Shot of Prevention

It’s important for doctors, nurses, health care professionals and parents to keep informed about changes to the recommended immunization schedule.    Today’s report from the American Academy of Family Physicians (AAFP) details the changes to the 2012 schedule as suggested by the CDC’s Advisory Committee on Immunization Practices (ACIP).  Some of the more significant changes concern the following:

Tetanus, diphtheria and acellular pertussis vaccine administration among health care personnel and pregnant women.  Specifically, if pregnant women have never received the Tdap vaccine, it is recommended that they be immunized during their second or third trimester rather than in the immediate postpartum period.  Addionally, for children who received Tdap as a catch-up dose at age 7 through 10 years, “an adolescent dose should not be given.”

Routine administration of hepatitis B vaccine in people with diabetes. 

The addition of the quadrivalent human papillomavirus vaccine for boys and young men.  In regards to boys, the HPV4 vaccination is recommended in boys 11 to 12 years of age, with catch-up vaccinations at age 13 to 21.  However, it is acceptable to begin HPV4 vaccination in boys as young as 9 years of age. 

A booster dose of the meningococcal vaccine for children at age 16 is now recommended.  The previous schedule recommended immunization at age 11 or 12, but due to waning immunity and higher risk in the late teen years, the new booster recommendation is intended to ensure that protection is maintained through the high-risk window, which occurs between 16 and 21 years, when many are living in close quarters, such as in college dormitories.

It also should be noted that the ACIP recommends that children 6 months to 8 years of age receive two doses of influenza vaccine during the current season if they did not receive at least one dose of the vaccine during the 2010-11 season.  It also clarifies the guidance for clarifies the guidance for giving the flu shot to kids with egg allergies. For more complete details on the changes, please refer to the following resources:

2012 Immunization Schedule for Children 0-6 years

2012 Immunization Schedule for Adolescents 7-18 years

2012 Adult Immunization Schedule

If you should have any questions, let us know and we will attempt to direct them to our scientific advisory board for clarification or response.

Last week, there was quite a lot of discussion about a YouTube video entitled, “Why This Nurse WON’T Vaccinate” that was posted by a woman who refers to herself as the “Patriot Nurse”.  I wrote a blog post here on Shot of Prevention that included the video, along with a point by point commentary from a vaccinating nurse who I refered to as the Canadian Nurse.  Since the Patriot Nurse didn’t allow comments on her YouTube video, my intent was to generate an open discussion here on Shot of PRevention, where we are proud to allow differing views in our comments.  As you can see, the post received quite a few comments and since it’s never been our policy to censor them, you can understand the debate that this video has sparked.

Well today I want to update you on some recent developments with The Patriot Nurse.

It appears that the statements made in the video by The Patriot Nurse were troubling to many people, including blog writer Martine O’Callaghan who writes for Autismum and Nerditorial. She too wanted to write about this video and bring it to the attention of her readers. However, she first tried to verify the identify of The Patriot Nurse, in order to establish her educational and occupational background and experience. That prompted her to write a letter to a birthing center in TN where she believed Ms. Greene (aka The Patriot Nurse) has been employed.

Ms. O’Callaghan explains in her recent blog post that she was in no way calling for the dismissal of The Patriot Nurse.  She simply wanted to verify whether this person representing herself as a nurse on the video was currently working for the birthing center.  She also inquired as to whether the Patriot Nurse’s views on vaccination coincided with the policies of the birthing center.  After all, if a member of the birthing center’s staff has opted out of vaccination, shouldn’t the pregnant women giving birth there be informed of this?  After all, there are dangerous vaccine preventable diseases that can be life threatening to an infant who is still too young to be vaccinated and many cases where infants have died as a result.

It appears that since our last posting, The Patriot Nurse took down the YouTube video and has since made a statement on her Facebook page that suggests that her employer had some questions for her in regards to it.

Certainly, there is nothing wrong with a woman sharing her personal opinions regarding vaccines on YouTube, right?

Unless you are a nurse who attempts to speak as an authority on the subject of vaccines and you happen to have direct contact with pregnant women and newborns, is that it?

So, where exactly does the line get drawn?   What are the ethical implications here?  What are the consequences to these actions?  And what should they be? 

I’m curious to hear what you think in regards to this topic?    However, I feel it is only fair to start off with a comment we received from the Canadian Nurse who first attempted to correct some of The Patriot Nurse’s misinformation.  She commented for Shot of Prevention as follows:

Good morning angry supporters of The Patriot Nurse (TPN).

No one is debating your RIGHT to choose whether or not to vaccinate. But if you have the right to NOT vaccinate, then a patient – especially parents who …will be giving birth to a vulnerable neonate under your care – should have the right to choose whether or not you act as their nurse.

NO one is after The Patriot Nurse’s job. A science writer for a legitimate science zine contacted her work to verify her identity. Which is exactly what a responsible writer does before publication – verifies a source.

Non-vaccinating nurses at other hospitals have to take isolation per-cautions(gloves, gown, mask). This is to protect them and protect the patients. Regardless of whether YOU think vaccines work – science sure thinks that they do, and the employers have a right and a duty to protect those under its care.

The Patriot Nurse is a sham. She states in her video that saying this comes as a great cost to her as a nurse. If she so firmly believes in her anti-vaccination rhetoric – so much so that she would post it online AND STATE THAT SHE WAS A NURSE – then she should be well aware of the potential consequences.

All of you crying “free speech” are being deceived. The Patriot Nurse has deleted EVERY SINGLE comment that was not entirely supportive of her. You can’t claim that her free speech is in jeopardy while she refuses that right to others.

The Patriot Nurse made a video. A stupid video. In which she makes very very basic scientific errors. She was called to answer to those errors on her page, on this blog, on Orac’s blog and elsewhere. She refused to do so. She is not interested in having a dialogue. She had her little diatribe and that was that. NO ONE is so special that they can make sweeping, erroneous statements without recourse.

I know that you anti-vaccination activists have a lot of other anti-vaccination friends online. But the fact of the matter is that 94% of people are still vaccinating. You’re a blip on the radar. You’re the new “trendy” thing to be against. But when it comes down to it, all but a handful of people are intelligent enough to realize that:

1) there is NOT a global conspiracy of scientists and doctors trying to poison your children

2) a few bad nurses or doctors do not discount the whole of the scientific method; nor are the opinions of a few more valid than the opinions of millions

 3) researching vaccines on Google is NOT equal to going to post-secondary education for 10+ years to be a physician, pediatrician, immunologist or what have you.

The Patriot Nurse is not a martyr. She is a nurse who is expected to uphold the ideals and principles of her nursing organization and employer. And seeing as those things adhere to evidence-based medicine – and she doesn’t – she now has a problem. She brought it on herself. It was her choice not to vaccinate, and it their choice (and DUTY to the public) to deal with her how they see fit.

A Tribute To Bob Keegan, by Amy Pisani

Bob Keegan at ECBT’s 20th Anniversary Gala in October – I was so thrilled to see him after many years.

This past Monday an my old friend, Bob Keegan, succumbed to his battle with cancer.  Since hearing the news, I’ve struggled to find the words to write about his incredibly selfless efforts to save the lives of literally millions of children; partly because I know that he’d be the first to demand that instead I should go out and take a hike with my bike…literally, or grab a beer and toast him instead.  Yet, I can’t help but wonder whether he was aware that in addition to dedicating his own life towards saving the lives of people throughout the world, that he inspired untold numbers of his peers to strive to also make a difference in the lives of others?  Bob Keegan was the type of man who always gave credit to others for the accomplishments that so often he himself envisioned and facilitated.

When Bob was in his early twenty’s he began his 30 year career with the Centers for Disease Control and Prevention (CDC) within the branch that is known as STD control (sexually transmittable disease control) working as a public health advisor in Newark, NJ, New York City and eventually Atlanta, GA – home of the CDC.  He helped to develop the first pre- and post-test counseling for HIV/AIDS during a time when the nation was first coming to grips with what would soon become a sexually transmitted disease epidemic.  He then spent five years coordinating CDC’s efforts to assure that refugees from Southeast Asia were properly immunized and treated for communicable diseases.

In 1991, Bob joined the newly formed Polio Eradication Activity Section of CDC along with five other dedicated individuals and a budget of only $3 million.  As the deputy director of what is now called the Global Immunization Division, the staff grew to 110 with a budget of $150 million.  Since 1988, the number of polio cases reported worldwide declined by 99 percent!  That translates into a disease that once infected 350,000 people every year in South Africa and Asia, now affects 1,000 children each year.  Yet, as I celebrate the writing of that number; I just felt Bob smack me over the head to tell me that 1,000 children is unacceptable when that number is zero here in the U.S.  Of course he is right, and so the charge continues on. Read more…

January has been a busy month here on Shot of Prevention.  We’ve had a parent speak out on the significance of HPV protection for her son, a pharmacuetical employee comment on how proud she is to help ensure the safety of vaccines, we’ve even had a nurse call out the non-vaccinating Patriot nurse for sharing misleading information on YouTube.  Of course, let’s not forget about the return of Andrew Wakefield and his plans to sue for libel. 

Which leads me to a great editorial that appeared this morning in The Huffington Post, entitled Unencumbered By Facts: What Upsets Me Most About the Anti-vaccine Movement.  In this article, Claire McCarthy, M.D, who is a pediatrician at Children’s Hospital Boston, Harvard Medical School, explained why the appearance of Andrew Wakefield on Good Morning American had given her the chills.  (View it for yourself and you’ll see exactly what she is referring to.)

She explains that “My only crusade as a pediatrician is to keep my patients healthy — and vaccines are part of what I use to do just that.”  But she questions how doctors are supposed to help parents understand the enormous benefits and occasional risks of vaccines when “We stick to the facts. But people like Andrew Wakefield don’t.”

Dr. McCarthy does a great job of communicating her frustration and explaining the challenges the medical community has in countering the much publicized anti-vaccine rhetoric.  And while she speaks as one individual pediatrician, I would venture to guess that many others have echoed her views, but are, as she described, often “drowned out” by the headlines and airtime devoted to people like Andrew Wakefield.

She concludes her article by referring to what Wakefield says at the end of the Good Morning America interview;

 ”Wakefield encouraged parents to get educated, and to read about immunizations. He even suggested the CDC website. He said, emphatically, that there are two sides to the story.  I couldn’t agree more. But just one of them is grounded in facts.”

I applaud Dr. McCarthy for speaking out and I encourage you to read her article.  Of course, you are encouraged to not just listen to her opinion, but to get the facts.  Vaccinations save lives!

If you follow immunization news at all, than you probably know the name Andrew Wakefield pretty well.  In fact, you’re probably tired of hearing it.

Personally, I try to avoid hearing it, reading it or even mentioning it, because when I do I get a big knot in the pit of my stomach.

I’m not trying to be dramatic.  It’s just that I believe this one man has done more to interfere with immunization advancements all across the world than anyone else in recent history.  And to be honest, that really upsets me…as a mother, as an American and as a global health advocate.

What surprises me most about Andrew Wakefield is how many people continue to idolize him as a direct result of one poorly executed study of just a handful of individuals conducted so many years ago.  He has miraculously managed to garner so much support among people that they often act as if they are brain-washed cult followers.  In their eyes, everything Wakefield says is truth and he can do no wrong.  In fact, every time I hear someone credit Wakefield, or even defend him, I can’t help but wonder if they’re just desperate to root for the underdog and convince themselves that the “establishment” is working against them.  How does he work his magic and convince people that he speaks “the truth” when the courts, and the science, continue to defy him?

It doesn’t seem to matter that the co-authors of Wakefield’s discredited study retracted their claims long ago.  It doesn’t matter that The Lancet, which initially published the study, retracted it in its entirety back in February, 2010.  It doesn’t even matter that the British General Medical Council determined that Wakefield was guilty of serious professional misconduct and as a result, stripped him of his medical license.  Despite all this, he somehow continues to persuade countless parents to forego MMR vaccinations, leaving children vulnerable to dangerous and sometimes life-threatening diseases.

When will his followers recognize that critical research funds have been spent disproving the hypothesis that Wakefield was never able to adequately prove?  And why won’t they accept the various allegations that Brian Deer so elaborately exposed in detail over a year ago?

It’s as if the gig is up, but none of his loyal followers are willing to admit it. Read more…

While you’ll often hear public health departments warning of influenza this time of year,there is also reason to be concerned over another contagious disease.   It’s known as ”whooping cough”, or pertussis, and it’s a highly contagious bacterial infection that can result in prolonged coughing spells that often lasting for weeks or even months. While one may think that coughing is just inconvenient, people with pertussis often cough violently and rapidly, over and over, until the air is gone from their lungs and they are forced to inhale with a loud “whooping” sound.  Pertussis can even lead to pneumonia, seizures, brain damage, mental retardation, and even death.

Statistics show that 50 out of every 10,000 people with pertussis will die and 90% of pertussis-associated deaths have been among babies less than one year old.  Since children are not fully immunized against pertussis until they receive all five doses of their DTaP vaccine (recommended at ages 2, 4, 6, 15-18 months and 4-6 years), infants are relatively unprotected and extremely vulnerable.  Since their bodies are unable to effectively clear the thick mucus from their chest if they do contract pertussis, the physical impact of this disease is often too much for them to handle.

While most children get immunized, under-immunization, as well as undiagnosed patients, can both contribute to the spread of pertussis.  For instance, children don’t always complete their immunization series.  Often, those who suffer with pertussis often mistake their illness as a persistent cold and never get properly diagnosed.  They often don’t realize that they could be spreading infection to others through the droplets in the air caused by their coughing and sneezing.  It even common for many teens and adults not to realize that their immunization has waned and that they need a Tdap booster shot in order to extend their protection.  That is why public health workers, doctors and even OB/GYNs, are now encouraging Tdap shots for adults, especially those who are in close contact with infants. Read more…