Shot of Prevention

By Amy Pisani

Hi Everyone.  Amy Wallace, who wrote the excellent cover story for the November issue of Wired Magazine on the anti-vaccine movement has just been interviewed on NPR: All Things Considered. She talks about the backlash she has experienced after writing the article, entitled “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All” (it’s a great read by the way). The article examines the anti-vaccine movement and their impact on public health and vaccination rates.

I have personally thanked Amy Wallace for not only writing an excellent piece of journalism, but for her courage in the face of the criticism she has encountered.  Since the article came out, she has taken a lot of spite from some prominent anti-vaccine bloggers – in fact, she has never received this much feedback in her 20 plus years of journalism.  Wallace says in the interview: “I’ve heard that I’m stupid. I’ve heard that I’m greedy. I’ve heard that I did this to get famous. I’ve heard that I’m a whore, I’m a prostitute.” Listen to the entire podcast at: http://www.npr.org/templates/player/mediaPlayer.html?action=1&t=1&islist=false&id=114249382&m=114254133

Ms. Wallace has been twittering about the mail she’s received since she wrote the article. Check out her Twitter feed, and for those of you who tweet, send her a positive shout out!

By Amy Pisani

Last night I was glued to my computer watching the live webcast of the Gates Foundation’s Living Proof Project:  U.S. Investments in Global Health are Working.  Bill and Melinda Gates gave an awesome multimedia presentation showcasing some of the truly impressive strides we have made in global health. I was so thrilled to hear Melinda Gates call vaccines the “great miracles of our lifetime.” Thanks to vaccination, we’ve been able to bring down cases of Diphtheria 93%, Tetanus 85%, and Measles 93% since 1980.

The presentation really hit home with me when they showed villages and people in the developing world that have benefited from vaccination. I was moved by the video they showed of a village in Nicaragua called Pantasma that was able to receive shipments of the vaccine against rotavirus, which kills 500,000 children in developing countries each year.  The video showed the health clinic in Pantasma,  which saw so many cases that they had to put two kids in each bed.  One of the doctors in the clinic said that when the vaccine arrived in Pantasma, the number of cases of rotavirus dropped – and there are now no children in their rotavirus ward. Eighty percent of Nicaraguan children under the age of 5 have now been vaccinated against rotavirus, a truly impressive number that can hopefully be replicated in other nations. 

These videos are so important to watch for two reasons. First, it’s important for people in the U.S.  to see how much our investments in global health are helping those in need. And second, I think we sometimes take our own health for granted in this country. The alarming trend of parents spacing out or skipping their children’s shots does not seem like such a big deal when we don’t see the devastation of these diseases in our everyday lives. Watching presentations like this one shows us that they are only a plane ride away.

A webcast of Bill and Melinda Gates’ presentation is available online, which you can view here: http://www.gatesfoundation.org/livingproofproject/Pages/impatient-optimists-speech.aspx

At the end of the speech, Bill and Melinda asked that everyone in the audience share this with one other person whose opinion they respect. I encourage all of you to do the same.

By Amy Pisani

I just read a good friend’s personal story  on how she practically knocked over an old lady in a walker (of course I exaggerate) to get into an elevator that would bring her closer to the maze of offices where her youngest daughter could get her H1N1 vaccine.  Why the urgency?  She has seen the bad side of vaccine preventable diseases in her line of work as director of Parents of Kids with Infectious Diseases (known to us vaccine advocate geeks as PKIDs).  To make her passion greater, her oldest contracted our latest virus invader…H1N1…and suffer she did! 

I could feel my friend’s anxiety as a mom who recently got her four year old the H1N1 and seasonal vaccines (yes, he turned five six days later and they were considering not prioritizing him, until I made it clear he was four years old, not five as he kept insisting!).  Now I am patiently waiting in the line for the recommendations to open up so that my nine year old can be protected too. I know he is no longer in the priority group, but after watching him suffer hospitalization as an infant from regular flu, I won’t rest until he gets his two sniffs of H1N1 too.  Yes, he did get his seasonal already (thank goodness)…and as we waited in the doctor’s office the receptionist came out with her printed sign “sorry, we are out of influenza vaccine supply, please call the office next week for an appointment”…next week has come and gone and they still don’t have any vaccine and the priority groups are still the very young.

Read the full post at PKIDs and please share your own stories about getting the H1N1 vaccine by posting a comment, below.

By Danielle Romaguera

I am pregnant with my fourth child due in December.  I must say that, while I am excited for this new addition to our family, I am also nervous about the H1N1 scare and its potential impact on my baby’s health as well as my own.

As you have probably heard in the news or read online, pregnant women are a greater risk for contracting H1N1.   We are the group most threatened by the illness.   Why?   I have done some research and here is what I have found:

• Our bodies change during pregnancy.   We have a harder time fighting off illness as our immune system is working overtime to protect the fetus.
• As the uterus grows and pushes the diaphragm up, it is harder for us to clear our lungs.
• Many of us are also in the younger age group most susceptible to catching the virus.

The news has been reporting on some accounts of pregnant women being affected by H1N1.  In some cases, the mother dies but they are able to save the child.  I was greatly saddened to hear about this case featured on NBC Nightly News.

It is extremely hard for me to watch these sad accounts but they should serve as a reminder to all of us to vaccinate ourselves against both H1N1 and the seasonal flu.  Talk to your doctor about getting the vaccines if you have not already.

I found the CDC’s site to be really helpful as guidance for pregnant women.  We need to protect ourselves and our babies.

By Dr. Ari Brown

A few years back, a mother that I knew well brought her four week old son into my office. She brought him in because she trusted her mommy instincts. She had three older children and she told me,   “I don’t know, but something’s wrong with this one!”He was having difficulty breathing. Some newborns have periodic breathing, where they pant for several breaths, pause, and then breath again. But this mom was describing something different. The baby would stop breathing and seemed like he couldn’t catch his breath.  And, he looked dusky when these events occurred. He was having these episodes a few times a day, and it scared even this seasoned mom.

When I examined him, he appeared perfectly normal until he started choking.  I turned to her and asked, “Are you afraid to sleep at night?” Her response—“YES!” I’ve learned over the years to always trust a mom’s judgment, so I picked up the phone.

The baby was admitted to our local children’s hospital.  During his stay, it was quite clear why his mom was so worried. He had numerous spells where he stopped breathing, and had so much trouble that he needed supplemental oxygen. He also had horrible coughing spells where he would turn red, choke, and gasp for breath. He had whooping cough.

It turns out that his mom had a hacking cough towards the end of her pregnancy that she just couldn’t shake. It continued in the weeks after she delivered, but she was too busy taking care of her newborn to worry about herself. She had whooping cough and had given it to her son.

Fortunately, this story has a happy ending. After several scary days in the hospital, receiving supplemental oxygen and constant monitoring, my little patient went home. He is a healthy, thriving kid today. But, not everyone who goes through this experience has this same rosy outcome.

Whooping cough often spreads from adults to those who are the most vulnerable—our babies, who, like my patient, are too young to be vaccinated.  Since 2005, teens and adults can receive a whooping cough booster vaccine that’s given in combination with their tetanus shot (called the TdaP vaccine).  Many hospitals now routinely give moms a TdaP booster shot right after delivery, which is a great first step. But, it’s important for all caretakers to roll up their sleeves for their precious baby. Dads, grandparents, or any other adult who spends time with a baby should get this shot. It’s called cocooning. By vaccinating those around the baby, you are protecting him from the disease.

If you can’t remember the last time you got your tetanus shot, or you got your last one when you were still seeing your pediatrician, it’s time to do it!

Ari Brown, MD, FAAP is a pediatrician in practice in Austin, TX and the author of Baby 411: Clear Answers and Smart Advice for your Baby’s First Year.

Editor’s Note: The whooping cough vaccine for children is combined with the tetanus and diphtheria vaccines (DTaP). To read more about whooping cough and how important it is for every child to receive each dose of their DTaP on time, please see The New York Times article “Risks: Pertussis Protection? Not From the Herd” at http://www.nytimes.com/2009/06/09/health/research/09risk.html?_r=2&ref=health

By Alison Singer
President, Autism Science Foundation

There are two main questions that parents of children with autism have been asking us about H1N1 virus and H1N1 vaccine. The first is whether our children are at higher risk from complications from H1N1 and thus need to be given prioritization with regard to vaccination. Much of this concern stems from the fact that because of communication challenges, kids with a developmental disability often can’t tell us when they are sick. Thus, treatment of an H1N1 infection might be delayed.

The second question on people’s minds is whether the vaccines will contain thimerosal. According to the CDC, the 2009 novel H1N1 influenza vaccines that FDA is licensing will be manufactured in several formulations. Some will come in multi-dose vials and will contain thimerosal as a preservative. Parents can be assured that the most recent and rigorous scientific research does not support the hypothesis that thimerosal-containing vaccines are harmful.

Should kids with autism be given priority in vaccination?

The September 3, 2009 issue of CDC’s Morbidity and Mortality Weekly Report (MMWR) reported that of the 36 children with a confirmed 2009 H1N1 infection who died between April and early August 2009, twenty-four had chronic medical conditions that have been recognized to increase the risk of complications from seasonal influenza.  In particular, many children had neurodevelopmental conditions, such as cerebral palsy, epilepsy, and developmental delay. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5834a1.htm).

One of the authors of this report, Dr. Georgina Peacock of the CDC’s National Center on Birth Defects and Developmental Disabilities, says that the majority of these children had neurodevelopmental disabilities that left them at risk for pulmonary compromise — this would include children that may have trouble clearing secretions, protecting their airway or difficulties coughing. In addition, almost all of the children had more than one neurodevelopmental problem, such as cerebral palsy and epilepsy.  Thus there is not a specific priority vaccination group for individuals with developmental delay or other neurodevelopmental conditions.

Dr. Peacock added that there has not been any prioritization for the 2009 H1N1 vaccine within the priority groups and stressed that all children and young adults should be vaccinated for 2009  H1N1 influenza  when it becomes available. In addition, children should be up to date on their pneumococcal vaccine–this would include the 7-valent vaccine (Prevnar) for children under 2 (which is part of routine vaccinations)  and  additionally  the 23-valent vaccine  (Pneumovax)  for children greater than 2 with a high-risk medical condition.  This will help to protect against some types of pneumonia, which a complication that can develop after influenza infection.

If children who are in one of the higher risk groups develop flu-like symptoms, including a fever, sore throat and/or cough, parents should contact their child’s doctor or seek medical attention.  Parents should talk to a doctor early if worried about their child’s illness.  There are anti-viral medications that can be helpful in treating influenza especially when started early. In addition, although not in a priority group, parents of children with developmental disabilities are urged to get vaccinated as soon as vaccine becomes available to the general public.

What About Thimerosal?

According to the CDC, the 2009 novel H1N1 influenza vaccines that FDA is licensing will be manufactured in several formulations. Some will come in multi-dose vials and will contain thimerosal as a preservative. Multi-dose vials of seasonal influenza vaccine also contain thimerosal to prevent potential contamination after the vial is opened.

Some vaccine manufacturers will be producing novel H1N1 influenza vaccine in single-dose units, which will not require the use of thimerosal as a preservative. In addition, the live-attenuated version of the vaccine, which is administered intranasally (through the nose), is produced in single-units and will not contain thimerosal.

Since 2001, no new vaccine licensed by FDA for use in children has contained thimerosal as a preservative, and all vaccines routinely recommended by CDC for children under six years of age have been thimerosal-free, or contain only trace amounts, except for multi-dose formulations of influenza vaccine. This was done as a precautionary step and not because there was evidence confirming that thimerosal-containing vaccines were causing health problems. The most recent and rigorous scientific research does not support the hypothesis that thimerosal-containing vaccines are harmful.

Thimerosal is an important preservative that protects vaccines against potential microbial contamination, which may occur in opened multi-dose vials of vaccine. Such contamination could cause serious illness or death. Since seasonal influenza vaccine is produced in large quantities for annual immunization campaigns, some of the vaccine is produced in multi-dose vials, and contains thimerosal to safeguard against possible contamination of the vial once it is opened.

Three leading federal agencies (CDC, FDA, and NIH) have reviewed the published research on thimerosal and found it to be a safe product to use in vaccines. Three independent organizations (The National Academy of Sciences’ Institute of Medicine (IOM), the Advisory Committee on Immunization Practices (ACIP), and the American Academy of Pediatrics (AAP)) reviewed the published research and also found thimerosal to be a safe product to use in vaccines.

Nonetheless, the presence of the preservative thimerosal in vaccines and suggestions of a relationship to autism has raised concerns. Since 2001, no new vaccine licensed by FDA for use in children has contained thimerosal as a preservative,  and all vaccines routinely recommended by CDC for children under six years of age have been thimerosal-free, or contain only trace amounts, except for some formulations of influenza vaccine, and yet, we have not seen reductions in the numbers of children diagnosed with autism, indicating that the cause of autism is not related to thimerosal.

H1N1 influenza vaccine is expected to have a similar safety profile to seasonal flu vaccines, which have a very good safety track record. Data from novel H1N1 trials among children are not available yet.

According to current federal plans, only unadjuvanted vaccines will be used in the United States during the 2009 flu season. This includes all of the 2009 H1N1 and seasonal influenza vaccines that will be available for children and adults in both the injectable and nasal spray formulations. Original plans for novel H1N1 vaccine referenced possible use of the adjuvant squalene, but this is no longer necessary given that testing showed that single dose H1N1 vaccination produced a stronger than expected immune response, thus reducing the need to “stretch” the amount of antigen available to the public by adding adjuvant to the vaccines.