Every Child By Two’s “State of the ImmUnion” campaign is honoring National Immunization Awareness Month (#NIAM16) with a Blog Relay highlighting the importance of vaccines across the lifespan. In this second guest post we hear from a California colleague who has a particular interest in Maternal-Child Health.
Dr. Elizabeth (Betsy) Rosenblum, who is a Professor of Clinical Medicine at UC – San Diego Health System, with joint appointments in the Departments of Family Medicine & Public Health and in Reproductive Medicine, works hard to help protect pregnant women and their babies from pertussis.
The shattering loss of a child is something no family ever wants to experience. Unfortunately, this year in California, two families have suffered this loss in a particularly devastating manner. These two children, both under six months of age, died from a vaccine-preventable illness: whooping cough.
Whooping cough? Isn’t that a disease from the past, like bubonic plague or smallpox?
The unfortunate answer is no. Whooping cough, or pertussis, is a disease that is still very much with us. It can infect both children and adults. It is most dangerous, however, for young infants. When whooping cough infects babies under two months of age, 90% will be hospitalized, 2-4% will suffer seizures, and 1 in 100 will die from complications of the disease.
How do infants get whooping cough?
The sad fact is, they get it from those around them. The disease is spread by infectious droplets in the air and is highly contagious. Adults with pertussis infection, who may only have a mild cough, may not realize they have the disease. And, tragically, adults have been shown to be a frequent source of infection to infants with whom they have close contact.
Is there any way to prevent pertussis in infants?
Fortunately, we have a vaccine, called Tdap. We know that when pregnant women are vaccinated during mid-pregnancy, their body has time to pass protective antibodies to their babies. These antibodies can help protect infants from the disease, until they are old enough to mount an immune response to their own pertussis vaccine.
I am a family physician, and care for many pregnant women and young families. I know from experience that some pregnant women are hesitant to get a vaccine, wondering if this might harm their growing baby. I try my best to explain that the opposite is true: that getting Tdap vaccine during pregnancy is far safer for their baby than NOT getting the vaccine. If born without protective antibodies, babies risk getting sick and dying from a potentially preventable disease.
Some of my patients tell me “I’ll get the Tdap vaccine, but I want to wait until after the baby is born.” Certainly, getting the vaccine is better than never getting it. However, this plan offers far less protection. In order for a baby to have protective antibodies circulating in his/her system from the moment of birth, the vaccine must be given at least 3-4 weeks prior to delivery. Currently in the United States, the recommended time of Tdap vaccination for pregnant women is between 27-36 weeks (6-8 months of pregnancy).
I care for some pregnant women whose children are closely spaced in age. When these women reach 27 weeks in a given pregnancy, I recommend Tdap. On occasion, they will tell me “I don’t need it, because I had it last year in my prior pregnancy.” However, in order to protect a newborn from whooping cough, a pregnant woman needs Tdap in each and every pregnancy. It is only when a woman receives the vaccine in a current pregnancy that she sends an abundant and protective amount of antibodies into the baby growing inside of her.
In order to protect infants from whooping cough, do other family members need to be vaccinated?
The answer to this question is a resounding YES! All family members, caregivers, and others who will be around an infant should be certain they are up-to-date with Tdap vaccine. When everyone around a baby is vaccinated, this provides a ‘cocoon’ of protection, greatly minimizing the chances a baby will get sick from the disease.
Children need five DTaP vaccines(the pediatric form of Tdap) at 2, 4, 6, 15 months and between ages 4-6. They need a Tdap booster at age 11. Adult men only need a single lifetime Tdap. Adult women only need a single lifetime Tdap, unless they are pregnant, in which case they need a Tdap in every pregnancy.
If a murderer was on the loose in California, intent on harming babies, there would be an immense outcry and demand for protection. Well, that murderer is pertussis. And, the best way to protect every infant from this disease is to spread the word of the importance of both maternal Tdap vaccination and vaccination for all members of our communities.
To determine what vaccines are needed before, during and after pregnancy, take a brief Pregnancy and Vaccination Quiz or visit the Pregnancy section of the Vaccinate Your Family website.
Dr. Rosenblum has completed a fellowship in Vaccine Science and Safety through the American Academy of Family Physicians. She chaired the Tdap Working Group in 2010, which coordinated UCSD’s response to the California pertussis epidemic. Her innovative work in designing and implementing a Tdap Cocooning Clinic led to her receiving the APhA Immunization Champion Award in 2011. She was chosen by the CDC to be the Childhood Immunization Champion for the State of California in 2014, in part due to her work in educating pregnant women and their families regarding the importance of childhood immunizations. She currently serves on two Advisory Committee on Immunization Practices (ACIP) work groups; the Tdap Work Group and the Combined Vaccine Work Group. She is also on the Steering Committee of the San Diego Immunization Coalition.
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.
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.
What Have We Learned From Last Year’s Measles Outbreak?
Last year the United States experienced a large, multi-state measles outbreak that was largely responsible for 189 measles cases that spread across 24 states and the District of Columbia. It’s believed that the outbreak started from a traveler who contracted measles overseas and then visited the Disneyland amusement park in California while infectious. Widespread media coverage of the outbreak helped elevate public concerns related to the dangers of measles infection, the consequences of a growing number of school vaccine exemptions and the risks of disease among those who were too young or medically unable to be vaccinated.
At this time last year, it seemed as though we were experiencing a tipping point; a growing number of people were beginning to realize that vaccine refusal had consequences that could threaten our nation’s public health. The fact that the personal decisions of a select few people was able to threaten herd immunity and the health of many unsuspecting families and communities was worrisome.
It was believed that more parents (including some who had previously refused vaccines) were seeking and accepting vaccination for their children as a direct result of the outbreak. However, to determine whether clinicians were experiencing any real or lasting changes in vaccine acceptance, Medscape conducted a survey of vaccine providers to find out.
The survey, conducted in July of 2015, included 1577 physicians, nurse practitioners and physician assistants who worked in pediatrics, family medicine and public health. Responses confirmed that the measles outbreaks induced more acceptance of the measles vaccine and vaccines in general. The survey also indicated that, for some parents, a greater acceptance of vaccines was directly related to the fear of the disease, the consequence of being denied admission to schools, daycares or camps, and a greater knowledge about vaccines as a result of more reading on the subject. However, in some cases there was no change.
Every Child By Two also experienced a heightened amount of interest in the months during and immediately following the outbreak with a record number of inquiries from parents. Most were asking for information about the dangers of measles infection and for clarification of the MMR (measles, mumps and rubella) vaccine schedule. There were many parents who were specifically inquiring as to the possiblity of vaccinating their children before the recommended age in order to protect them during the outbreak. Shot of Prevention blog posts that included content specific to measles infection and MMR vaccination had record numbers of views in the early months of 2015, and personal stories relating to the outbreak, were widely shared on social media.
One story that drew a lot of attention was an open letter by Dr. Tim Jacks, whose two children had to be quarantined after they were both exposed to measles at a Phoenix Children’s Hospital clinic. His 3-year-old daughter Maggie had a compromised immune system as a result of fighting acute lymphoblastic leukemia (blood cancer), while his 10 month old son Eli had received all his recommended vaccines, but was still too young for his first dose of MMR vaccine. While neither of his children ended up contracting measles, the frustration he expressed in his letter entitled “To the parent of the unvaccinated child who exposed my family to measles” hit a nerve with a lot of people.
The Focus of Immunization Rates Fades as Cases Dwindle
In reaching out to Dr. Jacks this week, it appears that the attention on vaccinations that was raised during last year’s outbreak appears to have been rather short-lived. He explained,
“As a pediatrician, I regularly discuss vaccines, exemptions, and last year’s outbreak. The cold facts and data only reach so many, so my family’s story adds a personal angle to the issue that questioning parents rarely consider. After the media exposure, many families were aware of our situation. However today, the measles issue is not on as many people’s minds. Vaccine exemption is however a hot issue in Arizona. The Arizona political arena is considering avenues to encourage vaccination and I am hopeful that the coming year will produce progress in that regard.”
Today, a little over a year since the outbreaks began, the good news is that there have only been two reported measles cases so far in 2016. However, it also appears that history may be destined to repeat itself.
Consider, for example, the reports out just this week about a California charter school student who tested positive for measles after returning home from traveling overseas. With just 43% of kindergarteners at the Yuba River Charter School being up-to-date on their MMR vaccine, the California Department of Public Health has attempted to prevent a measles outbreak by first closing the school to all students, and then remaining closed to those without a measles vaccine until April 8 as long as no new cases are documented.
Despite overwhelmingly high vaccination rates across the country, with a mere 1.7% national vaccine exemption rate among kindergartener’s for the 2014-2015 school year, and a 90%+ coverage of MMR vaccine among 19-35 month old children, these small pockets of unvaccinated children continue to present a risk of future measles outbreaks. Read more…