks to develop.

The US Department of Health and Human Services conducted the study, with Dr. Daniel Salmon of the National Vaccine Program Office leading the research.  Twenty-three million people were vaccinated for H1N1 in 2009 and data was gathered from six different adverse monitoring systems.

Dr. Salmon’s group found that 77 people developed Guillain Barré syndrome within 91 days of receiving the vaccine. The vaccine accounted for an extra 1.6 people per million developing the condition. However, in 2009, the H1N1 “Swine Flu” pandemic infected 61 million people and caused 12,470 deaths. The vaccine is credited with preventing nearly a million cases of H1N1 and saving 500 lives.

“Clinicians, policy makers, and those eligible for vaccination must consider the overall risks and benefits of vaccination, as defined by epidemiological studies,” Dr. Salmon concludes. “But [people] should be assured that the benefits of influenza A (H1N1) 2009 monovalent inactivated vaccines greatly outweighed the risks.”

Another group of researchers spent 13 years compiling data on millions of patients and have found no link between vaccines and GBS. Researchers studied tetanus, hepatitis, pneumonia and flu vaccines and found no heightened risk for GBS.

Most studies done since 1976 have found no link between GBS and vaccines. Only a couple studies have shown a small increase in risk among people who received flu vaccines, including the 2009 shot against H1N1. Dr. Roger Baxter, the co-director of the Vaccine Study Center at Kaiser Permanente in California was the lead author on the study and noted that because GBS is so rare, its extremely difficult to determine whether a particular vaccine could have caused increased cases, which is why this study looked at millions of patients.

“There’s definitely a connection in people’s minds that vaccines cause this syndrome. But if you look at the (medical) literature, that doesn’t bear out,” Dr. Baxter states. “The bottom line is we think vaccines are very safe for this outcome, that they do not result in GBS, and if they do, it’s so rare it’s nothing to be worried about.”

The study notes that there were 415 cases of GBS from 1995 to 2006, and two-thirds of those had a documented gastrointestinal or respiratory infection in the weeks before developing GBS. Only 25 people had received a vaccine of any kind within six weeks of the onset of GBS. It was also noted that GBS cases were 50 percent more common in the winter, mirroring seasonal rates of infections like the flu and other respiratory illnesses.

Dr. Daniel Salmon of the Institute for Vaccine Safety at John Hopkins University said, “The take home message is vaccines are not causing Guillain-Barré Syndrome at a rate, if at all, that would possibly make the benefits of vaccination not worthwhile.”