Shot of Prevention

By Christine Vara,

Next week is National Infant Immunization Awareness Week (NIIW) when efforts are made in hundreds of communities across the nation to increase awareness of the importance of immunization and to achieve immunization goals.  The week also provides an opportunity to celebrate immunization achievements, recognize successful collaboration and encourage better communication between parents and healthcare providers. With such ambitious goals, I wondered what type of events were scheduled to commemorate such an important week in public health. 

In reviewing the activities of specific states, I discovered onlya handful of states that have posted events on the CDC website.  While it appears that some states have not capitalized on NIIW to further their immunization efforts, others, like the state of Nevada, are extremely ambitious.  For instance, the Southern Nevada Immunization Coalition (SNIC) will offer 12 no-cost immunization clinics on various dates, with 5 focusing specifically on infants and children. These events will include health fairs and also feature lead testing, hearing and vision screenings, WIC, car seat safety checks, application assistance for Medicaid and Nevada UP, as well as other activities. 

At a time when there is a great deal of questions from parents regarding vaccines, I am surprised, and perhaps a bit disappointed, that more states aren’t utilizing NIIW as a focal point for discussion and public awareness of infant immunization.  While a national effort can certainly work to achieve the goals of NIIW, I believe that communication and involvement on a local level is critical to the effectiveness of the national campaign.   

The importance of state participation is clear, particularly when you consider the fact that many states have recently announced new requirements for school enrollment.  That point, coupled with the fact that children around the country are currently registering for fall Kindergarten, make it clear that good communication between parents and healthcare providers is critical. 

In registering my own child, I was surprised to discover that there were four new immunization changes in place this year for the state of VA.  Specifically, two of the necessary immunizations required that one of the four doses (of polio and DTaP) be administered after the fourth birthday.   According to my local school, this has caused some confusion amongst parents.  Upon first review, it may appear to a parent that the child’s immunization record is up to date since all the required immunizations were received.  However, to meet the new state requirements, certain immunizations need to occur within the specific time frame required and parents aren’t always aware of that.  

Through this example it is clear that there remains room for improvement in regards to communication regarding infant immunizations.  Hopefully, through the promotion of NIIW, we will hear about the immunization achievements met this year, as well as examples of collaborative events that can be used as a model in the future.  Surely there are some success stories out there and I hope to be able to share them with you.

By Christine Vara

The other night, after struggling with her homework, my daughter asked me “Mom, do you get mad at yourself when you make a mistake?”

I paused a moment before I recited one of my most frequently used mommy mantras.  “No one is perfect.  We all make mistakes.  What is important is that we learn from them.” 

Day after day, I expect my children to always try their best, but I know that they will make their share of mistakes.  Who doesn’t?  Yet, it is through these experiences that they will learn.  If we are too concerned about making mistakes, we neglect to try to accomplish that which has never been achieved.  This concept applies to my eight year old’s homework, as much as it does to my 13 year old’s soccer skills, and not surprisingly to society in general. 

This week many public health advocates gathered for the National Immunization Conference in Atlanta.  One of the goals of this conference, according to the CDC website, is to encourage participants to explore innovative strategies for developing programs, policy, and research in order to promote immunization coverage for all age groups.  A review of the agenda references a wide variety of immunization concerns such as barriers to vaccination, vaccine development and safety, immunization registries, health communication, education, policy and legislation, as well as global immunization surveillance. Kathleen Sebelius, Secretary of Health and Human Services, was even there to deliver the keynote address.

Of course, there are plenty of public health critics who voice their disappointment in regards to our public health system, and some even suggest improvements.  Fortunately, many of the health advocates attending this week’s conference were there to do the very same thing.    After reviewing the conference agenda, it is clear that the emphasis of this conference was to provide a forum for field experts to share their experiences and pass along lessons learned in an effort to improve practices, implementation and resources.  What better hope do we have for progress than a conference committed to comprehensive immunization education amongst the field experts?  Certainly there are models that are working that we can learn from and even continue to improve upon, which is why I am looking forward to hearing what was shared as the conference concludes.    

As parents, we need to be committed to doing our part as well.  Our children will continue to face life threatening diseases as adolescents and even adults.  If we are to ensure the health of our children and all children well into the future, than we need to remain vigilant and do our part to educate ourselves in regards to immunizations for all ages. We need to learn from one another and share resources, just as we expect the public health advocates to do at the conference. 

I’m curious to know what resources parents have found to be helpful.    For those who may have attended the conference, perhaps they can share their personal insight on the benefits of the conference.

By Christine Vara

Whether your child is four days, two months, or 42 years old, as a parent you will always feel the need to protect them.  After all, no one has a bigger interest in the life of a child than their parent.  When it comes to my own five children, I try to protect them from preventable disease the best way that I can, realizing there is only so much that I can control.  For instance, I am so militant about my hand washing rule that before my four-year old eats, she now willingly proves that she has washed her hands by sticking them in front of my face and saying, “Smell mommy. See? I wash my hands.” 

I’ve realized that despite the good food I prepare and the healthy habits I try to instill, germs and viruses are everywhere. Good health for our children is a constant struggle – a struggle within their own immune systems.  It’s not uncommon for kids to get run down as a result of their active lifestyle, and if they’re not getting enough rest their bodies become less effective at combating disease. That is why I inquire with my doctor about ways that I can further protect my children from unnecessary illness.  As my youngest daughter turns five next week, she’s preparing to enter kindergarten and I’ve begun preparing myself for her vaccinations by researching the current recommendations prior to her well visit. 

In conversations with others, I’ve learned that some parents are worried about the number of vaccines that their children need to receive, as well as multiple vaccines suggested in one visit. Some parents decide to forego the recommended schedule and “space out” the shots, concerned that multiple vaccinations might overwhelm a child’s immune system.   While it seems reasonable for parents to have these concerns, doctors explain that an infant’s immune system can handle many more vaccines than are actually given at one time.  In a recent article in this month’s Parents magazine, one doctor explains that “young children are exposed to more antigens – bacteria, viruses, toxins, and other substances that can stimulate disease-fighting antibodies – in a single day of eating, playing, and breathing than they are through immunizations.”  The article, entitled “Vaccines:  The Reality Behind the Debate”, provides an excellent overview of the concerns that many parents have when it comes time to vaccinate their children, and it presents a clear understanding of the perceived risks, as well as the medical benefits of vaccines.

It’s important to note that the Centers for Disease Control and Prevention (CDC) has developed a recommended schedule  based upon the need to protect our children by the age when they are most vulnerable to the diseases we are vaccinating them against.  It is the high number of hospitalizations and deaths in children that even justified the years of research required to create these vaccines.  Therefore, the CDC recommends completing the series of immunizations prior to when the child is at the greatest risk. 

Sometimes this includes multiple immunizations that are offered in one combination, such as the DTaP.  While this also seems to raise concerns from some parents, once again the research shows a track record of safety and effectiveness for these vaccines.  Extensive testing ensures that the ingredients for each vaccine do not interfere with one another in combination.  Thus, they remain safe, while also being more convenient.  One shot versus three sounds like a benefit to me. 

Hopefully parents will begin to understand that when we alter the vaccination schedule we actually leave our children open to infection without providing any benefit to the child.  This involves taking chances – assuming that our own schedule will be safe and effective, while ignoring the recommendations of doctors and scientists who have extensive knowledge about vaccine development.  If you are still uncertain about the recommended schedule, check out the video Q&As on vaccinateyourbaby.org  and hear the simple, straightforward explanations from specialists in the field.   

As parents, we must continue to hold our children’s best interest at heart.  That includes learning about preventable disease, understanding the benefits of vaccines and doing our part to protect our children from unnecessary suffering and illness.  Taking the time to understand the correlation between these things will allow us to engage in healthy dialogue directly with our health care providers as well as with one another.

By Christine Vara

A recent NPR article I read chronicled a measles resurgence tied to people who intentionally choose to go unvaccinated.  In Vancouver, foreign travelers to the Olympics apparently brought with them more than luggage.  In fact, they were carrying two different strains of the measles from Asia.

It’s not surprising really.  The Olympics is the pinnacle of international sports and people swarmed to Vancouver to be a part of it.  However, with the global traveler comes the threat of contagious diseases and, so far, the disease has spread to 16 people in Vancouver, with half of them  residing in one large unvaccinated household.

Similarly in 2008, a seven year old boy, who was an intentionally unvaccinated US resident, returned from a visit to Switzerland and unknowingly exposed 839 people to the measles.  Of these 839, 73 were unvaccinated children (25 of these children from households that chose not to vaccinate) and 48 were children younger than 12 months old and yet to receive the measles vaccine. To limit the spread of the virus any further, parents of those 73 unvaccinated children were asked to isolate their kids by keeping them home for three weeks!  Trust me:  that’s no walk in the park for any parent.

Fortunately, in that case, the vigorous response from public health agencies helped to track and contain the outbreak. But what do we expect to find with this outbreak in Vancouver?  According to NPR, just a generation ago, up to 4 million U.S. children got measles every year, hundreds died, and thousands were left with permanent brain damage. It became a national health crisis and a vaccine was eventually developed that effectively protected people from contracting measles.  Nowadays, many people do not consider measles a threat.  After all, you hardly ever hear about it.  And many people have never seen it.  In fact, I wonder how effective today’s doctors would be in diagnosing it since it is not all that prevalent.  Perhaps that justifies the choice some people make to forego the available vaccine.

So, I had to ask myself the question: If the numbers of unvaccinated people influence the spread of diseases, but are not large, just how many people need to refuse vaccines in order for these diseases to resurrect themselves in greater numbers and with more severe outcomes?  In other words, what is the percentage of unvaccinated people that will tip the scales of social health away from overwhelming protection from a disease due to high rates of immunization—what health officials call “herd immunity”?

Shockingly, experts say measles is so contagious that more than 95 percent of a population needs to be immunized in order to prevent mass infection.  If as little as five percent of people go unvaccinated, the herd immunity becomes threatened, resulting in a higher number of vulnerable children.  It’s surprising that such a small percentage of unvaccinated population can contribute such great risk.  However, health officials say there are growing pockets of “vaccine refusers” across the country, giving viruses like the measles the opportunity to impact public health at much greater levels.

Now it’s important to note that in some communities in this country there are as many as 10 percent of the childhood population that goes unvaccinated so this is a definite concern in the U.S.  Consider another NPR article, dated April 5, regarding a recent measles epidemic in Zimbabwe where the official count is over 2,000 cases and about 200 deaths.  The Zimbabwean Health Minister highlights the importance of herd immunity saying, “estimated coverage for measles is well below 70 percent, so there’s no herd immunity.”  The article goes on to say that the epidemic began in two sects whose leaders oppose vaccination.  As more and more Americans refuse vaccinations, is this what we have to look forward to?

Currently, herd immunity, as unflattering as it may sound, might be one of the primary factors protecting the very people who choose not to immunize.  While I would not interfere with the fact that people should have a choice whether to vaccinate or not, I am concerned about the numbers.  Fortunately there are still enough people receiving vaccinations to protect the community at large.  Because others are vaccinated, it greatly reduces the risk of the unvaccinated.  However, as in the cases cited above, unvaccinated individuals are typically the first to fall victim to a case of preventable disease.

What are your thoughts on herd immunity and its effectiveness in protecting our population from major, preventable epidemics?

By Christine Vara

I have just read a very insightful article from the Chicago Tribune regarding Dr. Oz and his proliferation of medical information on both his current television show and the website that supports it.  The article leads with the header, “Celebrity surgeon’s goal is to offer ‘as much information as possible’ on health issues. But critics say that inclusive approach does the public a disservice.” 

As a brief overview, Dr. Oz is a cardiac surgeon who was a regular guest on “The Oprah Winfrey Show” before becoming a celebrity himself.  The Chicago Tribune article brings to light several instances where claims made through the site are not supported by medical science.  Dr. Oz’s spokespeople explain that to offer a fair discussion, they must include various voices and even controversial opinions. 

While I can certainly appreciate an open dialogue, it seems that in the interest of “entertainment” this celebrity doctor walks a fine line between the opinions of a few with the evidence of scientific research.  By the simple nature of him being a doctor himself, people will listen, which accounts for the 3.7 million viewers to his show daily.  However, the concerns I have are not with the sharing or discussing of information, or even the questioning of current medical beliefs.  It remains important to medical advancement that we use this kind of dialogue to direct us in further research to prove various hypotheses.  My concerns are that when mass media starts involving the lay people in this medical conversation, it is easy for many of us to confuse suggestion of evidence with proven research.  

Dr. Oz’s website includes small print that clarifies that his website is for “information and entertainment purposes only”.  However, I feel that it can be misleading to have information that is not substantiated by scientific evidence used for entertainment purposes.   The disservice comes when the medical profession puts celebrity status and sensational media tactics above their duty to serve the public well being.  Please read the Chicago Tribune article and let me know your thoughts.

Every Child By Two Welcomes Christine Vara as Our

New Co-Editor on Shot of Prevention

By Christine Vara

Who am I?

Well, to sum it up, I am an educated woman with a diverse background in communications and public service.   I’m married to a wonderful man whom I adore, but rarely see due to his dedicated 25 years of military service and frequent deployments.  Fortunately, I have mastered the art of relocating, and recently completed my sixth move in 15 years (which is actually not bad as far as military families go).  Throw in the fact that I have five children between the ages of four and 13 and you can begin to imagine how my life can be complex, to say the least.

Friends and family would agree that I am an overachiever.  While I hate to admit it, I’m also a perfectionist who often struggles with the decisions that I make as a mother.  I would say that while I can make decisions, I struggle with the possibility that I might make the wrong decision, so I commonly belabor every choice.  I try to be fair in how I formulate my opinions as a mother, wife and woman in my day-to-day life.  I believe that there are two sides (or more!) to every story (which is often exemplified in how I deal with arguments between my children).  Most importantly, I believe we all have the right to our own opinions and that a healthy dialogue about our views is the key to greater understanding of any topic.  Which brings me to Shot of Prevention.

Like any mom, the birth of my first child brought about great joy and new choices that I would have to make.  Natural labor or epidural? Pacifier or no pacifier? Breastfeed or bottle feed? Vaccinate or not vaccinate? After much investigation and discussion, I realized that each choice had its own set of pros and cons. Ultimately, the decisions that my husband and I made would forever impact our own lives as well as those of our children.

Parenting choices only continue throughout your life and over the course of the past year, I have come to realize that vaccination is also a lifelong process.  Recently, my oldest child was offered the Gardasil vaccine, my youngest child received a list of immunization requirements for kindergarten and another child contracted H1N1.  I suddenly recognized that vaccines are not just something to concern ourselves with while our children are young.  This is a science that continues to evolve and with the recent  attention on current vaccine news, I am now committed to keeping myself engaged in the dialogue.

Join me on my journey

Unfortunately, what I have found is that the vaccine dialogue can be very clinical, and subsequently confusing, to those of us who are not well versed in “public health speak.”  The challenge lies in seeking out reputable sources of information to assist us in educating ourselves about the benefits, concerns and effective uses of vaccines to protect us from preventable diseases.  As parents, we decipher an enormous amount of information from doctors, scientists and public health advocates, while also being influenced by the questions and concerns of our family, friends and neighbors.  I have been familiar with Every Child By Two (ECBT) for some time now, and have consistently found this organization to be a credible source for fact-based information on vaccine safety.  For this reason, I’m honored to partner with ECBT and the Vaccinate Your Baby campaign as a contributor on this blog.  As a writer and a parent, I will be discussing these issues closely with Shot of Prevention co-editor, Amy Pisani and other ECBT staff on a regular basis.

I invite you to join me on my journey, as I attempt to make sense of the mixed messages I often hear regarding vaccines.  There have been several recent events that have prompted both confusion and curiosity for me, and I hope to reveal them to you on Shot of Prevention .Through the exposure of this blog and other social media venues, I will hopefully encourage an open dialogue where I can not only address various questions of mine, but shed light on a multitude of questions that you may have.  Therefore, please always feel free to leave a comment on my entries or submit questions for future discussion.  I promise to read each and every one of them.