Author: Vincent Iannelli, MD

Get a Vaccine Checkup Before Traveling with Your Kids

Get vaccinated. Measles is just a plane ride away.
Get vaccinated: Bring home fun souvenirs, photos, and fantastic memories, not measles!

Got plans to travel this spring or summer?

Going out of the country?

Taking the kids?

While a trip abroad can be a great experience for kids, whether you are just site seeing or you are visiting family, don’t forget to take some simple precautions so that your family comes back safe and healthy.

Get a Vaccine Checkup Before You Travel

It is important to remember that just because your kids are up-to-date on their routine childhood immunizations, that doesn’t mean that they are ready to travel out of the country.

It might surprise some folks to know that there are many vaccines that kids in the United States don’t routinely get, like vaccines that protect against cholera, yellow fever, typhoid, and Japanese encephalitis, etc. These are considered to be travel vaccines and may be recommended or required depending on where you are going.

How do you know which vaccines your kids need?

The CDC Traveler’s Health website is the best place to figure it out. With a list of 245 destinations, in addition to offering advice on how to avoid vaccine-preventable diseases, you get recommendations on avoiding others too, like Zika and malaria.

Don’t wait until the last minute before checking on these vaccine recommendations though. These are not vaccines that most pediatricians have in their office, so call or visit your pediatrician a few months in advance to plan out how you will get them. As a last resort, if your pediatrician can’t order them, can’t help you get them from an area pharmacy, and they aren’t available at your local health department, you might look to see if there is a “travel clinic” nearby.

Don’t Forget the Early MMR Recommendations

It’s also important to remember to make sure your child’s routine vaccines are up-to-date too. Confusing things a little, that can mean getting their MMR vaccines early.

Many parents, and some pediatricians,  often forget that before traveling out of the United States:

  • Infants 6 months through 11 months of age should receive one dose of MMR vaccine. While this early dose should provide protection while traveling, it doesn’t provide full protection, doesn’t count as the 12 to 15 month routine dose, and will need to be repeated.
  • Children 12 months of age and older should receive two doses of MMR vaccine separated by at least 28 days. So even if your child is less than 4-years, he or she needs two doses of MMR before traveling out of the country. This second early dose won’t have to be repeated when they do turn 4.
  • Teenagers and adults who do not have evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days. While some adults are considered fully vaccinated with one dose of MMR, that isn’t true if they are traveling out of the country. Travelers need two doses!

Continuing outbreaks of measles linked to unvaccinated and partially vaccinated travelers highlight the need to spread the word about these recommendations.

Traveling is fun. Be sure to bring back some great memories and a few souvenirs. Don’t bring home measles or other diseases that you can then spread to others in your community or on the plane ride home.

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Vaccines and SIDS

Rates of most causes of sudden infant death, including SIDS, have dropped since the mid-1990s.
Rates of most causes of sudden infant death, including SIDS, have dropped since the mid-1990s.

Long before Andy Wakefield scared parents with the idea that vaccines could be linked to autism, we had the myth that vaccines caused SIDS or sudden infant death syndrome.

SIDS

SIDS is the “cause assigned to infant deaths that cannot be explained after a thorough case investigation, including a scene investigation, autopsy, and review of the clinical history.”

Like other types of sudden unexpected infant death (SUID), including sleep related deaths, the incidence of SIDS decreased dramatically in the mid-1990s after the American Academy of Pediatrics introduced their safe sleep recommendations.

These recommendations have evolved over the years, which is now called Safe to Sleep, and now include advice about room sharing instead of bedsharing, the protective role of breastfeeding and getting immunized, avoiding overheating, using pacifiers, and getting regular prenatal care, etc.

Vaccines and SIDS

The fact that getting immunized is thought to have a protective role against SIDS should help folks understand that vaccines do not cause SIDS.

“There is no evidence that there is a causal relationship between immunizations and SIDS. Indeed, recent evidence suggests that vaccination may have a protective effect against SIDS.”

AAP Task Force on Sudden Infant Death Syndrome

It is very easy to see why some would think they could be linked though. The highest risk of SIDS coincides with the ages of the two and four month well child checks, when infants are vaccinated. But as many of us understand, correlation does not imply causation. Just because two things happen at the same time doesn’t mean that one caused the other.

It also didn’t help that in 1999, ABC’s 20/20 did a misleading episode, “Who’s Calling the Shots?,” which claimed that the hepatitis B vaccine could cause SIDS.

But it is easy to see that they were wrong.

For one thing, even as we are giving infants more vaccines and protecting them from more diseases, fewer infants are dying of SIDS. How can that be if vaccines are linked to SIDS?

And why is the infant mortality rate in the United States continuing to go down, recently reaching a record low?

Also, many studies, such as this one, “Probability of Coincident Vaccination in the 24 or 48 Hours Preceding Sudden Infant Death Syndrome Death in Australia,” showed that coincident vaccination and SIDS can be expected to occur by chance alone. In fact, for the infants in this study, they showed that “if a child experienced an illness at the age of 8 weeks, then there is a 7% chance (or probability of 0.07) that the child would have been vaccinated in the preceding 24 hours.”

“…when a number of well-controlled studies were conducted during the 1980s, the investigators found, nearly unanimously, that the number of SIDS deaths temporally associated with DTP vaccination was within the range expected to occur by chance. In other words, the SIDS deaths would have occurred even if no vaccinations had been given.”

WHO Six Common Misconceptions About Immunization

And other studies actually showed that getting vaccinated reduced an infant’s risk of dying of SIDS.

What To Know About Vaccines and SIDS

Vaccines do not cause SIDS.

In fact, getting vaccinated is now thought to have a protective effect against SIDS!

For More Information on Vaccines and SIDS

Are Immigrants and Refugees Spreading Disease in the United States?

Neither the tired, poor, huddled masses yearning to breathe free, the wretched refuse of your teeming shore, nor the homeless, tempest-tossed, are not spreading diseases on our shores or anywhere else.
Neither the tired, poor, huddled masses yearning to breathe free, the wretched refuse of your teeming shore, nor the homeless, tempest-tossed, are not spreading diseases on our shores or anywhere else. (Photo by Vincent Iannelli, MD)

Why do some folks think that immigrants and refugees are spreading disease in the United States?

It certainly doesn’t help that Lou Dobbs once pushed the false idea that “illegal aliens” were fueling outbreaks of disease in the United States:

“The invasion of illegal aliens is threatening the health of many Americans. Highly-contagious diseases are now crossing our borders decades after those diseases had been eradicated in this country.”

Lou Dobbs Tonight

He warned, on his show in 2005, that “there are rising fears that once eradicated diseases are now returning to this country through our open borders. Those diseases are threatening the health of nearly every American as well as illegal aliens themselves.”

The once “eradicated diseases” he was talking about was leprosy. Of course though, he was wrong – leprosy has never been eradicated and it has not been increasing. Since 1985, there have been about 100 to 300 cases a year in the United States – no where near the “7,000 in the past three years” that Dobbs reported.

Immigrant Disease Spreading Propaganda Blitz

More recently, “as the taxpayer funded refugee resettlement industry launches a propaganda blitz about the so-called World Refugee Day” in 2016, Breitbart News reported that “six diseases that were recently near eradication are making a comeback in the United States.”

Of these six diseases, three – measles, mumps, and whooping cough – are vaccine-preventable and have very little to do with immigrants or refugees. Often, they have to do with unvaccinated United States citizens traveling out of the country, getting sick, and coming home to start an outbreak.

There was an outbreak of measles among a Somali community in Hennepin County, Minnesota in 2011, involving 14, mostly unvaccinated people. But they were unvaccinated because the anti-vaccine crowd (Wakefield) scared them away from being vaccinated over fears of autism, not because they were recent refugees.

Another Breitbart disease, scarlet fever, is simply the rash that you get when you have a strep infection, like strep throat. It is very common in kids and the incidence hasn’t changed over the years in the United States. For an unknown reason, the UK is seeing higher rates of scarlet fever though.

The last two Breitbart News warns about are bubonic plague and tuberculosis.

While there were 16 cases of plague in the United States in 2015, that is not unusual. The CDC reports that “in recent decades, an average of seven human plague cases have been reported each year (range: 1–17 cases per year).”

“The bacteria that cause plague, Yersinia pestis, maintain their existence in a cycle involving rodents and their fleas.”

CDC – Plague ecology in the United States

Anyway, you get bubonic plague from infected fleas and flea bites, not other sick people. You can get pneumonic plague from a sick person, but that hasn’t happened in the United States since 1924.

What about tuberculosis? That must be increasing because of new immigrants and refugees, right?

Nope. After years and years of decreasing, the number of cases and incidence rate has leveled off at its lowest level, about 9,500 cases since 2013. That’s compared to just over 14,000 cases in 2005. While that’s not to say that more work has to be done in working to eliminate tuberculosis, it is not making any kind of comeback.

Other Breitbart articles warned that “Syrian Refugees Spreading Flesh-Eating Disease, Polio, Measles, Tuberculosis, Hepatitis” and “EXCLUSIVE – Syrian Refugees Bringing Flesh-Eating Disease into U.S.?”

The “Flesh-Eating Disease” Breitbart is talking about isn’t the flesh-eating bacteria. It is a parasite that isn’t even spread from person to person. It is spread by sand fleas.

And rates of tuberculosis are actually lower in Syria than in most of Europe.

“In spite of the common perception of an association between migration and the importation of infectious diseases, there is no systematic association.”

World Health Organization

Tragically, while there have been some outbreaks of measles, polio, and other diseases in Syria, refugees are not spreading these diseases to Europe or the United States.

Of course, Breitbart isn’t the only  one participating in the immigrant disease spreading propaganda blitz these days.

“Likewise, tremendous infectious disease is pouring across the border. The United States has become a dumping ground for Mexico and, in fact, for many other parts of the world.”

Donald Trump (2015)

From politicians spreading misleading information about “tremendous infectious disease” to everyone else spamming each other with tales of immigrants spreading everything from Ebola and EV-D68 to worms, the net result is folks being scared of immigrants and refugees for no good reason.

Mychal Massie, in an Invasion USA report for WND recently wrote about a briefing given to the Arizona State Senate warning about a “Medical Ticking Time Bomb” warning that “illegals” were bringing scurvy, pernicious lice, and worms, etc. into the US.

Now unless immigrants are stealing all of our vitamin C, I don’t think that we have to worry that we will start see epidemics of scurvy any time soon.

We might have to worry about even larger outbreaks of measles and other vaccine-preventable diseases, but it won’t be immigrants or refugees causing them. It will be because more folks are skipping out on getting vaccinated and protected.

For More Information on Immigrants and Refugees

Cancer Vaccines Can Prevent and Treat Many Cancers

The CDC recommends HPV vaccination for 11 and 12 year olds.
The CDC recommends HPV vaccination for 11 and 12 year olds.

When you think about a cancer vaccine, what do you imagine?

Hopefully it isn’t the anti-vaccine myth that the polio vaccine causes cancer – it doesn’t.

Is it a vaccine that prevents all cancer, a so-called universal cancer vaccine? Or vaccines that target specific types of cancer?

Or do you get thoughts of a cancer vaccine that targets and kills cancer cells, treating patients once they already have cancer?

Sound too futuristic?

While a universal cancer vaccine is likely for than a few years away, many people are surprised that some of the vaccines in the current childhood and adolescent immunization schedule can actually prevent cancer.

Another vaccine is approved to treat cancer.

And that’s good news, as cancer is now the leading cause of death in the United States.

Current Cancer Vaccines

When cancer is caused by an infection, it makes sense that you can prevent the cancer by preventing the infection in the first place. That is the rationale for the current preventive cancer vaccines for the human papillomavirus (HPV) and hepatitis B:

  • Gardasil – an HPV vaccine that can be given to preteen boys and girls to protect against most genital warts and anal cancer. Gardasil also protects women against most cervical cancers.
  • Hepatitis B – the hepatitis B vaccine prevents hepatitis B infections, which when they become chronic, can develop into liver cancer.

For these vaccines to be effective, they have to be given before you are exposed to the virus. That is why it is critical for preteens to get the HPV vaccine before they become sexually active teens and young adults.

Since babies can get hepatitis B if their mother is infected and they are more likely to develop chronic hepatitis B infections, it is also important that all infants be vaccinated with the hepatitis B vaccine. Vaccination programs that instead try to target just those newborns of mothers already known to be infected with hepatitis B are much less successful than universal vaccination programs.

In addition to a preventive cancer vaccine, another type of cancer vaccine is the therapeutic or cancer treatment vaccine. This type of cancer vaccine actually helps your body fight the cancer.

So far, only one cancer treatment vaccine has been approved by the FDA.

Provenge is approved for some men with metastatic prostate cancer, increasing their survival by about 4 months. Provenge works by stimulating T lymphocytes, a part of our immune system, to kill prostate cancer cells.

Cancer Vaccines in Development

Although there are just four approved cancer vaccines in use today, there are many more in development, including:

  • DCVax(R)-L – in phase III trials to treat certain patients with glioblastoma multiforme, a type of brain tumor.
  • NeuVax – in multiple phase II trails, including one for certain patients with breast cancer to help prevent breast cancer recurrence.
  • Rindopepimut – in phase III trial to treat certain patients with glioblastoma.
  • Tecemotide – in phase III clinical trials for certain patients with non-small cell lung cancer.

Even more cancer vaccines are in phase I and phase II trials, such as WDVAX, which is in phase I clinical trials to treat certain patients with melanoma.

Although perhaps not as far along and still in early exploratory or pre-clinical research stages, there are other preventive cancer vaccines being developed too. These new vaccines would provide protection against hepatitis C (liver cancer), Epstein-Barr virus (Burkitt lymphoma, non-Hodgkin lymphoma, and Hodgkin lymphoma, etc.), Helicobacter pylori (stomach cancer), schistosomes (bladder cancer), and liver flukes (liver cancer).

What To Know About Cancer Vaccines

In addition to the hepatitis B and HPV vaccines that can prevent cancer, multiple vaccines are being developed to actually treat cancer.

For More Information On Cancer Vaccines

 

Hedda Get Bedda Doll and Other Measles Stories

Hedda Get Bedda originally came with a hospital bed.
The Hedda Get Bedda doll originally came with a hospital bed.

In the early 1960s, the American Character Doll Company produced a series of Whimsie dolls, including:

  • Annie the Astronut
  • Fanny the Flapper
  • Hilda the Hillbilly
  • Lena the Cleaner (baseball)
  • Samson the Strongman
  • Simon the Degree
  • Wheeler the Dealer (casino dealer)
  • Zero the Hero

Hardly politically correct for our times, the stereotyped dolls do provide a look at the history of their time.

One other doll, Hedda Get Bedda, is especially helpful in that sense.

Made in 1961, this Whimsie doll could change her face, letting you know how she was feeling when you turned the knob on her head. She could go from having a sleeping face, to a sick face (perhaps having chicken pox or measles), to a happy face (once you made her better).

Does the fact that she also came with a hospital bed mean anything?

Just like some anti-vaccine folks like to think that the simple fact that they made a doll that had measles or chicken pox could possibly mean that they looked at them as mild diseases, you could just as easily say that including the hospital bed means ‘they’ understand they were life-threatening diseases that could put land you in the hospital.

We are talking about the pre-vaccine era after all, and in 1961, and when the Hedda Get Bedda doll came out, there were about 503,282 cases of measles in the United States and 432 measles deaths.

Like the Brady Bunch measles episode, the Hedda Get Bedda doll is sometimes used to push the myth that vaccine-preventable diseases aren’t that serious, helping folks justify their decisions to intentionally skip or delay vaccines and leaving their kids unprotected.

“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”

Walter Orenstein, MD

For example, if you believed that measles, chicken pox, or Hib were mild diseases, then you might feel better about not getting your child the MMR, chicken pox, or Hib vaccines.

Sure, many people get measles and do get better without any complications. On their way to getting better though, even they have high, hard to control fever for 5 to 7 days, with coughing and extreme irritability.

But while most get better, we shouldn’t forget that some people don’t survive measles without complications. Natural immunity sometimes comes with a price, from vision problems and permanent hearing loss to brain damage.

And tragically, some people don’t get to survive measles.

Get Educated. Get Vaccinated.

For More Information and Measles Stories

Mumps Outbreaks

Pre-Vaccine Era Mumps Outbreaks

In the pre-vaccine era, mumps was a common childhood infection that could cause orchitis, meningitis, pancreatitis, deafness, and even death.

There were about 212,000 cases a year in the early 1960s, before the first mumps vaccine was licensed in 1968.

Post-Vaccine Era Mumps Outbreaks

Tips to prevent getting sick with the mumps.
A large Ohio mumps outbreak prompted an education campaign to help protect everyone from getting sick.

As with other vaccine-preventable diseases, there was a big drop in cases of mumps once the mumps vaccine was introduced.

In 1968, there were just over 152,000 cases and 25 deaths  and just ten years later, in 1978, that was down to 16,817 cases and 3 deaths.

Once the recommendation for the second dose of MMR came in 1990, it looked like mumps was on it’s way out.

We went from 5,292 cases and one death that year, to just 906 cases and no deaths in 1995. When measles hit its low point of 37 cases in 2004, there were just 258 cases of mumps.

That wasn’t the end for mumps though, as we had some up and down years, including big outbreaks in:

  • 2006 – 6,584 cases among Midwest college students and one death
  • 2008 – only 454 cases, but one death
  • 2009 – 1,991 cases and two deaths
  • 2010 – 2,612 cases mostly among Orthodox Jewish communities and two deaths
  • 2011 – 370 cases
  • 2012 – 229 cases
  • 2013 – 584 cases
  • 2014 – 1,223 cases involving a large outbreak in Ohio and in the NHL
  • 2015 – 1,057 cases mostly among university students in Iowa and Illinois

Could this all be because of waning immunity?

2016 Mumps Outbreaks

So far in 2016, the CDC reports that there have been:

  • at least 4,619 cases of mumps
  • cases have been reported in all states except Delaware, Louisiana, Vermont, and Wyoming
  • seven states, AK, IA, IN, IL, MA, NY, and OK with more than 100 cases in 2016

The most recent, ongoing outbreaks are in:

  • Arkansas (at least 2,159 cases) – which may be fueled by a large community of Marshall Islanders living in close quarters, with low levels of vaccinations among adults in the community
  • Oklahoma (at least 324 cases)
  • Washington (93 cases)
  • Long Beach, New York (45 cases), and at State University of New York (SUNY) at New Paltz in New York (13 cases)
  • Harvard University (4 cases)
  • University of Missouri (31 cases)
  • Tufts University (9 cases)
  • Texas – with most of the cases in North Texas, including a large outbreak in Johnson County (72 cases) and two other outbreaks linked to four different cheerleading competitions.

At SUNY New Paltz, most of the cases were among the swim team. In addition, 20 unvaccinated students were sent home from school under quarantine until December 3.

In Arkansas, 42 workplaces, 39 schools in six school districts, six colleges and two private schools in Benton, Carroll, Conway, Faulkner, Madison, Pulaski, and Washington counties are seeing most of the cases. A quarantine is in effect, with unvaccinated children being kept out of school for 26 days from the date of exposure or for the duration of the outbreak, whichever is longer.

Many of these outbreaks occur despite many of the cases having had two doses of the MMR vaccine. A third dose is sometimes recommended during these outbreaks.

That doesn’t mean that the MMR vaccine doesn’t work. After all, just compare today’s rates of mumps, even if they are a little higher than we would like, to pre-vaccine levels…

Getting two doses of the MMR vaccine is still the best way to avoid mumps.

There is no general recommendations to get extra shots though.

Keep in mind that the MMR vaccine isn’t just for kids. Adults who didn’t have mumps when they were kids (or who were born before 1957, when most kids got mumps), should make sure they are vaccinated (at least one dose) and protected too.

For More Information on Mumps Outbreaks:

References on Mumps Outbreaks:
CDC. Reported Cases and Deaths from Vaccine Preventable Diseases, United States, 1950-2013.

Updated on December 24, 2016

US Presidents and Vaccines

You would think that getting kids vaccinated and protected against vaccine-preventable diseases would be a non-partisan issue, but it unfortunately isn’t always the case.

donald-trump

Even before Donald Trump brought up false claims that vaccines cause autism, we have seen what can happen when funding for vaccines dropped. Federal support for vaccines dropped while Reagan was in office and we quickly saw outbreaks of vaccine-preventable diseases, including many deaths.

Fortunately, most American Presidents have strongly supported vaccines.

There is no longer any reason why American children should suffer from polio, diphtheria, whooping cough, or tetanus. … I am asking the American people to join in a nationwide vaccination program to stamp out these four diseases.

JFK in 1962

  • George Washington – had smallpox and later mandated that every soldier in the Continental Army had to be inoculated against smallpox
  • John Adams – was innoculated against smallpox (before Jenner‘s vaccine was available), as were his wife and children
  • Thomas Jefferson – conducted his own smallpox vaccine trials
  • James Madison – signed the Vaccine Act of 1813 – An Act to encourage Vaccination.
  • James K Polk – died of cholera, a now vaccine-preventable disease, three months after his term ended
  • Zachary Taylor – died of cholera while still in office
  • Abraham Lincoln – developed smallpox while he was in office
  • Franklin D Roosevelt – had polio and founded the National Foundation for Infantile Paralysis, which was later renamed the March of Dimes, and helped fund Jonas Salk‘s research on the first polio vaccine
  • Harry S Truman – had diphtheria as a child, which may have left him with vision problems, and was vaccinated against smallpox
  • Dwight D Eisenhower – signed the Polio Vaccination Assistance Act in 1955, which gave $30 million in federal grants to states to cover the costs of planning and conducting polio vaccination programs, including purchasing polio vaccine
  • John F Kennedy – signed the Vaccination Assistance Act in 1962 (Section 317 of the Public Health Service Act), which started as a three year program to help get kids vaccinated against polio, diphtheria, tetanus, and pertussis, but it has been continuously reauthorized ever since
  • Lyndon B Johnson – established a legacy of US leadership in global immunization by funding the CDC Smallpox Eradication program in 1965 (smallpox wasn’t eradicated until 1980)
  • Richard Nixon – observed that scientists who helped develop the polio vaccine with Jonas Salk “deserve far greater respect and support by the people whom they serve than they now receive.”
  • Gerald Ford – instituted a swine flu vaccination program for an outbreak that never appeared
  • Jimmy Carter – his National Childhood Immunization Initiative in 1977 reached its goal of immunizing 90% of children
  • Ronald Reagan – signed the National Childhood Vaccine Injury Act (NCVIA) of 1986, which created VAERS and the NVICP, while federal support for vaccine programs reached a low point in his years in office, as rates of children living in poverty and without health insurance increased
  • George HW Bush – his immunization action plan in 1991 once again raised immunization rates following three years of measles outbreaks
  • Bill Clinton – his Childhood Immunization Initiative in 1993 which included signing the Vaccines for Children (VFC) Act, provided free vaccines to many children
  • George W Bush – announced a major smallpox vaccination program in 2002, but very few healthcare workers actually volunteered to get vaccinated
  • Barack Obama – declared the 2009 H1N1 swine flu outbreak a national emergency, Obamacare requires health insurance plans to pay for vaccines without co-pays, made the Ebola outbreak a national security priority, and helped keep funding for Zika vaccine research going

What can we expect our next President to do about vaccines and vaccination rates?

For More Information on US Presidents and Vaccines:

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