And with each new vaccine, there comes more protection against anal and genital warts and anal, genital, head and neck, and cervical cancers.
Gardasil9, the only HPV vaccine available in the United States, increases the protection level against cervical cancer from 70 to 90%!
Should You Get an Extra Dose of Gardasil9?
Has your child already finished their HPV vaccine series?
With which HPV vaccine?
To be clear, if they have finished the series, then they are considered to be fully vaccinated and protected.
“Persons who have completed a valid series with any HPV vaccine do not need any additional doses.”
National Cancer Institute on Human Papillomavirus (HPV) Vaccines
Remember, the key, high-risk strains that cause most HPV-associated cancer are HPV-16 and 18, which are present in all of the HPV vaccines.
The extra coverage in Gardasil9 to HPV strains 31, 33, 45, 52, and 58 could prevent an additional 10% of invasive HPV associated cancers or about 3,800 cases each year though, mostly in women.
Should you get any extra doses of Gardasil9 for this extra coverage?
“Administration of a 3-dose regimen of 9vHPV vaccine to adolescent girls and young women 12-26 years of age who are prior qHPV vaccine recipients is highly immunogenic with respect to HPV types 31/33/45/52/58 and generally well tolerated.”
Garland et al on Safety and immunogenicity of a 9-valent HPV vaccine in females 12-26 years of age who previously received the quadrivalent HPV vaccine.
While safe to do and it works, there is no formal recommendation that anyone actually get any extra doses of Gardasil9 at this time.
It is something to consider if you want the extra protection though.
Will we get even more coverage in future HPV vaccines? The future might come in different types of vaccines or even in therapeutic vaccines. There doesn’t seem to be a new version of Gardasil with expanded strain coverage in the immediate pipeline though.
And chicken pox parties, while not as common as some folks imagine, were definitely a thing, because you didn’t want your child to become an adult and get chicken pox, when it was more dangerous. But since most kids got chicken pox so easily, most got it when they were kids, even without a chicken pox parties, and tragically, many learned that it wasn’t only dangerous to adults.
These days, most cases and outbreaks of chicken pox are in unvaccinated children and adults.
7 new cases in the outbreak associated with the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 41 in that outbreak, including 4 cases in the community as the outbreak continues to spread (Nov 2018)
6 new cases at the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 34 in that outbreak (Nov 2018)
at least 5 cases at Daybreak Primary School in Battle Ground in Clark County, Washington, leading to quarantine of at least 38 unvaccinated students who will be kept out of class for at least 21 days (Oct 2018)
at least 5 cases at two schools in Ottawa County, Michigan, including Waukazoo Elementary and Kids First – Early Childhood Center in Jenison, leading to the quarantine of at least 34 children (Oct 2018)
a cluster of chicken pox cases in Grant County, Washington at Park Orchard Elementary, North Elementary and Longview Elementary schools (Sept 2018)
at least 5 cases at the The Little Red School House Too daycare in Westbrook, Maine (May 2016)
These cases are just the tip of the iceberg though, as there are still about 7,000 to 10,000 chickenpox cases reported in the United States each year. And that’s with some states, like Oregon and Washington, not reporting cases of this Nationally Notifiable Condition to the CDC.
Still, since chicken pox caused a few hundred deaths and at least 10,000 hospitalizations each year less than twenty-five years ago, that’s a lot of progress.
Getting Chicken Pox
How do you get chicken pox?
Since it is very contagious, if your child is exposed to someone with chicken pox or shingles, then they might develop chicken pox in about 10 to 21 days (incubation period).
are unvaccinated, either intentionally, because they have a true medical exemption, or because they are too young for the vaccine, which is first given when kids are 12-months-old
are partially vaccinated, with only one dose of the chicken pox vaccine
have a problem with their immune system, including kids getting chemotherapy
In addition to being at risk for chicken pox, non-immune pregnant women, newborns born to women who develop chicken pox at around the time of delivery, premature babies, and those are immunocompromised can be at risk for severe disease.
Avoiding Chicken Pox
Want to avoid chicken pox and the chance of ending up in a chicken pox quarantine and having to stay out of school for 3 weeks or more?
That’s not an option for some kids with true medical exemptions though, including most kids who are immunocompromised. When they get caught up in one of these outbreaks and get exposed to chicken pox, it becomes a matter of life and death to work to try and prevent their getting chicken pox.
It surely doesn’t help that even after a natural infection, we don’t build up immunity to protect us from flu viruses in subsequent years. Or that even though the flu vaccine isn’t as effective as we would like, many people don’t get vaccinated and protected.
Mostly, the flu is deadly because it can lead to severe symptoms in many people, even otherwise healthy people.
Although most people associate the flu with a fever, runny nose, cough, and body aches, the flu virus can rarely cause a primary viral pneumonia. Even when it doesn’t, an influenza infection can make it harder to breath. The flu virus can also cause severe bronchiolitis, like RSV does, croup, and can trigger asthma attacks.
Other severe complications that can be deadly include:
myocarditis (inflammation of the heart) and pericarditis
“Most people who get flu will recover in a few days to less than two weeks, but some people will develop complications (such as pneumonia) as a result of flu, some of which can be life-threatening and result in death.”
CDC on Flu Symptoms & Complications
But why do some people develop these flu complications and die, while others don’t?
That’s the real question most people want answered, not what the flu does to our body and how the flu virus attaches to and enters our cells, replicates, destroys our cells, triggers an immune response, and causes symptoms.
If you must know, you can likely blame it on a combination of the virulence factors of the flu virus strain and host factors of the person who is infected, but mostly, it’s because the flu can be a deadly disease.
That’s when you get worsening flu symptoms and signs, which might include trouble breathing, chest pain, dehydration, irritability, lethargy, confusion, or persistent vomiting, etc.
“Before a vaccine became available in 1963, measles was a rite of passage among American children. A red rash would spread over their bodies. They would develop a high fever. Severe cases could cause blindness or brain damage, or even death.”
CDC says measles almost eliminated in U.S.
Instead, most people develop 10 days of measles symptoms, including a high fever, cough, runny nose, watery eyes, and a rash. Photophobia, irritability, sore throat, headache, and abdominal pain are other symptoms that children with measles might have.
“From 1964 through 1971, 16.7% of the death certificates reviewed noted some underlying pathologic condition.”
Roger Barkin, MD on Measles mortality. Analysis of the primary cause of death.
It is most often children, typically young children, without any medical problems who die.
In the post-vaccination era, no one would be expected to die with measles, but those with immune system problems sometimes do, as most others are vaccinated and protected. As vaccinated rates drop though, even otherwise healthy children and adults can once again die of measles.
“Complications were reported in 672 (9.8%) cases, including otitis media in 318 (4.6%) cases, pneumonia in 178 (2.6%), diarrhea in 171 (2.5%), and encephalitis in five (0.1%). Nine hundred thirteen patients (13.3%) were hospitalized, and 10 measles-associated fatalities were reported (case-fatality rate: 1.5 deaths per 1000 reported cases). Eight of the deaths were reported in children less than 5 years of age, all of whom were unvaccinated. None had a reported underlying illness or immunodeficiency. Most deaths have been attributed to pneumonia.”
Measles — United States, First 26 Weeks, 1989
Probably not, but from 1989 to 1991 there were at least 123 measles deaths across the United States, even after measles had been declining for years with the introduction of the measles vaccine in the 1960s. Most of the deaths were otherwise healthy, without underlying medical problems.
Because we don’t typically hear any details about measles deaths, including the almost 90,000 measles deaths that continue to occur around the world each year, most people likely assume that measles only kills in third world countries, where kids are already sick or malnourished. Of course, that wouldn’t explain how over one hundred people died with measles in Europe over the past few years…
Still think that measles isn’t deadly?
Tragically, there are plenty of stories (although most are never reported in the news and we don’t hear about them) and case reports that will prove you wrong:
Olivia Dahl died with measles when she was 7-years-old (1962)
an unvaccinated 3-year-old died in Maricopa County (1970)
a 13-year-old girl who had previously been vaccinated with one of the first inactivated measles vaccines which were found to be ineffective and were replaced with the newer live vaccines died in Michigan (1978)
a 9-month-old died in Chicago (1990)
an unvaccinated 13-year-old died in Kansas (1990)
Tammy Bowman, an 11-year-old unvaccinated girl died in Michigan (1990)
an unvaccinated 13-year-old became the first person in the UK to die with measles in 14 years (2006)
a 14-year-old died of Subacute Sclerosing Panencephalitis (SSPE), a late complication of a natural measles infection (2015)
a 16-year-old who had received a heart transplant when she was 2-years-old died in France (2018)
an unvaccinated toddler in Jerusalem (2018)
Measles as a rite of passage?
“We baby boomers were apparently the last generation whose doctors, and therefore parents, accepted the measles as just one more annoying rite of passage of childhood that also happened to prime the immune system and provide lifelong immunity. Medical texts prior to the advent of the vaccine described measles as a benign, selflimiting (sic) childhood infectious disease that posed little risk to the average well-nourished child.”
Darrerl Crain, DC on The Great Measles Misunderstanding
While early pediatric textbooks did a great job describing the symptoms of measles, they also did a great job of documenting that measles was never a benign disease, something anti-vaccine folks still misunderstand because vaccines can do such a good job controlling the disease.
Do benign, self-limiting childhood infections diseases kill hundreds of children every year?
Measles as a rite of passage is something we don’t want to have to go back to. It was a rite of passage that was endured because there was no other choice.
a previously healthy, unvaccinated 23-month-old boy developed chicken pox and died three weeks later after developing sepsis, possible viral meningoencephalitis, bacterial endocarditis, and heart failure. (1996)
a previously healthy, unvaccinated 21-month old developed chicken pox and died four days later because of hemorrhagic complications (1997)
an unvaccinated 5-year-old boy with asthma was treated with one dose of prednisone at home for an asthma attack while recovering from chicken pox and died the next day (1997)
a healthy, unvaccinated 6-year-old boy developed chicken pox, was hospitalized three days later, and died the next day (1998)
an 8-year-old being treated for leukemia developed chicken pox and died two weeks later (1998)
an unvaccinated 9-year-old girl was exposed to an unvaccinated children with chicken pox in after-school child care and school, developed chicken pox and died three days later with secondary cellulitis and sepsis. (2002)
a previously healthy, unvaccinated 11-year-old girl developed septic shock and died soon after being admitted to a Pediatric Intensive Care Unit. (2002)
an unvaccinated 12-year-old boy was exposed to an unvaccinated classmate with chickenpox, developed chicken pox two weeks later, was admitted to the hospital after three days because of trouble breathing, and died on his second hospital day after suffering a cardiopulmonary arrest. (2003)
an unvaccinated 10-year-old girl developed chicken pox, with worsening 10 days later, including ataxia and mental status changes. After being hospitalized for three days, she began to have seizures and was declared brain dead the next day. (2004)
an unvaccinated 14-month-old girl developed chicken pox and worsened over the next three to five days. She eventually developed septic shock, was treated in an ER, and died within one hour of being transferred to a children’s hospital for further care. (2004)
a previously healthy, unvaccinated 15-year-old developed chicken pox, was admitted to the hospital three days later in septic shock, and died three weeks later. (2009)
a partially vaccinated 4-year-old girl who was being treated for acute lymphoblastic leukemia (ALL) was exposed to a cousin with chicken pox and later developed multi-organ failure and died (2012)
Chicken pox has always been a deadly disease.
“In the prevaccine era, approximately 11,000 persons with varicella required hospitalization each year. Hospitalization rates were approximately 2 to 3 per 1,000 cases among healthy children and 8 per 1,000 cases among adults. Death occurred in approximately 1 in 60,000 cases. From 1990 through 1996, an average of 103 deaths from varicella were reported each year. Most deaths occur in immunocompetent children and adults”
Epidemiology and Prevention of Vaccine-Preventable Diseases
Although chicken pox is definitely riskier if you are older and have pre-existing medical problems, as you can see from these kids who died, many were otherwise healthy and many were very young.
It is well known that you can very rarely develop polio after being vaccinated with the oral polio vaccine.
VAPP or vaccine-associated paralytic polio are cases of polio that are actually caused by the polio vaccine. That’s why many countries switch over to the inactivated form of the polio vaccine once polio is under good control.
But can you get polio after an injection?
What is Provocation Polio?
You are probably thinking, sure, if the injection is full of live polio virus, right?
But this is actually the idea behind provocation polio.
No, the injection doesn’t give you polio, but if you are already infected with polio, the idea is that getting an injection could be a risk factor for developing paralytic polio.
“Provocation poliomyelitis describes the enhanced risk of paralytic manifestations that follows injection in the 30 days preceding paralysis onset.”
Remember, most people with polio don’t actually have any symptoms, although some do have flu-like symptoms. And fewer than 1% develop paralysis or weakness when they have polio. Although that doesn’t sound like a lot, during a polio epidemic, when a lot of kids are getting polio, the cases of paralytic polio quickly add up.
What else can provoke paralytic polio?
strenuous exercise (paralytic polio)
tonsillectomy (bulbar polio)
So how does an injection provoke paralytic polio?
“Skeletal muscle injury induces retrograde axonal transport of poliovirus and thereby facilitates viral invasion of the central nervous system and the progression of spinal cord damage.”
Gromeier et al on Mechanism of Injury-Provoked Poliomyelitis
Injury to a muscle by the needle is thought to have allowed the polio virus to move through the nerves in the area to the spinal cord, as long as the polio virus was already in their blood. How do we know it was the needle and not the vaccine itself? In experiments, they injected saline, and not an actual vaccine.
Is this how everyone developed paralytic polio?
Remember, kids didn’t get many vaccines around the time we were seeing polio outbreaks in the 1940s and 50s, although other injections, like penicillin were also thought to provoke paralytic polio.
Why were they getting penicillin? Often to treat congenital syphilis.
And although they went so far as to delay vaccines during outbreaks and to not do tonsillectomies during the summer, when polio outbreaks were more common, kids still got paralytic polio.
Could Provocation AFM Be a Thing?
Have you guessed why some folks are talking about provocation polio again, even though we are on the verge of eradicating polio?
“Seizing on a 2014 historical perspective piece on a phenomenon known as “polio provocation” in the highly respected medical journal, The Lancet, anti-vaccine forces have attempted to link the recent AFM cases (as they attempt to do with many other medical occurrences) to childhood vaccinations.”
Dr. Amesh Adalja on Clusters of polio-like illness in the US not a cause for panic
“…is there any relationship between vaccination status and a developing acute flaccid myelitis? Meaning, are vaccines a risk factor? And the data so far says no, the overwhelming number of children who have gotten AFM have had no recent vaccination of any kind or vaccine exposure. These cases over these years have been happening before flu season and flu vaccination starts, which is one of the questions that comes up, and there hasn’t been any pattern to vaccine exposure of any kind in developing AFM. So far, we have not found a link between the two.”
Benjamin Greenberg, MD on 2018 Podcast on Acute Flaccid Myelitis
For vaccines to provoke AFM, you would have to have gotten a recent vaccine.
We aren’t seeing that and anything else all of the kids with AFM had in common that might provoke paralysis, like acupuncture, cupping, or dry needling, would likely have come out in epidemiological reports.
While some folks still believe that the flu is a mild infection, most people understand that the flu is a very dangerous disease.
A dangerous disease that kills hundreds of children and tens of thousands of adults each year in the United States.
Who Dies from the Flu?
In addition to thinking that the flu isn’t dangerous, some folks misunderstand just who is at risk for dying from the flu.
While it is certainly true that some people at higher risk than others, including those who are very young, very old, and those with chronic medical problems, it is very important to understand that just about anyone can die when they get the flu.
Just consider the 2017-18 flu season, in which 181 children died.
In addition to the fact that half of the kids who died were otherwise healthy, without an underlying high risk medical condition, it is important to realize that up to 80% were unvaccinated.