There is a report of more measles here in Seattle. Measles is a highly contagious and potentially severe infection that causes fever, rash, cough, and red, watery eyes. It is mainly spread through the air after a person with measles coughs or sneezes. King County Public Health released information today detailing new cases and potential places for public exposure to measles infections between July 9th & July 15th. These two new cases are unrelated to the measles case earlier this month in a traveler at the Sea-Tac airport. Much of the information here is thanks to the public health department.
Local public health officials have confirmed measles infections in two siblings, an adult and a child, who were in several public locations during the time that they were contagious. The siblings have been visiting from out of state and public health officials believe that they acquired measles outside of Washington State.
Locations where possible exposures may have occurred:
Jenny McCarthy is officially joining The View. “Do I have opinions?” one reporter asked today. Yup.
My concerns center around Jenny McCarthy’s past willingness to trade-in her experience for expertise. That is, she widely shared her theories and anecdotes about her son’s experience with learning challenges and falsely placed blame on vaccines for his then-diagnosed autism. I will not discount her private experience. What I discount is her decision to leverage a modeling/pornography career to message about health. She aligned herself with pseudoscience. She mistook “mommy instinct” for fact. She partnered with the debunked Andrew Wakefield and has been an ardent spokesperson for Generation Rescue. She directed families away from life-saving vaccines and pointed them towards costly and unproven treatments like chelation for learning and behavioral challenges. In sum, she created fear.
She created myths around “greening” vaccines, a concept that lives on today and make very little sense.
Her myth (stating the MMR vaccine caused her son’s autism) has potentially increased disease burden. Outbreaks of measles in Europe have overwhelmed France and Wales in the past few years and under-vaccinated communities persist here in the US. In part, this is because of Jenny’s megaphone.
The auspicious truth is when Andrew Wakefield was debunked her fervor slowed. I hear less about Jenny McCarthy in the exam room these days. She’s retreated from the vaccine discussion. Trouble is, I still hear about the myth she methodically created. Some families remain scared and confused about true benefits/risks when it comes to life-saving vaccines. I’m angry she’s made so many parents falter. Read full post »
This Tuesday evening, I’m joining Seth Mnookin at Town Hall in Seattle to discuss vaccines, modern parenthood, and (mis)information about vaccinations online. Although you may know Seth Mnookin secondary to his crucial role in the Boston Marathon Bombings story this past week, at his other day job he’s the co-director of the graduate program in science writing at MIT. He’ll be here in Seattle because he is also the author of a powerful book, Panic Virus, that details the history of vaccine hesitancy in the US.
A True Story of Medicine, Science, and Fear.
Although the book sits on the nonfiction shelf, it reads like a thriller. Think Contagion meets John le Carre´. I’m not exaggerating here: when I first read the book 2 years ago, I pulled a near-all-nighter because I couldn’t put it down. I don’t think that’s because I’m a pediatrician, I believe I couldn’t put it down because I’m a mom.
I met Seth nearly 2 years ago and he signed my scribbled-in copy of his extraordinary book. Panic Virus changed my understanding of vaccine hesitancy. There are parts of the book that caused my stomach to drop and certainly parts of the book that made me worry. Read full post »
This is a guest blog from Karen Ernst. Karen is the mother of three boys and a military wife. She sometimes teaches English and enjoys advocating for and working with children. She is the co-leader of Voices for Vaccines and one of the founders of the Minnesota Childhood Immunization Coalition.
The preschool class party was one of the last hurrahs for my then five year old. The entire family attended, including our ten-day old newborn, whose only interest was nursing. His lack of other interests turned out to be good fortune because another mother-son duo at the party were contagious with chicken pox and began showing symptoms the day after the party. Had the mother held my newborn or the child played with him, the results could have been fatal for our son.
Having immunized my older child, who played with his contagious friend, I was relieved that no one in our home contracted chicken pox and no one passed it on to our new baby.
While I was angry when the mother revealed that she’d purposely left her son unvaccinated against chicken pox, I felt proud that I had chosen well, I had protected both my children, and I had understood and agreed with what public health officials had proposed: that children need the varicella vaccine. I had both done what I was supposed to, and nothing bad happened. So that’s the end of the story, right?
Today a Seattle mom advertised on an online parenting community that both of her children had chickenpox and then invited (non-vaccinated) children over for exposure. That’s the invite from 1:19pm today.
It turns out people are still having chickenpox parties.
Part of this makes my head spin. I just don’t get it, despite having had many families in my practice decline or hesitate or delay the chickenpox shot. I don’t think parents know what virus they are dealing with. After I posted this invitation on Twitter, I had physicians all over the country sharing stories (some included below).
Chickenpox can cause serious infection complications and rarely it can be lethal. Before the vaccine was approved and put into use in 1995, hundreds of children and adults died in this country every year from chickenpox and thousands were hospitalized. Although most young children get chickenpox and recover (only left with pox or scars) some children develop life-threatening secondary infections. Some children develop severe pneumonia (1 in 1000 children), some develop brain infections, and some children develop flesh-eating bacterial infections in their scabs that can even be fatal.
After I saw the pox party invite this afternoon I became slightly enraged. I mean, there are NUMEROUS children and adults in our community immunosuppressed and/or on chemo that could develop life-ending complications if exposed to varicella. And some families are intentionally exposing their children to a potentially harmful infection. After 2 doses of the chickenpox shot (varicella) 99% of patients are immune to chickenpox. Although some children can get chicken pox once vaccinated, they typically only have a few pox and do not develop severe side effects or die.
The pox party just shows me how much work we have to do to build trust in vaccines and vaccine-safety. My boys have both had 2 doses of the varicella vaccine. I’m thrilled they are protected and unlikely to ever get chickenpox or spread it to a community member who could be more at risk. They likely won’t get shingles, either.
Chickenpox Facts & Stats:
Varicella shots hurt upon injection (children tell me it really stings). We give the shot twice, once at 1 year of age and once at 4 years of age. The shot can commonly cause arm soreness and lowgrade fever. In less than 5% of children, a small rash develops, often around the site of the shot. That’s a good sign the immune system is being triggered to fight off future infections. The rash that can develop after the shot is not contagious. Read full post »
Since 2005, teen immunizations have been recommended at the 11 year-old well child check-up but rates of teens who keep up to date on their shots lag. In an ideal community, 90% of us would be up to date on shots to prevent disease spread most effectively. Back in 2007, teen recommendations were expanded to include HPV vaccine for girls. In 2011, both boys and girls were recommended to get HPV shots. Although the majority of teens get the Tdap shot (tetanus and whooping cough booster) only around 1/3 of teen girls are up-to-date on their HPV shot when most recently surveyed.
HPV (human papillomavirus shot, requires 3 doses over 6 months)
A Pediatrics Study on teen shots revealed that parents may not get their teen shots due to concerns about safety or not understanding the shot was recommended. Not all shots are required by schools; I think some families tend to experience that as an endorsement for the shot being less important. In the survey conducted between 2008-2010, researchers sought to understand trends and rationale for lagging shots: Read full post »
New immunization recommendations come out every February. They’re released to assist parents and clinicians in keeping all children up to date and protected from life-threatening infections. The update reflects new science and discoveries, while improving the schedule of vaccines due to outbreaks of infection or improved understandings of how to protect children better amidst a potential resurgence.
This is relevant to every parent: every year the rules for what-children-need-which-shots-when can change. Just when we think all of our children are “up to date,” new science evolves that potentially changes their immunization status. For example, read about new information published this year for the Tdap shot–how & why our children’s immunity fades.
We have to do our best to avoid making false promises to children about “not needing a shot” when they go in to see the doctor. Just when we do, we find our child is due for a necessary booster or missed vaccine. Commonly, children are missing the last shot in a series of immunizations (for example, to protect children and teens from HPV, they need 3 total shots or children haven’t had the second chicken pox shot). In my opinion, the promises broken break trust with our children and amp fear around going to the doctor. Much of the anguish around shots is the anticipation of them. So an update…
2013 Immunization Recommendations And Reminders:
This 2013 immunization recommendations have been simplified into one chart for all children from birth to age 18 (used to be 2 charts). It details the timing for shots and the necessary intervals between doses for all children. The detailed footnote section explains rationale for all the rules. In my opinion the 2013 schedule is easier to read and easier to understand.
Tdap for every pregnant woman, every pregnancy: the biggest change to the schedule is the recommendation that all pregnant women get a Tdap shot (protecting against tetanus-diphtheria-pertussis or “whooping cough”) in the 2nd half of each and every pregnancy. This recommendation was made due to surges in whooping cough infections, epidemics, and a 50-year high in positive cases. Because whooping cough is most risky to newborns we want pregnant women protected. Ninety percent of those who die from whooping cough are infants. The strategy to vaccinate during every pregnancy takes into count how quickly protection from the vaccine fades after we get it. And the reality the vaccine isn’t 100% effective. About 80% of those who get it are protected. The best way to protect us all is to have all children and adults up to date on their Tdap. Read full post »
News of a whooping cough death in the Seattle area rang out yesterday. By afternoon, many of my patients in clinic had heard the news. Although the epidemic levels of whooping cough have gradually faded since a peak of cases here in May, the risk is still very real.
Newborn babies are at particularly elevated risk for serious complications from pertussis (whooping cough) infections. Unlike older children and adults who often have cough & coughing fits with vomiting, babies can have severe respiratory distress, pauses in breathing, or even stop breathing. Rarely it can be deadly.
Infants are most likely to catch whooping cough from a parent. We have to cocoon newborns everywhere: surround them with people who are vaccinated and less likely to spread whooping cough infection.
This tragic death serves up a reminder for we pediatricians, family docs, and clinicians everywhere to maintain our efforts and amp up our passion to keep babies surrounded by immunized family and friends. We can’t let up.
Are You Up To Date On Your Whooping Cough Shots?
More than anything, we need to ensure family members (mothers, fathers, grandparents, and siblings) all are up-to-date on their whooping cough shot. The shot is imperfect (meaning not everyone who gets the shot is always immune — most estimates find that 80% of us who get the shot are protected) and we know some of our immunity to whooping cough can fade year after year. So the more people immunized the less likely we are to have whooping cough in our community. Read full post »
In 2006, I entered pediatric practice. It was the same year that the Advisory Commission on Immunization Practice (ACIP) recommended to start giving 11 year-old girls the Human Papilloma Virus (HPV) vaccine. Therefore, I’ve really never practiced pediatrics (outside of my training) without the ability to offer up immunization and protection against HPV virus; I’ve been discussing this for about 6 years. We now give HPV shots to both boys and girls because it’s so common–about 50% of all adults who are sexually active will get one form of HPV in their lifetime.
HPV virus can come into our body and do no harm. But it also can come into our bodies and cause vaginal, penis, anal and oral/throat warts. Other strains of HPV also cause changes in the cervix that can lead to cervical cancer and can rarely lead to penile cancer and/or tongue/throat cancer. Teens and adults can get HPV from oral, vaginal, or anal sex. Condoms don’t provide 100% protection from getting it.
GREAT NEWS: Being protected (by the HPV shot) doesn’t trigger risky sexual behaviors in teens.
Nice to have an immunization to protect against the potential development of such disfiguring, embarrassing, and uncomfortable lesions. And what a windfall to have a vaccine that prevents cancer. I often say to my patients, “If my grandmother only knew that I’d see the day where we could prevent cancer.” I mean it—if she only could have seen the day (she died in the late 1980’s).
The reality is though, parents to teenage girls have consistently been hesitant in getting the HPV vaccine in my office. Over the 6 years hesitancy around getting HPV vaccine has lessened, but many of my patients’ parents have told me they don’t want their girls or boys to feel that getting the shots is a green light for sexual activity. And many have worried that having their girls immunized will make them more likely to engage in earlier sexual activity. Read full post »
This is part deux to an earlier video/post describing the global effort to reduce flu & reasons why we need one every year. Infants and children under age 5 are at higher risk for serious complications from influenza infection. Influenza (“the flu”) is an illness that strikes during the late fall and early winter annually in our country. Great thing is, there is a global effort to coordinate knowledge to reduce the consequences of severe infections. Each year a new flu shot is released to protect us. All children need a flu shot. The reason? It’s estimated that somewhere between 10-40% of all children, each year, get influenza. Sometimes it’s a mild upper respiratory infection, but sometimes it can cause severe lung infections and even death. Each year hundreds of children die in our country from flu even though it is a vaccine-preventable illness. I hear lots of myths and rumors about the flu shot in clinic (more than any other vaccine). Check out my friend Dr Claire McCarthy’s post on de-bunking the myths.
Of those children who are seriously ill and hospitalized, somewhere between 1/3 to 1/2 can be children with no underlying medical issues. Healthy children get the flu, too. If your child has underlying neurologic problems, wheezing or asthma, or diabetes they are also considered higher risk for severe infection.
It takes a well-immunized community to reduce the spread of influenza. And our children, swapping spit and snot at school, are one of our most precious groups to protect.
Which Flu Vaccine And How Many to Get?
Infants 6 months of age and up can get flu shot. Most infants will need two doses, separated by 1 month, while all children over age 9 years need only one dose. If you have a young child (<9 years) and they have never had the flu shot before, they will need two doses. Ask your child’s doctor how many doses your baby, toddler, or child needs this year. What you need to know about flu.
There are two types of vaccine, the flu shot & the nasal spray. Both protect against the same virus strains. Check out www.flu.gov. Here’s a quick explanation: Read full post »
Seattle Children’s provides healthcare for the special needs of children regardless of race, color, creed, national origin, religion, sex (gender), sexual orientation or disability. Financial assistance for medically necessary services is based on family income and hospital resources and is provided to children under age 21 whose primary residence is in Washington, Alaska, Montana or Idaho.