Yesterday California Governor Jerry Brown signed a childhood vaccination bill into law along with a letter stating, “The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases. While it’s true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community.” The hash-tagged, much discussed bill (#SB277) was co-authored and proposed to lawmakers by Dr Richard Pan, a pediatrician and CA state senator in Sacramento. The law, SB 277, establishes one of the toughest mandatory vaccination requirements in the nation for school children and those in child-care centers. As imagined, the process of getting the bill into law was not for the faint of heart. Riding on realities of necessary community immunity unveiled during the 2014-2015 Disney measles outbreak, the idea of mandating vaccines for public health still ignited evocative and divisive bullying campaigns on social media.
Testimony before the state senate was reported to be passionate, evocative, and compelling from both sides. The law passed the senate by a 24 – 14 vote and went to the governor. By signing the bill into law yesterday, Governor Brown acknowledges a tenet in public health and vaccination: vaccines are for individuals, yes, but they also serve to protect others — those especially vulnerable and not. Read full post »
Two new Pediatrics studies are out this week teaching us more about the effectiveness of the whooping cough vaccine. Lots to learn about how we protect babies and reminders here why we’re immunizing moms during EVERY pregnancy:
First, the good news: traditionally we have been trained to tell parents that the first shots we give during infancy aren’t fully protective for infants but rather the beginning of creating immunity against the diseases they prevent. However, a study conducted by researchers at the CDC looked back at cases of infants with pertussis from 1991-2008 and they found evidence that babies who received their whooping cough shot as early as they could, at the age of 6 weeks, were less likely to be hospitalized and/or die from the infection. Wonderful news! The first evidence out there that even that first shot, when given as early as possible, helps protect very young infants who are most at risk from whooping cough. New parents can increase protection, even during outbreaks like we’re having right now, by getting their babies immunized on-time and as early as possible.
The not so good (but important) news: the effectiveness of the Tdap shot given to young teens (explained more below) doesn’t always provide long-lasting protection and wanes significantly in the years after the 11-year-old booster dose is given. New research out found after 1 year, about 70% of teens are still protected from the booster, but by 4 years after the shot only about a 1/3 of them are. More:
There’s a beautiful story of success tucked away in the recent measles outbreak in the United States. Sometimes we forget to talk about it. When measles popped up at Disneyland in December 2014, it made headlines as the public remained thirsty for the media’s support in understanding who was at risk and why. I spoke to dozens of media outlets about the outbreak, under-vaccinated populations, the MMR vaccine, and how to protect those most vulnerable during an outbreak. We all emphasized those at biggest risk: infants too young to be immunized, those who were unvaccinated, or those too ill to be vaccinated. Measles is an illness I would be terrified to get — and I don’t like that people who aren’t protected are at risk for both catching the disease and spreading it. I think the public gets this in new ways although I hate that it takes outbreaks to capture attention and drive this education and understanding.
Measles virus, and the vaccine we have to prevent it, form a unique pair because although measles is wildly infectious and can be life-threatening the immunization is wildly effective and life-saving (>99% of those immunized are protected for life). It is a safe vaccine with minimal side effects. What a fortune and a triumph in prevention medicine. A terrible disease, once thought to be eradicated in the U.S., is swiftly prevented by a vaccine that nearly everyone in the population can get after their 1st birthday.
The measles outbreak continues to spread, with 121 cases now reported in 17 states (CDC data as of February 6th). Many states are getting serious about detailing why exemptions for vaccines exist and looking at ways to better protect the population. This week in the Seattle Times three local pediatricians speak out for removing both personal choice and religious exemptions to protect the public and vulnerable children. And here, Dr Paul Offit writes about religious exemptions asking, “What Would Jesus Do About Measles.”
There’s no question vaccines are having their moment. We are working through tough questions. In the Seattle Times piece, Drs. Diekema, Opel, and Marcuse keenly point out:
We hold dear both freedom of choice and public health.
Finding an optimal balance is clearly of great import. This will take great advocacy and work to help continue to build trust in the MMR vaccine that is safe and highly effective at preventing measles infections.
Though I’ve been lucky enough to avoid seeing measles thus far in my medical education and career, this serious, uber-contagious disease has given some parents and caregivers pause when it comes to putting their unprotected (read: too young to vaccinate) infants in a situation where their health could be compromised. Many mothers have emailed, tweeted and Facebook messaged me asking how they can protect their little ones who haven’t received their vaccinations yet and my simple answer is this: cocooning. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections. Read full post »
Many parents around the U.S. are asking what to do about a possible measles exposure with a baby at home who is too young to be immunized. Should they stay home? Can they travel? Should they cancel that trip to Utah or to Vermont or even to Disney next month? Can they head out to the store without worry? Are they “safe?”
I hate that I can’t completely say they are safe. Measles is wildly contagious and during an outbreak it can spread, especially to older infants who aren’t vaccinated yet. The good news is that risk is low (more than 90% of us won’t get measles because we’re vaccinated so we also won’t spread it to you!). Some parents are also wondering about getting the vaccine before the baby turns 1 year because they’ve heard the recommendation for infants traveling abroad: infants traveling outside the U.S. are recommended to get an MMR (measles, mumps, rubella) shot if they are over 6 months of age (of note, babies who get the shot as an infant also get the usual shot again at 12 months of age). Without travel plans we wait to immunize babies with their first MMR vaccine until they are 12 months of age. Over 95% of babies who get the shot at 12 months of age are protected against measles and over 99% are protected for a lifetime after the 2nd dose (given at least 1 month later). Wow, right?
“This is not going to be the end-all-be-all post on protecting your infant or child from measles'” Dr Matthew Kronman, a pediatric infectious disease expert at Seattle Children’s, reminded me as we chatted today. Advice and guidance for protecting babies and children will change as we learn again how to protect our population from measles infection while unvaccinated pockets of people remain.
The CDC warns that the outbreak could grow (there’s over 100 cases in 14 states as of today) and nationally there’s a palpable dialogue going on between the herd (those immunized) and those not. Politicians are involved — Governor Christie talked today about “choice;” Obama is urging parents to immunize right along side the president of the American Academy of Pediatrics who released another urgent statement. Pediatricians, family docs, nurse practitioners and health workers everywhere are encouraging parents to get shots up-to-date to protect their own children and vulnerable populations (this includes infants). Here’s a bit of evidence and information that can hopefully curb anxiety for parents to babies. I teamed up with Dr Edgar Marcuse, a lifelong scholar with vaccines, former pediatrician at Seattle Children’s and an emeritus professor of pediatrics at University of Washington and Dr Matthew Kronman. Here are 7 tips about infants and families that may help shape your thinking: Read full post »
Is it partly our responsibility, as parents, to ensure our kids are in an immunized, safe environment? Maybe so.
Unsurprisingly, most parents want to make sure their children attend a school or daycare with children up-to-date on immunizations. This week is National Influenza Vaccination Week and provides a hearty reminder. Established by the CDC in 2005, it began as a way to raise vaccination rates during the month of December. Vaccinations historically tend to drop at the end of November (we get busy, we don’t go to the doctor), but this is only the beginning of flu season and it’s not too late to get yourself and your family protected. Influenza peaks in February and March so December is still a great time to get immunized for anything, including flu.
Although many daycare facilities are mandated to check immunization status at entry, not all keep up on the records as children age. New data finds many preschoolers are late to get their shot leaving about 1/4 of them in daycare/preschool not fully protected at any given time.
In a scenario where 1 in 4 children in their daycare center were not up-to-date with vaccinations, 74% of parents would consider removing their own children from that childcare center; another 11% would consider removal of their children only if an outbreak occurred. ~National Poll on Children’s Health
Lots of information floating around this past week about influenza. Of anything, remember this: it’s easiest to predict that influenza can be unpredictable and it’s also still true that a flu shot is the best way to protect your family from flu. I’ll explain why, along with a recap of what you should know about new data, here.
Flu season is just getting started in the United States (circulating infections in nearly all states) and this past week the CDC announced new information about a strain of Influenza A, H3N2. This is exactly what the CDC is supposed to do: keep us informed and help us prepare for an influenza season. This year the information standing out is risks surrounding the strain of H3N2 that has “drifted” and the reality that when H3N2 is the most common strain of flu going around it tends to cause more serious infections.
When Influenza Virus “Drifts”
Vaccines for each year’s flu are formulated months in advance to allow time for vaccine manufacturing and distribution.
100 centers around the world provide influenza surveillance and predict which strains will circulate to the US and North America. Decisions are made in February each year for the next year’s vaccine. Researchers look at trends to determine which viruses may be more prevalent.
The vaccine protects against three (trivalent vaccine) or four flu viruses (quadrivalent vaccine), based on the world’s predictions. Typically each flu vaccine has at least two strains of Influenza A and one or two strains of Influenza B. Of anything that is consistent it’s that flu seasons are unpredictable.
H3N2 is one strain of Influenza A in this year’s vaccine. The “drifted” vaccine is just another form of H3N2 that has different characteristics.
Flu viruses often “drift,” this happens every few years. The drifted H3N2 virus is one specific type selected for the 2015 southern hemisphere influenza vaccine (point being: this isn’t an unknown virus, it was just unknown how much it would spread in the US).
A Seattle high school recently announced a minor outbreak of whooping cough: 13 students were diagnosed with laboratory-confirmed pertussis. None of the teens are contagious as of today, but it poses an interesting question about protecting our children and communities. A health advocate and friend on twitter suggested a savvy reminder: we can help teenage babysitters get up to date to protect young babies and children. Yes! Is it our parental responsibility to make sure babysitters, nannies or even sweet grandmas are properly vaccinated? Should it be the question we ask before we inquire if they’ve completed CPR training? Perhaps.
It’s hard enough to ask grandparents and friends to vaccinate or “cocoon” to protect our youngest and most vulnerable. It may be a challenge with the neighbor babysitter as well. I’d suggest just saying, “Hey, did you get your 11 year-old shots and your flu vaccine this year?” Thing is, one hurdle may be that your 15 year-old sitter may not know if they’ve had their teen pertussis shot. As a reminder, all children are given immunizations for whooping cough (DTaP) at 2, 4, 6, and 15 months. They then receive another dose at age 4. Then a tween booster dose (the Tdap shot) at age 11 years.
Many children prepare for the big job of babysitting by taking classes. At Children’s our next Better Babysitters class is November 22nd. I’m working to ensure that instructors make sure they help teens determine if they’re up-to-date on immunizations during the course!
Highly contagious bacterial infection (pertussis) of the nose and throat causes “whooping cough.”
Easily spread by coughing and sneezing. Symptoms appear 7-10 days after exposure (on average)
Symptoms differ by age, babies & young children may have severe coughing spells or even pauses in breathing. We worry most about newborns, young infants under 2 months of age but also consider babies under 6 months of age “high-risk.”
Adults and older children could have fever, runny nose and bad cough that progresses into coughing fits, “whooping” sounds with cough, or even a cough that lasts over 100 days (even if treated). Treatment prevents spread, not the cough.
Today’s post is written by Dr Alok Patel, a third year resident at Seattle Children’s. I met him last year as he immersed himself in training. Since then we’ve been syncing up, learning together about ways he can use his voice, his teeming passion, and his media channels to improve the health of populations everywhere. He’s peppered with ideas, brimming with enthusiasm (it’s possible he speaks faster than I do) and diligently working to carve out his path as a public advocate, storyteller, and pediatrician. He’s a self-described, “wannabe medical journalist [working] to bridge the gap between public health and everyday.” He’ll finish his training this summer and begin his career officially; I suspect we’ll hear lots from him. In the past year we’ve both attended powerful social media summits at The Gates Foundation. And we’ve both stepped away inspired to do more. Dr Patel is starting to tell his stories publicly. Take a peek at his story below – the final quote left me slightly breathless…
Turn on the news these days and it’s easy to feel like the world is falling apart. Globally, people are suffering from different diseases and even though public health officials are making great strides internationally, I often find my self wondering “what can I do to help?” And then I get overwhelmed by the idea of where to start.
Last month I had the opportunity to attend the Gates Social on Science Innovation, a workshop that unites people with two common interests, a love for social media and desire to enhance global health. Surrounded by “impatient optimists,” a software engineer, film director, marine biologist and elementary school teacher I was struck by the fact that we all have innovative ideas… and we all need help getting them off the ground.
I can’t speak for the other attendees, but my “awakening” of sorts took place during a presentation of New York Times Columnist, Nicholas Kristof. He was discussing the variety of stories he’s told, from the harsh realities of child prostitution, to the innovative games that are teaching anti-parasite practices on your phone. Then he said something that really resonated with me. Read full post »
It’s 2014 and it’s a reality that you can protect a child, teen or young adult from a cancer-causing virus with a series of just three shots. About 79 million Americans are currently infected with Human Papillomavirus (HPV), a virus that can cause warts but also lead to cancer (anogenital and/or throat cancers). Most data find 14 million new people are infected with the virus every year. Most of the time, HPV enters our body and our immune system gets rid of it on its own, however sometimes HPV causes trouble at the cellular level. Fortunately there’s a safe and effective way to stop the spread of HPV, prevent some strains of the virus from ever causing cellular changes in our body and ultimately prevent the related cancers it triggers: the HPV vaccine.
HPV Vaccine Is Safe
The HPV vaccine isn’t really “new” anymore. Between June 2006-March 2014, approximately 67 million doses of HPV vaccines were distributed. The vaccine is made from one protein from the HPV virus, designed to trigger a protective immune response; the vaccine cannot cause HPV infection or cancer. A recent study by Pediatrics found the HPV vaccine to be not only effective, but long-lasting. The study followed vaccinated girls and boys for eight years and showed evidence of durability; the HPV-antibodies remained at high levels over the years after immunization. Read full post »
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