‘vaccine hesitancy’

All Articles tagged ‘vaccine hesitancy’

Vaccines, Profanity, And Professionalism

Screenshot 2015-02-01 12.30.40You’ve likely seen the Jimmy Kimmel “public service announcement” on vaccines. Over 3 1/2 million people have viewed it on Youtube so if you’re not yet one of them you’ll likely add to the tally now. The first 3 minutes of the monologue are spot-on and they’re also very funny. Jimmy takes a stand against the “anti-vaxxers.” He mentions that some parents are more scared of “gluten than small pox” and references the reality that some schools in this country have 20% of students opted out of some vaccines. His monologue is followed by a series of pediatricians voicing profane frustration. Most people think the video is hilarious and many of us fired up about vaccines feel a rush when the safety and trust we have in vaccines gets the spotlight like it does here. Jimmy’s script is brilliantly written and his execution is direct.

Thing is, I didn’t like the video. I was left feeling somewhat uncomfortable and embarrassed for my profession. Immediately I wanted to explain that even though many of us are frustrated with where we are on vaccine hesitancy, we really aren’t interested in offending. We will always work to partner with parents –we won’t mock, swear, or intimidate you. Our goal is to support, protect, and cure children whenever we can and our privileged responsibility is to listen to parental fear and connect families with resources that soothe. This really is why we went to medical school.

It’s exciting when celebrities voice-up and stand to talk about vaccine issues that reflect science. It’s especially exciting when they include practicing physicians. Counseling families who are hesitant or flat-out refuse vaccines is a part of the job for every pediatrician. A study published in the journal Pediatrics this week found 93% of pediatricians had reported they’d been asked by parents to skip or delay vaccines in the last month. The current measles outbreak has changed the tone of these conversations for many of us; I’ve written about my new stance because I’m enraged pockets of measles can even occur in 2015. That being said, even though I really do like to swear like these pediatricians when I’m out of public earshot, I’m unsure the tactic of this PSA will do any good for those parents who hesitate to immunize their children according to the tested and safe schedule.

It seems to me that if parenting is governed by love, pediatrics is governed by respect for that love and for the integrity of children individually.

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Cocooning For Measles

2-12 measles cocooningThe 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 »

Measles Outbreak With A Baby At Home

baby-O-e13075541951481Many 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 »

Enraged By 2015 Measles In America

Screenshot 2015-02-01 12.30.40I wept at the end of the movie I watched last night, The Imitation Game. The reason really was this: it reminded me how we’re just so terrible to each other at times. How much suffering occurs when we don’t think things through. The movie wasn’t about measles or vaccination, but injustices in it pushed me to leave my Sunday morning with my children to share this:

My patience with vaccine hesitancy has pivoted. I’m embarrassed to say it took an outbreak of measles stemming at Disney to move me from impatient and passionate to hands-on-my-hips fired-up and disappointed. Today I feel a bit of outrage that unvaccinated families are not pounding on the door to get their MMR vaccine, even on Superbowl Sunday. In my mind they should be doing so selfishly (for personal protection) and they should be doing so altruistically (for others who really count on them). I expect both from the public.

Read Charlie and the Chocolate Factory author Roald Dahl’s 1988 message about his daughter’s death from measles — insane that it rings true today.

I feel somewhat enraged that many parents with babies in the United States are nervous right now about their infants getting measles. The chance is small but it shouldn’t even be a chance when there is a vaccine that is nearly 100% protective for those milling around these delicious babies. I’m angry because a friend of mine has a child who got measles when she was too young to be immunized. I’m enraged that children who fulfill their “Make A Wish” trip to Disneyland — after a liver transplant or after chemotherapy or after a tumor is cut out of their bone — must feel a little shaky making the choice to go there now. Can you imagine getting a short straw like a liver that didn’t work like it should or a childhood cancer diagnosis and then getting another one (increased measles risk) just when you’re elevated to celebrate your life? Read full post »

3 Shots: Protect Against Cancer

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 »

Knowing The Benefit Of MMR Shot

A new study out today in Pediatrics reminds us that parents want information about the direct benefits shots have on their baby’s health and wellbeing. Not surprising, of course, but a good reminder for pediatricians, parents, and those who speak out on the value of vaccines to remember that primary motivation for parents in getting immunizations is to protect their child, not just protect the community. As a mom I feel the same way. As vaccination rates have decreased in pockets around the US these past few decades, and as non-medical vaccine exemptions (refusing immunization on philosophical grounds) increase, and as media coverage around the benefits of immunizing “the herd” remain a mainstay, returning to the individual benefit of vaccines makes sense. Parents really want to do what is best for their baby. They want to hear how and why to protect their baby. Vaccines do that.

The MMR vaccine protects your child from getting the diseases measles, mumps, or rubella or the complications caused by these diseases. After receiving this vaccine, your child will not miss school or activities due to these illnesses and will be able to play with friends during an outbreak.   — The message shared with parents in the research study

I like this study for two reasons:

  1. Parents Want To Know Why: In the study researchers went right to parents, mostly moms (80% of participants) between age 18 and 65 years of age, to share messages about MMR shot benefits to their baby and society and then gauged their intention to immunize their baby with MMR at 1 year of age. What I also really liked was the way the benefit was framed around a child’s wellness and their ability to play and be with friends!
  2. It Serves Up a Great Reminder:  We pediatricians, nurse practitioners, family docs, RNs, and MAs need to tell families what shots children are getting and we really need to stress WHY they are getting them in the context of life. We need to make the protection a shot provides relevant every time we order and administer the vaccine!

Pediatrics Study:

In the study, researchers compared about 800 parent responses in 4 groups (each group had about 200 parents). In one group parents got information only from CDC Vaccine Information Statement (VIS) about benefits/risks of MMR vaccine. In another group, parents got information about benefits of MMR shot to their baby and the VIS information. In a third group, parents got information about MMR benefit to baby and to population, along with VIS. And in the last group parents got information only about benefits of the shot for protecting the community along with the VIS.

Results: Parents were more likely to report their intention to get their infants the MMR shot when they heard about the benefit of the shot directly to their baby or when they heard about benefits directly to their baby and the population. When they heard only about risks/benefits of shot and risks/benefit to society, the information presented did not increase their intention to get the shot.

Conclusions: Parents are more likely to want to get their child up to date on immunizations if they know direct benefit on their child’s ability to go to school and play and be with friends.

Let’s focus on what matters to parents to young children when we talk about vaccine benefits — health, wellness, play, friendship, and opportunity.

For more on benefits of MMR shot for children and the diseases it prevents read here. Immunizations do cause optimism…

Your Social Network, Your Kids’ Vaccines

network

We live in a profoundly different time today when it comes to caregiving, parenting, and gaining health care/advice than we did even 5 or 10 years ago. The internet has changed things dramatically. During an interview recently a reporter asked, “You were raised on digital media, yes?”  Well, no. I didn’t started using email until late 1995 just prior to leaving college, didn’t get a cell phone until I was teaching, didn’t have a working computer in my apartment until I started my master’s degree (after med school), and didn’t join social media until 2008. It was bedrest with my second pregnancy that urged the establishment of a profile on Facebook. That online community changed everything.

I’m no digital native but I may act like one.

My husband, my friends, and the doctors I’ve chosen to help me raise my boys certainly do color my belief about the world. So do the things I read and watch online.

There has been 3 measles cases in Seattle this July and 58 cases of measles in Brooklyn, NY since March. Measles is preventable with a very effective vaccine. The vaccine is so good that after 2 doses of the MMR shot, over 99% of people are protected against measles for life. However, often our community shapes our decisions to vaccinate…

An insightful Pediatrics study and accompanying editorial published earlier this year illuminate the reality that social networks carry big weight for parents making decisions about immunizations. We do make decisions in the context of our lives and the social network we choose to use as a sounding board really does help us determine what to do in moments of confusion. Read full post »

Jenny On The View

450px-Jenny_McCarthy_Addresses_AudienceJenny 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 »

Modern Parenthood, Vaccines, And Myth With Mnookin

panicThis 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 »

A Voice For Vaccines

Karen ErnstThis 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?

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