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.
Breaking News: Flu season has peaked, but isn’t over yet. (see below)
While flu season typically peaks in February, it is very important to understand that there are few things that are typical about the flu.
Since 1982, while we have been twice as likely to see a flu activity peak in February than other winter months, we have been just as likely to get that peak in December, January, or March. That makes it important to get your flu vaccine as soon as you can.
You really never know if it is going to be an early, average, or late flu season.
While there will likely be some surprises this flu season – there always are – there are some things that you can unfortunately count on.
Among these flu facts include that:
there have been 1,482 pediatric flu deaths since the 2003-04 flu season, including 89 flu deaths last year
about 113 kids die of the flu each year – most of them unvaccinated
antiviral flu medicines, such as Tamiflu, while recommended to treat high-risk people, including kids under 2 to 5 years of age, have very modest benefits at best (they don’t do all that much, are expensive, don’t taste good, and can have side effects, etc.)
a flu vaccine is the best way to decrease your child’s chances of getting the flu
And even in a mild flu season, a lot of kids get sick with the flu.
This Year’s Flu Season
When does flu season start?
In general, flu season starts when you begin to see people around you with signs and symptoms of the flu, including fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue, etc.
To be more accurate, you can also look at reports for flu activity in your area, especially the weekly reports from the CDC.
Those flu reports can also help you determine when flu season ends.
As of late-March, the CDC is reporting that “flu activity decreased but remains elevated in the United States.”
The CDC has also recently reported that:
this year’s flu vaccine reduces “the risk for influenza-associated medical visits by approximately half”
influenza A (H3N2) viruses, a component of this year’s flu vaccine, predominated early in this year’s flu season, which could be a sign of a severe flu season. In general, “H3N2-predominant seasons have been associated with more severe illness and higher mortality, especially in older people and young children…”
Is it a match? – “…antigenic and/or genetic characterization shows that the majority of the tested viruses remain similar to the recommended components of the 2016-2017 Northern Hemisphere vaccines.”
As often happens on the downside of a flu season peak, we are starting to see more and more influenza B each week
There are reports of a new avian influenza A(H7N9) epidemic in China. Although deadly, there is fortunately no reports of sustained human-to-human transmission of this flu virus strain that is usually associated with poultry exposure.
Next year’s flu vaccine won’t be changing much, except that “The A(H1N1)pdm09 virus has been updated compared to the virus recommended for northern hemisphere 2016-2017 influenza season.”
18 states (down from 24), including Alaska, Connecticut, Delaware, Iowa, Kentucky, Maine, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Rhode Island, South Carolina, Vermont, Virginia, and Wisconsin, are still reporting widespread flu activity (the highest level)
18 states (down from 19), including Arizona, California, Florida, Georgia, Kansas, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Mexico, Oklahoma, Pennsylvania, Tennessee, and Washington, and Puerto Rico are now reporting regional flu activity
12 states (up from 5), Alabama, Arkansas, Hawaii, Idaho, Illinois, Indiana, Montana, Oregon, South Dakota, Texas, West Virginia, and Wyoming, are now reporting local flu activity
2 states (same as last week), Colorado and Utah, are now reporting sporadic flu activity
there have been 72 pediatric deaths this flu season, including reports of 5 new deaths this week
Have you and your family gotten been vaccinated and protected against the flu yet?
“Anyone who has not gotten vaccinated yet this season should get vaccinated now.”
CDC Influenza Situation Update
If not, this is still a good time to get a flu vaccine.
Recent Flu Seasons
Are H3N2 predominant flu seasons really worse than others?
2003-04 flu season – 152 pediatric flu deaths (H3N2-predominant)
2004-05 flu season – 47 pediatric flu deaths
2005-06 flu season – 46 pediatric flu deaths
2006-07 flu season – 77 pediatric flu deaths
2007-08 flu season – 88 pediatric flu deaths (H3N2-predominant)
2012-13 flu season – 171 pediatric flu deaths (H3N2-predominant)
2013-14 flu season – 111 pediatric flu deaths
2014-15 flu season – 148 pediatric flu deaths (H3N2-predominant)
2015-16 flu season – 89 pediatric flu deaths
In addition to high levels of pediatric flu deaths, the CDC reports that the four flu seasons that were H3N2-predominant in recent years were “the four seasons with the highest flu-associated mortality levels in the past decade.”
There are many doctors and other health professionals who do and recommend things that are far out of the mainstream. They may tell their patients to skip or delay vaccines, that vaccine-preventable diseases aren’t that bad, or even that vaccines don’t work, etc.
And yet, many are surprised when some of them face disciplinary actions from their state’s medical boards, such as:
was preparing alternative vaccinations for children for more than a decade
gave patients modified vaccinations containing cat saliva and vodka
was signing state forms certifying he had given pediatric patients their conventional shots
used a WaveFront 2000 device to detoxify vaccines of mercury
Dr. Lin’s medical license has been suspended and he was supposed to have “a hearing before the Medical Disciplinary Board is set for Oct. 11 in Chicago.” That hearing didn’t happen though and he is now supposed to have a new hearing on November 21.
Dr. Bob Sears is also facing disciplinary action from his state’s medical board.
An anti-vaccine doctor in Arizona, Dr. Jack Wolfson, a holistic cardiologist, was also investigated by his state’s medical board following several complaints that were made during a recent measles outbreak.
Joseph Mercola, D.O. is another anti-vaccine doctor who has faced trouble in the past. A frequent guest on the Dr. Oz show, he has gotten several warnings from the FDA for marketing a thermal camera as a cancer screening device and making false and misleading claims about natural supplemental products he markets.
Even Dr. Oz has gotten into some trouble in recent years, testifying before Congress about weight loss scams.
For More Information On Doctors Facing Disciplinary Actions Over Vaccines:
Vaccines aren’t often recalled. There have been about 18 recalls of vaccines since 2006.
While that might seem like a lot, remember that at least 2.5 billion doses of vaccines have been given in that time .
When vaccines are recalled, it is typically because:
there is a loss of potency over time (typically flu vaccines near the middle or end of flu season)
there are minor production or manufacturing issues
Fortunately, these recalls don’t usually seem to involve major problems.
They are also a testament to just how closely vaccines are inspected after they are manufactured.
Recent vaccine recalls include:
Fluzone Quadrivalent – 3 lots had declined below the stability specification limit for 2 strains (2015)
Flulaval Quadrivalent – 13 lots of thimerosal-free pre-filled syringes were recalled because of loss of potency (2015)
Gardasil – one lot was recalled “due to the potential for a limited number of vials to contain glass particles” (2013)
Menveo – two lots were recalled “following observation of higher-than-specified levels of residual moisture within the lyophilized MenA component vial” (2013)
Recombivax HB – one lot was recalled “due to the potential for a limited number of cracked vials to be present in the lot.” (2013)
Typhim Vi – two lots of prefilled syringes and 20-dose vials because the “lots are at risk for lower antigen content” (2012)
MMR-II – one lot was recalled because it had not been shipped before being released. (2012)
Prevnar 13 – one lot was recalled because “the lot was formulated and filled with expired serotype 3 conjugate material.” (2012)
Fluvirin – one lot was recalled because “for a small number of vials, cracked vial necks leading to broken vials have been detected” (2010)
RabAvert Rabies Vaccine Kits – one lot was recalled because “as the stopper and the metal crimp dislodge from the vial completely when removing the protective cap.” (2010)
Prevnar 7 – 4 lots were recalled because “a potential exists for syringes to have been distributed with a rubber formulation in the syringe tip caps that was not approved for use with Prevnar.” (2010)
2009 H1N1 intranasal vaccine – 13 lots were recalled because of a “slight decrease in the potency of the H1N1 component of the vaccine” (2009)
2009 H1N1 vaccine – 4 lots were recalled because they were “intended for children 6 through 35 months of age” (2009)
Prevnar 7 – 1 lot was recalled because some of pre-filled syringes were “not intended for commercial use” (2009)
Fluvirin – 5 lots was recalled because of “a minor deviation in the potency of the A/Brisbane (H1N1) component of the vaccine” (2009)
PedvaxHib and Comvax – 13 lots were recalled because of a “lack of assurance of product sterility” (2007)
Fluvirin – 2 lots were recalled because they were shipped “in either a frozen state and/or below the required storage temperature” (2006)
Decavac – one carton (about 3000 Td shots) was recalled because it ” exceeded labeled temperature requirements during shipment” (2006)
These vaccine recalls shouldn’t scare you away from getting your kids vaccinated.
None led to “serious adverse events,” as some folks try to scare parents.
If anything, they should reassure you just how safe vaccines are. After all, from these vaccine recalls, you now know that ‘they’ are:
monitoring the potency of vaccines after they are manufactured
monitoring the temperatures of the vaccines while they are being shipped and stored
continuing to do quality testing, even after the vaccine is released
Remember, according to the CDC:
There have been only a few vaccine recalls or withdrawals due to concerns about either how well the vaccine was working or about its safety. Several vaccine lots have been recalled in recent years because of a possible safety concern before anyone reported any injury. Rather, the manufacturer’s quality testing noticed some irregularity in some vaccine vials. In these cases, the safety of these vaccines was monitored continuously before and after they were in use.
Of these recalls, one of the largest was the 2007 recall of PedvaxHib and Comvax by Merck over concerns “about potential contamination with bacteria called B. cereus.” Fortunately, “no evidence of B. cereus infection was found in recipients of recalled Hib vaccines.”
If one of your child’s vaccines have been recalled, you will likely be notified by your pediatrician, who would have been notified by the manufacturer of the vaccine.
But at their October meeting, the ACIP did recommend that preteens needed only two rounds of HPV vaccine, instead of three.
This follows FDA approval for Gardasil 9 on a 2-dose regimen for individuals 9 through 14 years of age in early October.
Remember that children who are at least 9 years old (traditionally 11 or 12 year old boys and girls) have traditionally gotten three doses of Gardasil, with:
the second dose at least 1 to 2 months after the first dose, and
the third dose at least 6 months after the first dose
With the new recommendations, if your child is under 15 years old when getting the first dose, then he or she will need only two doses of HPV vaccine to complete the series, with the second dose 6 to 12 months after the first.
What if your child has already gotten three doses? Then your child is well protected against HPV.
If your child has already gotten a second dose 1 to 2 months after the first, then they will have to wait to get the third dose following the 3 dose original schedule. The same goes if your child is already at least 15 years old. Neither will benefit from the new recommendation.
Many of us have heard the news that there are “300 new vaccines in the pipeline.”
Of course, no one really believes that means scientists are out there developing vaccines against 300 separate diseases or that it will mean that kids will some day get 300 more vaccines.
So what does it mean?
Surprisingly, it doesn’t even mean 300 new vaccines in the pipeline anymore. The latest, 2016 update of the Medicines in Development for Vaccines report from the Pharmaceutical Research and Manufacturers of America now states that there are “More Than 250 Vaccines in Development Pipeline.”
To understand what that means, you have to take a look at the vaccines being developed, which include:
124 for infectious diseases
105 for cancers
thirteen for allergies
eight for neurological disorders
seven for other conditions
And even of the 124 vaccines in development or testing for infectious diseases:
36 are to prevent or treat HIV
25 are to prevent influenza, including new nasal flu vaccines
8 are for RSV
8 are for Ebola
So when they talk about “300 vaccines in the pipeline,” remember that even when you consider that only 124 of them are for infectious diseases, of those, 77 are for just 4 different infectious diseases.
The other 47 vaccines in various stages of development include vaccines for CMV, tuberculosis, dengue, Zika, GBS, West Nile virus, Staph, herpes, hepatitis C, E. coli, pseudomonas, malaria, C. diff infections, Shigella, norovirus, anthrax, smallpox, and ricin.
Some others are for infections that you have likely never heard of, including viral hemorrhagic fever, Ross River virus infections, and Venezuelan equine encephalitis.
And unfortunately, only 17 of these infectious disease vaccines are in stage III trials, which means that very, very few are close to seeing the inside of a pediatrician’s office.
Potential New Vaccines
Which vaccines have the greatest potential to be protecting our kids soon?
Based on which vaccines have completed phase III trials and have been submitted for registration to the FDA, the one likely candidate seems to be:
Dengvaxia – a dengue fever vaccine developed by Sanofi Pasteur which has already been approved in Brazil, Mexico, the Philippines, El Salvador and Costa Rica and is on a Fast Tract schedule in the United States
Other vaccines in late development phases include:
Shingrix – a new shingles vaccine
an MMR vaccine from GSK (already available in other countries)
Men Quad TT – a “second generation” meningococcal vaccine
And we may see the combination, pentavalent MenABCW-135Y meningococcal vaccine by 2021.
Breaking News – We already have reports of measles cases in at least 67 people from 11 states (California, Colorado, Florida, Michigan, Minnesota, Nebraska, New Jersey, New York, Pennsylvania, Utah, and Washington) in 2017, including an ongoing outbreak in Minnesota that is now up to 32 cases. Also many reports of measles outbreaks in Europe. (see below)
We have come a long way since the development of the first measles vaccines in the early 1960s…
Pre-Vaccine Era Measles Outbreaks
In the pre-vaccine era, measles was a very common childhood disease.
As it is now, it was also a deadly disease.
In the 1950s, there were 5,487,332 cases (just under 550,000 a year) and 4,950 deaths (about 500 each year).
In 1962, there were 469,924 cases of measles in the United States and 432 deaths.
Post-Vaccine Era Measles Outbreaks
The first measles vaccines were licensed between 1963 and 1965, but it was the first national measles eradication campaign in 1966 that got people vaccinated and measles rates down.
In 1970, there were only 47,351 cases and 89 deaths.
Rates continued to drop until the large outbreaks between 1989 to 1991, when there were 55,622 cases and 123 deaths. The addition of a measles booster shot got measles outbreaks under control again. By 2000, when measles was declared eliminated in the United States, there were just 86 cases and one death.
Post-Elimination Era Measles Outbreaks
Declaring measles eliminated in the United States didn’t mean that we didn’t have any more measles, after all, it hasn’t been eradicated yet. It just that we are no longer seeing the endemic spread of measles. Since 2000, measles outbreaks have been imported from outside the country, or at least they are started by cases that are imported.
We have seen more than a few records in the post-elimination era, including:
the year with the historic low number of measles cases – 37 cases in 2004
the year with the largest number of cases since 1994 – 667 cases in 2014
the largest single outbreak since the endemic spread of measles was eliminated – 377 cases in Ohio in 2014
In 2015, we got a reminder of how deadly measles can be. Although there have been other measles deaths and SSPE deaths in the past ten years, unlike the 2015 death, they are usually buried in CDC reports and aren’t published in the newspaper.
2017 Measles Outbreaks
The first new case of 2017 was an unvaccinated adult in San Luis Obispo County, California who was exposed to international travelers over the holidays. The person exposed others to measles at the Twin Cities Community Hospital emergency department in Templeton while contagious in early January.
The second case of 2017 was related to an LA county outbreak that started at the end of 2016 – a resident of Ventura County.
And it goes on already, with other measles cases in 2017 including:
at least 67 cases (as of late April)
cases in 11 states, including California, Colorado, Florida, Michigan, Minnesota, Nebraska, New Jersey, New York, Pennsylvania, Utah, and Washington
an infant in San Luis Obispo County that was too young to be vaccinated and who had contact with an unvaccinated adult with measles
one new case in the Los Angeles County outbreak, which is now up to 20 confirmed measles cases (including 18 in LA County), all unvaccinated
four new cases in Ventura County, California that are linked to another Ventura County measles case and the LA County outbreak, which is now up to 24 cases
a case in Jersey City, New Jersey following international travel who exposed people at multiple places, including a hospital, pharmacy, mall, and on a commuter train
an unvaccinated 7-month-old baby from Passaic County, New Jersey who had been traveling out of the country and may have exposed others at area hospitals (a good reminder that infants who are at least 6 months old should get an MMR vaccine before leaving the country)
two cases in Salt Lake County, Utah – which began in a resident who had “received all appropriate vaccinations” and developed measles after traveling outside the US and then spread to another person “who had contact with the first case.” According to the SLCoHD, “One of the two individuals with measles had received one MMR vaccine.”
two cases in King County, Washington – a man and his 6-month-old infant, both unvaccinated, developed measles after traveling to Asia, and exposed many others around Seattle, including at a Whole Foods, a sandwich shop, their apartment building, and two Amazon buildings.
a confirmed case in Omaha, Nebraska, who exposed people on a Delta flight and multiple places in Douglas and Sarpy counties, including the Bergan Mercy Hospital Emergency Room.
two children in Minnesota without a known source of infection
another child in Minnesota – among the three Somali Minnesotans in this outbreak are two children who are just two years old – all of the cases were unvaccinated and two required hospitalization, although the common source is still not known. Vaccine hesitancy has been a problem among the Somali Minnesotans because of Wakefield‘s MMR study.
five more unvaccinated children in Minnesota, as the outbreak grows to 8.
a confirmed case in North Platte, Nebraska who may have exposed others at a middle school, church youth group, the Great Plains Health Emergency Room, a medical office, and a lab.
a resident of Livingston County, Michigan who exposed others at area restaurants and St. Joseph Mercy Brighton Hospital after getting measles on a plane ride with an unvaccinated child
another case in Minnesota, bringing the outbreak count to 9 unvaccinated children.
three more cases in Minnesota, bringing this outbreak case count to 12, with at least 200 people in quarantine.
eight more cases in Minnesota, bringing this outbreak case count to 20 young children under age 5 years, and now including an infant under age 12 months.
four more cases in Minnesota, bringing this outbreak case count to 24 young children under age 5 years and surpassing the size of the 2011 measles outbreak in the Somali community in the same area, which was also mostly among intentionally unvaccinated children.
five more cases in Minnesota, including the first outside of Hennepin County – spreading to nearby Stearns County, bringing this outbreak case count to 29 young children under age 5 years, with only one that was vaccinated.
the latest cases – three more cases in Minnesota, as the outbreak spreads to the third county – Ramsey County.
How many cases will we end up with this year? It is certainly getting off to a quick start, which could mean a big year for measles, although it is certainly hard to predict what will happen.
2016 Measles Outbreaks
Starting slow, 2016 ended as a fairly average year for measles:
cases in 17 states, including Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Tennessee, Texas, and Utah
a large outbreak in Arizona, 23 cases, linked to a private detention center
a large outbreak in Shelby County, Tennessee, at least seven cases, including six unvaccinated and one partially vaccinated child
a case in Colorado in which an unvaccinated adult traveled internationally and ended up exposing many people “from Dec. 21 to 29, 2016, who was at a wide variety of locations in the Denver-Boulder area,” including an Urgent Care center and the Parker Adventist Hospital Emergency Department
As in other years, many of these outbreaks involved unvaccinated children and adults. One case involved a child at the Yuba River Charter School in California, a Waldorf School with very high rates of unvaccinated children.
International Measles Outbreaks
The endemic spread of measles was stopped or eliminated in 2000. Since then, most of the measles outbreaks in the United States begin when someone travels out of the country, gets sick, and exposes others. Or less commonly, when an international traveler brings measles into the country.
That makes it easy to understand that large outbreaks of measles in other parts of the world could increase the risk that we have more outbreaks here. And that’s what happened in 2014 when there was an epidemic of measles in the Philippines and we ended up with the most cases since 1994, many linked to travel to and from the Philippines.
This year, the world is seeing large outbreaks of measles in:
European Union – Austria (71 cases), Belgium (266 cases), Bulgaria (61 cases, including one death – a 10-month old unvaccinated child), Denmark, France (134 cases, including 2 cases of encephalitis), Germany (410 cases), Hungary (41 cases), Iceland (2 cases. 10-month-old unvaccinated twin siblings), Italy (1,603 cases), Portugal (21 cases, including one death), Spain (35 cases), and Sweden (15 cases). The largest outbreak is in Romania, where there have been 4,793 cases and 21 deaths in the past 13 months.
Switzerland – the Swiss Sentinel Surveillance Network already reports 52 measles cases in 2017, compared to 36 in 2015 and 71 in 2016. Many of the cases are in young adults, aged 20-24 years. There has been one death, a vaccinated man being treated for leukemia.
Australia – 34 cases so far in 2017
Canada – over 30 cases including an outbreak in Nova Scotia (15 cases)
Japan – 139 cases so far in 2017 (they had 5 in April 2016…)
Guinea – a measles epidemic has been declared in the country, with at least 1,527 cases and 2 deaths this year
Indonesia – island of Bali
Republican of South Sudan
These outbreaks are a great reminder to review the special vaccine travel requirements, including that adults who “plan to travel internationally should receive 2 doses of MMR at least 28 days apart,” that infants traveling abroad can get their first dose of MMR as early as age 6 to 11 months, with a repeat dose at age 12 months, and that “children aged who are greater than or equal to 12 months need 2 doses of MMR vaccine before traveling overseas,” even if they aren’t four to six years old yet.