Category: Immunization News

The Latest Measles Outbreak in Kansas

Several things are troubling about the measles outbreak in Kansas.

For one thing, it involved a lot of infants who were too young to be vaccinated. Their parents didn’t get to make a choice about getting vaccinated or getting measles. They got measles.

An ongoing outbreak in Kansas is up to 10 cases.
An ongoing outbreak in Kansas is up to 10 cases.

Also, as the case count climbs to 10, we still don’t know how the outbreak got started.

Does that mean someone else is still out there that exposed these kids to measles?

The Latest Measles Outbreak in Kansas

Since the outbreak in a daycare in Johnson County was discovered on March 8, a total of 10 measles cases have been identified, including:

  • eight Johnson County residents
  • one Linn County resident associated with the daycare
  • one Miami County resident not associated with the daycare

These cases may have exposed others at:

  • Auburn Pharmacy ; 625 E Main. St, Mound City, KS; on March 13th from 4:15 PM to 6:45 PM
  • Aldi’s ; 15290 W. 119th St Olathe, KS 66062; on March 2nd from 3:00 PM to 5:00 PM
  • Payless Discount Foods ; 2101 E. Santa Fe St, Olathe, KS; on March 6th from 10:00 AM to 12:30 PM
  • El Potro Mexican Café ; 602 N Pearl St, Paola, KS on March 7th from 4:00 PM to 8:00 PM
  • Children’s Mercy Hospital Kansas Emergency Department ; 5808 W 110th St, Overland Park, KS on March 8th and March 10th in the morning
  • AMC Dine – In Studio 28 ; 12075 S. Strang Line Rd, Olathe, KS; March 9th from 3:30 PM to 7:30 PM
  • Budget Coin Laundry ; 798 E Main St, Gardner, KS; on March 9th from 8:00 PM – 11:00 PM
  • Olathe YMCA swimming pool and locker room ; 21400 W. 153rd St, Olathe, KS; on March 10th from 9:30 AM to 1:00 PM
  • Bath and Body Works at Legends Outlets ; 1803 Village W Pkwy, Kansas City, KS; on March 10th from 1:00 PM to 3:00 PM
  • Crazy 8 at Legends Outlets ; 1843 Village W Pkwy, Kansas City, KS ; on March 10th after 1:00 PM to 3:00 PM
  • Orange Leaf ; 11524 W 135th St Overland Park, KS; on March 10th from 3:00 PM to 6:00 PM

If you were exposed and aren’t immune to measles (two doses of the MMR vaccine provide good protection), then you should watch for signs and symptoms to develop 10 to 21 days after your last exposure (in quarantine).

That means that we could expect to see new cases associated with this outbreak any time between March 12th (the earliest exposure) and April 3rd (the last exposure and the longest incubation period).

A History of Measles Outbreaks in Kansas

Some folks probably recall that this isn’t the first big measles outbreak in Kansas.

One of the largest measles outbreaks of 2014 was in the Kansas City metropolitan area. That year, at least 28 people developed measles, including a newborn who was only two weeks old.

In addition to the outbreak in Kansas City, there was another large outbreak that year in Sedgwick County – Wichita, Kansas.

And like most measles outbreaks, other states were affected too. Someone from Texas developed measles after getting exposed to measles at a softball tournament in Wichita.

More recently, outbreaks in Kansas have included:

  • a suspected case at William Allen White Elementary School in Lyon County, Kansas which has led to the quarantine of unvaccinated students for 3 weeks (2017)
  • a case in Butler County, Kansas. (2017)
  • a case in Sedgwick County, Kansas, a child too young to be vaccinated who may have been exposed at a church. Three other exposed infants who were too young to be vaccinated and who were considered at risk to get measles in this outbreak received immunoglobulin treatment. (2017)
  • a second case in the Wichita, Kansas area, this time in Sedgwick County, with exposures at a church, dental office, elementary school, and multiple stores over at least 3 days. (2017)

Why are there still so many measles outbreaks in Kansas?

Like in other places with outbreaks, it is likely explained by relatively high levels of non-medical exemptions and clusters of unvaccinated children and adults.

Hopefully this outbreak will be a good reminder that vaccines are necessary and everyone will get their kids caught up and protected.

What to Know About the Measles Outbreak in Kansas

Kansas is in the middle of another large measles outbreak and as usual, it is mostly among those who are unvaccinated, including many too young to be vaccinated.

More on the Measles Outbreak in Kansas

Measles Returns to California

Is anyone surprised that a student in California has measles?

A health advisory about measles in Santa Clara County.

Actually, a lot of folks are probably surprised. After all, didn’t lawmakers in California recently pass a law that mandated everyone in school get vaccinated?

Well yeah, but SB277 didn’t apply to all students. Only new students and those transitioning to a new grade span (for example, moving from K-6th to 7th grade) have to meet the new minimum immunization requirements. That means it will take more than a few years until all of the kids already in school whose parents have skipped or delayed any vaccines have gotten caught up or have graduated.

And that means we will still see some of these outbreaks of vaccine preventable diseases.

There is also a little issue with medical exemptions somehow rising being abused after the personal belief exemption was eliminated in the state…

Measles Outbreaks in California

When you think of measles and California, most people probably think of the 2015 Disneyland outbreak, which was linked to:

  • 134 cases in California, including at least 50 cases without a known source
  • 13 cases in Arizona, Nebraska, Utah, Colorado, Washington, and Oregon
  • 1 case in Mexico
  • 159 cases in Canada

The Disneyland outbreak included a lot of intentionally unvaccinated kids and kept unvaccinated kids from school, closed daycare centers, and led to hospitalizations of more than a few people.

“The ongoing measles outbreak linked to the Disneyland Resort in Anaheim, California, shines a glaring spotlight on our nation’s growing antivaccination movement and the prevalence of vaccination-hesitant parents.”

Majumder et al. on Substandard Vaccination Compliance and the 2015 Measles Outbreak

Schools in California were closed for at least two weeks in 1917 because of measles epidemics.

The Disneyland outbreak wasn’t the first big measles outbreak in California in recent years though.

No, I’m not talking about the really big outbreaks from the pre-vaccine era. Or even the outbreaks in the late 1980s, just before we started giving an MMR booster. Believe it or not, 75 people died between 1988 and 1990 with measles – just in California.

More recently, there was the 2008 outbreak in San Diego that was triggered by an unvaccinated 7-year-old boy who had traveled to Switzerland with his family.

He returned with measles and got at least 10 other unvaccinated children sick, including four infants who were too young to be vaccinated and were unknowingly exposed at their pediatrician’s office.

“Almost 100 children (including babies who were too young for the MMR vaccine) were quarantined or hospitalized after they were exposed at the pediatrician’s office, Whole Foods or day care. In all, 11 children caught the measles. As it turns out, the boy who spread measles is a patient of Dr. Bob Sears…”

OC’s Dr. Bob Sears discusses measles outbreak on NPR

One of those infants was hospitalized when his fever spiked to 106 degrees and he wouldn’t eat or drink.

“We spent 3 days in the hospital fearing we might lose our baby boy. He couldn’t drink or eat, so he was on an IV, and for a while he seemed to be wasting away. When he began to be able to drink again we got to take him home. But the doctors told us to expect the disease to continue to run its course, including high fever—which did spike as high as 106 degrees. We spent a week waking at all hours to stay on schedule with fever reducing medications and soothing him with damp wash cloths. Also, as instructed, we watched closely for signs of lethargy or non-responsiveness. If we’d seen that, we’d have gone back to the hospital immediately.”

Megan Campbell on 106 Degrees: A True Story

Measles cases also began rising in 2011, as unvaccinated travelers brought measles back from trips to Europe, Asia, and Africa, where there were large outbreaks.  There were 31 measles cases in California in 2011.

While 31 cases might not seem like much, consider that between 2001 through 2006, there were just 66 cases in California, with only 4 cases in 2005!

Will we ever get to a year with just 4 cases in California again?

It didn’t happen in 2017.

Last year started with a big outbreak in Los Angeles County that grew to include at least 24 cases and a few surrounding counties. There was also a case involving an unvaccinated student at Laguna Beach High in Orange County which led to the quarantine of at least 6 unvaccinated students.

The Latest California Measles Outbreak

What kind of a measles year will we see in 2018 in California?

There is just one case, so far.

Did you eat lunch at the Westgate Center food court on Friday, March 2?
Did you eat lunch at the Westgate Center food court on Friday, March 2?

An unvaccinated student returned from a trip to Europe and developed measles, exposing others between February 28 through March 2 in Santa Clara County at a school in Campbell and at the Westgate Center food court in San Jose.

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died.
The measles rash begins 3-5 days after other measles symptoms, which is why measles is often hard to diagnose.

With an average incubation period of 10 to 12 days, that means exposed people might begin to show symptoms by March 14. Keep in mind that the incubation period can be as long as 21 days though, so be on the watch for measles symptoms until at least March 23 if you could have been exposed.

Would you recognize measles?

It is important to understand that the first symptoms of measles don’t include a rash. Instead, you get a high fever, runny nose, cough, and pink eye. The measles rash comes a few days later, as the high fever continues.

It is also important to understand the the MMR vaccine is safe and works very well to prevent measles.

This exposure is a great reminder that vaccines are necessary and that you shouldn’t wait for your kids to get exposed to get them caught up and vaccinated and protected.

What to Know About Measles Outbreaks in California

A recent outbreak of measles in California, this time in Santa Clara County, is a good reminder that the MMR vaccine is necessary to keep your kids protected.

More on Measles Outbreaks in California

Mumps at the National Cheerleaders Association All-Star National Championship

The boys and girls at the 2018 National Cheerleaders Association All-Star National Championship in Dallas were hoping to go home with a trophy.

Some got a little more – exposure to mumps.

Mumps at the National Cheerleaders Association All-Star National Championship

If you don’t have a kid in competitive cheer, you should know that the NCA All-Star Nationals is a big deal.

Over 1,300 teams with more than 23,000 cheerleaders were competing. They came from 9 countries and 38 states for a 3 day competition at the Kay Bailey Hutchison Convention Center in downtown Dallas.

The Texas Department of State Health Services has issued a warning that a person with mumps was present at the NCA All-Star Nationals.
The Texas Department of State Health Services has issued a warning that a person with mumps was present at the NCA All-Star Nationals.

They worked hard, but they had fun.

And some of them may have been exposed to mumps.

What to Do If You Were Exposed to Mumps at the NCA All-Star Nationals

So what do you do if you were exposed to mumps in Dallas?

While mumps is a vaccine-preventable disease, even kids who have gotten two MMR shots can still get mumps. That’s because waning immunity causes the vaccine to become less effective over time.

Still, mumps is not nearly as contagious as other vaccine-preventable diseases, such as measles. You generally have to have close contact with someone with mumps to catch it.

“The mumps virus replicates in the upper respiratory tract and spreads through direct contact with respiratory secretions or saliva or through fomites. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps.”

CDC on Mumps for Healthcare Providers

Unless you were on the same team as the person with mumps (if it was a cheerleader), your risk of getting sick probably isn’t that high. Of course, the risk goes up the more contact you had.

Mumps is not just for kids anymoreUnfortunately, neither a post-exposure dose of MMR nor immune globulin work to prevent mumps after you are already exposed.

At this point, whether or not your child is vaccinated, all you can do is wait and watch to see if they develop signs or symptoms of mumps.

With an incubation period of 12 to 25 days, that means that those who were exposed could get sick between March 7 and March 22.

While there is no treatment for mumps, you do want to watch for complications and make sure you don’t expose anyone else.

And if your child is unvaccinated, this exposure is a good reminder that outbreaks still happen, vaccines are necessary, and this is a good time to get caught up.

Mumps and Cheer

Not surprisingly, this isn’t the first time we are hearing about mumps at a cheer competition.

In 2016, mumps exposures at several cheer competitions in North Texas led to at least 11 cases of mumps.

Why cheer? It’s not cheer, but the nature of cheer competitions. You just have a lot of older kids together at these competitions from a lot of different places and the MMR vaccine is known to have an issue with waning immunity.

Fortunately, most of these kids are vaccinated, which helps keep these outbreaks from really getting out of control, like they did in the pre-vaccine era.

What to Know About Mumps at the NCA All-Star Nationals

Tens of thousands of kids could have been exposed to mumps at a cheerleader competition in Dallas.

More on Mumps at the NCA All-Star Nationals




The Strategic Plan to Develop a Universal Influenza Vaccine

Even before you get to talk about problems with flu vaccine effectiveness,  it becomes clear that everyone wants a better flu vaccine.

One big problem with the current generation of flu vaccines?

You have to get them each and every year.

Developing a Better Flu Vaccine

So what would we all want in a new and better flu vaccine?

It would:

  • last longer, so you didn’t have to get a new vaccine every year
  • be more effective
  • cover more flu vaccine strains, so it wasn’t a “guess” about which flu strains to include in the flu vaccine each year and we didn’t have to worry about drifted flu vaccine strains or new and emerging strains for which there is no vaccine

A universal flu vaccine, which covers all possible flu strains, would be ideal.

So why haven’t we been working on developing a universal flu vaccine?

Well, we have.

It just isn’t that easy.

Many different research teams have been working on a universal flu vaccine for years and some have already had some success.

Does that mean we will see a universal flu vaccine soon?

Unfortunately, of the almost 40 organizations working on improved flu vaccines, including a universal flu vaccine, about 30 are still in preclinical or phase 1 trials. So the answer is no, we will not see a universal flu vaccine soon.

The Strategic Plan to Develop a Universal Influenza Vaccine

Maybe that will change now that more and more folks are pushing for a better flu vaccine and we see the effects of severe flu seasons without a good vaccine.

Of course, talk isn’t enough.

“A priority for the National Institute of Allergy and Infectious Diseases (NIAID) is development of an influenza vaccine providing durable protection against multiple influenza strains, including those that may cause a pandemic, i.e., a universal influenza vaccine. To invigorate research efforts, NIAID developed a strategic plan focused on knowledge gaps in three major research areas, as well as additional resources required to ensure progress towards a universal influenza vaccine. NIAID will use this plan as a foundation for future investments in influenza research and will support and coordinate a consortium of multidisciplinary scientists focused on accelerating progress towards this goal.”

Erbelding et al on A Universal Influenza Vaccine: The Strategic Plan for the National Institute of Allergy and Infectious Diseases

That’s why it is also encouraging that we have seen the:

  • The Flu Vaccine Act would help fund a universal flu vaccine.the Pathway to a Universal Influenza Vaccine workshop convened by the National Institute of Allergy and Infectious Diseases (NIAID) in 2017
  • the Strategic Plan for Developing a Universal Influenza Vaccine by the NIAID that was announced in 2018
  • U.S. Sen. Ed Markey (D-MA) introduced the Flu Vaccine Act, which would invest $1 billion towards development of a universal flu vaccine

Knowing that developing a universal flu vaccine is a priority of the NIAID and that so many organizations are already working towards this goal is very reassuring.

Hopefully we are a lot closer than some folks thing.

Until then, a seasonal flu vaccine is the best way to avoid the flu and serious flu complications.

What to Know About Developing a Universal Influenza Vaccine

Developing a better flu vaccine, including a universal flu vaccine, is an even bigger priority with the announcement of the Strategic Plan for Developing a Universal Influenza Vaccine.

More on Developing a Universal Influenza Vaccine

FluMist Is Coming Back

FluMist is a live, attenuated nasal spray flu vaccine.

While pediatricians, parents and kids loved it, since it wasn’t a shot, it hasn’t been available since 2016 because it was found to be less effective than flu shots against the H1N1 strain of flu.

The History of FluMist

FluMist had been a good option for kids who don't want to get a flu shot every year.
FluMist had been a good option for kids who don’t want to get a flu shot every year. Photo by Vincent Iannelli, MD

The FluMist nasal spray was first approved in 2003 for healthy kids over age 5 years and adults up to age 49 years.

In 2007, the age range was expanded to included healthy children between the ages of 2 and 5 years.

It quickly became a favorite of kids who didn’t like the idea of getting a flu shot each year, although some kids didn’t like getting something sprayed into their nose.

Next, in 2012, FluMist Quadrivalent, with protection against four strains of flu virus, was approved.

While some experts initially thought it might work better than traditional flu shots and it actually became the preferred flu vaccine for kids in 2014, by 2016, FluMist was no longer recommended in the United States.

The Return of FluMist

On February 12, 2017, at a meeting of the Advisory Committee on Immunization Practices (ACIP), members voted to once again recommended FluMist Quadrivalent to prevent the flu. It will be available for next year’s flu season, although the recommendation still has to be approved by the director of the CDC.

What happened to FluMist?

“In the 2013-2014 influenza season, when lower than expected effectiveness of FluMist Quadrivalent was first observed, Influenza A (H1N1) was the predominant circulating influenza virus strain. When the data showing lower than expected vaccine effectiveness became available, FDA began working with MedImmune to investigate potential reasons for this finding.”

FDA Information Regarding FluMist Quadrivalent Vaccine

Although they worked on a fix after the 2013-2014 influenza season, the following season showed poor effectiveness for all flu vaccines because of a drifted flu strain. So it wasn’t until the following year that it was noticed that FluMist still didn’t work as well as a flu shot against H1N1 flu strains, at least not in the United States.

Surprisingly, studies in other countries, including Finland and the UK showed that FluMist did work.

And now MedImmune, the company that makes FluMist, has replaced the H1N1 seed virus it uses to make FluMist, and preliminary testing shows that it is more effective and should be as effective as a flu shot.

That’s why the ACIP voted 12-2 to make FluMist available for the 2018-2019 flu season.

Will you get it for your kids next year, instead of a regular flu shot? If the number of parents and kids asking for FluMist this year is any guide, many will be glad it’s back.

What to Know About the Return of FluMist

FluMist has hopefully been improved, been made more effective, and will be ready to help prevent the flu for the 2018-2019 flu season. It will be an especially good option for those kids who don’t want a shot.

More on the Return of Flumist

What Are the Changes in the 2018 Immunization Schedules?

As they do every year, the Advisory Committee on Immunization Practices (ACIP) just released an updated immunization schedule.

The 2018 immunization schedule didn't bring any changes for most kids.
The 2018 immunization schedule doesn’t bring any changes for most kids.

And just like in most other recent years, there were few big changes or announcements.

That means that most kids won’t need any extra shots when they go to their next well check up with their pediatrician or to start school.

What Are the Changes in the 2018 Immunization Schedules?

There are some changes though…

  • A third dose of MMR is now recommended for some people during outbreaks of mumps.
  • MenHibrix was removed from the schedule, which was expected, as this combination meningococcal vaccine for high risk kids was discontinued in 2016 because of low demand. Fortunately, this doesn’t mean that any kids will be left unprotected. They can just get one of the other meningococcal vaccines if they need it, with a separate Hib vaccine, just like other infants.
  • Menomune was removed from the schedule, which was expected, as this older meningococcal vaccine was discontinued in 2017, as it was replaced with the newer meningococcal conjugate vaccines (Menactra and Menveo).
  • Shingrix, the new recombinant shingles vaccine is added to the schedule for adults aged 50 or older. They should get 2 doses 2 to 6 months apart, even if they have had shingles in the past or have had the older Zostavax already. And Shingrix becomes the preferred shingles vaccine for those who are at least 60 years old.

The other changes are to the formatting of the schedule and schedule footnotes.

“The schedule footnotes are presented in a new simplified format. The goal was to remove unnecessary text while preserving all pertinent information and maintaining clarity. This was accomplished by a transition from complete sentences to bullets, removal of unnecessary or redundant language, and formatting changes.”

CDC on Changes to This Year’s Schedule

So, unless your child is in a mumps outbreak, the new immunization schedule shouldn’t mean any extra vaccines.

What to Know About the 2018 Immunization Schedule

The 2018 immunization schedule from the CDC, AAP, ACOG, and AAFP incorporates the latest recommendations from the ACIP, including that folks in a mumps outbreak might need a third dose of MMR.

More on the 2018 Immunization Schedule

A 6-year-old in Florida With Rabies Has Died

Never touch a bat that you find on the ground during the day, as it might have rabies.
Never touch a bat that you find in your home or on the ground during the day, as it might have rabies. Photo by Radu Privantu (CC BY 2.0)

As most people understand, rabies is a little different than most vaccine-preventable diseases.

Unlike other vaccines, you typically don’t get a rabies vaccine until after you are exposed to the rabies virus. That’s why the rabies vaccine isn’t on the routine childhood immunization schedule.

And that’s why we also try to routinely vaccinate all of the animals around us that might get rabies, especially our pets.

It’s also why it’s important to avoid animals that might have rabies, including unfamiliar cats and dogs, and wild animals, especially bats, raccoons, skunks, foxes, and coyotes.

A 6-year-old in Florida Has Rabies

Unfortunately, this strategy doesn’t always work.

A 6-year-old in Florida, Ryker Roque, was recently exposed to rabies when his father found a sick bat and placed it in a bucket on their porch. Little Ryker eventually put his hand in the bucket and was “scratched” by the bat, even though his father had warned him not to touch the bat.

Could someone search for advice on Google on treating a bite from a rabid animal and come away thinking their child doesn't need rabies shots from an anti-vaccine website?
Could someone search for advice on Google on treating a bite from a rabid animal and come away thinking their child doesn’t need rabies shots from an anti-vaccine website?

After searching for information on what to do if a child is bitten by a sick bat, Ryker’s parents decided to wash his hands with soap and hot water.

“If you think your pet has been bitten by a bat, contact a veterinarian or your health department for assistance immediately and have the bat tested for rabies.”

CDC on Coming in contact with bats

The Today Show reports that they didn’t take him for rabies shots, even though they “knew they should have,” because “Ryker cried at the thought of getting shots.”

In a more common scenario, or maybe what happened here, parents simply decide that the risk is low and they take their chances. This is even more common after a child is bitten by a stray cat or dog and you simply don’t have vaccination records or an animal to put in quarantine.

Experimental Treatments for Rabies

When traditional post-exposure prophylaxis isn’t used – human rabies immune globulin and a series of rabies shots to prevent someone from getting rabies, the disease is historically fatal. We have no good treatments for human rabies and rabies encephalitis.

“The poor prognosis in rabies may reflect the fact that infection induces immune unresponsiveness, characterized by impaired T-cell function, with altered cytokine patterns, inhibition of T-cell proliferation, and the destruction of immune cells.”

Alan C Jackson on Current and future approaches to the therapy of human rabies

Fortunately, some experimental treatments have been developed that can offer at least a little bit of hope when someone gets rabies, including:

  • The Milwaukee Protocol – developed for a 15-year-old girl in Wisconsin who developed rabies symptoms one month after picking up a bat that had fallen to the floor at church. The bat bit her as she carried it outside. As her symptoms progressed, she was put into a drug induced coma, put on a ventilator, and given antiviral medications. She eventually recovered with mild to moderate after-effects, but most others on the protocol do not recover at all.
  • use of rabies virus-neutralizing human monoclonal antibodies
  • new experimental vaccines

Tragically, reports about recovery from rabies and rabies encephalitis are rare.

Things that might point to a favorable outcome, in addition to being vaccinated, including being young and healthy, having mild symptoms when treatment is started, and being exposed to rabies from a bat, instead of a dog or other animal.

Unfortunately, like many others, Ryker died while on the protocol.

Anti-Vaccine Websites and Rabies Vaccines

Believe it or not, anti-vaccine websites even work to scare folks away from getting rabies vaccines after their kids are exposed to a rabid animal.

  • Age of Autism promotes a self published book about a child who “who regressed into autism following a series of rabies vaccines when he was three and a half”
  • The Healthy Home Economist claims that our pets are suffering from vaccinosis, that pet vaccines contain a toxic chemical cocktail, and that they are a scientific fraud.
  • GreenMedinfo published an article from Suzanne Humphries, MD warns that an ingredient in the rabies vaccine “could possibly throw children or adults onto dialysis and/or a kidney transplant”
  • Kelly Brogan, MD, in her “review article,” Psychobiology of Vaccination Effects: Bidirectional Relevance of Depression, continues to push the idea that the rabies vaccine can cause ADEM.

And of course, almost every anti-vaccine website and anti-vaccine expert pushes the idea that vaccines don’t work.

Get educated. While vaccines are always necessary, there are some situations when they are critically important.

What to Know About Bats and Rabies

Rabies is a vaccine-preventable disease, so be sure to seek quick medical attention if there is ever a possibility that your child was exposed to a rabid animal, whether it is a dog, cat, bat, raccoon, skunk, fox, or coyote.

More on Bats and Rabies

Updated January 15, 2018