Author: Vincent Iannelli, MD

Why Are You Still Worried About the MMR Vaccine?

We know why most folks got scared of the MMR vaccine.

Who's to blame for low immunization rates and continuing outbreaks?
Who’s to blame for low immunization rates and continuing outbreaks?

And most of us remember when most folks welcomed the MMR vaccine the end of endemic measles in the United States.

Why You Were Worried About the MMR Vaccine

Of course, that all changed when Andrew Wakefield spoke at the press conference for his 1998 Lancet paper and said:

“And I have to say that there is sufficient anxiety in my own mind of the safety, the long term safety of the polyvalent, that is the MMR vaccination in combination, that I think that it should be suspended in favour of the single vaccines, that is continued use of the individual measles, mumps and rubella components… there is no doubt that if you give three viruses together, three live viruses, then you potentially increase the risk of an adverse event occurring, particularly when one of those viruses influences the immune system in the way that measles does. And it may be, and studies will show this or not, that giving the measles on its own reduces the risk of this particular syndrome developing… the risk of this particular syndrome developing is related to the combined vaccine, the MMR, rather than the single vaccines…. People have been saying for some time, people on the periphery of autism, have been saying for some time that this may well be related to bowel damage.”

Although there was no evidence for any of that, vaccination rates went down and measles rates went up – the Wakefield Factor.

MMR vaccination rates had dropped below 80% by 2003, when the first measles outbreaks in the UK began. They didn't fully recover until 2012.
MMR vaccination rates had dropped below 80% by 2003, when the first measles outbreaks in the UK began. They didn’t fully recover until 2012.

But no, it wasn’t one person at a press conference that us lead down a decade of worry about the MMR vaccine.

“And then the nurse gave my son that shot. And I remember going, “Oh, God, no!” And soon thereafter I noticed a change. The soul was gone from his eyes.”

Jenny McCarthy on Oprah

Andrew Wakefield had plenty of help!

Not only from anti-vaccine celebrities, but from the media and their scare stories.

Why Are You Still Worried About the MMR Vaccine?

But that is all old news.

Over and over again, we see new studies that show that the MMR vaccine is safe and is not associated with autism.

Andrew Wakefield’s work was never replicated.

The MMR vaccine never contained thimerosal and doesn’t even contain aluminum, which I mention only because those are ingredients that some folks get scared about, not because they are harmful.

Vaccines are safe. The MMR vaccine is safe.

And more and more, as predicted, we are seeing why vaccines are necessary – more and more outbreaksOutbreaks that are proving to be deadly.

Why are you still worried about the MMR vaccine?

Because anti-vaccine folks are still scaring you away from vaccinating and protecting your kids!

Don’t listen to them!

More on MMR Vaccine Fears

How Can I Get Vaccinated If My Parents Are Anti-Vaccine?

What do kids do when their parents are anti-vaccine?

    Most teens do know what's in a vaccine and they want to get vaccinated and protected.
Most teens do know what’s in a vaccine and they want to get vaccinated and protected.

Whether or not they know it, they hide in the herd, at least until they understand what’s going on.

And then they often make a choice to either continue with their parents beliefs and remain unprotected or they get caught up.

Can Minors Consent to Getting Vaccinated?

Since getting vaccinated is a medical procedure, in most cases, you are still going to need the consent of a parent, guardian, or other adult family member if you are still a minor, which leaves out simply going out and getting caught up.

“State law is generally the controlling authority for whether parental consent is required or minors may consent for their own health care, including vaccination.”

Abigail English, JD on  the Legal Basis of Consent for Health Care and Vaccination for Adolescents

Are you still a minor?

“In most states, age 18 is the age of majority and thus, before treating a patient under the age of 18, consent must be obtained from the patient’s parent or legal guardian.”

Ann McNary, JD on Consent to Treatment of Minors

When it comes to immunizations and health care, in addition to what state you live in, that likely depends on whether or not you are an emancipated minor (court order), married minor, pregnant minor, or minor parent (situational emancipation). It also can depend on the type of health care you are seeking, like if a minor is seeking birth control or treatment for an STD.

“States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.”

Convention on the Rights of the Child

Are you a mature minor? In some states, you can also give consent for medical procedures, including getting vaccinated, if you are a mature minor – someone who is old enough to understand and appreciate the consequences of a medical procedure.

In Washington, for example, minors may get immunizations without their parents consent after their health care provider evaluates the minor’s “age, intelligence, maturity, training, experience, economic independence or lack thereof, general conduct as an adult and freedom from the control of parents.”

Fourteen other states, including Alabama, Alaska, Arkansas, Delaware, Idaho, Illinois, Kansas, Louisiana, Maine, Massachusetts, Montana, Nevada, Oregon, Pennsylvania, South Carolina, Tennessee, and West Virginia have laws that allow mature minors to consent to general medical treatment either in all or a range of restricted circumstances.

How Can I Get Vaccinated If My Parents Are Anti-Vaccine?

Believe it or not, this question comes up a lot more than you can ever imagine.

If you are old enough to consent to getting vaccinated on your own, then you are all set and can start to get caught up on your immunizations.

If not, then your options are more limited, but might include:

  • talking to your parents about your concerns
  • asking someone, like your pediatrician, to be an advocate and talk to your parents with you
  • petitioning the court for emancipation ( you may get a whole lot more than the ability to get consent to get vaccinated though…)
  • waiting until you are old enough to consent to get vaccinated without your parent’s permission

While waiting is likely the easiest option, since that leaves you at risk for getting a vaccine-preventable disease, you should probably think about talking to your parents.

Why don’t they want you to get vaccinated? Do they have specific concerns about side effects? Do they have a religious objection?

Vaccines are safe and necessary. Hopefully you can help your parents understand that and they will allow you to get caught up on all of your vaccines.

More on Getting Vaccinated If Your Parents Are Anti-Vaccine

How Do Anti-Vaccine Folks Think?

Does it sometimes seem like anti-vaccine folks are speaking a foreign language?

It definitely seems like they misunderstand and misuse a lot of scientific terms, like evidence, research, and toxin, doesn’t it?

Anti-Vaccine Glossary

The first step to understanding someone who is truly anti-vaccine and unnecessarily puts their kids at risk for vaccine-preventable diseases, might be to understand how they misunderstand most things about vaccines…

Measles is highly contagious, which is likely why all of the Brady kids got sick.
Anti-vax folks get the message of the Brady Bunch measles episode all wrong…

For example, many of them believe that anecdotes and case studies are strong evidence and on par with the preponderance of evidence that has shown that vaccines are safe, effective, and necessary.

What other terms do they get wrong?

When you say… Anti-Vaccine folks think…
research I googled it and found something on an anti-vaccine website that confirms what I already thought
peer review I had my anti-vaccine friends, some of whom are actually in charge of the journal, take a look at it
personal stories can only be anecdotal vaccine injury scare stories, but never about regretting a skipped vaccine or personal stories about vaccine-preventable diseases
aluminum mercury
consensus my anti-vaccine friends on Facebook
shills anyone who supports vaccines
pediatrician a vaccine pusher
science pseudoscience
learn the risk learn the exaggerated risks of vaccines that I’m going to scare you about
expert anyone who agrees with me
unavoidably unsafe vaccines can’t ever be safe to anyone in any circumstance ever
toxin anything and everything that sounds sciency
placebo pure saline
chemical anything that isn’t natural, not understanding that everything is a chemical
scientist anyone who took a science class in high school or college
doctor typically a chiropractor
medicine non-evidence based therapies that don’t involve Big Pharma, aren’t covered by insurance, and are likely very expensive
risk can only come from a vaccine, never from skipping or delaying a vaccine or from a vaccine-preventable disease
shedding what happens when someone gets a vaccine
vaccine injury anything and everything bad that happens to you in the days, weeks, months, and years after you get vaccinated or in the days, weeks, months, and years before you were born because of the vaccines your parents or grandparents received
religious vaccine exemption I just don’t want to vaccinate and protect my kids, so will lie and say it is about religion
vaccine preventable disease since many anti-vaccine folks don’t really think that vaccines work, they might act more confused if you use this term
informed consent when I tell you all of the bad stuff about vaccines, most of which isn’t true, and leave out any talk of benefits
leaky gut explains every major problem kids have after getting vaccinated
MAPS doctors the new DAN doctors
VAERS a list of vaccine-injuries
herd immunity doesn’t exist, but can only happen from natural immunity
hiding in the herd what used to protect unvaccinated kids, until more and more folks started listening to us to our anti-vaccine propaganda
package inserts can be used to scare parents about SIDS and autism
do your research go to an anti-vaccine forum or website
cherry picking what does picking cherries have to do with vaccines???
natural immunity easy life-long immunity without any consequences
vaccine choice I want to do it my way, no matter how many choices I have
germ theory germs don’t cause disease and if they did, vaccines didn’t stop them, it was better nutrition and sanitation
homeopathy vaccines don’t work, weekly chiropractic adjustments can keep you healthy, and natural immunity is best, but buy some homeopathic vaccines anyway
essential oils definitely not being sold as part of a multi-level marketing scheme
monkey pox just smallpox renamed
Guillain-Barré Syndrome just polio renamed
roseola just measles renamed
SIDS a vaccine injury
vitamin K a vaccine to be avoided
cognitive dissonance how we sleep at night after skipping or delaying vaccines and leave our kids unnecessarily unprotected from life-threatening diseases
Andrew Wakefield “…Nelson Mandela and Jesus Christ rolled up into one.”

Get it?

It’s why many people have a hard time talking to friends and family members who are anti-vaccine. And even visits to the pediatrician to talk about vaccines don’t always go so well.

More on the Anti-Vaccine to Science Translator

Why Do You Need to Get a Flu Vaccine Each Year?

A yearly flu vaccine is the best way to protect yourself and your family against the flu.

But why do you need to get a flu vaccine each and every year?

Why Do You Need to Get a Flu Vaccine Each Year?

Hopefully we will one day have a universal flu vaccine that covers all flu strains and offers longer lasting protection.

Most folks know we don’t have that flu vaccine yet…

“A flu vaccine is needed every season for two reasons. First, the body’s immune response from vaccination declines over time, so an annual vaccine is needed for optimal protection. Second, because flu viruses are constantly changing, the formulation of the flu vaccine is reviewed each year and updated as needed to keep up with changing flu viruses. For the best protection, everyone 6 months and older should get vaccinated annually.”

CDC on Key Facts About Seasonal Flu Vaccine

So because the protection from the flu vaccine wanes or wears off relatively quickly, even if the flu vaccine strains don’t change from one year to the next, you should get a new flu vaccine.

How long does the protection from the flu vaccine last?

“An analysis from the 2011–12 through 2013–14 seasons noted protection ranging from 54% to 67% during days 0 through 180 postvaccination.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

The flu vaccines takes about two weeks to become effective and should then last for at least six months – long enough to get  you through the average flu season.

“A number of observational studies and a post hoc analysis from a randomized controlled trial have reported decreases in vaccine effectiveness (VE) within a single influenza season, with increasing time postvaccination. Waning effects have not been observed consistently across age groups, virus subtypes, and seasons; and observed declines in protection could be at least in part attributable to bias, unmeasured confounding, or the late season emergence of antigenic drift variants that are less well-matched to the vaccine strain. Some studies suggest this occurs to a greater degree with A(H3N2) viruses than with A(H1N1) or B viruses . This effect might also vary with recipient age; in some studies waning was more pronounced among older adults and younger children. Rates of decline in VE have also varied.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

That means it should last past the peak of the average flu season, which is typically between December and March.

And in most young, healthy people, the protection likely lasts even longer.

Make sure you are vaccinated well before flu season starts.
Make sure you are vaccinated well before flu season peaks, which since 1982 has occurred as early as October and as late as March, but is most common in February.

Still, there is some concern that the protection from the flu vaccine can wear off during a flu season, especially if you are very young, very old, or have chronic medical problems, and you get your flu vaccine early and you get exposed late – in April or May.

Of course, that’s not a good reason to delay getting a flu vaccine though, as waiting too long might leave you unprotected if flu peaks early, in October or November.

What to Know About Why You Need the Flu Vaccine Every Year

Since the flu vaccine strains can change and protection doesn’t last from season to season, get a flu vaccine each year. It’s the best way to protect yourself and your family against the flu.

More on Why You Need the Flu Vaccine Every Year

Do They Really Just Guess at Which Strain to Put in the Flu Vaccine?

Every year we hear experts telling us to get vaccinated against the flu.

And more often than not, we hear critics telling us that the flu vaccine isn’t going to work that well because it isn’t a good match.

Is that because they just guess at which flu strains to put into the flu vaccine each year, as some folks say?

Do They Really Just Guess at Which Strain to Put in the Flu Vaccine?

Of course they don’t guess at which vaccine strain to put in the flu vaccine!

“Flu viruses are constantly changing, so the vaccine composition is reviewed each year and updated as needed based on which influenza viruses are making people sick, the extent to which those viruses are spreading, and how well the previous season’s vaccine protects against those viruses.”

CDC on Selecting Viruses for the Seasonal Influenza Vaccine

There are over 100 flu centers in over 100 countries that are involved in testing thousands of flu virus samples each year. Representative samples from these centers then go to the five major World Health Organization (WHO) Collaborating Centers for Reference and Research on Influenza.

The directors of these centers review these samples and other available information and make a recommendation on which vaccine strains to include in the flu vaccine for the next flu season. Each country then considers this recommendation and decides which flu strains to include in their flu vaccine.

“The influenza viruses in the seasonal flu vaccine are selected each year based on surveillance data indicating which viruses are circulating and forecasts about which viruses are the most likely to circulate during the coming season.”

CDC on Selecting Viruses for the Seasonal Influenza Vaccine

Although they don’t have a crystal ball and so can’t know exactly which flu strains will be making us sick each flu season, it is hardly a wild guess.

How often are they right?

“During seasons when most circulating influenza viruses are closely related to the viruses in the influenza vaccine, the vaccine effectiveness estimate has ranged from 50-60% among the overall population.”

WHO on Vaccine effectiveness estimates for seasonal influenza vaccines

Actually, they are right in most years! So if it is a guess, than the folks who choose which strains to include in the flu vaccine are very good guessers!

Except for a few years when their was a poor match, the flu season is typically between 37 to 60% effective.
Except for a few years when their was a poor match, the flu season is typically between 37 to 60% effective.

There have actually only been a few times in recent years when we have had mismatched flu strains. And in one of those years, they picked the right strain, but then the strain changed or drifted before the start of flu season.

“One hundred fifty-six (22%) of the 709 influenza A(H3N2) isolates were characterized as antigenically similar to A/Wyoming/3/2003, which is the A/Fujian/411/2002-like (H3N2) component of the 2004-05 influenza vaccine, and 553 (78%) were characterized as A/California/7/2004-like.”

2004-05 U.S. Influenza Season Summary

Not surprisingly, flu vaccine effectiveness goes way down during a mismatch year. During the 2004-05 flu season, for example, the overall vaccine effectiveness of the flu vaccine was just 10%.

Of course, in most years, flu vaccine is typically much more effective than that.

How effective will flu vaccines be this season?

Will this year’s flu vaccine be a good match?

We won’t know until flu season is well under way, not that you should wait for an answer to get your flu vaccine. The benefits of the flu vaccine extend beyond preventing the flu, so it is a good idea to get vaccinated even in a year when there might not be a good match.

More on Selecting Flu Vaccine Strains

Why Don’t People with HIV or HepB Have to Wear Badges?

There is a very good reason why people with HIV and hepatitis B don’t have to wear distinctive badges.

Have you ever thought that people with HIV should wear badges???
Have you ever thought that people with HIV should wear badges???

And whether or not they work in a hospital, it has nothing to do with the fact that they don’t pose a risk to others, and it has nothing to do with health care workers who refuse to get a flu shot and have to wear a mask.

Confidentiality Rules and Civil Rights

Hopefully we have gotten over a lot of the misinformation and stigma that once kept kids with HIV and hepatitis B out of schools and teens and adults out of work.

“Ryan White confidentiality guidelines have helped allay the fears that many people living with HIV have around unwanted disclosure and HIV discrimination.”

Building Trust: Confidentiality and the Ryan White HIV/AIDS Program

And of course, that’s why people with HIV and hepatitis B don’t have to “wear any distinctive badges or clothing.”

The Americans with Disabilities Act (ADA) is the most powerful law safeguarding the rights of children in public and private schools and daycare centers. The law also prevents any organization or business from discriminating against a person because of a real or perceived disability, such as an infectious disease.

A second law, Section 504 of the Rehabilitation Act, bars schools, colleges and other organizations receiving federal funding from discriminating against children with disabilities. Section 504 identifies chronic liver disease as a “hidden disability.”

Legal Protections for Children with Viral Hepatitis

In fact, laws protect people with HIV/AIDS and other conditions, so that no one would try and make them “wear any distinctive badges or clothing.”

“Almost 30 years after the onset of the epidemic, HIV stigma and discrimination—fed largely by ignorance and animus—persist and continue to have a forceful impact on people living with HIV.”

HIV Stigma and Discrimination Persist, Even in Health Care

Or at least you would hope no one would try and make them wear a badge…

More on Rights of People with HIV and Hepatitis B

Why Do Some Folks Wear a Mask During Flu Season?

Wearing a surgical mask is very common when people are sick and want to avoid spreading their germs to others. They are also commonly worn when people are healthy and are just afraid of getting sick.

Why Do Some Folks Wear a Mask During Flu Season?

Is that why you see some folks wearing masks during flu season?

If you are worried about your privacy, why announce something on Facebook?
If you were worried about your privacy, would you talk about it on Facebook?

Maybe, but some folks actually have to wear a mask during flu season.

Well, they have to because they decide they don’t want to get a flu vaccine, but still want to keep their job that could put others at risk if they got sick with the flu. So basically, it is unvaccinated health care personal and others who work around sick and vulnerable people who might have to wear a mask when they are at work.

Why don’t they just get vaccinated and protected against the flu?

That’s a good question…

Some other questions to consider as you think about flu vaccine mandates include:

  • Do unvaccinated health care workers pose a risk to others in the course of their jobs? Of course they do. Health care personal are at high risk to get the flu, since they are often around people who are sick with the flu, and are at higher risk to get the flu if they are unvaccinated.
  • Does wearing a mask protect anyone? – Yes, they actually do and recent studies have concluded that “surgical face masks worn by infected persons are potentially an effective means of limiting the spread of influenza.”
  • Does getting a flu shot prevent you from catching the flu? – Flu shots aren’t the most effective vaccine we have, but they are the best way to avoid catching the flu, being 10 to 60% effective since 2004.
  • Does getting a flu shot prevent you from spreading the flu to others? Yes, and several studies have shown lower rates of nosocomial cases among hospitalized patients as more health care personal get vaccinated!
  • Does getting a flu shot just cause you to have milder symptoms? The flu vaccine does has many benefits besides preventing the flu, but it is certainly not limited to just causing milder symptoms.
  • Does wearing a mask violate your HIPAA rights? No. Unless you announce it, no one knows why you are wearing a face mask. Maybe you have herpes or a cold or are just afraid of getting sick. And the Health Insurance Portability and Accountability Act only protects patients, not employees.

So why don’t all health care personal get a flu vaccine each year?

Most do.

And while some people seem to be against the idea of mandates for health care workers getting flu shots, most think it is a great idea.

“I support this requirement. I think it is a good idea. Ethically, it makes total sense. First, every doctor, nurse, and HCW knows that they are supposed to put patient interests ahead of their own interests. Whatever you think about flu shots, it is good for patients that their healthcare providers are vaccinated against the flu, particularly among patients who cannot themselves be vaccinated, such as some of the elderly, babies, people with immune diseases, and people who just received transplants or are getting cancer treatment. Vaccination does not help them. They are all immunosuppressed.”

Art Caplan on The Law: Get a Flu Shot or Wear a Mask, Healthcare Workers!

In fact, most think that there is both an ethical and a legal rationale for flu vaccine mandates for health care workers.

“Doctors and other healthcare providers have an ethical obligation to make decisions and take actions that protect patients from preventable harm. 5 Many patients are highly vulnerable to flu, so choosing not to be vaccinated is choosing to do harm—a choice that has no place in healthcare.”

Doctors choosing not to be vaccinated is choosing to do harm

It is hard to imagine that some doctors and nurses not only skip getting vaccinated, putting others at risk, but then don’t even want to wear a mask.

More on Wearing Masks During Flu Season