Category: Vaccine Education

What Should You Do If Your Child Might Have Measles

As you hear more and more about measles outbreaks, eventually you might think that your child has measles.

Why?

Until a child develops the classic measles rash, the symptoms of measles can mimic many other more common viral illnesses, as they include fever, cough, coryza, red eyes, and irritability.

What Should You Do If Your Child Might Have Measles

And while many other viruses can cause a fever and rash, it is really only measles that causes the classic pattern of 3 or 4 days of high fever, followed by the appearance of a rash with continued fever.

Unfortunately, by the time your child has developed the rash, you may have already have gone to the doctor or ER a few times, exposing a lot of people to measles.

If your child has measles, don’t give it to anyone else.

That’s why it’s important to try and recognize measles as early as possible, so that you don’t expose anyone else and get them sick too.

It is especially important to think about measles if your child:

  • traveled out of the country in the past 7 to 21 days, the incubation period for measles
  • recently traveled to or lives in an area that is experiencing measles outbreaks
  • is not yet fully vaccinated, with two doses of MMR, keeping in mind that a small minority of people can get measles even if they are fully vaccinated

So what do you do if your child might have measles?

Ideally, you would call your health care provider, clinic, or emergency room ahead of time and let them know that you are concerned about measles. That allows them to take steps to minimize the risk that your child will expose others to measles.

While the child is isolated, health care professionals can then decide if it is necessary to do further testing for measles. If they do suspect measles, they may even call the local health department for further help.

If necessary, post-exposure prophylaxis might also be provided for the child’s contacts.

What if you aren’t sure if your child has measles? Put a mask on them anyway if there is any doubt! Don’t take a chance on causing a big outbreak.

During some outbreaks, communities have even had to implement universal masking of all patients and all family members to help get their outbreak under control.

And remember that the best way to stop these outbreaks is for everyone to get fully vaccinated on time and on schedule.

More on Measles Exposure Prevention Measures

How Do You Get Caught up If You Have Never Been Vaccinated?

Why would someone have never gotten any vaccines and need to catch up?

Getting caught up on your vaccines is easy.
Getting caught up on your vaccines is easy.

The usual story is that a child’s vaccines were delayed or skipped for some reason, typically over fears of anti-vaccine propaganda.

You can always get caught up though, right?

Well, not always…

Tragically, kids can get sick and catch these vaccine-preventable diseases before they have time to get vaccinated and protected. You can wait too long to get vaccinated!

How Do You Get Caught up If You Have Never Been Vaccinated?

That’s why it is important to get caught up as soon as possible.

How does that work?

The first step is figuring out which vaccines you need, considering that:

  • rotavirus vaccines are only given up to age 9-months
  • Hib and Prevnar are typically only given up to age 5-years, unless someone has specific conditions that put them at high risk for disease, although Prevnar becomes routine again at age 65-years
  • the polio vaccine is typically only given up to age 18-years
  • the meningococcal vaccines (MenACWY and MenB) are routinely given to teens and young adults through age 16 to 23-years, but older high-risk adults can also be vaccinated if necessary
  • the HPV vaccines are routinely given up to age 26-years, although they are FDA approved to be given through age 45 years
  • hepatitis A vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • hepatitis B vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • the Pneumovax (PPSV23) and shingles vaccines are given to seniors
  • if you already had a natural case of chicken pox, while you won’t need to be vaccinated, some folks might need a varicella titer to confirm that they are immune

So, depending on your age when you are starting your catch-up, there may be some vaccines that you don’t need anymore.

Still, unless you have a contraindication, you will likely at least need:

  • a yearly flu vaccine
  • 1 to 2 doses (high risk groups) of MMR
  • 2 doses of the chicken pox vaccine (Varivax)
  • 1 dose of Tdap, followed by 2 doses of Td

What’s next?

Once you have an idea of which vaccines you need, you should schedule an appointment with your health care provider and get vaccinated and protected.

A local pharmacy or health department are other places that might offer vaccines to older teens and adults.

More on Getting Caught up on Vaccines

How Often Should You Do Vaccine Titer Testing?

We sometimes hear about folks doing vaccine titer testing.

A vaccine titer is a blood test that can determine whether or not you are immune to a disease after you get a vaccine.

While that sounds good, after all, why not check and be sure, it has downsides. Chief among them is that the results aren’t always accurate.

That’s right. You can sometimes have a negative titer test, but still be immune because of memory B cells and the anamnestic response.

How Often Should You Do Vaccine Titer Testing?

So how often should you do vaccine titer testing?

It depends, but most folks might never have it done!

Why not?

Vaccines work very well, so you would typically not need to routinely check and confirm that you are immune after being vaccinated. And, this is also important, the vaccine titer tests don’t always work that well, titer testing isn’t available for all vaccines (you can’t do titer testing for Hib and pertussis), and the testing can be expensive.

So we usually just do the testing (a quantitative titer) for folks that are in high risk situations, including:

  • pregnancy – rubella titer only (HBsAg is also done, but that’s not a vaccine titer test, but rather to see if you are chronically infected with hepatitis B)
  • healthcare workers – anti-HBs (antibody to the hepatitis B surface antigen to confirm immunity after being vaccinated)
  • students in nursing school and medical school, etc. – anti-HBs
  • children and adults exposed in an outbreakmeasles, chicken pox, mumps, etc., but only if we are unsure if they were previously vaccinated and protected
  • after a needlestick injury, etc. – to confirm immunity to hepatitis B
  • babies born to a mother with hepatitis B – to confirm that their hepatitis B vaccine worked

Vaccine titer testing might also be done for:

  • internationally adopted children – to confirm that they are immune if we unsure about all of the vaccines the child got in other countries
  • children and adults with lost vaccine records – to confirm that they are immune, since we are unsure about all of the vaccines they got
  • evaluation of children and adults with immune system problems – to help identify what immune system problems they might have – typically involves checking pneumococcal titers, giving Prevnar, and then checking pneumococcal titers again
  • people at continuous or frequent risk for rabies – rabies titer testing every 6 months to 2 years
  • patients with inflammatory bowel disease, before starting immunosuppressive therapy – hepatitis A and hepatitis B titers, as they might be at increased risk for hepatitis

While checking titers is easy, it is sometimes harder to know what to do with the results you get.

Of all of these different titers, only one tells you that you are immune due to vaccination.
Of all of these different titers, only one tells you that you are immune due to vaccination.

It is especially important to know that:

  • most people don’t need to have their titers checked routinely if they are not in one of the high-risk groups noted above
  • it isn’t practical to get titers tested as a method of potentially skipping one or more doses of your child’s vaccines, after all, if the titer is negative, then you are still going to have to get vaccinated
  • a healthcare provider with a negative measles titer after two doses of the MMR vaccine does not need another dose of vaccine
  • a healthcare provider who has anti-HBs <10 mIU/mL (negative titer) after three doses of the hepatitis B vaccine should get another dose of vaccine and repeat testing in 1 to 2 months – if still <10 mIU/mL, they should then get two more doses of hepatitis B vaccine (for a total of 6 doses) and repeat testing. If still negative, these documented nonresponders will need HBIG as post-exposure prophylaxis for any future hepatitis B exposures, but no further doses of hepatitis B vaccine.
  • vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine, with a maximum of three doses, and should not be tested again
  • postvaccination titer testing is not recommended after the chicken pox vaccine
  • in addition to not being able to test titers for pertussis and Hib immunity, it is becoming difficult to test poliovirus type 2 titers, as the test uses a live virus that isn’t routinely available anymore (type 2 polio has been eradicated)

Still think you need vaccine titer testing?

More on Vaccine Titer Testing

I’m Not Anti-Vaccine, I Just Don’t Believe in the HPV Vaccine

Believe it or not, there are some parents who get their kids each and every vaccine, but skip the one that protects them from cancer.

I’m Not Anti-Vaccine, I Just Don’t Believe in the HPV Vaccine

Why?

HPV Vaccine is Cancer Prevention.

That’s a good question.

And although they won’t have a good answer, some of their reasons include that:

  • the HPV vaccine is too new – even though Gardasil was first approved in 2006 and the first phase 1 and phase 2 trials began in 1997!
  • they don’t think it is necessary – even though about 4,200 women die of cervical cancer each year (that’s just in the United States), even in this age of routine pap tests
  • it might lead their kids to have early sex or unprotected sex – even though studies show it won’t
  • Michele Bachmann once said it caused mental retardation – even though she had no evidence to support her claim
  • the HPV vaccine is too controversial – any “controversy” about Gardasil and Cervarix is made up by anti-vaccine folks
  • HPV vaccines can cause POTS, ASIA, primary ovarian failure, venous blood clots, behavior problems, or multiple sclerosis, etc. – even though over and over, studies have found HPV vaccines to be safe and to not cause any of the other serious side effects or vaccine induced diseases you read about on the Internet that scare you away from vaccinating and protecting your kids
  • it is banned in Utah – even though that isn’t true
  • it doesn’t provide life-long protection – even though the protection has been found to be long-lasting, as long as we have been giving the vaccine so far
  • it is banned in Japan and France – even though HPV vaccines aren’t banned anywhere and are actually on the immunization schedule in at least 64 countries
  • Katie Couric once did a scary segment on HPV vaccines – well, she did but later apologized… after being called out for pushing anti-vaccine misinformation
  • an HPV vaccine researcher says it’s dangerous – no, the HPV vaccine researcher, Diane Harper, actually says it is a safe vaccine
  • HPV vaccines are just for girls – even though there are around 11,000 cases of HPV induced cancer in men each year, including anal cancer and cancers of the mouth/throat and penis
  • their kids are too young and can get it later, when they are older – even though protection is likely better when they get the vaccine when they are younger, and you don’t want to wait too long, when you increase the chance that they will have had sex and will already be exposed to HPV

So why aren’t you getting your kids vaccinated and protected… against cancer?

Need to do more research? Read the links below and then schedule your kids for their HPV vaccine.

More on HPV Vaccine Safety

How Long Is a Vaccine Month?

Are you ever concerned that your kids will get their vaccines too early or too late?

Vaccine intervals are typically based on weeks and "months."
Vaccine intervals are typically based on weeks and “months.” But how long is a month?

For example, if your child needs a booster dose of a vaccine in a month, just how long is that?

Does it depend on which month you are in?

For intervals of 3 months or less, you should use 28 days (4 weeks) as a “month.”

Ask the Experts on Scheduling Vaccines

In general, while we often use calendar months, because it is more convenient, you can use a minimum interval of 28 days or 4 weeks as a full month, as long as we are only counting up to three months.

So a second flu shot after a dose on January 1st could be done as early as January 29th. That’s technically one month (28 days, 4 weeks) later. And no, you wouldn’t have to repeat the second dose if you got it on February 1st, as we are typically worried about the minimum intervals or spacing and not about getting the dose a little late.

For intervals of 4 months or longer, you should consider a month a “calendar month”: the interval from one calendar date to the next a month later.

Ask the Experts on Scheduling Vaccines

And just count calendar months if you are counting more than 3 months. So if you got a vaccine on January 1 and needed another 4 months later, you would return on May 1.

Why switch to using “calendar months” for longer intervals? With longer 28 day intervals, scheduling mistakes will likely be made.

More on Spacing and Scheduling Vaccine Doses

What Is a Vaccine?

You know what a vaccine is, right?

The word vaccine comes from the vaccinia virus that was in the original smallpox vaccine.
The word vaccine comes from the vaccinia virus that was in the original smallpox vaccine.

The flu shot you get each year is a vaccine.

Vaccine: A product that stimulates a person’s immune system to produce immunity to a specific disease, protecting the person from that disease. Vaccines are usually administered through needle injections, but can also be administered by mouth or sprayed into the nose.

Immunization: The Basics

The smallpox shot that Edward Jenner developed was a vaccine.

Vaccine Definitions

While that is an easy enough definition to understand, that there are many different types of vaccines does make it a little more complicated.

There are:

  • Live-attenuated vaccines – made from a weakened or attenuated form of a virus or bacteria
  • Inactivated vaccines – made from a killed form of virus or bacteria
  • Subunit, recombinant, polysaccharide, and conjugate vaccines – made from only specific pieces of a virus or bacteria
  • Toxoid vaccines – made to target a toxin that a bacteria makes and not the bacteria itself

And of course all of these types of vaccines work to produce immunity to specific diseases – vaccination.

Immunization: A process by which a person becomes protected against a disease through vaccination. This term is often used interchangeably with vaccination or inoculation.

Immunization: The Basics

What other definitions are important to know when you talk about vaccines?

  • active immunity – immunity that you get from having a disease (natural immunity) or getting a vaccine and making antibodies
  • adjuvant – a substance that helps boost your body’s immune response to a vaccine so that you can use a minimum amount of antigen, reducing side effects
  • antibodies – protective proteins that you make against antigens
  • antigens – specific substances (can be part of a virus or bacteria) that trigger an immune response
  • attenuation – a virus or bacteria that is made less potent, so that it can produce an immune response without causing disease
  • elimination – getting rid of a disease in a specific area
  • endemic – the baseline level of disease in an area
  • eradication – getting rid of a disease everywhere (smallpox)
  • epidemic – an increase in the number of cases of a disease over a large geographic area
  • herd immunity – when enough people in a community are protected and have immunity, so that disease is unlikely to spread
  • immunity – protection against a disease
  • incubation period – how long it takes to develop symptoms after you are exposed to a disease
  • outbreak – an increase in the number of cases of a disease over a small geographic area
  • pandemic – an increase in the number of cases of a disease over several countries or continents
  • passive immunity – temporary immunity that you get after being given antibodies, either via a shot of immunoglobulin or a mother’s antibodies are transferred to her baby through her placenta
  • placebo – classically defined as “a comparator in a vaccine trial that does not include the antigen under study”
  • quarantine – isolating someone so that they don’t get others sick
  • titer – an antibody count that can often be used to predict immunity

Got all of that?

So what about variolation, the process that was used before Jenner developed his smallpox vaccine? Was that also a vaccine?

It did produce immunity to smallpox, which is the basic definition of a vaccine, but still, variolation is typically concerned an immunization technique and not a vaccine.

More on Vaccine Definitions

Do I Have to Sign a Consent Form Before Getting a Vaccine?

Most people likely think that they need to sign a consent form before getting their kids vaccinated?

Why?

Do I Have to Sign a Consent Form Before Getting a Vaccine?

Because many pediatricians and clinics have parents sign a form acknowledging that they have received a Vaccine Information Statement (VIS), so they likely figure that they are required to sign.

While it may be common practice, unless it is required by state law, no one has to actually sign a consent form before getting vaccinated. A signature is not required by federal law.

Of course, that doesn’t mean that you don’t have to get informed consent before giving a vaccine. You just don’t typically need a signature to confirm that you got informed consent.

“Those who are capable of giving consent may do so in writing, orally or by co­operation. Completion of a consent form is not a legal requirement. A signature on a consent form does not itself prove that the consent is valid but it does serve to record the decision that was reached, and the discussions that have taken place. The Bristol Royal Infirmary Inquiry Final Report (2001) reported that ‘too great a regard is paid to the symbolic act of signing a piece of paper rather than to the real task… which involves explaining what is to take place. ’”

Green Book: Chapter 2 Consent (UK)

So why do you have to sign when your child is getting a vaccine?

“There is no federal requirement for signed consent for any dose of vaccine. The federal requirement is to provide all adult patients or parents/legal representatives of minor children with the appropriate VIS for each dose of vaccine administered… Some clinics, agencies, and/or state immunization programs may have requirements for signatures.”

Ask the Experts About Documenting Vaccination

Although not usually required and the signature shouldn’t be the focus of consent, a signature still helps to confirm that informed consent was provided.

More on Signing Vaccine Consent Forms