Maine Public Health Professional Recognized as Immunization Champion

Every state needs a local source for parents to get immunization information they can trust.  In addition to state health departments, many states have immunization coalitions, immunization program managers and various public health professionals that help to ensure that parents get the vaccine information and access they need to keep their families healthy.  

Cassandra GranthamIn Maine for instance, public health advocates and policy makers understand that less than optimal vaccination rates are impacting the health of the state through disease outbreaks, missed school, hospitalizations and even, in some cases, death.  Unfortunately, the state of Maine has been ranked as having one of the highest rates of whooping cough infections and unvaccinated kindergartners in the nation.  However, through the work of dedicated public health professionals like Cassandra Grantham, the Maine Childhood Immunization Champion Award recipient,  the state is making great strides at addressing these concerns.

Cassandra was born and raised in Maine.  She loves her state and its people, and she is determined to help prevent the spread of disease in Maine communities.  As the parent of two children, Cassandra realizes that fellow Maine parents just want to do what’s best for their children.  That is why she has made it both a personal and professional priority to ensure that parents have access to scientifically accurate information about vaccines so that they can make well-informed immunization decisions for themselves and their children.

As Program Director of Child Health at MaineHealth, a not-for-profit healthcare system serving 11 of Maine’s 16 counties, as well as co-chair of the Maine Immunization Coalition, Cassandra has served as the backbone of the state’s immunization programs since 2010.

1240040_532110726862813_3266206_nOver the past few years she has launched several educational initiatives, such as the creation of the Vax Maine Kids website, the Vax Maine Kids Facebook page and the Vax Maine Kids blog which addresses a various childhood health topics ranging from safe sleep to immunizations.  She even launched the Kohl’s Vax Kids program, designed to increase immunization awareness among parents who are most likely to delay or skip their child’s vaccinations. Read more…

Every Child By Two Parent Advocate Receives Childhood Immunization Champion Award

April 20, 2015 2 comments

Each year I look over the list of Childhood Immunization Champion Award winners and I am truly inspired. 

During National Infant Immunization Week (April 18-25, 2015) the CDC and the CDC Foundation recognizes “Champions” from every state.  While the Champions are often public health professionals, doctors and nurses, being selected as a Champion isn’t just about doing your job.champ-award

Being a Champion requires an extraordinary effort.  It’s about going above and beyond.  And it’s about promoting childhood immunizations in a way that exemplifies a commitment to change, even in the face of adversity or resistance.

IN-TornhoutThis year I’m proud to say that I know a true Champion, and she is a parent advocate just like many of you.  The truth is that Katie Van Tornhout didn’t need a formal award to be considered a Champion in my eyes, but I’m thrilled to know that her passion and commitment are being recognized by people who devote their entire professional lives to promoting childhood immunizations.

callie_van_tornhoutI came to know Katie in a very unfortunate way.  After five years and four miscarriages, Katie and Craig Van Tornhout celebrated the birth of their daughter Callie in 2010.   Although their baby arrived a few weeks early, she was truly a miracle.  Despite the fact that they had barely left the house with Callie after her birth, their joy quickly turned to grief when a disease called pertussis, also known as whooping cough, claimed her life at just 38 days old.

It is in these challenging moments of adversity that we are often tested, and yet it was through the pain and sorrow of their loss that the Van Tornhouts – along with their angel Callie – have become forceful agents of change.  Since losing her daughter, Katie has been determined to spare other children from pertussis and prevent other parents from suffering a similar tragedy. Read more…

Time to Speak Out in Support of Strong School Vaccine Policies

April 14, 2015 97 comments

jyTzFXoGLast week California legislators were asked to cast a very important vote on a very critical matter – school vaccine exemptions.

California Senate Bill 277 would remove the Personal Belief Exemption (PBE) option from the school and child care enrollment requirements and require schools to publicly provide information about their immunization rates.  Last week the first hearing of the bill passed the Senate Health Committee in a 6-2 vote.  The bill now faces an Education Committee hearing on April 15th at 9am before potentially moving to a Senate floor vote.

But what happens to this bill doesn’t just pertain to parents in California. What happens in California is important to every parent across the country and here’s why…

Unlike Vegas, what happens in California doesn’t stay in California.  

Consider the ongoing measles outbreak that is linked to the Disneyland Resort.  What began as a single case of measles in a popular tourist location in Anaheim, California quickly spread to 7 states and into both Canada and Mexico.  While it’s fascinating to see the dynamics of how diseases spread, this situation illustrates how an outbreak of an infectious disease in one location can quickly spread across the country in a matter of weeks.

As the number of measles cases climbed, healthcare providers and public health professionals grew increasingly concerned.  And parents with infants too young to be immunized, and parents of children who are immunocompromised – like Jennifer Hibben-White and Dr. Tim Jacks – grew increasingly angry.  The result has been a surge in state bills aimed at tightening school vaccine exemption policies.

School vaccine policies are governed by the states. 

What parents may not realize, is that each state governs their own school vaccine requirements.  In fact, Every Child By Two was founded in 1991 by Former First Lady Rosalynn Carter and Former Fist Lady of Arkansas Betty Bumpers as a response to a U.S. measles epidemic which sickened more than 55,000 individuals, hospitalized over 11,000 and killed more than 120 people, including young children.  In response to this outbreak, the two co-founders traveled the entire nation to alert people about immunization concerns.  As a result, they’ve been credited with the passage of laws mandating school-age vaccination requirements in every state and the establishment of immunization coalitions that continue to operate in most states.

While every state allows for valid medical exemptions to vaccinations, states differ as to whether they will allow personal belief or religious exemptions (though very few religions actually oppose vaccines).ExImmunMap15

Additionally, the procedures by which a parent can obtain an exemption for their child also vary by state.  In most states, it can be as easy as a parent signing a piece of paper.  In fact, filing an exemption is often much easier than fulfilling the requirement of getting vaccinated.  Therefore, it’s presumed that exemptions rates may be on the rise partly because parents are becoming increasingly aware of just how easy they are to get.

Ultimately, the states are accountable for the number of school vaccination exemptions.  However, it’s the persistent efforts of vaccine critics that continually encourage parents to refuse vaccines that may be responsible.  In fact, there are various websites and forums that are known to assist parents in navigating exemption requirements.

So now, concerned about outbreaks of diseases like measles and whooping cough, and amidst evidence that the current  measles outbreak has been driven by those who refuse vaccines, state legislators are looking to address the matter through the introduction of new immunization related bills.  There are eight states (CA, MD, OK, VT, WA, NC, ME and RI) with bills that are trying to remove personal belief or religious exemptions.  There are four states (CT, NJ, NM and TX) looking to tighten the rules that apply to religious exemptions.  There are six states (CO, TX, IL, MN, PA, and OR)  trying to add some kind of educational component to current exemption policies.  There are plenty of other immunization related bills – estimated to be as many as 110 – under consideration so far this year.   Read more…

Efforts to Support Autism Awareness Often Derailed by Vaccine Critics

April 2, 2015 2 comments

autismdayThe fact is that I’m not autistic and I do not have an autistic child.  Therefore, I’m often reluctant to speak out on the subject of autism.  This is not because I don’t support the autism community – I most certainly do!  But because I don’t consider myself part of the inner circle of the autism community.

The way I see it, this inner circle is reserved for individuals with autism, as well as the family members, educators, therapists, researchers, and caregivers that support those living with autism.  And I would never want to presume to know what they need.  However, I listen intently to their calls for action, and hope to help them in overcoming their challenges by offering funds and support.

From my “outsider’s” point of view, autism awareness is about understanding, acceptance, inclusion, improved quality of life, and better support and resources for autistic individuals and those who assist them.  I believe every individual deserves the opportunity to lead a full, healthy and meaningful life.  But then again, who am I to define what constitutes a full, healthy and meaningful life?  When it comes to autism, I believe that research is critical in helping to understand how best to assist autistic individuals and their families, and not hinder or restrict them in any way.

vaxnoautism1When I investigate the extensive research that is being conducted on the subject of autism, it is truly awe-inspiring. There is so much we have learned, and yet, still so much to understand and discover.  Research is beginning to reveal various genetic factors that appear to contribute to autism.  We continue to learn about early interventions and successful treatments.  And we’ve spent an enormous amount of resources investigating a potential link between vaccines and autism.

To address concerns that maybe childhood vaccines were contributing to the rise in autism, multiple studies were conducted to look at children who received vaccines in comparison to those who didn’t, and in comparison to those who received them on a different or slower schedule.  There were even studies that looked into specific vaccines, such as the measles, mumps and rubella vaccination (MMR), as well as research into vaccine ingredients such as a preservative know as thimerosal.

The results of all these studies were clear and experts agree; there is no relation between vaccines and autism.  But despite the scientific evidence, suggestions that vaccines are a cause of autism continue to appear within comments on this blog, comments on our Vaccinate Your Baby Facebook page, and on countless sites all over the internet.

Today, as I perused various social media platforms on World Autism Awareness Day, I noted the ways people were “talking” about autism, and I was saddened to see that some people who are speaking on behalf of the autism community are also actively encouraging vaccine refusal.

Unfortunately, this dialogue is more hurtful than helpful.  Unvaccinated children are suffering with preventable diseases and sometimes even spreading dangerous diseases to others.   To add insult to injury, one of the most well-known autism advocacy organizations in the U.S. (Autism Speaks) continues to send mixed messages about their position on the subject of vaccines and autism.

Just a few weeks ago, I wrote a blog post that suggested that #AutismSpeaksTooLate on the subject of vaccines.

It’s no secret that Autism Speaks has continually made statements that seemingly perpetuate the idea of a vaccine/autism link. For instance, their Strategic Plan for Science, which outlines the group’s priorities for the years 2013 to 2017, also makes similar suggestions of a causal relationship by stating: Read more…

I’m a Pediatrician and I Gave My Daughter Pertussis

March 26, 2015 67 comments

By, Rebecca Bakke MD, FAAP

As a pediatrician, I am often asked the question, “What would you do if she was your child?”

I B (32)always try to answer this question as honestly as I can.  Sometimes, when the answer is not very straightforward, l can say sincerely, “I don’t know. “ Other times, such as when parents have concerns about immunizations, the answer is easy.

Vaccination is one of the most polarizing issues in our country, and because I immunize infants and children every single day at work, the controversy frequently makes its way into my office. Anxious first-time parents cradle their newborn babies while nervously reviewing the vaccine schedule, then look up at me and ask what I think about delaying vaccines, trying an alternate vaccine schedule or forgoing them all together.

What would you do if she was your child?” 

Parents are not usually surprised when I say that I vaccinate all three of my children according to the recommended CDC schedule. They expect that as a pediatrician, I have seen the horrors of vaccine-preventable disease and believe in the ability of vaccines to prevent these now rare illnesses.  This is, of course, true. They are usually quite surprised, however, when I tell them that my most significant experience with vaccine preventable disease happened not while I was working as a doctor, but as a first-time parent.

IMG_2769My first pregnancy was gloriously uneventful, and I was full of the joyous anticipation and occasional irrational terror that most first-time mothers share.  I followed all the rules. I took my prenatal vitamins, avoided sushi, cut back on caffeine and made a special effort to get adequate sleep and exercise. I spent hours online reading reviews on strollers, car seats and cribs. I was pregnant during the 2009-2010 H1N1 (“swine flu”) epidemic, and I was terrified of the toll the disease could take on my unborn baby and me.  I even cared for babies in the NICU who were born far too early because their mothers became critically ill from influenza while pregnant. I spent months wearing a mask at work, and I stood in line at the Department of Health to get the H1N1 vaccine just one day before it was available from Employee Health at my hospital.

IMG_3039Claire Noelle was born on a snowy January morning, and I remember being overwhelmed by the instantaneous love and devotion I felt for this tiny baby I had only just met. We took her home the next day, and like most new parents, spent the first several weeks of her life gazing at her and relishing in every sweet newborn expression, sigh and sneeze.

When Claire was 5 weeks old and just starting to smile, she started coughing. Initially, it was only after I nursed her, and I thought it was reflux. But when the coughing worsened, I panicked.  I reflected on the fact that I was recovering from a mild cold when Claire was born, and had been coughing ever since.  My cough was nothing remarkable, but Claire’s cough was starting to sound an awful lot like pertussis (whooping cough).  We took her to the pediatrician. The next day he called and confirmed my fear: Claire had pertussis.

The next three weeks were the darkest of my life. Antibiotic treatment for pertussis prevents the spread of the disease, but after the coughing starts no medication can alter the disease course. If you have ever seen a child with pertussis you know why it is called whooping cough. Infants and children have such long coughing spells that they cough until their lungs are completely out of breath, then they inhale desperately (“whoop”) before the coughing fits start again.

Claire would cough cough cough cough cough and whoop, cough cough cough cough cough and whoop for an hour straight several times per day. 

She coughed until her lips turned blue. 

She coughed until she vomited so many times that she lost weight. 

The coughing completely and violently took over her precious 9 pound body. 

Infants with pertussis, especially infants as young as Claire was, are at high risk for complications.  

The coughing fits can lead to bleeding in the brain.

They can get pneumonia.

They can have periods of apnea, where they stop breathing.

Many end up on a ventilator.

One to two percent of infants with pertussis die.

I knew these things, and I was terrified. But nobody could stop the coughing.

IMG_0058Claire was fortunate. We were fortunate. She recovered without any complications. But dozens of infants born in 2010, including at least one infant in our community, died of whooping cough. Many of these babies were too young to be vaccinated. So was Claire.

But I was not. While I was pregnant, I spent a whole lot of time researching strollers, but failed to take any time to get a vaccine that could have prevented my baby from getting a life threatening illness. And I am a pediatrician. I, of all people, should have known better.  Because of this, it is now part of my mission to make sure that the families that I take care of do know better.

Today, all expectant women should be vaccinated with Tdap during every pregnancy, preferably in the third trimester (between the 27th and 36th week). By getting vaccinated during pregnancy, mothers build antibodies that are transferred to the newborn, providing protection against pertussis before the baby can get their first dose of DTaP vaccine at 2 months old. Tdap vaccine also protects mothers during delivery, which makes them less likely to transmit pertussis to their babies. This recommendation is not only supported by The American College of Obstetricians and Gynecologists, but also by the Centers for Disease Control and Prevention (CDC).

What would I do if she was my child?

I would vaccinate.

For more information, visit these special CDC webpages dedicated to whooping cough information for pregnant women and healthcare providers here.
About the author:  Rebecca Bakke MD, FAAP is a pediatrician at Sanford Health and a clinical assistant professor of pediatrics at the University of North Dakota School of Medicine. She lives in Fargo, ND with her husband and three young children.

Public Health’s March Madness: Flu Activity Remains High

March 18, 2015 3 comments

Even as temperatures climb, daylight extends and the promise of Spring lingers around the corner, the United States is still facing the threat of the flu.

usmap09While influenza activity has begun to decline across the United States in recent weeks, the CDC’s influenza surveillance systems still show elevated activity as we enter the month of March.  Although the average length of a flu season for the past 13 seasons has been 13 weeks, flu activity has been elevated this season for 16 consecutive weeks so far.  As of March 7, 2015 there were still 9 states reporting widespread activity, 29 states reporting regional activity and 11 states reporting local activity. Even though the season started early this year, it is expected to continue for several more weeks and  we can already see that it has been dangerous, deadly and unpredictable this season.

Flu Remains Deadly

As of February 21, 2015, the proportion of deaths attributed to pneumonia and influenza remains above the epidemic threshold and has exceeded that threshold for eight consecutive weeks.  Additionally, seven children have died of influenza between March 1-7, 2015, bringing the total number of flu-associated pediatric deaths reported so far this season to 104.

Death isn’t the Only Detrimental Outcome of Flu

While it’s true that the majority of individuals who suffer with the flu will survive, the CDC also monitors hospitalizations that are associated with influenza infection.  So far this season the most affected age group has been adults 65 years of age and older, and they’ve accounted for more than 60% of reported influenza-associated hospitalizations.  This supports the need for wide-spread vaccination among older individuals and their caregivers, to include nursing home employees and health care workers.  As of February, 21, 2015, the most commonly reported underlying medical conditions among hospitalized adults were cardiovascular disease, metabolic disorders, and obesity.

Children, especially those under 5  years of age, have the second-highest hospitalization rate this season, with the most commonly reported underlying medical conditions to be asthma, neurologic disorders, and immune suppression. Among hospitalized women of childbearing age, 26% were pregnant. However, while certain medical conditions can increase your risk of complications from influenza, seven percent of adults and 39% of hospitalized children had no identified underlying medical conditions, illustrating the fact that flu can be life-threatening even to a previously healthy individual.

The Flu Came On Early, Strong and With It’s Share of Surprises

Read more…

New ACIP Recommendations for Meningococcal, Influenza and HPV Vaccines

March 10, 2015 4 comments
Photo Credit: James Gathany, Centers for Disease Control and Prevention

Photo Credit: James Gathany, Centers for Disease Control and Prevention

written by: Amy Pisani, MS, Executive Director, Every Child By Two

The Advisory Committee on Immunization Practices (ACIP) conducted an abbreviated meeting on February 26, 2015 due to the threat of a winter storm in the Atlanta, Georgia region.  The ACIP, which consists of 15 voting members who have expertise in vaccinology, immunology, healthcare and public health, makes recommendations to the Centers for Disease Control and Prevention (CDC) regarding vaccinations approved for use by the Food and Drug Administration (FDA).  The recommendations pertain to the timing and intervals of vaccines which are included on the childhood, adolescent and adult immunization schedules.   At this February meeting, the ACIP conducted three important votes which altered or created new recommendations for meningococcal vaccine, influenza vaccine and HPV vaccine.  

Meningococcal Serogroup B Vaccine

Two new vaccines to protect against meningococcal serogroup B, which has been spreading through college campuses in recent years, were recently approved by the FDA. The Trumenba vaccine is developed by Pfizer Pharmaceuticals and requires three doses and the Bexsero vaccine has been developed by Novartis Vaccines and Diagnostics requiring two doses.  The ACIP has previously recommended one dose of MCV4 vaccine at ages 11-12, and a booster at age 16 to protects against the A, C, W and Y strains of meningococcal bacteria   Nearly 80% of teens between the ages of 13 and 17 have received at least one dose of the MCV4 vaccine, which is fairly remarkable considering the fact that it is recommended, but not mandated for use within states nationwide.  However, because of the complicated nature of the virus, the new meningococcal serogroup B vaccine would require a separate series of shots, in addition to those recommended for MCV4 vaccine.

The serogroup B strain of meningococcal is considered the most common cause of meningococcal disease  among adolescents here in the U.S. with a fatality rate of 12 percent in 11-19 year olds and 17 percent in 20 year olds over the last 14 years.  While the number of meningococcal cases have declined since 1996, many advocates believe that the aggressive nature of this disease, which often kills or maims it’s victims within hours, necessitates a broad recommendation for the vaccine.  However, the ACIP discussion at the February meeting was limited to recommendations for those at high risk for serogroup B infection, with a follow up vote anticipated at the upcoming June meeting where the Committee will review data and make a determination on whether to recommend the vaccine for a broader population. Several advocates traveled to the meeting to provide their testimonials.  These included parents of those lost to the disease as well as survivors who have suffered amputations and serious life-long health consequences of this invasive disease.  Dr. Mary Ferris, who helped lead efforts to contain the 2014 meningococcal outbreak at University of California’s Santa Barbara campus, provided compelling testimony regarding the impact of the outbreak on the university.  Ferris noted that four cases, one of which led to the amputation of a student, spread panic throughout the campus and the local community.  Students were banned from volunteering at the on-campus daycare and attempts were made by the local community to close the campus entirely.   Dr. Ferris urged the Committee to consider the broadest recommendation Read more…

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