Category: Immunization News

Believe It or Not, Chicken Pox Parties Are Still a Thing

Do you remember having chicken pox?

Oh boy, I sure do!

I was about six or seven years old and it was bad. Still, I’m not sure if I remember because I had such a bad case or because it made me miss Halloween that year.

It was almost certainly both, as I remember being covered in spots from head to toe.

What I don’t recall is having many visitors. Why didn’t my mom throw me a chicken pox party!

I also don’t remember going to a chicken pox party to get sick.

Believe It or Not, Chicken Pox Parties Are Still a Thing

Whether or not chicken pox parties were ever that popular, the approval of the chicken pox vaccine in 1995 should have put an end to the practice.

After all, why intentionally expose your child to a potentially life-threatening disease, when a safe and effective vaccine is readily available?

“Chickenpox (varicella) is generally a much milder illness in children than in adults, with considerably lower rates of severe disease and death. Varicella is also virtually universal in many populations, meaning that very few individuals escape infection over a lifetime. Thus, a sound logic underlies the idea of chickenpox parties, at which susceptible children can acquire the contagious causative pathogen, varicella zoster virus (VZV), from their peers. However, chickenpox is not without risks, even for children of this age; severe, complicated, and occasionally fatal varicella occur in previously healthy children, as well as the immunocompromised (who are at very considerable risk).”

Hambleton et al on Chickenpox Party or Varicella Vaccine?

Most folks understand that. They get their kids vaccinated and have helped get chicken pox under very good control, with outbreaks of chicken pox declining over 95%.

“Each year, more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented by varicella vaccination in the United States”

CDC on Monitoring the Impact of Varicella Vaccination

Apparently, not everyone has gotten the message though.

Remember when CPS had to investigate the mom who was having chicken pox parties in Plano, Texas a few years ago?

“On the page, parents post where they live and ask if anyone with a child who has the chicken pox would be willing to send saliva, infected lollipops or clothing through the mail.”

CBS 5 Investigates mail order diseases

Or when anti-vaccine folks were selling and mailing lollipops contaminated with chicken pox to folks so that they could skip the trouble of finding a chicken pox party?

And then there’s that time that a family served chicken pox contaminated punch at their chicken pox party. Oh wait, that was The Simpsons

Chicken pox party - The Simpsons did it.
Chicken pox party – The Simpsons did it in the Milhouse of Sand and Fog episode in Season 17.

So what are they up to now?

Folks are still advertising chicken pox parties in anti-vaccine Facebook groups.
Folks are still advertising chicken pox parties in anti-vaccine Facebook groups.

More of the same…

Does she know that the chicken pox vaccine likely decreases your risk of getting shingles later in life?
Does she know that the chicken pox vaccine likely decreases your risk of getting shingles later in life?

Apparently, there are still plenty of folks looking for chicken pox parties to infect their kids.

Why?

It is easy to see a lot of cognitive biases at play in the decision to host or bring a child to a chicken pox party, including ambiguity aversion (prefer what they think are the known risks of getting the disease), bandwagoning (they think everyone else is doing it, because in their echo chambers of anti-vaccine propaganda, everyone might), and optimism bias, etc.

There is also a very poor perception of risks, as the risks from a natural chicken pox infection are far, far greater than any risk from the vaccine.

Don't forget to tent!!!
Don’t forget to tent and share breath!!!

In bigger news, Facebook has groups who’s mission is “finding pox,” so that parents can get their kids sick!

The mission of PX Colorado is finding pox!
The mission of PX Colorado is finding pox!

How many other PoX type groups are there on Facebook?

How many other parents are intentionally not vaccinating their kids and intentionally exposing them to chicken pox?

Do any of them quarantine or isolate their kids for 10 to 21 days after the chicken pox party, so as to not expose anyone who is too young to be vaccinated, too young to be fully vaccinated, or has a true medical exemption to getting vaccinated, including those who are immunocompromised?

Do they understand the consequences of having these pox parties?

The latest chicken pox party hostess is apparently a nurse - at least for now...
The latest chicken pox party hostess is apparently a nurse – at least for now…

Of course, an investigation from CPS, the health department, or a medical board isn’t the most serious consequence that should discourage folks from hosting or attending a chicken pox party.

Chicken pox can be a serious, even life-threatening infection. Sure, many kids just get a mild case, but others get more serious cases and have bad complications, including skin infections, encephalitis, sepsis, or stroke.

And some people do still die from chicken pox, which is supposed to be a mild, childhood illness.

“This report describes a varicella death in an unvaccinated, previously healthy adolescent aged 15 years.”

Varicella Death of an Unvaccinated, Previously Healthy Adolescent — Ohio, 2009

Fortunately, these deaths have been nearly eliminated thanks to the chicken pox vaccine.

And that’s why parents who are on a mission for “finding pox” should rethink things and switch to a mission to get their kids vaccinated and protected.

More on Chicken Pox Parties

Did the FDA Approve a New HPV Vaccine for Adults?

What do you know about the HPV vaccine?

Hopefully you know that it can prevent cervical cancer and that lots of folks spread misinformation that is intended to confuse and scare you away from getting vaccinated and protected with it and other vaccines.

Did the FDA Approve a New HPV Vaccine for Adults?

News that the approved ages for Gardasil have been expanded will likely add to that confusion for a little while.

The FDA simply approved the expanded use of the existing Gardasil 9 vaccine – not a new vaccine.
The FDA simply approved the expanded use of the existing Gardasil 9 vaccine – not a new vaccine.

The first thing to understand is that the FDA did not approve a new Gardasil vaccine for older adults.

They very simply expanded the age recommendations for who should get the existing Gardasil 9 vaccine, which was approved back in 2014, replacing the original Gardasil vaccine, which was approved in 2006.

“The U.S. Food and Drug Administration today approved a supplemental application for Gardasil 9 (Human Papillomavirus (HPV) 9-valent Vaccine, Recombinant) expanding the approved use of the vaccine to include women and men aged 27 through 45 years.”

Why the new age indication?

“In a study in approximately 3,200 women 27 through 45 years of age, followed for an average of 3.5 years, Gardasil was 88 percent effective in the prevention of a combined endpoint of persistent infection, genital warts, vulvar and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer related to HPV types covered by the vaccine.”

But isn’t the whole point of giving the HPV vaccine to preteens that you want to get them vaccinated and protected before they are sexually active and exposed to and infected by HPV?

Sure, but if you didn’t, and unless you are sure that you have been exposed to and have been infected by all 9 types of HPV strains that Gardasil 9 protects you against, then the vaccine is still a good idea when you are older.

Except FDA approval doesn’t automatically mean that your insurance company will pay for it.

That usually comes once a vaccine is formally added to the immunization schedule by the ACIP.

“In a 2005 study, 92% of insurance plans reported following Advisory Committee on Immunization Practices recommendations to determine covered vaccines; of those, 60% could extend coverage within 3 months after issuance of recommendations and 13% in 1 month.”

Lindley et al on Financing the Delivery of Vaccines to Children and Adolescents: Challenges to the Current System

And Obamacare still requires insurance plans to provide ACIP-recommended vaccines at no charge.

Will Gardasil 9 be added to the immunization schedule for adults?

The extended age indication for Gardasil 9 will be discussed at the next ACIP meeting.
The extended age indication for Gardasil 9 will be discussed at the next ACIP meeting.

We should know sooner, rather than later. It is on the agenda for the next ACIP meeting on October 25…

More on Gardasil for Older Adults

What’s the Real Risk from the Contaminated Vaccines in India?

Most people understand that polio vaccines have helped to control and get us close to eradicating polio.

Many even know that there are two types of polio vaccine – the inactivated Salk vaccine and the live Sabin vaccine.

Some might even know that there are actually three strains of polio virus that we have traditionally gotten vaccinated against, and that one of those strains, type 2, has already been eradicated.

“In April 2016 a switch was implemented from trivalent OPV to bivalent OPV in routine immunization programmes.”

OPV Cessation

That’s why we have switched to using a bivalent OPV which only contains type 1 and 3 serotypes.

Contaminated Vaccines in India

What does all of this have to do with the news of contaminated vaccines in India?

“At least three batches of polio vaccines containing 1.5 lakh vials have been found contaminated with type 2 polio virus, putting at risk India’s “polio free” status as children born after April 2016 — when the type 2 virus was withdrawn worldwide including in India — do not have immunity to this particular virus, sources said.”

Unfortunately, some contaminated vaccines were actually administered to children in the Indian states of Maharashtra, Telengana, and Uttar Pradesh before the contamination was discovered.

Will these kids get polio?

No, as the vaccines weren’t contaminated with wild polio virus.

It seems that Bio-Med Private Limited was still producing and distributing polio vaccine with the type 2 vaccine virus, even though this type of vaccine was discontinued a few years ago.

Why?

We will  hopefully find out, as the managing director of Bio-Med Pvt Ltd has been arrested, but we don’t know yet.

We do know that there is little risk from these vaccines and they won’t put India’s “polio free” status at risk.

Why would there be any risk from kids getting an extra vaccine virus strain?

It’s because the type 2 strain of polio is the most likely to cause cVDPV, or outbreaks of polio that are actually caused by the polio vaccine.

Fortunately, these outbreaks are very rare.

A dose of IPV is the backup plan to make sure a problems with the switch to bOPV doesn't end up in a tragedy.
A dose of IPV is the backup plan to make sure any problems with the switch to bOPV doesn’t end up in a tragedy.

But kids in the area are at even less at risk from these “contaminated” vaccines because as part of the plan to switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV), they likely got a dose of IPV, which includes protection against all three polio virus strains.

Not that this means that it isn’t a problem that a company was making and distributing a vaccine that kids shouldn’t have been getting.

That is terrible!

It just isn’t as big a danger as some folks are making it out to be. It is extremely unlikely that there will be any cases of polio in India, and definitely not a resurgence of polio because of these vaccines, as some have suggested.

The real risk will be that an isolated event will scare folks away from getting vaccinated and protected, even though we know that these events are rare and that vaccines are safe.

More on Contaminated Vaccines in India

Crisis at the Nordic Cochrane Centre

This could be it for the Nordic Cochrane Centre.

“I regret to inform you that I have been expelled from membership in the Cochrane Collaboration by the favourable vote of 6 of the 13 members of the Governing Board. No clear reasoned justification has been given for my expulsion aside from accusing me of causing “disrepute” for the organization.”

Peter Gøtzsche on A moral governance crisis: the growing lack of democratic collaboration and scientific pluralism in Cochrane

Or at least for Peter Gøtzsche and his association with the Cochrane Collaboration, which he co-founded in 1993.

I’m not sure how he thinks that there was no clear justification for his being expelled though.

Crisis at the Nordic Cochrane Centre

Most folks understand why Peter Gøtzsche was expelled from the Cochrane Collaboration…

They remember that he recently published a poorly done analysis in BMJ Evidence-Based Medicine, The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias that was critical of a Cochrane Review on the HPV vaccine, Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors, which concluded that the HPV vaccines work and that they are safe.

While Gøtzsche’s analysis prompted the Cochrane Collaboration to initiate an investigation, they concluded that his analysis “substantially overstated its criticisms” and that the allegations were “not warranted and provided an inaccurate and sensationalized report of their analysis.”

Is that it?

Nope.

Many people are also familiar with the Nordic Cochrane Centre because of their involvement in continued complaints about the HPV vaccine. Complaints that were not approved by the Cochrane Collaboration and that were not an official Cochrane viewpoint!

“…we highlight here how academic colleagues, under the purported banner of a respected authority, raise concerns about the HPV vaccine but they cite an evidence base of small and poor quality studies and ignore the extensive wealth of global literature that vividly demonstrate the excellent efficacy and safety record of the vaccine.”

Head et al on Inadvisable anti-vaccination sentiment: Human Papilloma Virus immunisation falsely under the microscope

Complaints that had already been investigated and dismissed by the European Medicines Agency and refuted by many other studies.

“This week at its meeting in Edinburgh, Cochrane’s Governing Board considered, as planned, the findings of an independent review and additional complaints related to the conduct of a Member. The Board’s conclusion was communicated to the individual concerned and is part of an ongoing process. The Co-Chairs of the Board will provide further details once this process is complete.

Following this, four Board members (Gerald Gartlehner, David Hammerstein Mintz, Joerg Meerpohl and Nancy Santesso) decided to resign as Cochrane trustees with immediate effect.”

Message from the Governing Board

Unfortunately, Gøtzsche’s being expelled led to others leaving the Cochrane Governing Board, including two appointed trustees who volunteered to step down to to comply with Cochrane’s Articles of Association.

Although they may not have been defending Gøtzsche's opinions or behaviors, four other board members resigned in solidarity.
Although they may not have been defending Gøtzsche’s opinions or behaviors, four other board members resigned in solidarity.

We can hope that this is the end of the matter, as Cochrane will soon have an election for new board members.

Peter Gøtzsche is out at the Cochrane Collaboration.
Peter Gøtzsche is out at the Cochrane Collaboration.

Will he be kept on at the Nordic Cochrane Centre, which he founded? Will the Nordic Cochrane Centre be allowed to keep ‘Cochrane’ in their name?

The Nordic Cochrane Centre is primarily funded by the Danish Government, and what do they get besides all of the anti-HPV vaccine stuff?

“Antidepressant drugs are another major killer that people could do well without.”

Peter C Gøtzsche: Prescription drugs are the third leading cause of death

Peter Gøtzsche seems to be against cancer screening, psychiatric drugs, and thinks that Big Pharma has corrupted health care. Is that the “plurality of opinions, views, and perspectives” that folks want at Cochrane or anywhere else in medicine?

Unfortunately, I bet this isn’t the last that we have heard from him.

More on the Crisis at the Nordic Cochrane Centre

Which Flu Vaccine Should You Get?

After decades with a single type of flu vaccine – the flu shot – there are now many different kinds of flu vaccines that many of us can choose from. And your choices are not just between the nasal spray flu vaccine vs a flu shot. There are also a lot of different kinds of flu shots available now.

Everyone needs a flu shot. When will you get yours?
Everyone needs a flu shot. When will you get yours? Photo by Gabriel Saldana (CC BY-SA 2.0)

Having choices is nice.

It would be also be nice to have a little more guidance on what to do with these choices.

Are any of the flu vaccines better than others?

Which Flu Vaccine Should You Get?

This year, we will have:

  • quadrivalent flu shots – Afluria, Fluarix, FluLaval, Fluzone, Fluzone Pediatric Dose
  • quadrivalent flu shots that are cell-culture based – Flucelvax
  • quadrivalent flu shots that can be given intradermally – Fluzone Intradermal
  • trivalent flu shots – Afluria
  • trivalent flu shots that are adjuvanted – Fluad
  • high dose trivalent flu shots – Fluzone High-Dose
  • quadrivalent flu shots that are made with recombinant technology – Flublok
  • nasal spray flu vaccine – Flumist

Which one should you get?

It is actually easy to start by asking which one you should get for your kids, as many of these flu vaccine options are only available for adults and seniors.

Flu Vaccine Options

Before you start thinking too long and hard about potential options, keep in mind that you might not have as many options as you think.

“Not all products are likely to be uniformly available in any practice setting or locality. Vaccination should not be delayed in order to obtain a specific product when an appropriate one is already available.”

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

Doctors and clinics might not stock multiple brands or types of flu vaccines, so you might have to get whatever flu vaccine that they have available.

“Within these guidelines and approved indications, where more than one type of vaccine is appropriate and available, no preferential recommendation is made for use of any influenza vaccine product over another.”

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

And that’s okay. In most cases, there haven’t been head to head studies showing that one flu vaccine is better than another.

Flu Vaccine Options for Kids

Still, since these options might be available to you, it is good to know about them.

This year, younger kids, between the ages of 6 months and 3 years, can either get:

  • FluLaval Quadrilvalent
  • Fluarix Quadrivalent
  • Fluzone Quadrivalent Pediatric

While you are unlikely to notice a difference, both FluLaval and Fluarix are given at a 0.5ml dose containing 15 µg of HA per vaccine virus, while Fluzone is given at a 0.25ml dose containing 7.5 µg of HA per vaccine virus. Why the difference? “Safety and reactogenicity were similar between the two vaccines,” even at the different doses.

Basically, these are just different brands of the same type of flu shot.

There are even more options as your kids get older though, including  Fluzone Quadrivalent (age three and above), Afluria Quadrivalent or Trivalent (age five and above), Flucelvax Quadrivalent (age four and above), FluLaval and Fluarix.

Of these, some folks wonder if Flucelvax, since it isn’t made in chicken eggs, might be more effective than the others. Remember, one of the things that are thought to make the flu vaccine less effective than most other vaccines is that they are made in eggs, leading to mutations. And there is actually some evidence that those flu vaccines that are not made in eggs might be more effective.

“And the University of Pittsburgh Medical Center is taking that a step further, saying it will only be buying the two egg-free vaccines on the market: Flucelvax and FluBlok. That’s because there is some evidence these two formulations may work better than the older vaccines grown in eggs, said Dr. Richard Zimmerman, who advises the UPMC Influenza Committee.”

Guidance on which flu vaccine to get: Shots for kids, maybe go egg-free

Again, remember that the CDC has made “no preferential recommendation” for one flu vaccine over another. Why not? We don’t have enough information to make that kind of recommendation.

Should parents only ask for Flucelvax? That would only work if they made enough doses for every kid to get vaccinated, which they didn’t. Should you hold out until you can find FluceIvax for your kids? No, since doing that might leave them unvaccinated once flu season hits.

What else should you know about your flu vaccine options? While over 80% of flu vaccines are now thimerosal free, most of these flu vaccines are still available in multi-dose vials with thimerosal.

Also thimerosal free, this year, Flumist is back as an option. It is available for healthy kids who are at least two years old. Although the AAP has issued a preference for flu shots this year, the ACIP says that kids can get either Flumist or a flu shot.

What about if your kids are allergic to eggs?

“Persons who report having had reactions to egg involving symptoms other than urticaria (hives), such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may similarly receive any licensed, recommended, and age-appropriate influenza vaccine (i.e., any IIV, RIV4, or LAIV4) that is otherwise appropriate for their health status.”

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

Unless they had a severe allergic reaction to a previous flu vaccine, they can get any available flu vaccine, especially if the previous reaction was only hives or they are able to eat eggs.

What if you want a flu vaccine without aluminum? Take your pick. While it would be safe it was, aluminum is not an ingredient in flu vaccines.

Flu Vaccine Options for Adults

In addition to all of the flu vaccines available for older kids, adults have a few more options:

  • Afluria Quadrivalent or Trivalent can be given by jet injector  to those between the ages of 18 and 64 years
  • Flublok Quadrivalent – a recombinant flu shot that can be given to those who are at least 18 years old
  • Fluzone High-Dose – a trivalent flu shot with a higher dose of flu virus antigens (4 times the amount of antigen as a regular flu shot) that is available for seniors who are at least 65 years old
  • Fluad – a trivalent flu shot with an adjuvant that is available for seniors who are at least 65 years old

Why get a flu vaccine with a jet injector instead of a standard needle? High-pressure jet injectors don’t use needles!

Like FluceIvax, Flublok is not made in chicken eggs. The recombinant hemagglutinin(HA) proteins are made in insect cell lines. Does Flublok work better than egg based flu vaccines? That’s the theory, but again, there is no preference for one of these vaccines over another.

Seniors have even more choices.

Should they get Fluzone High-Dose, Fluad, or one of the other flu vaccines? Both have been shown to be more effective than standard flu vaccines in seniors, but they have not been compared against each other.

“In a Canadian observational study of 282 people aged 65 years and older conducted during the 2011-12 season, Fluad was 63% more effective than regular-dose unadjuvanted flu shots.”

CDC on People 65 Years and Older & Influenza

But neither Fluzone High-Dose nor Fluad are quadrivalent, so only protect against three flu virus strains.

Is there a quadrivalent flu shot for older adults that might work better than standard flu shots?

Yes. FluceIvax and Flublok are non-egg based quadrivalent flu shots that might be more effective than standard flu vaccines.

So are you more confused now that you know you have so many options? Just remember that for most people, the mistake isn’t about choosing the right flu vaccine, it is about not getting vaccinated.

What to Know About Your Flu Vaccine Options

While it might seem like you have a lot more options in a flu vaccine this year and that some might be more effective than others, keep in mind that availability will likely greatly limit these “options.”

And the best flu vaccine is the one that you actually get, as it will be the one that reduces your risk of getting the flu. Missing your chance to get vaccinated and protected because you are waiting for a specific brand or type of flu vaccine isn’t going to help keep the flu away.

More on Your Flu Vaccine Options

Flumist Is Not Just a Last Resort

The return of FluMist has hit a slight snag.

Most folks will remember that 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. So it will be available for this year’s flu season.

Many parents and pediatricians welcomed the news, as it meant that many kids could avoid getting a shot and could get the nasal spray flu vaccine instead.

Why did flu vaccine rates drop in younger school age kids when Flumist wasn't available?
Why did flu vaccine rates drop in younger school age kids when Flumist wasn’t available?

It was especially good news for those kids who skipped getting a flu vaccine because they didn’t want to get a shot when Flumist wasn’t available.

Flumist as a Last Resort?

So what’s the problem?

“The Academy recommends pediatricians give children inactivated influenza vaccine in the upcoming season and use live attenuated vaccine only as a last resort.”

American Academy of Pediatrics

Members of the AAP Committee on Infectious Diseases (COID) are concerned that FluMist, even after it has been changed to address previous issues, may not work as well as a standard flu shot.

“Influenza is unpredictable from year to year, so we really want to immunize as many kids as we can against the flu with what we think will be the most effective product. That’s why we’re recommending the flu shot this coming season.”

Henry H. Bernstein, D.O., M.H.C.M., FAAP

While many of us were surprised by the “last resort” phrasing from the AAP, maybe we shouldn’t have been.

In addition to being an ex officio member of the AAP Committee on Infectious Diseases (COID), Henry H. Bernstein was one of only two members of the ACIP who voted against bringing FluMist back, going against the opinion of twelve other members who voted in favor of FluMist.

Dr. Henry H. Bernstein is also the “leading voice on AAP’s annual policy statement on preventing flu in children with flu vaccines.”

“The data reviewed showed that receiving the nasal spray vaccine is better than not getting any vaccine at all,” said Flor Munoz, MD, FAAP, member of the AAP Committee on Infectious Diseases. “If you get the nasal spray vaccine, just be aware that, depending on the performance of the new vaccine formulation, there might be a chance you will not be fully protected against H1N1 strains of flu. The efficacy of this new formulation has not yet been determined.”

It is important to note that the AAP is not saying that Flumist won’t work though.

“The effectiveness of this new formulation of LAIV4 has not been confirmed, since A/H1N1 virus has not widely circulated recently.”

AAP influenza immunization recommendations revised for 2018-’19 season

They are basically saying that if the reformulated version of Flumist doesn’t work as it is predicted to work, then your kids might not be protected. They are concerned that we haven’t seen the new version of Flumist work in real world studies against the H1N1 strain of the flu.

Flumist Is Not Just a Last Resort

Fortunately, the AAP has somewhat rephrased their message about Flumist (LAIV4). While they still recommend that the inactivated influenza vaccine (flu shots) be the primary choice for children, they now say that:

“LAIV4 may be offered for children who would not otherwise receive an influenza vaccine (and for whom it is appropriate by age and health status).”

AAP influenza immunization recommendations revised for 2018-’19 season

Importantly though, parents and pediatricians should note that the recommendations of the Advisory Committee on Immunization Practices (ACIP) for the 2018–19 flu season very clearly make no preferential recommendation for the use of any influenza vaccine product over another.

“Following two seasons (2016–17 and 2017–18) during which ACIP recommended that LAIV4 not be used, for the 2018–19 season, vaccination providers may choose to administer any licensed, age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). LAIV4 is an option for those for whom it is appropriate.”

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

And the ACIP and CDC aren’t the only ones who disagree with the AAP’s decision.

“So I think the AAP was wrong, frankly, to say that FluMist should only be used as a last-resort vaccine for influenza. Rather, they should have gone along with what the ACIP said, which was that these vaccines can now be used interchangeably for persons aged 2-49 years.”

Paul Offit, MD on FluMist: Reasonable Vaccine Option or ‘Last Resort’ for the Upcoming Flu Season?

So what should you do?

If it is going to be a battle getting your kids a flu shot and you might you might have even skipped it the last few years because Flumist wasn’t available, then your choice is very clear.

Get vaccinated with Flumist, as long as your child is at least two years old and otherwise meets the requirements.

And don’t feel bad or worried that your decision is leaving your child unprotected. Remember that Flumist is recommended by the ACIP and CDC and has been used continuously in most other countries (under the name Fluenz).

Your next battle might simply be finding Flumist. Because of the AAP’s “last resort” comment, some pediatricians didn’t even bother ordering any doses.

More on the Latest Flumist Recommendations

Update on the Samoa Vaccine Tragedy

Breaking News – the inquiry into the deaths of two infants a few months ago continues to be delayed, all immunizations were halted by mistake, not just MMR and kids are starting to get vaccine preventable diseases (see below).

Many people remember that two young children died in Samoa in early July, shortly after getting an MMR vaccine.

Two toddlers died after being vaccinated at Safotu Hospital in Samoa.
Two toddlers died after being vaccinated at Safotu Hospital in Samoa.

Both incidents happened on the same day in the same hospital on the island of Savai’i.

“Until the investigations have been completed and reported on we cannot say what did happen.

However, given the batch of vaccine involved had been in use in that country since August last year, and given the same batch of vaccine has been used in South American countries and the Caribbean island nations without incident, it seems unlikely that there was anything wrong with the vaccine.

The reports from the parents of the children affected on Friday indicate the reactions occurred within minutes after vaccination. This would preclude a response to the vaccine viruses as this takes at least a week. While anaphylaxis occurs within minutes and can be fatal when not treated the odds of seeing this twice in a day at the same place, given a chance of 1 in a million doses, is literally astronomical.”

Dr. Helen Petousis Harrison on What happened in Samoa?

And while many people have speculated on what had happened, we didn’t get much new information until the Attorney General Lemalu Herman Retzlaff issued a press statement:

It can be confirmed that one of the nurses involved with the vaccination injections of the two babies who passed away 6th July 2018, was charged by police on Saturday 4th August 2018. She is set to appear in Court 14th August 2018, where the charges will be confirmed publicly.

According to AG Lemalu, “the file was referred to this office for advice last week, after swift and hard-working investigations by the CID section of the Ministry of Police both in Apia and Savaii, which is to be commended.”

“And the decision to charge was thereafter supported by advice; and it is also confirmed by Police, that investigations are still active and on-going.”

Both nurses have now been charged and both have entered not guilty pleas to charges of manslaughter, negligence and conspiracy to defeat the course of justice.

A trial is set for January 21, 2019.

Apparently though, an ongoing investigation into the deaths of the two toddlers that had been adjourned until September 12, as they were still waiting on the the post mortem reports from the pathologist in Australia, has been suspended even further.

“The inquiry into the deaths of two babies in Samoa has been suspended until further information is available from post mortem results”

Delays in Samoa deaths inquiry

So, we still don’t know what happened.

Were the vaccines contaminated somehow?

Was an error made?

Why were the nurses charged with manslaughter? Many think the main issue is that the nurses continued to use the MMR vaccine even after the first baby died.

“This particular vaccine batch lot arrived to Samoa in August 2017 and has been in use since then. The same vaccine batch lot used in Samoa is also in use in a number of South American and Caribbean countries (Belize, Ecuador, St. Vincent, Trinidad Tobago, Chile, Aruba, Dutch Antilles, St. Kitts & Nevis and Cuba) with no reports of adverse events from those countries.”

Government of Samoa – Ministry of Health Press Statement

Whatever happened, it is important to remember that these kinds of tragedies are very rare and that vaccines are safe.

There certainly doesn’t seem to be a good reason to continue to halt all vaccinations in Samoa!

“This stop order is for the M.M.R. to be put on hold for the time being until the case and the investigation are completed,” said Tagaloa.

“But in relation to other vaccines, the ministry did not have any stop order on this. We advise that the other vaccination still continue, especially the vaccinations relating to newborns.”

He added the stop order in question was issued by the National Health Service (N.H.S.) and it involves all vaccinations from the day of the incident.

“But we have already advised them to continue with the other vaccines except for the M.M.R. vaccinations.”

Order to stop immunisation only for M.M.R.

Vaccinations in Samoa, except for MMR, will resume thanks to a push by their Nurses Association.

What’s next? The post mortem results and the trial. Hopefully they don’t wait until the trial to resume MMR vaccinations though…

More on Samoa Vaccine Tragedy

Updated on September 30, 2018