After losing her son Evan to meningococcal disease, Lynn Bozof’s life became a mission to prevent other families from experiencing similar tragedies. She has since co-founded the National Meningitis Association (NMA), to help educate people about the dangers of meningococcal disease. In this special State of the ImmUnion post, Lynn addresses some of the most common questions parents have asked her about meningococcal disease and the ways it can be prevented.
How would you describe the current “State of the ImmUnion” for meningococcal disease? How many cases of meningococcal disease are there in a typical year? Are enough people protected?
In the 14 years since NMA was founded, vaccination rates have climbed steadily while disease incidence has declined. Although we are pleased with this progress, there is much more work to be done to strengthen the State of the ImmUnion.
Annually, there are approximately 800-1200 cases of meningococcal disease in the United States. As an organization comprised of survivors and families who have lost children to this devastating disease, we at NMA know that one case is too many.
While the Centers for Disease Control and Prevention (CDC) routinely recommends meningococcal vaccines beginning at age 11-12, one in five U.S. teens are not vaccinated as recommended and one-third of those who get the first dose don’t go on to get their booster dose. This leaves adolescents unprotected as they enter some of their most vulnerable years.
What can parents do to protect their families from meningococcal disease?
As a parent who lost my college-age son, Evan, to meningococcal disease, I urge all parents to make sure their child is vaccinated. Vaccination offers the best protection against this disease, and parents should understand that to be fully vaccinated against meningococcal disease, your child should receive two kinds of meningococcal vaccines.
There are five major serogroups of meningococcal disease: A, C, W, Y and B.
MenACWY Vaccine: The Centers for Disease Control and Prevention (CDC) recommends meningococcal vaccination against serogroups A, C, W and Y for all children at 11-12, with a booster at age 16.
MenB Vaccine: After the FDA approved this vaccine in 2014, the CDC made a permissive recommendation for children ages 16-23, with a preferred age of 16 to 18 years.
Because it behaves somewhat differently, the B serogroup was not included in the ACWY vaccine, and it took longer for scientists to design an effective vaccine.
Today, nearly half (43 percent) of all meningococcal disease cases among U.S. teens and young adults are caused by serogroup B. Since MenB is a relatively new vaccine, and not routinely recommended, many parents and healthcare professionals remain unaware of this vaccine. This is particularly concerning since it’s the most common cause of meningococcal disease in adolescents and the cause of several outbreaks on college campuses in recent years. This is why we urge parents to have a conversation with your child’s doctor to ensure your child is fully vaccinated.
My doctor never mentioned a separate vaccine for serogroup B? Why is that?
While the MenACWY vaccine has been routinely recommended since 2005, the MenB vaccine received FDA approval in 2014. That is not to say this is a “new” vaccine. The MenB vaccine has been used in other countries for many years already, and safety and efficacy data from these countries has been extensively reviewed by the CDC’s Advisory Committee for Immunization Practices (ACIP). After FDA approval in the U.S., the Committee gave this vaccine a permissive or “category B” recommendation. Unlike a routine recommendation, this recommendation puts more responsibility on parents to request the vaccine, which is why it is important to be proactive and ask your doctor about it.
Are there certain people who should be particularly concerned about meningococcal disease? How easily does it spread?
Vaccines are recommended for adolescents and young adults because they are at higher risk of contracting meningococcal disease.
The following factors increase the risk of disease: being an adolescent or young adult, spending time in large crowds like parties or dorms, and participating in behaviors like kissing or sharing drinks. But, anyone at any age can contract it.
Other people who are at higher risk for the disease include:
- Infants under 1 year of age
- People living in crowded settings like college dorms or military barracks
- People living with HIV
- Those with persistent complement component deficiency or anatomic or functional asplenia
- People traveling to certain areas outside the U.S. such as the meningitis belt in Africa
- Laboratory personnel who are routinely exposed to meningococcal bacteria
- Those who might have been exposed to meningococcal disease during an outbreak
Meningococcal disease is contagious. It is spread through the exchange of respiratory secretions during close contact such as kissing, sharing drinks or coughing on someone. Although meningococcal bacteria are very dangerous, they cannot live outside the body for very long. This means the infection is not as easily spread as a cold virus. About one in ten people carry meningococcal bacteria in their nose or throat without showing any signs or symptoms of the disease. These people can unknowingly transmit the bacteria to others.
Of those who contract the disease, 1 in 10 will die and 2 in 10 will suffer from long term complications, including deafness, brain damage, or limb amputations.
My child was required to get a meningitis vaccine before middle school. Is she still protected or does she need a booster? If so, when should she get one?
What value do vaccines have in your life?
Throughout July and August, Shot of Prevention is encouraging people to address this question. Today’s guest post, by clinical cardiologist Dharmaraj Karthikesan, provides a personal perspective from someone who is genuinely concerned about the health and well-being of people who choose not to vaccinate themselves or their children.
Here’s what Dr. Karthikesan has to say:
I’ve heard people say that deaths from preventable diseases are the will of God. Indeed all men must die, but not all have to die stupid. I believe ignorance is deadly. Sadly, it can also be contagious.
My issue resides with people who are opposed to vaccination and recently this issue became very personal.
See, I have a new nephew in the family. He lives in another country and so I only get to see him on Skype. However, his parents were considering a visit and I was really looking forward to seeing him. But due to the outbreak of diphtheria in Malaysia, where I live, I advised his parents to postpone their visit. See my nephew hasn’t completed his vaccination schedule and I feared for his health.
My fears are not unfounded. This is the reality we are living in; where our lives are dictated by the decision of others. And every decision not to vaccinate affects the health of others in our community and in our world.
As a doctor, I try to appeal to people’s sense and reason when they tell me that they have decided against vaccinating. Sometimes that communication fails and so I’ve decided to try to employ one other method.
Do you instinctively feel that your child is safe without vaccination?
Do you instinctively feel secure knowing that your child will recover regardless of the infectious disease that they may contract?
Do you instinctively feel impervious to all manner of infectious disease, even those which are airborne, just because you eat a certain diet or take certain homeopathic remedies?
If it is difficult to honestly answer these questions affirmatively, then I beg you to consider what I have to say.
Vaccines are safe.
I state the obvious first. I understand and empathize with those who feel that vaccines are dangerous and those who believe vaccines can be harmful or detrimental to health. Let’s assume that this is true. For a moment, let’s assume they are worse than death, or worse than the defects and disabilities they cause.
Let’s start with polio, which can cause disability and even suffocation if it involves the breathing muscles. Assuming your child recovers from polio, he may never run or play like a normal child. Are you prepared to accept that?
How about diphtheria, which affects your child’s breathing. In severe forms, it can affect the heart and nerves leading to death. Are you willing to take that chance?
Now how about pertussis, which is known to cause violent, uncontrollable coughing making it extremely difficult for a child to get air into their lungs. About half of babies who get pertussis need care in the hospital, and 1 out of 100 babies will die. Is this the kind of suffering you want for your child?
There are serious dangers with all vaccine preventable diseases. However, vaccines work to prevent infection by developing an immunity that imitates the infection. This imitation spares one from suffering with severe illness. Instead, vaccination allows the immune system to develop an arsenal of weapons in the form of’ ‘antibodies’. If your child should ever be exposed to these infections in the future, these antibodies will prevent the infection from spreading to your child by eliminating the threat early and preventing your child from getting sick. It’s quite simple actually. Once the body knows the ‘enemy’, it is better able to defeat it.
So the question that begs for an answer is this;
Do you want your child to be facing these diseases alone, or do you want a strong arsenal of vaccines helping to form a protective shield?
The choice is yours. But that’s the problem actually. Vaccines are a choice and people’s choices are sometimes influenced by inaccurate information.
Doctors don’t make money from selling vaccines.
This guest post was written by Alethea Mshar out of concern for her son Ben. A version of this post originally appeared on her blog Ben’s Writing, Running Mom.
Like all parents, my child’s health is very important to me. That’s why, even after getting an autism diagnosis for my son, I still believe in and advocate for vaccinations.
I don’t believe autism is caused by MMR or any other vaccinations.
The allegations made by Andrew Wakefield, the man who tried to convince the world of an MMR vaccine-autism link, were based on falsified data, yet he continues to make his claim to try to frighten people throughout the world. This article by Brian Deer systematically addresses Wakefield’s flawed theories and debunks the autism myth that Andrew Wakefield has perpetuated.
As if that weren’t enough, there have been countless studies that have investigated any possible link between vaccines and autism and no evidence can be found to support such a link. (You can access the latest published research here, here and here.)
The science is clear, and yet there are many autism advocacy organizations that continue to install fear in parents who just want what’s best for their children.
As this Newsweek article explains:
“Despite the science, organizations involved in the anti-vaccine movement still hope to find some evidence that vaccines threaten children’s health. For example, the autism advocacy organization SafeMinds, —whose mission is to raise awareness about how certain environmental exposures may be linked to autism, recently funded research it hoped would prove vaccines cause autism in children. But this effort appears to have backfired for the organization—since the study they funded failed to show any link between autism and vaccines.”
Alycia Halladay, chief science officer at the Autism Science Foundation, commends SafeMinds for financially supporting the study, but she worries that some autism advocates may be asking the wrong questions.
“I’m not saying that we need to stop funding research in the environment, because we know the environment does impact neurodevelopment,” she says.
However, Halladay explains that organizations that look to blame vaccines for causing autism are “playing whack-a-mole”.
“First, the proposed association was between the MMR vaccines and autism. Then that was disproven. Then it was the thimerosal components in vaccines; now that has been further disproven in a carefully designed animal model study that aimed to specifically examine that question. It has also been suggested that the association is because of vaccine timing, but that too has been disproven. The target always seems to be moving, and the expectation is that scientific resources will be diverted to address each new modification of this hypothesized link.”
While there may always be people who will believe there is a link between vaccines and autism, despite the science that proves otherwise, I’m writing today to explain another issue that has swayed my decision to support vaccines.
This issue is one of life and death for my son Ben.
I realize, very clearly, that without vaccinations my son would die.
That is why I am a fan of modern medicine and the science that makes vaccines possible. If Ben had been born a century sooner, he wouldn’t have survived his Hirschsprung’s disease. Had he been born less than a half century sooner, he wouldn’t have survived leukemia. As it is, we have come face to face with his mortality several times. I see vaccinations along the same lines as chemotherapy – far from perfect, but with the help of the scientific method, getting better all the time. Vaccines, and even chemotherapy in Ben’s case, are the best shot we have at giving our child a long, healthy life.
For us, though, it goes a step further.
Ben is also immunocompromised.
That means that even fully vaccinated, he doesn’t have enough ability to fight off diseases. He is that kid. The kid who needs herd immunity. He’s the reason our whole family gets flu shots and chicken pox vaccines. He’s the kid who needed boosters for pneumococcal vaccines – because his body lost immunity to them. Even though we do our best to protect him, he’s the kid that could get infected during a measles outbreak. And he is the kid whose body is weak and who is very likely to succumb to a disease like measles, which would inevitably hospitalize him or worse…cost him his life.
I wrote this piece after weeks of consideration. I realize this could ruffle feathers. So I ask…
If you don’t vaccinate, have you researched the diseases we vaccinate against as well as the side effects of vaccinations? Have you seen what polio and diphtheria can do? Do you realize that if measles encephalitis sets in that your child will be isolated in the Intensive Care Unit while you wait to find out if he or she is the lucky one who survives with brain damage? And do you realize that, statistically speaking, the greatest risk in getting a vaccine for your child is driving your child to the doctor’s office?
I realize the rhetoric goes around and around, and that I’m about as likely to change your mind as you are likely to change mine. But if there’s that tiny chance that you’re really considering all the facts, I’m hopeful that Ben’s face and plight would make a difference. After all, I am his mother, and I must do everything I can to protect him and keep him healthy. I have to try.
I have a sad feeling that it will take a true epidemic to turn the tide. I just hope that my child will not end up as a casualty. He is not a statistic, nor would I ever want him to be one…he’s our precious child and we don’t want to lose him.
So please remember, your vaccination status could mean the life or death of a child like Ben.
Every Child By Two is collaborating with various immunization advocacy organizations to collect personal stories about the value of vaccines. These stories will then be shared with state and federal legislators throughout National Immunization Awareness Month (NIAM) in August. Help ensure that our government representatives know that our country, our communities, our students and our families deserve protection from vaccine preventable diseases. Join the movement and speak out in favor of vaccines by sharing your story at the following link: bit.ly/28NoZCR.
Three times a year a specialized group of medical and public health experts meet to review scientific data related to vaccine safety and effectiveness. This group, known as the Advisory Committee on Immunization Practices (ACIP), has an enormous responsibility. They establish, update and continually evaluate all the vaccine recommendations that are made in the United States for infants, adolescents and adults. Health insurance coverage of vaccines is based on these recommendations and the ACIP guidelines are considered the gold standard among healthcare providers.
Last week, in their second meeting of 2016, the ACIP discussed cholera, meningococcal, hepatitis, influenza, RSV and HPV vaccines, as well as the safety of maternal Tdap immunization and the laboratory containment of Poliovirus Type 2.
Below you will find a recap of the highlights of the June 2016 ACIP meeting to help keep you informed of the latest ACIP recommendations and considerations.
The most significant and somewhat surprising decision that occurred during last week’s ACIP meeting was that the Committee voted in favor of an interim recommendation that live attenuated influenza vaccine (LAIV), also known as the nasal spray flu vaccine, should not be used during the 2016-2017 flu season.
The vote followed an extensive review of data investigating the effectiveness of the nasal spray flu vaccine over the past three flu seasons. The data showed vaccine effectiveness for nasal spray vaccine among children 2 through 17 years during 2015-2016 was only 3% effective (with a 95% Confidence Interval of -49-37%). In comparison, flu shots had a vaccine effectiveness estimate of 63% against any flu virus among children 2 through 17 years (with a 95% Confidence Interval of 52-72%). This estimate clearly indicates that while no protective benefit could be measured from the nasal spray vaccine in this past season, flu shots provided measurable protection in comparison.
The disappointing vaccine effectiveness data for the nasal spray vaccine during the 2015-2016 season follows two previous seasons (2013-2014 and 2014-2015) that also showed poor and/or lower than expected vaccine effectiveness for LAIV. (More information about past LAIV VE data is available here.)
While it’s disheartening to see data suggesting that the nasal spray flu vaccine did not work as well as expected, the data did suggest that flu shots did perform well and offered substantial protection against influenza this past season. Some patients prefer the nasal spray flu vaccine due to an aversion to needles and may be disappointed in this vote. However, the action taken by the ACIP emphasizes the important role they fill in continually measuring and evaluating vaccine effectiveness. Only after a thorough review of the latest scientific data and discussion among the Committee do they decide to alter vaccine recommendations to ensure that they are in the best interest of the public’s health.
ACIP continues to recommend annual flu vaccination, with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) for everyone 6 months and older and the CDC expects that there should be no shortage of injectable vaccines. However, it should be noted that with the ACIP vote the nasal spray flu vaccine should not be used during the 2016-2017 season and therefore should not be offered by providers or clinics and will not be covered under the Vaccines For Children (VFC) program.
A vote was taken to recommend the vaccine for people traveling to high risk areas.
For more information about cholera visit the CDC travel page here and for up-to-date travel alerts that address various destinations and diseases, we recommend visiting Passport Health’s travel alerts here.
The first part of the discussion of meningococcal vaccines was a consideration of the data on the serogroup B vaccine Trumenba. This particular vaccine is currently administered on a three dose schedule, however Pfizer’s Dr. Laura York indicated during her presentation that the FDA has approved both a 2 and 3 dose schedule based on the data showing both schedules to be considered safe and effective. While immunity data suggests that the 3 dose schedule may confer slightly greater immunity over longer periods of time, the 2 dose schedule would be considered optimal in the case of an outbreak or when it is important to confer rapid immunity. The committee will be reviewing more data on the duration of immunity and the safety of a 2 dose versus 3 dose schedule at the October meeting, before a formal recommendation is made for persons at increased risk, for use during outbreaks or for all healthy adolescents. Read more…
by Judith Shaw Beatty
In 1949, the year I was hit by the poliovirus, 42,000 cases of polio were reported in the United States and 2,720 people died, most of them children.
I was diagnosed with paralytic poliomyelitis, which is experienced in less than 1 percent of poliovirus infections. Not only did it immobilize me completely from the neck down, it also attacked my lungs. It was August, a popular month for polio, and I was six years old.
A few weeks before, my parents, younger sister and I had moved from the outskirts of New York City to Rowayton, Connecticut, which back then was a small town of 1,200 people. My father had gotten a job as associate editor at Collier’s Magazine and my mother was a homemaker, and our new two-story house with its big yard was in sharp contrast to the tiny apartment we had come from.
The poliovirus attacks very quickly.
I was playing with other children at a lawn party and developed such a terrible headache we had to go home. When I woke up the next morning, my legs were so weak I couldn’t stand on them and I could barely lift my arms. It took all day for the doctor to visit the house and examine me, and that night I was taken to the Englewood Hospital in Bridgeport and put in an iron lung.
My mother told me years later that the prognosis was very poor and I was expected to die within hours.
One of the children I was playing with at the party was John Leavitt, who many years later went to work in the field of biotechnology at the Bureau of Biologics of the FDA. Part of his work involved growing live poliovirus, and it was necessary to be tested for polio antibody titre. All those years later, he learned that he must have had the natural polio infection based on the results.
Now, looking back, we realize that while I went home and ended up in an iron lung, John ended up with a flu-like disease with no paralysis. To this day, no one knows why the vast majority of people attacked by the virus recovered with no residual effect and so many others went on to spend the rest of their lives in wheelchairs.
After I was taken to the hospital, the health department put a yellow quarantine sign on the front of our house and at the end of our driveway.
My mother said that when she and Dad would go to the beach in town, people would grab their blankets and umbrellas and move. At the grocery store, my mother said she could hear people whispering and staring. No one wanted to be near my family. Everybody knew of somebody who had died from polio or was crippled by it, and 1949 turned out to be a record year. At its peak in the 1940s and 1950s, polio would paralyze or kill 500,000 people worldwide every year. And there was no vaccine for it, so there was no defense against this invisible, raging monster that struck indiscriminately.
I have no memory of being in the iron lung.
In the past week, Marco Arturo has become an internet sensation.
As a young science enthusiast, he posted a video in hopes of spreading a viral message and preventing viral infections. He is a proclaimer of truth (that’s right, there is no evidence linking vaccines to autism), and a clever entertainer as well (mic drop!). He’s young, he’s hip and he’s obviously got some great adult influencers who’ve taught him a thing or two about evidence-based research.
In case you’ve missed the video, you can check it out here or on Marco’s Facebook page.
The truth is that we need more kids like Marco to speak out about the benefit of vaccines. But first, as adults, we need to help ensure that kids today understand the science behind vaccines.
Do our children realize the dangers of infectious diseases? Do they know the basics about how our immune systems work? Do they have a good understanding of how vaccines help to provide immunity, and can they appreciate the impact that immunity can have on global health?
As the school year wraps up, you may be wondering how you can continue to impart some knowledge on your children this summer. Marco’s video message can serve as a source of inspiration. This is not about encouraging your child to be a famous scientist. This is about making sure they understand their own immune system and how vaccines can keep them healthy. After all, what child wouldn’t want to learn about nasty infectious diseases that invade our bodies and threaten to turn us all into zombies? Oh, sorry, I meant to say turn us into sick people with cooties!
If you’re a parent, grandparent, caregiver or teacher who would like to introduce a young child, preteen or teen to important scientific concepts related to infectious disease, check out the following resources:
Activity Booklet: For the kids who don’t want to catch the cooties, but who are very interested in learning more about them, CHOP’s Vaccine Education Center offers a fantastic 16-page activity booklet that is available in both English and Spanish. This book teaches younger children about vaccines, how they work, and a little about some of the scientists who helped to develop them. You can download the booklet here.
Books: There are lots of books that address the subject of vaccines. One example is The Shots Book, an illustrated children’s book written by teen author Ethan Posard. In this delightful story, author Ethan and his puppy become community immunity superheroes after getting their vaccines. Their experiences help explain how vaccines work, how they protect our health, and how they help protect the health of others in our community. The book is also the basis of several public service announcements being utilized by the Florida Chapter of the AAP as seen below.
Comics: Cimaza comics help educate kids about virology in an entertaining and creative manner. In their featured book The Adventures of the Regatjes, readers discover the fascinating story of an 18-month-old unvaccinated boy who dies as a result of a measles infection. In this engaging story, readers are introduced to amazing characters and end up learning a great deal about virology and vaccination.
In the weekly comic book series Zanzare, readers follow the global mystery of the Zika virus where we meet the mosquitoes implicated in its spread. The story is told through the lens of world mythology, but the virology presented comes straight from reputable journals such as NEJM and The Lancet. Thrilling and intriguing, Zanzare is a visionary mixture of ancient legend and up-to-the-minute fact.
Games for All Ages
The Vaccine Education Center at The Children’s Hospital of Philadelphia has developed several educational initiatives.
Trivia Game: While today’s teens may not be familiar with the once popular game Trivial Pursuit, they probably do remember when Trivia Crack was all the rage. After all, who doesn’t love testing their trivia knowledge? Kids of all ages, and even adults, can test their knowledge of vaccines and learn more about vaccine history, safety and science by playing The Children’s Hospital of Philadelphia (CHOP) “Just the Vax” Trivia game.
Vax Pax Hero: The Vaccine Education Center also offers a web-based video game designed for elementary and early adolescent-aged children called Vax Pack Hero. In this game children can explore different parts of the body, learn more about different germs and help patients to overcome one of 21 vaccine-preventable diseases. To defeat the germs and return patients to good health, players must choose from one of 50 real-life Vaccine Heroes. The heroes come from many backgrounds, to include doctors and scientists who have developed vaccines, as well as engineers, authors, politicians, philanthropists, diplomats, a milkmaid, and even two small children. As players learn more about the real-life accomplishments of each Vaccine Hero, they learn how each of these individuals can be effective in beating different germs in the game. There’s even a way for kids to win free prizes
Solve the Outbreak App: The Centers for Disease Control and Prevention (CDC) has developed a clever app called Solve the Outbreak which is a fun, interactive game that helps kids learn about disease outbreaks and what it takes to contain them. Players receive clues and analyze data in order to solve a case and save lives.
As they work their way up to the title of Disease Detective they must ask themselves, “Do I quarantine the village, talk to people who are sick or ask for more lab results?” While simulating what it’s like to work on the front lines of public health, kids learn to appreciate what it takes to keep a population safe. You can download the app for free here.
Teachers’ Resources & Kids’ Websites
This online destination created by the Centers for Disease Control and Prevention (CDC), is specially designed for kids 9-13 years old. BAM! Body and Mind gives them the educational information they need to make healthy lifestyle choices. By using kid-friendly lingo, games, quizzes and other interactive features, the site teaches kids all about their body and mind. Of course, learning how to prevent disease is important to maintaining our health. In the Disease section, students can learn about CDC “disease detectives” and follow the “Immune Platoon” as they battle against the enemy diseases in the Disease Database. There’s plenty for kids to explore on this site and lots of activities to engage in.
Share Your Suggestions in the Comments Below
These are just a few of the many education materials and resources that can be found on the subject of immunity and infectious diseases. We hope you will take a moment to share your own suggestions in the comments below so that we can all do our best to inspire young minds.
By providing children with a good understanding of the science behind vaccines, we can help prepare them to make critical health decisions throughout their lifetime as patients, parents and public health advocates.