Currently, the ACIP recommends that adolescents receive the quadrivalent meningococcal conjugate vaccine (MCV4) at ages 11-12, with a booster dose at age 16, to protect against the A, C, W and Y strains of meningococcal bacteria. Statistics show that nearly 80% of teens have received at least one dose of this vaccine, which is fairly remarkable considering the fact that the vaccine is recommended, but is not mandated for school or college in most states. However, it’s important that parents realize that the MCV4 vaccine does not prevent serogroup B meningococcal disease, which currently accounts for 1/3 of all U.S. cases of meningococcal disease and has been spreading through college campuses in recent years.
Fortunately, two new vaccines to protect against meningococcal serogroup B were recently approved by the FDA. The Trumenba vaccine is developed by Pfizer Pharmaceuticals and requires three doses, and the two-dose Bexsero vaccine was developed by Novartis Vaccines and Diagnostics (GSK acquired Novartis Vaccines in March 2015, excluding the Novartis influenza division). After these vaccines received FDA approval in late 2014, the ACIP recommended a meningococcal serogroup B vaccine (MenB) for certain high-risk groups at their next meeting in February 2015.
However, many people questioned why the recommendation wasn’t for a broader population. If the ACIP recommends that all adolescents protect themselves with the MCV4 vaccine, why wouldn’t they also be suggesting parents protect their children from the dangers of serogroup B as well? Read more…
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.
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.
This 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.
I 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…
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).
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…
By, Rebecca Bakke MD, FAAP
As a pediatrician, I am often asked the question, “What would you do if she was your child?”
I 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.
My 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.
Claire 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.
Claire 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.
Being a mom to Molly and Frankie is, without a doubt, the most rewarding role I’ve ever had. As we prepared to welcome another baby into our home this fall, I was reminded of just how fragile and precious a newborn can be.
In recent interviews with Fox News and CNN, I shared my concerns over the growing number of unvaccinated children in the area where we live. It frightens me to think that my baby may possibly be exposed to a dangerous and life-threatening disease before he is old enough to be vaccinated himself. It seems unfair that while I do everything in my power to protect this delicate new life, others are making a choice that puts my child at serious risk.
I have real reason to worry. When my second daughter Molly was just 10 months old she contracted whooping cough (also known as pertussis). As any parent can relate, it’s scary when your child gets sick, but it’s especially upsetting when you realize that your child is part of the largest outbreak of whooping cough in over fifty years. As an advocate for Every Child By Two’s Vaccinate Your Baby initiative, I was all too aware of the fact that whooping cough can be deadly for infants, and yet here we were facing that terrible diagnosis. We were incredibly fortunate that Molly fully recovered, but I’ll admit that I was completely rattled by the experience.
Fortunately, since that time, scientists have been closely examining the possible causes for the large number of whooping cough cases over the past few years and have made recommendations aimed at curbing the outbreaks. Part of the problem is that the immunity against the disease is wearing off so that people throughout the U.S. are less immune to whooping cough. Therefore, it’s more important than ever for infants to receive all five recommended doses of the DTaP (diphtheria, tetanus and pertussis) vaccine, followed by the booster shot of the adult version of the pertussis vaccine (Tdap) at 11 or 12 years old. It’s staggering to note that 83% of infants who are diagnosed with whooping cough got it from a family member, most often their own parents. Therefore, adults need to make sure they get a Tdap booster before a new baby arrives to protect themselves and to stop the spread of the disease to infants, who are most likely to become seriously ill from the disease.
Most important for newborns, the CDC’s Advisory Committee on Immunization Practices took a good hard look at the pertussis research and concluded that we can best protect newborns by ensuring that pregnant women receive an adult Tdap booster in their last trimester of each pregnancy. By getting vaccinated during pregnancy, not only was I protected, but antibodies were transferred to my baby through the placenta, providing my baby with protection against pertussis before he could start getting DTaP vaccine at two months of age. So I followed my doctor’s advice and not only received the Tdap vaccine during my last trimester, but I also got a flu shot.
Just as I have the ability to protect my newborn from pertussis, I also have the ability to protect him and other members of my family from influenza. I’ve learned that due to changes in a pregnant woman’s immune system, heart and lungs, I was more prone to serious complications from the flu such as pre-term labor and delivery, hospitalization and even death. And, since children can’t be vaccinated against the flu before six months of age, everyone in our family must do all we can to protect our baby boy. With my child being born in the midst of flu season, I wanted to do everything I could to protect him from a disease that causes more than 20,000 children under the age of five to be hospitalized each year. I find it upsetting to learn that with all the medical resources available to us here in the U.S., last year’s flu season claimed the lives of 109 precious children.
I’ll admit that as a parent I’m concerned about the threat of vaccine-preventable diseases, especially as a result of people choosing not to vaccinate. But I refuse to stand by and watch as others put my children’s health at risk. By getting the flu and pertussis vaccines during my pregnancy, I felt empowered that I could do something positive to protect my child. And you can too.
Talk to your doctor if you have questions about vaccines. In addition, encourage your friends and family to utilize the resources provided by reputable organizations, such as Every Child By Two and the American College of Obstetricians and Gynecologists. And be sure to immunize yourself and your entire family.
After being notified that he and his family were exposed to measles, Dr. Tim Jacks signed on to the family’s online CaringBridge journal to vent his frustration. His 3 year old daughter Maggie is fighting acute lymphoblastic leukemia (blood cancer) and as a result has a compromised immune system. His 10 month old son Eli received all his recommended vaccines, but is too young for his first dose of MMR (measles, mumps and rubella) vaccine. The children were with their mother at a Phoenix Children’s Hospital clinic when they were exposed to measles. Frustrated and concerned, Dr. Jacks wrote a journal entry as though he was speaking directly to the person who was responsible for putting his family at risk. The next day, Kid Nurse reprinted the story and Dr. Jacks and his wife were soon being interviewed by various national news outlets, to include CNN, FoxNews as seen here:
Dr. Tim Jacks, DO, FAAP is board certified by the American Board of Pediatrics and a fellow of the American Academy of Pediatrics.
As an Every Child By Two Immunization Champion, he has given us permission to share his story here on Shot of Prevention, as well as on our Vaccinate Your Baby website. Every Child By Two has also invited him to present testimony in front of the U.S. Senate Health, Education, Labor and Pensions Committee on The Reemergence of Vaccine-Preventable Disease: Exploring the Public Health Successes and Challenges at 10am on Tuesday, February 10, 2015.
We hope that his personal experiences will help educate Congress about the plight of those who depend on herd immunity and the importance of protecting those who are most vulnerable to vaccine preventable diseases.
To the parent of the unvaccinated child who exposed my family to measles:
I have a number of strong feelings surging through my body right now. Towards my family, I am feeling extra protective like a papa bear. Towards you, unvaccinating parent, I feel anger and frustration at your choices. Read more…
Rafiki, the wise old mandrill in Disney’s Lion King movie, made a profound statement that is extremely relevant to the current U.S. measles outbreak that began in Disneyland in December, 2014:
Yes, the past can hurt. Infectious diseases have a history of being dangerous and deadly.
All you have to do is look at history to see how many millions of lives have been lost, or how many people have been permanently disabled, by infectious diseases. It’s no small number. And, there’s a long list of diseases that we can now prevent that have been leading killers in the past. Today, vaccination greatly reduces disease, disability, death and inequity worldwide. Vaccines given to infants and young children in the U.S. over the past two decades will prevent 322 million illnesses, 21 million hospitalizations and 732,000 deaths over the course of their lifetimes. While it’s hard to see what doesn’t occur, the fact remains that vaccines save lives and prevent suffering.
Some people will choose to run from the past. They’re called vaccine refusers.
No matter how much scientific evidence there is to prove vaccines are responsible for the incredible reduction of disease worldwide, there will always be some people who will run from the truth. They either debate it, or simply ignore it. These are the people who purposely refuse vaccines. Sometimes they focus their efforts on trying to pin every possible ailment known to man (from SIDS, asthma, allergies, autism, etc.) on vaccines. Other times they focus on the risk associated with vaccines. In the case of the MMR vaccine, they prefer to focus on the less than a one in one million chance of a serious adverse reaction rather than the fact that one or two of every 1,000 children who have measles will likely die. What is particularly frustrating is their tendency to ignore the present reality as well as the past. In cases when the scientific community has investigated their concerns, they ignore the findings because they fail to support their previously held beliefs.
Most people have learned from the past, but remain at risk from those who haven’t.
Thankfully, the overwhelming majority of people vaccinate. These are the people who actively try to protect themselves, their families, and others in their community, by contributing to the benefits of herd immunity and trying to reduce the transmission of vaccine preventable diseases. Unfortunately, the minority can sometimes jeopardize the herd.
Take the Van Tornhout family for instance. Today mark’s the fifth anniversary of their daughter Callie’s death. Callie was exposed to pertussis before she was old enough to begin her DTaP (diphtheria, tetanus and pertussis) vaccination series. Her story was featured on CNN last week, as an example of how concerning the current measles outbreak is. Unfortunately, there are many children under the age of one who are too young to receive the regularly scheduled MMR (measles, mumps, rubella) vaccine who are at increased risk of complications of measles as a direct result of this outbreak.
Sadly, the Van Tornhout’s can’t run from the past. Every day without their daughter Callie is a reminder of why they must continue to educate people on the importance of vaccines.
Stories like Callie’s are shared repeatedly. On the national news. On various social media sites. On websites and blogs. And even around the family dinner table. We share these stories so people will realize that these diseases still pose a threat to our children, especially those too young to be fully vaccinated. Unfortunately, some people remain conflicted about the lessons of the past. On the one hand, they consider vaccinating to protect themselves and their children from these preventable diseases because they hear stories about children like Callie. But on the other hand, they’re frightened by prolific misinformation that reinforces their suspicions that vaccines may be harmful. For fear of making the wrong decision, they fail to make the responsible decision to vaccinate, which then results in a decision which jeopardizes the health of everyone else in their communities.