Shot of Prevention

How is it possible that one tiny baby, who only graced this planet for a mere 27 days, can have such an enormous impact on people today?

I believe it has to do with passion…persistence… and the horrible impact of a disease called pertussis.

Kaliah was only 27 days old when she lost her life to pertussis.  However, her life – like every other child’s life – was precious.  And her family – like every other family – did everything possible to try to prevent this tragedy.  Now Kaliah’s family is grieving.  But they are also fighting.  Fighting to find the strength and courage to share Kaliah’s story to spare other families from experiencing their unimaginable pain.

The story begins with the heartfelt words of her young mother, Chelsey, who explains

 “When I first held her, my entire life changed at that moment.” 

She shares the pain of this devastating disease as she reveals the shocking discovery that both she and her baby had pertussis.  She elaborates on the details of the difficult days that followed, as we come to learn that Kaliah would not survive.  One can’t help but feel the sorrow as we hear how Kaliah was suffering.   Chelsey concludes her story by saying,

“I keep telling myself that god gave me Kaliah for a reason, even if I couldn’t have her forever. I knew that when she passed I would make her live on and share her story to save other babies from this horrible disease. I would not let her die for no reason. She was too beautiful for the earth. I am doing my best to educate the world by telling Kaliah’s story.”

According to Shot By Shot, who recently featured this story as one of the many stories of vaccine preventable diseases that they have posted on their website, the details of Kaliah’s life…and death…have already been shared with 1.5 million viewers in just a matter of a few days.  And it’s clear that this story is getting so much attention because it’s touching people in real ways.

Unfortunately, this is just one of the many stories we hear about children dying from pertussis.   There are plenty others like it.  Like Carter’s story, Callie’s story, Gabrielle’s story and many, many more.  In fact, at this very point in time, there are pertussis outbreaks in Washington state, as well as Wisconsin, Colorado and various other states.  People of all ages may currently be suffering with pertussis.  But the worst part is that they may not even know it.  Some, may even be passing it unknowingly on to their own infant children.

Fortunately there is a vaccine to help prevent pertussis.  It’s called a Tdap and it provides immunity for tetanus, diphtheria and pertussis.  However, just because there is a vaccine to prevent pertussis, doesn’t mean people no longer suffer from this illness.  There are a number of reasons why there continue to be outbreaks around the country. Read more…

According to recent reports in The Gainesville Sun, there is a chickenpox outbreak in Florida that has recently spread to five different schools.  Currently, the outbreak involves 65 cases in which 26 children were infected from the Bhaktivedanta Academy, 25 children from the Alachua Learning Center, one child in a public school and 13 others — four adults, eight children and one infant.

Before you go dismissing this as “just a few cases of chickenpox”,  please read Josh’s story, recently highlighted by the Children’s Hospital of Philadelphia.  Josh’s mother, Bev Connelly, talks openly about her son and says,

“… our world changed forever on April 13, 1996, when Josh died suddenly from chickenpox. I couldn’t believe that chickenpox could be that severe. I was one of seven kids, and we had all had chickenpox as children, and we knew lots of other people who had it too. No one had ever died.”

Unfortunately, Bev explains that Josh contracted chicken pox right around the time that the vaccine was first introduced.

“When Josh got chickenpox, the vaccine was new. His doctor was offering it when kids came in for their annual check-up. Josh’s check-up would have been in July.”

Bev goes on to say,

“Sadly, the doctor told me that he had been having trouble convincing parents to get the vaccine for their children. I always believed in vaccines, so I would like to think that I would have gotten the vaccine when it was offered in July, but I never had the chance. When Josh died, the local newspaper ran a story about him. After that, the doctor said he had an easier time convincing people to get their child vaccinated. I wished so much that I still had Josh . . . that I still had that chance to make the decision about the chickenpox vaccine, but I knew, for us, it was too late and I took comfort in knowing that when people heard about Josh, they decided to protect their children from the same thing. It was like Josh’s gift—not only to me, but to others. “

Unfortunately, even 15 years after the vaccine has been introduced, there are parents who still refuse this particular vaccine. Not only are they refusing the vaccine, but there is evidence that some are actively seeking a varicella infection through various parenting forums and social media outlets like the ”Find a Pox Party in Your Area” Facebook page.  People have even been known to mail chicken pox lollipops and other contaminated items to help spread the varicella infection to children in various areas of the country.

Obviously, these actions come from parents that believe it is better to infect their child “naturally” with the live varicella virus than have them attain immunity through the use of a safe and controlled vaccine.  But one must wonder if they have ever stopped to consider that mailing these items are not only illegal, but potentially dangerous as they can be exposing their children to a whole host of other infections.

However, as I read reports regarding the current cases in Florida, there are a few other points that I would like to offer for discussion. Read more…

Each year, our local elementary school organizes a Heritage Night to celebrate the global diversity that exists within our school community.  This special event encourages both students and their parents to share their cultural cuisine, traditional dress and honored customs with one another in an engaging and interactive way.

The first year my family and I attended Heritage Night, I knew very little about the cultural diversity of the 500 elementary students who attend my children’s school in northern Virginia, just outside of Washington, DC.  But now, three years later, I feel privileged to know that my children live in such a diverse community with direct ties to dozens of different countries. The fact is that some of my children’s best friends come from Afghanistan, Bolivia, Ethiopia, Korea, India and many other places around the globe.  Even those students who were born in the U.S. still have family ties in other countries and frequently travel overseas to visit.  Many of them have witnessed the differences in living conditions, schooling and health care that occur in these other  countries and they share these experiences at Heritage Night.

Fortunately, as these children forge friendships with their peers, they gain a better understanding and appreciation of what life is like outside of the U.S.  Heritage Night provides an excellent opportunity to educate children about the importance of being global citizens.  That is not to say that we don’t want them to appreciate their citizenship in the United States.  We certainly do.  However, if we can acknowledge the benefits and privileges that we do have, we can also understand how important it is for us to help others.  By cooperating with other nations, both now and in the future, we can work to address the most important and far-reaching international challenges that exist.

That is especially true when it comes to providing children with a shot at a healthy life.  So, in honor of Heritage Night, I called upon the students and parents who were present to join me in advocating for better access to life-saving vaccines by supporting the UN Foundation’s Shot@Life campaign. Read more…

We covered this before and will no doubt cover it again.

The use of philosophical vaccine exemptions available in many states allow children to attend public schools without the state mandated vaccinations.  In some states, such as Vermont, there is concern about the growing use of these exemptions and how an increased number of unvaccinated children may threaten the health of other students.  There are a number of new laws in various states to address these concerns, some even calling for a more comprehensive discussion of vaccinations benefits before allowing parents to opt out of the required vaccines.

In Vermont a recent bill to remove philosophical exemptions has passed the Vermont State Senate with a 25-4 vote in favor of the new legislation.  However, even with overwhelming support in the State Senate, there may still be a struggle to get it through the House.  Currently, the bill has been assigned to the House Health Care Committee for further review, who are already hearing from opponents of the bill.

A recent op-ed from Dr. Lou DiNicola, a pediatrician at Gifford Medical Center in Randolph and the president of the American Academy of Pediatrics Vermont Chapter ran in the Valley News and the Rutland Herald.  It highlighted the concerns that parents and pediatricians have in regards to the use of philosophical exemptions in Vermont, stating,

“Last year 5.4 percent of all kindergarteners, or more than 1 in 20, were enrolled in public schools by parents who used the philosophical exemption to avoid immunizations. The recent surge in the potentially deadly but preventable disease whooping cough is an indicator of how Vermont’s reduced immunization rate is leading to real-world consequences. Last year the Department of Health reported 91 cases. In 2010 it was only 18.”

If you would like to help protect the health of children in Vermont by supporting the removal of the philosophical exemptions, it’s important that you take action by contacting the Speaker of the House Shap Smith,  the House Health Care Committee and your representative or all representatives.  You can also call and leave a message at the State House for a committee member to call you back at 802-828-2228.

The committee may also be planning a public hearing one evening next week and we will be sure to keep you updated on any further information we receive.  If this bill is to proceed it can not be accomplished without your involvement at this critical time.

Of course, we welcome your comments about this bill and hope you will let us know if you plan to take action to support it.

Representative Shap Smith, Speaker of the House
(802) 828-2245 or speaker@leg.state.vt.us

House Health Care Committee
Mike Fisher of Lincoln, Chair  – (802) 453-5517 or mfisher@leg.state.vt.us
Sarah Copeland-Hanzas of Bradford, Vice Chair – (802) 222-3536 or scopelandhanzas@leg.state.vt.us
Paul Poirier of Barre City, Ranking Member - (802) 476-7870 or ppoirier@leg.state.vt.us, paulpoirier33@gmail.com
Leigh Dakin of Chester, Clerk  – (802) 875-3456 or ldakin@leg.state.vt.us
Jim Eckhardt of Chittenden – (802) 342-0140 or jeckhardt@leg.state.vt.us
Patti Komline of Dorset - (802) 867-4232 or pkomline@leg.state.vt.us
Mary Morrissey of Bennington – (802) 442-2092 or mmorrissey@leg.state.vt.us
Chris Pearson of Burlington – (802) 860-3933 or cpearson@leg.state.vt.us
Kristy Spengler of Colchester – (802) 864-6567 or seashre@msn.com
George Till, M.D. of Jericho – (802) 899-2984 or gtill@leg.state.vt.us
Mark Woodward of Johnson – (802) 635-7166 or mwoodward@leg.state.vt.us

Week after week, I read about doctors who are refusing patients who refuse vaccines.  It’s an ongoing debate that has drawn a great deal of commendation and criticism.

On the one hand, doctors are admired for taking a strong stand in support of timely immunizations.  They typically make these policy decisions based on a number of different reasons.

• They understand that there is no scientific reason to deny vaccines or even delay them.
• They don’t want to see their patients at risk of contracting a preventable disease if they remain unvaccinated.
• They don’t want to put other patients at risk in their waiting rooms.

But until yesterday, I hadn’t even considered that doctors may also want to protect themselves from both liability and disease.

Take the story of pediatrician Dr. Lori Breaux in yesterday’s USA Today article.  Tennessean writer Tom Wilemon explains how Dr. Breaux  had to admit her own 2-week-old infant into an intensive care unit with whooping cough after she had treated a patient with the disease.  Upon reading this I realized that I had never stopped to think about the risk to the doctors.  Not only do they treat patients with preventable diseases, but they can easily bring them home to young or vulnerable family members.

That’s not to say that doctor’s shouldn’t treat these patients.  Of course, that is what is expected.  However, in the case of preventable diseases, I can now understand why a doctor may want to minimize the risk in the same way that Dr. Breaux has done.  She makes parents sign a waiver every time they bring an unvaccinated child in for treatment, because it’s not just about her own personal health, but also about the direct impact that is made upon others when one parent decides not to vaccinate their child.

While it is a doctor’s prerogative as to whether they will treat patients who refuse vaccines or not, I found it interesting to also consider another moral  perspective on this debate.

Just yesterday, Art Caplan from the Department of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine posted a piece on Medscape that urged doctors not to dismiss patients who won’t vaccinate.  He explains,

“…you may have a chance at persuading them to vaccinate their children. I am going to argue that it is important to try hard to not dismiss these people but stick with them to see if you can persuade them.”

Dr. Caplan suggests that there are two reasons that parents hesitate about vaccinations; Read more…

Does the fact that vaccines are not 100% effective mean that they have no value in preventing disease?

Certainly not.

When we are vaccinated, we expect that the shot we receive will prevent us from acquiring certain diseases. After all, vaccinations are injections intended to stimulate the immune system so that it is able to recognize invading bacteria and viruses and produce antibodies to destroy or disable them, thereby preventing disease.  While this is certainly the intent of the vaccination, it is not always the result.

The unfortunate reality is that not every person will generate a protective immune response to a particular vaccine on a given day.  Chalk it up as a scientific limitation of modern-day medicine, but the truth is that vaccines are not 100% effective.

A person could produce an immune response to one vaccine, but not another. Or they could respond well to a vaccine on one day and not another. In fact, some people may never generate a protective response to a specific vaccine no matter how many times they receive it. And since we don’t always know why this happens, we can’t predict exactly when it will happen either. That is why we must accept that just because we are vaccinated doesn’t ensure that we are completely protected.

Fortunately, science does provide a way for us to test whether a person has generated an appropriate response to a vaccine by way of a blood test that is refered to as an antibody titer.  The National Institute of Health defines the antibody titer and explains that it is used to determine:

• The strength of an immune response to the body’s own tissue in diseases such as systemic lupus erythematosus (SLE) and other autoimmune disorders
• Your need for a booster immunization
• Whether a recent vaccine caused a strong enough response from your immune system to protect you against the specific disease
• Whether you have, or recently had, an infection such as mononucleosis or viral hepatitis

The fact that vaccines are not 100% effective actually helps explain why the vaccinated population should remain concerned about the number of non-vaccinated people there are within a community. The number of people immune to a specific disease versus those who are not immune can directly impact the likelihood of disease transmission.  

Certainly it is anticipated that most people will generate the expected immune response.  And even though some people may not have immunity because they are either (1) purposely unvaccinated, (2) too young or medically unable to be vaccinated, or (3) vaccinated but unable to elicit the proper immune response, The National Institute of Health explains they may still be protected through a concept called “community immunity”. Read more…