Remembering Nadja, another precious child lost to measles
By Erica DeWald
Europe has been in the midst of a measles outbreak since 2016 which, so far, has resulted in 48 deaths. Unfortunately, many people are at risk, including children who are not yet old enough to receive the vaccine and those with compromised immune systems.
One mother in Serbia has chosen to share the story of losing her young daughter, Nadja, in the hopes that it will encourage other parents to vaccinate their children against measles and other vaccine-preventable diseases.
Nadja was diagnosed with an autoimmune condition when she was a year old. Her hypoparathyroidism, due to hypoglycaemia and hypocalcaemia, meant she could not keep her calcium levels high enough through simple oral therapy. She needed regular IV injections at her local hospital. The condition also made it harder for Nadja to fight infections and placed her among the high-risk group of people who cannot be vaccinated. She instead relied on those around her to protect her from vaccine-preventable diseases.
In January of this year, Nadja was admitted to the hospital but there was no room in the isolation unit. She ended up sharing a room for three days with another li
ttle boy. Her mother, Dragana, later learned the boy had been diagnosed with measles. Dragana recounted,
“At the moment, my world collapsed, I knew that she would get it, but again in the depths of the soul I hoped she will not.”
Three days later, measles caused Nadja to develop a high fever and she fell into a coma from which she never awoke. Despite multiple attempts and two resuscitations over the course of three months to stabilize Nadja, she died on April 4 from heart failure.
Measles is not just a threat in Europe. Here in the United States we are seeing increasing outbreaks of the disease. In the past week health officials have reported confirmed or suspected cases in Oregon and Washington as well as New Jersey. Since 2014, over 1,000 cases of measles have occurred in the U.S. placing communities at serious risk. That’s because it’s one of the most easily spread viruses we know of, and as many as 1 out of every 20 children with measles will get pneumonia, and about 1 child in every 1,000 who get measles will develop encephalitis. As a result, the disease still kills hundreds of thousands of children each year around the world.
Dragana has begun a Facebook page to remember her daughter and to warn others of the deadly consequences of measles. Please take a moment to follow her page and share it with your friends and families in remembrance of Nadja.
Have questions about the dangers of measles or what you can do to stop the spread of outbreaks?
- Read the Centers for Disease Control and Prevention’s measles vaccination recommendations,
- Check out our previous blog posts on measles,
- Ask us your questions in the comments section.
CA Medical Board Takes Action to Protect Children’s Health: Dr. Bob Sears Placed on Probation
By Amy Pisani, Executive Director, ECBT (mother of two fully vaccinated teenage boys)
Last week, the Medical Board of California ordered a 35-month probation for Dr. Bob Sears, an Orange County pediatrician who is best known for hawking an “alternative” vaccination schedule for young children, promoting the unproven theory that vaccines cause autism, and being a champion for parents who seek to claim exemptions from school vaccination requirements.
The revocation of Dr. Sears’ medical license was stayed by the Medical Board, which allows him to continue practicing medicine, as long as he follows certain requirements of his probation including taking Board-approved medical education and ethics classes, and allowing a Board-approved monitor to watch and report on his medical practices. Through this disciplinary order, the Medical Board is providing Sears with a clear warning against future misconduct.
The overall charges against Sears include gross negligence and repeated negligence in his care and treatment of a patient (a child called J.G), and failure to maintain adequate and accurate records. The formal accusation brought by the Executive Director of the Medical Board of California Kimberly Kirchmeyer provides specific examples of Sears’ departures from the medical standard of care, “which require that a physician who is evaluating a patient for possible reaction to vaccines obtain a detailed history of the vaccines previously received as well as the reaction that occurred. Based on that information the physician should provide an evidence-based recommendation for future immunizations.” The accusation continues “the respondent was grossly negligent and departed from the standard of care in that he did not obtain the basic information necessary for decision making prior to determining to exclude the possibility of future vaccines leaving both the patient, the patient’s mother, and his future contacts at risk for preventable and communicable diseases.”
Forbes’ contributor Tara Haelle, who has been following this case against Dr. Bob Sears since last year, noted that:
“the charges involve much more than writing a vaccine exemption letter. According to the accusation, Sears failed to test the same toddler for neurological problems after the child was hit on the head with a hammer and failed to investigate alleged vaccine reactions that, if they did occur, would have been life-threatening. He also prescribed garlic for the child’s ear infection despite there being no evidence of its effectiveness. Such departures from the medical standard of care prompt questions about what other ways Sears might be practicing negligently beyond this complaint.”
Ms. Haelle’s latest Forbes article offers insight into Dr. Sears’ extensive history of anti-vaccination practices and advocacy efforts:
“When physicians practice this type of substandard care, it places children’s lives at risk. Dr. Sears’ bias against vaccines flies in the face of overwhelming evidence of the safety and necessity of timely vaccinations,” Amy Pisani, MS, executive director of Every Child By Two told me.
“With notoriety comes great responsibility. Dr. Sears’ promotion of his ‘alternative vaccine schedule’ has helped perpetuate the myth that vaccines are not safe for children, which is shameful,” Pisani said. “This ruling should send a strong message to providers that the practice of medicine must be based on evidence, not anecdote, and signing vaccine waivers without medical necessity is not an acceptable practice.”
Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law, details the legal ramifications of Sears’ probation and offers insight into Sears’ past actions in a recent Skeptical Raptor post
Like many moms, I was an avid follower of the advice of Dr. Bill Sears, the father or Dr. Bob Spears and the well-known pediatrician who offered advice to parents on child rearing and attachment parenting. Over the last decade, it has been very disturbing to see Dr. Bob using his father’s name and the Sears Parenting Library to sell his books, which contain inaccurate vaccination information and fuel parents’ fears about vaccines. Dr. Bob Sears’ “alternative” vaccination schedule, which encourages parents to either skip or delay recommended vaccines for their children, is dangerous and ignores the importance of following the Centers for Disease Control and Prevention’s (CDC’s) recommended schedule.
The CDC sets the U.S. immunization schedules for children, teens and adults based on recommendations from the Advisory Committee on Immunization Practices (ACIP). The ACIP, which is made up of medical and public health experts, carefully considers many factors, including the safety and effectiveness of vaccines, before recommending a vaccine for use. As a result, the CDC’s recommended childhood immunization schedule (from birth to 18 years old) is the ONLY vaccination schedule for children and teens that is rigorously tested for safety and effectiveness. No “alternative” or “non-standard” schedule has ever been tested. The CDC’s recommended schedule is also endorsed by the leading medical groups including the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). The vaccines in the schedule are carefully timed to provide protection to children when they are most vulnerable to diseases, and when the vaccines will produce the strongest response from their immune system.
Learn more about how the vaccine schedule is determined and why it is never okay to delay a child’s vaccines.
Advisory Committee on Immunization Practices June 2018 Meeting Update
The Advisory Committee on Immunization Practices (ACIP) held their second of three annual meetings at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA last week. ECBT staff took advantage of the opportunity to view the meeting via webcast, and strongly encourage members of the public to take advantage of this technology in order to gain a better understanding of the deliberations that take place to ensure the ongoing safety and effectiveness of the vaccines licensed for use in the U.S.
The CDC sets the recommended immunization schedules for people of all ages in the U.S. based on recommendations from the ACIP. The ACIP establishes, updates and continually evaluates all the vaccine recommendations that are made in the United States for infants, adolescents and adults. These guidelines are considered the gold standard among healthcare providers. The ACIP consists of 15 voting members, 8 ex officio members and 30 non-voting representatives who participate voluntarily. In addition to the three meetings per year, which are open to the public, ACIP members serve on various work groups that are active throughout the year. Work groups review the latest studies on specific vaccines (including safety and efficacy reports), in order to provide recommendations to the larger committee.
Last week the ACIP voted on recommendations for influenza (flu) and anthrax vaccinations, and discussed HPV, mumps, shingles (herpes zoster), Japanese encephalitis, and pneumococcal vaccines. Votes and highlights from the discussions are detailed below.
Influenza (Flu) Vaccination Discussion and Vote
It will come as no surprise to our readers that the flu virus hit a brutal blow to people of all ages during the very severe 2017-18 flu season in the U.S., striking at nearly the same time nationwide.
Influenza A (H3N2) was the predominant circulating strain and this year the effectiveness of the vaccine against this strain was approximately 24% (similar to the previous flu season). Effectiveness against the influenza A (H1N1) strain was 65% and 49% against the influenza B (Yamagata) strain.
Now the good news – vaccination reduced flu-related visits to healthcare providers (outpatient) by 40% among all people ages 6 months and older. Among adults, the vaccine reduced outpatient visits and hospitalizations by 22%.
The ACIP listened to vaccine safety reports provided by representatives from the Food and Drug Administration (FDA), vaccine manufacturers, and the vaccine safety surveillance systems in the U.S. – the Vaccine Adverse Event Reporting System (VAERS) and Vaccine Safety Datalink (VSD) which is a collaboration between CDC and nine healthcare organizations that began in 1990 and analyzes up to 10 million immunization records per year to ensure ongoing safety. After an extensive review of the safety of this season’s flu vaccines, the ACIP confirmed that there were no vaccine safety signals of concern including anaphylaxis, narcolepsy and Guillian-Barre Syndrome, each of which received increased scrutiny due to a number of news and anecdotal reports in recent years.
The ACIP approved the following influenza recommendations for the 2018-19 season:
Everyone 6 months of age and older should be vaccinated with any licensed, age-appropriate influenza vaccine (IIV, recombinant influenza vaccine [RIV], or LAIV), as indicated. No preference is given for any one vaccine over another. In its February meeting, the ACIP once again recommended LAIV (the nasal spray vaccine known as FluMist) for healthy, non-pregnant people 2 through 49 years old during the 2018-19 season. This recommendation was made after ACIP reviewed effectiveness data presented by the manufacturers of FluMist.
Of Note: The Redbook Committee of the American Academy of Pediatrics, who typically endorses the recommendations of the ACIP, have stated a preference for the flu shot (IIV or RIV) over the nasal spray vaccine (LAIV), recommending that pediatricians only give the nasal spray as a last resort. This decision by the AAP is not without controversy as it may lead to confusion among parents and their providers. ECBT Board Member Dr. Paul Offit recently created a Medscape video explaining why he agrees with the ACIP’s decision to recommend the use of FluMist in children based on the effectiveness data.
Pneumococcal Vaccination Discussion
Two pneumococcal vaccines are currently recommended for all adults over the age of 65 – one dose of pneumococcal conjugate vaccine (PCV13) with a booster dose of pneumococcal polysaccharide vaccine (PPSV). ACIP is re-examining whether PCV13 should be routinely recommended for otherwise healthy older adults. Some experts believe the childhood recommendations for routine vaccination with PCV13 is sufficiently lowering the disease burden in adults by reducing the circulation of the disease in communities. In data presented to the ACIP, however, it seems there are persistent disparities in the rate of pneumococcal disease and vaccine uptake 
among minority populations and those in poverty, which puts into question whether it would be wise to eliminate the vaccine recommendation for adults. The ACIP will continue to deliberate the data and have continued discussions into 2019.
Anthrax Vaccination Discussion and Vote
The anthrax vaccine is currently approved for use by the FDA for 18-65 year olds, and is usually given to select populations of adults (i.e. military). As the Department of Health and Human Services (HHS) and CDC review their plans for responding to an anthrax “mass event”, they have asked ACIP to offer guidance on how best to use the vaccine in the event of emergency. Specifically, they asked ACIP whether the anthrax vaccine would be equally effective and safe if they had to administer the vaccine in fewer or smaller doses to ensure there was enough vaccine for everyone affected. Also under consideration was the utilization of different types of needles to be used in the event of a needle shortage. The current vaccine is given subcutaneously, not intramuscularly, like typical vaccines. Intramuscular needles are therefore more readily available.
After reviewing the data, the ACIP agreed unanimously that reduced dosing would still save lives, as would offering the vaccine intramuscularly instead of subcutaneously. There was no data, however, on whether reduced doses given intramuscularly would be equally effective. The Committee also offered their recommendations on the duration of antimicrobial treatment following vaccination. There is a new intramuscular anthrax vaccine on the horizon which may help federal agencies better plan for a possible emergency situation.
The ACIP made the following recommendations:
The intramuscular route of administration may be used if the subcutaneous route presents clinical, operational, or logistical challenges that may delay or prevent effective vaccination.
- Should there be an inadequate supply of anthrax vaccine available for Post Exposure Prophylaxis (PEP), either 2 full doses or 3 half doses of AVA may be used to expand vaccine coverage.
- In immunocompetent individuals 18-65 years of age, antimicrobials given in conjunction with vaccine may be discontinued at 42 days after the first vaccine dose or 2 weeks after the last vaccine dose, whichever comes later.
Japanese Encephalitis Vaccination Discussion
The cell culture-derived Japanese encephalitis vaccine (JE-VC) is both safe and effective, but given how few U.S. travelers contract the disease, ACIP is re-evaluating their recommendations. They are in the midst of re-evaluating the cost effectiveness of the vaccine and whether their recommendations should be more targeted. ACIP will continue deliberations at a future meeting.
Mumps Vaccination Discussion
Mumps outbreaks continue to crop up throughout the nation. From late 2016 through 2017, there were 56 outbreaks, which included 3,914 cases, and in 2018, there have already been 30 outbreaks, including 1,415 cases. The ACIP previously recommended the use of a 3rd dose of mumps virus-containing vaccine (MMR) for people identified at increased risk during a mumps outbreak. 
During the June, 2018 ACIP meeting, the CDC provided guidance for public health officials to assist them on the use of a 3rd dose of MMR vaccine during an outbreak, including identifying groups of people at risk for acquiring mumps during an outbreak; assessing transmission in the settings to determine if groups are at increased risk; and how to implement a 3rd dose recommendation.
Shingles (Herpes Zoster) Vaccination Discussion
In October 2017, ACIP made recommendations for a new recombinant zoster vaccine (RZV) called Shingrix. The vaccine is recommended for the prevention of shingles and related complications for adults 50 years of age and older. It is also recommended for adults 50 and older who previously received zoster vaccine live (ZVL), and it is preferred over ZVL for the prevention of shingles and related complications.
GSK, the manufacturer of Shingrix, reported to the Committee that it is increasing the number of doses available due to high demand and shipping delays. They are also continuing to study the safety and effectiveness of the vaccine. The CDC also continues to monitor shingles vaccine coverage and vaccine supply. As it does with all vaccines, the CDC is using U.S. safety surveillance systems – VAERS and VSD – to monitor the shingles vaccine (RZV). VAERS is a passive system that is not designed to determine if a vaccine caused a health problem, but does help to detect unusual or unexpected patterns of adverse events that might indicate a possible safety problem with a vaccine. The CDC reported that were 680 reports to VAERS between October 20, 2017 and April 27, 2018, and the majority concerned females. There were no unusual patterns or unexpected adverse events. 48 (7%) of reports involved co-administration with 1 or more other vaccines, and the most commonly reported side effects from RZV were injection site pain and pyrexia (fever).
The CDC also reported to ACIP about VSD monitoring of the shingles vaccine. The staff of the VSD conducted vaccine safety studies based on questions and concerns raised from the medical literature and reports to VAERS. As of May 31, 2018, 37,303 total doses of RZV were administered at the participating VSD sites. The VSD monitoring for RZV includes high priority short-term outcomes (GBS, anaphylaxis, and acute myocardial infarction); lower priority short-term outcomes for descriptive analysis (gout, local and systematic reactions); and longer-term outcomes (potential immune-mediated diseases). Evidence of safety and effectiveness of shingles vaccine in immunocompromised is currently being reviewed.
The CDC has created a number of resources for RZV. For providers, the CDC developed a report published in MMWR on vaccine administrative errors, a Continuing Medical Education program (CME) called “You Call the Shots”, a Medscape video, web pages, webinars/conferences and fact sheets. For the public, the CDC created a vaccine information statement (VIS) on the RZV, web pages and a fact sheet.
Human Papillomavirus (HPV) Vaccination Discussion
In October 2018, the FDA is expected to complete a review of scientific studies to determine whether 9-valent HPV vaccine (GARDASIL®9) is safe and effective for use in adults ages 27 to 45. The vaccine will continue to serve as a prophylactic to prevent new infections, and is not expected to prevent progression of the disease among those who already have a HPV infection. The ACIP is also simultaneously reviewing the evidence that has been sent to the FDA and will determine whether to recommend the vaccine if and when the FDA approves the vaccine for use among mid-aged adults. Factoring into the ACIP decision will be the fact that the overall population-level benefit will be lower among mid-aged adults than among younger populations. This is due to the fact that this
population may have already been exposed to HPV and thus already have an infection, or have immunity against some strains of the disease. In addition they tend to have fewer new sex partners and have several other factors that will make the vaccine less beneficial (but not without merit) for this older group than for those ages 11-12, who can be vaccinated prior to exposure.
The ACIP’s HPV work group is also continuing to review data in consideration of “harmonizing” the schedule for males and females so that both populations would be recommended up to the age of 26 instead of up to age 21 for males and up to age 26 for females and will report back to the full ACIP at a future meeting.
ECBT will keep you informed on this and other deliberations of this important committee.
Learn more about each of these vaccines and the diseases they prevent on the Vaccinate Your Family website and Facebook page.
With School Vaccine Exemptions on the Rise, What Can Be Done to Protect Our Students?
Today, PloS Medicine published a study that examined the increase we are seeing across the country in philosophical exemptions to school vaccine requirements, also known as personal belief exemptions.
According to the authors, 12 of the 18 states that allow philosophical exemptions have seen an increase in parents choosing to exempt their children from one or more vaccines. As a result, several metropolitan areas are at risk of an outbreak of disease, such as measles, similar to the one we saw originate at Disneyland in Anaheim, California three years ago.
The Washington Post notes that the study “characterized many rural counties, as well as urban areas, as ‘hotspots’ because their high exemption rates put them at risk for epidemics of measles, whooping cough and other pediatric infectious diseases.”
Amy Pisani, Executive Director of Every Child By Two/Vaccinate Your Family, expressed concern about what is known as the “community protection threshold” by stating,
“It’s alarming to see the rise in exemption rates across this country, putting communities at greater risk. Parents need to understand that timely vaccines are critical to protecting children’s health and should be at the top of the family’s to-do list.”
While the study reveals some interesting data points, there’s little information as to why it appears that parents are increasingly claiming exemptions for their children.
In most states, the school vaccine exemptions tend to be elevated in a handful of communities, as opposed to a general rise in exemptions throughout the state. It appears that more research needs to be done to better inform public health policymakers regarding the underlying reasons parents are exempting their children from school required vaccines.
In the meantime, some of the states with the highest levels of exemptions have passed legislation to make nonmedical exemptions more difficult to obtain. For example:
- In Washington state, a law was passed that required parents to have their exemption form signed by a health care provider.
- In Oregon, parents have the option of watching an online module on the dangers of not vaccinating or getting a form signed by a health care provider.
While both states saw an immediate and encouraging reduction in the number of exemptions claimed, it appears that these policies have not been effective over time and exemptions are once again on the rise.
- In Washington, the state’s kindergarten exemption rate fell from 6% to 4.5% in the first year following the new policy. Five years later, however, the rate has increased slightly to 4.8%.
- In Oregon, the rate dropped from 7% to 5.8% the year after their new law went into effect. Just three years later, more kindergarteners than ever – 7.5% – are now exempt from one or more vaccinations.
Tightening laws and policies clearly does not keep those parents who are intent on seeking exemptions from obtaining them. But how about eliminating nonmedical exemptions?
After the 2014-2015 measles outbreak in California, the state legislature decided to eliminate all nonmedical exemptions. Again, one year after the law was passed exemption rates fell dramatically and, most importantly, vaccination rates rose well above community immunity thresholds, thus better protecting communities against disease outbreaks.
But what will the future hold? Will parents who have philosophical reasons to avoid vaccines for their children find ways to obtain medical exemptions?
Initial data suggests that may be the case. According to an article in JAMA, the California medical exemption rate reflected a three-fold increase following the introduction of the law, from 0.17% to 0.51%. According to the article’s authors,
“Some vaccine-hesitant parents may have successfully located physicians willing to exercise the broader discretion provided by SB 277 for granting [medical exemptions]…If true, this practice would be inconsistent with the recommendation from the American Academy of Pediatrics to reserve [medical exemptions] for children having contraindications.”
In the coming years, public health partners may have a better sense of whether eliminating nonmedical exemptions can sustainably increase vaccination rates and protect our communities against dangerous vaccine-preventable diseases. We will also be looking to additional studies to learn how many parents are choosing exemptions because they have true personal objections to vaccinations, or because they don’t view vaccination as a priority among their long back-to-school lists.
In the meantime, it’s important to help state legislators and the public understand what has been tried to-date and what are the most promising policy paths forward.
Here are some ways that you can be informed and help to inform others:
- Consider sharing Vaccinate Your Family’s fact sheet on the impacts of exemption legislation with your local lawmakers to remind them of their role in strengthening our defenses against vaccine-preventable disease.
- Check out Vaccinate Your Family’s 2018 State of the ImmUnion report to learn more about federal policies that aim to protect our families and communities from dangerous diseases.
- Help ensure children are better informed about how diseases develop and how vaccines work with the immune system by sharing specially designed science curricula from The Vaccine Maker’s Project with school nurses and science teachers at your local elementary, middle or high schools.
- Find out more about the vaccination rates in your state and community by contacting your local schools, public health department or reviewing the latest CDC vaccination coverage reports.
- Stay informed about the latest immunization news and research by following Vaccinate Your Family’s Facebook, Twitter and Instagram accounts, subscribing to this Shot of Prevention blog and sharing the information we discuss on these channels with your social contacts.
Together we can work to ensure that students get the protections they deserve in their schools and communities.
American Cancer Society Announces Goal to End HPV Cancers
It has been 12 years since the FDA approved the first HPV vaccine. To mark the occasion, the American Cancer Society has launched a public health campaign with one very ambitious goal – to eliminate vaccine-preventable HPV cancers.
Since the HPV vaccine has been proven to be so highly effective, experts and organizations in the U.S. and around the world are talking about how the vaccine can be used to eliminate HPV cancers, starting with cervical cancer. As one of the most respected cancer organizations in the world, the American Cancer Society is uniquely positioned to lead the fight against all HPV related cancers.
How do they plan to achieve this goal?
By using their Mission: HPV Cancer Free Campaign to increase HPV vaccination rates for preteens to at least 80% by June 2026, the 20-year anniversary of the FDA’s approval of the first HPV vaccine.
Considering the number of adolescents who are receiving other recommended vaccines, like the meningococcal vaccine, this objective seems both reasonable and achievable.
However, in order for the vaccine to prevent any of the six HPV related cancers, such as cancer of the cervix, vulva, vagina, penis, anus, head and neck (also called oropharyngeal cancer), children need to be vaccinated before potential exposure. By getting children vaccinated as recommended, at 11-12 years of age, parents can help ensure the vaccine is administered before sexual activity begins, and when studies show children to have the most optimal immune response to the vaccine.
While the HPV vaccine has been shown to be both safe and effective, the unfortunate reality is that only about 40% of boys and girls in the U.S. are fully protected with the recommended 2 or 3 doses of HPV vaccine. This is unfortunate because we know that 9 out of 10 adults will have an HPV infection at some point in their lifetime.
Many of these HPV infections may eventually clear up on their own. However, the fact remains that some infections will develop into dangerous cancers years, or even decades, after initial exposure. While doctors routinely screen for cervical cancer, there are no recommended cancer screening tests for the other 20,000 cases of cancers caused by HPV infections each year in the United States. Considering that there are often no early symptoms of these cancers, many of these cases will go undetected until they have progressed to a late and dangerous stage.
This is why HPV vaccination is so important. Preventing cancer is always better than treating it.
So how can you help the American Cancer Society in their goal to end HPV cancers?
Parents:
Educate yourself about HPV and make sure the children in your life are vaccinated. Read some of the most common myths about HPV vaccine here and help to dispel these myths by sharing accurate and evidence-based information about HPV and HPV vaccination with your friends and family.
Learn more about HPV and HPV vaccination, by reviewing the informative new resources that have been developed as part of the American Cancer Society’s Mission:HPV Cancer Free campaign, to include the following:
- Take a Shot at Cancer Handout
- HPV: Don’t Wait to Vaccinate
- Protecting Our Children From HPV
- HPV Vaccine: Just the Facts For Parents
Also, hear the stories of HPV cancer survivors and the providers who have cared for them to consider why prevention is critical in our fight to end cancer.
Clinicians and Health Care Providers:
Your strong recommendation is the biggest predictor of whether your patients will receive timely HPV vaccination. To ensure you are prepared to make the most of your discussions with your patients and their parents, check out the library of provider resources available on the National HPV Roundtable website. There is even a special suite of Clinical Action Guides tailored to six different professional audiences, to include:
- Physician/Physician Assistant/Nurse Practitioner Guide
- Nurse & Medical Assistant Guide
- Dental Health Professionals Guide
- Large Health Systems Guide
- Office Team Guide
- Small Private Practices Guide
The goal of the Mission: HPV Cancer Free campaign may be to increase HPV vaccination, but the purpose behind the goal is our ultimate motivator. With the HPV vaccine, we have the power to prevent cancer, and that is something that deserves a chance. By uniting in this endeavor, we can change lives, save lives and make HPV cancer history.
What You Don’t Know About Hepatitis Can Hurt You
More than four million Americans are living with viral hepatitis, but most don’t know they’re infected.
Many people can live with hepatitis for decades without feeling sick or exhibiting any symptoms. But left untreated, there are three different types of viral hepatitis which can cause serious health problems, including liver damage, liver failure, liver cancer or even cirrhosis, a condition that causes permanent scarring of the liver.
In honor of Hepatitis Awareness Month, learn how the different types of viral hepatitis are spread, as well as how they can be prevented or treated.
Hepatitis A
Hepatitis A can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.
It is usually spread by contact with people who are infected or from contact with objects, food, water or drinks contaminated by the feces of an infected person, which can easily happen if someone doesn’t properly wash his or her hands after using the toilet. It’s important to know that not all people with hepatitis A have symptoms, but it’s more likely for adults to have symptoms than children. If symptoms develop, they usually appear two to six weeks after being infected and may include:
- Fatigue
- Nausea and vomiting
- Loss of appetite
- Fever
- Dark urine
- Gray-colored stools
- Joint pain
- Yellowing of the skin and eyes (jaundice)
- Severe stomach pains and diarrhea (mainly in children)
The good news is that hepatitis A is easily prevented with a safe and effective vaccine. For the best protection, it is recommended that children receive two doses of Hep A vaccine with the first dose being administered between 12 and 23 months of age, and a second dose administered 6 to 18 months after the first dose. Adults who have not been previously vaccinated, or who are at risk due to their work or travel. should also be vaccinated. Since the introduction of the vaccine, cases of hepatitis A have plummeted across the country. However, outbreaks still do occur.
Currently, there are reported outbreaks in West Virginia, Kentucky and California in which hundreds of cases have been identified and several deaths have occurred. This is why all everyone should ensure they are protected against hepatitis A.
Hepatitis B
People who get infected with the hepatitis B virus, especially young children, can go on to develop a chronic or lifelong infection which can cause serious liver damage, liver failure, liver cancer or cirrhosis.
Hepatitis B virus can be spread through contact with an infected person’s blood, semen, or other body fluids. This may happen when someone has a cut or sore, when someone is bitten by another person (as in the case of children in daycare), through the sharing of a toothbrush or food has been chewed (like in the case of young children), from an infected mother to her baby during childbirth, through sexual contact, or by sharing needles, syringes, or other drug-injection equipment.
Not all people with hepatitis B have symptoms. However, if they occur, they usually appear about three months after infection and can range from mild to severe, including:
- Dark urine
- Fever
- Joint, muscle and stomach pain
- Loss of appetite
- Nausea, diarrhea and vomiting
- Fatigue
- Yellowing of your skin and the whites of your eyes (jaundice)
The best way to prevent hepatitis B is by getting vaccinated. The vaccine is recommended for:
- All infants, starting with the first dose of hepatitis B vaccine within 24 hours of birth. This shot acts as a safety net, reducing the risk of a child getting hepatitis B from moms or family members who may not know they are infected with the disease. Additional doses of the vaccine should be given between 1 and 2 months, and between 6 and 18 months of age.Newborns who become infected with hepatitis B virus have a 90% chance of developing chronic Hepatitis B, which can eventually lead to serious health problems, including liver damage, liver cancer, and even death. This is why the birth dose has been an extremely effective way of reducing the risk of chronic Hepatitis B infection.
- All children and adolescents younger than 19 years of age who have not been fully vaccinated against hepatitis B
- Unvaccinated adults at risk for hepatitis, in addition to any adult who wants to be protected from hepatitis B.
Unfortunately, many people got infected before the hepatitis B vaccine was widely available. That’s why the CDC recommends that anyone born in areas where hepatitis B is common (such as Asia, the Pacific Islands or Africa), or whose parents were born in these regions, get tested for hepatitis B.
You can learn more about who may be at increased risk of hepatitis B here. Fortunately, treatments are available that can delay or reduce the risk of developing liver cancer.
Hepatitis C
For some people, hepatitis C is a short-term illness, but for 70%–85% of people who become infected, it becomes a long-term, chronic infection which can cause serious liver damage and even liver cancer over time. Unfortunately, the majority of infected people are not aware of their infection because they are not clinically ill.
In the past, hepatitis C was spread through blood transfusions and organ transplants. However, widespread screening of the blood supply began in 1990 and the hepatitis C virus was virtually eliminated from the blood supply by 1992. Today, most people become infected with hepatitis C by sharing needles, syringes, or any other equipment to inject drugs. For reasons that are not entirely understood, people born from 1945 to 1965 are five times more likely to have hepatitis C than other age groups.
Unfortunately, there is currently no vaccine to prevent hepatitis C. However, once diagnosed, most people can be treated and cured in just 8 to 12 weeks, reducing liver cancer risk by 75%. This is why awareness and testing is so critical.
The CDC has developed an online Hepatitis Risk Assessment to help people find out if they should get tested or vaccinated for viral hepatitis.
The assessment, which takes only five minutes, will provide personalized testing and vaccination recommendations for hepatitis A, hepatitis B, and/or hepatitis C. Take it today and protect yourself from these viruses that can so easily go undetected.
Nurses, Teachers and Mothers All Influence Immunization Uptake
This week is not only National Nurses Week, but it’s Teacher Appreciation Week and soon to be Mother’s Day. As I sat down to acknowledge nurses, teachers and mothers, one person came to mind – Mary Beth Koslap-Petraco, DNP, PNP-BC, CPNP
If you ever get the chance to meet Dr. Koslap-Petraco, there are three things you will immediately recognize.
She is a leader among nurses.
She is incredibly passionate about immunization education.
And she adores her family – especially her mother.
A few years ago, Dr. Koslap-Petraco shared the story of how her mother’s life was forever altered by polio. In honor of her mother, Mildred Bliss Koslap, who recently passed away at the age of 98, I want to share her story once again. The Koslap family story is a reminder of the role that mothers, nurses and teachers have in ensuring that people of all ages embrace immunization as a way to prevent debilitating diseases.
Dr. Koslap-Petraco begins the story by explaining that it was the summer of 1923, and her mother was only three years old:
“During that period in our history, it was common for families like mine to escape the heat of New York City and travel upstate to cooler weather. That summer, the family chose to reside in a guest house in Utica, NY. My mom arrived to Utica a fully-functioning and fun-loving child, but on a subsequent Sunday morning, she remembers not being able to get out of bed due to paralysis on the right side of her body. She was able to scream out for help initially, but her voice consistently diminished throughout the day, only to disappear for a week.
Her father called for medical assistance, but during this time in Utica, people strictly followed what were known as Blue Laws—forbidding any type of work or major exertion to be made on Sunday. With time, my grandfather was able to convince a kind-hearted Jewish doctor to come over. He instantly recognized my mother’s condition as polio. The periodic massages and other treatments that my mother had to undergo were hassle enough for a young child, but the emotional strain for her was even worse.
After a short time, her siblings were not allowed to play with her, for fear that they might come down with polio themselves. And when my mother—born left-handed—entered school, she was constantly punished by the nuns who directed her to write using her right hand. What they did not understand was that my mother had lost the ability to grasp objects with this hand as a result of her polio. To this day she remains able to hold nothing more than a glass of water with her right hand.
To me, it’s important that I never lose sight of the experiences like this that my mother and her family had to endure that one hot summer in 1923. What’s even more important is that I acknowledge the fact that polio is no longer a significant threat to the health of people in America. Science and research have delivered so much to us, including the means to eliminate the threat of major preventable diseases like polio.”
Mildred appears to have had a great life, raising three strong, successful and independent daughters and living to know not only five grandsons, but seven precious great-grandchildren. But that doesn’t mean she didn’t suffer throughout her life from her experience with polio at the age of three. Her scars served as a constant reminder of the dangers of polio – a disease that greatly impacted her life, her parents’ lives, her siblings’ lives and even the lives of her children, grandchildren and great-grandchildren.
As a mother, I’m happy that my children will never have to suffer through the same experiences that Mildred did. I’m even grateful that my own parents chose to vaccinate me as a child and that they raised me to value the preventive power of vaccines.
I’m thankful to all the nurses who take the time to educate others about the benefits of vaccines, care for people who are suffering from vaccine preventable diseases, and bear the responsibility of administering vaccines. I’m also encouraged by non-profit organizations like Nurses Who Vaccinate, which help to position nurses and other health care professionals as vocal vaccine advocates among their colleagues, patients, and the public.
And I’m grateful to all the teachers who do their part to educate people of all ages about the dangers of infectious diseases and how vaccines can help to boost our immune system. I’m especially impressed with organizations like The Vaccine Makers Project which offers scientifically supported, historically accurate, and emotionally compelling content that teachers can use in the classroom to help excite young people about the power of vaccines.
While polio does still exist in the world, we are extremely close to eradicating it, thanks to the success of vaccines. However, as long as there are communities with polio vaccination rates that fall below the 80-86% level that is needed to prevent the spread of the disease, there is still a risk of a polio outbreak As you take the time to thank mothers, nurses and teachers this week, be sure to also learn more about polio and polio prevention on the Vaccinate Your Family website.
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