Tag: contraindications

Are Your Kids at High Risk for Flu Complications?

Everyone should get a flu vaccine each year, as long as they are at least six months old and have no true contraindications.

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)

That has been the recommendation since at least the 2010-11 flu season.

And while most kids get vaccinated, not all do.

Are Your Kids at High Risk for Flu Complications?

There are some kids, those at high risk for flu complications, who definitely shouldn’t skip or delay their flu vaccine.

  • all children aged 6 through 59 months (younger than age 5 years);
  • children who have chronic medical conditions, including pulmonary (such as asthma and cystic fibrosis), cardiovascular (excluding isolated hypertension), genetic (Down syndrome), renal, hepatic, neurologic (cerebral palsy, epilepsy, stroke, muscular dystrophy, and spina bifida, etc.), hematologic (sickle cell disease), or metabolic disorders (including diabetes mellitus and mitochondrial disorders);
  • children who are immunocompromised due to any cause (including immunosuppression caused by medications or by HIV infection);
  • teens who are or will be pregnant during the influenza season;
  • children and adolescents (aged 6 months through 18 years) who are receiving aspirin- or salicylate-containing medications (like for Kawasaki disease) and who might be at risk for experiencing Reye syndrome after influenza virus infection;
  • residents of nursing homes and other long-term care facilities;
  • American Indians/Alaska Natives;
  • children who are extremely obese (body mass index ≥40).

You also shouldn’t skip or delay getting a flu vaccine if your:

  • kids are household contacts of children aged ≤59 months (i.e., aged <5 years) and adults aged ≥50 years, particularly contacts of children aged <6 months;
  • kids are household contacts of someone with a medical condition that puts them at higher risk for severe complications from influenza.

Again, since everyone should get a flu vaccine, these higher risk classes shouldn’t determine whether or not you vaccinate your kids, but they might influence the timing.

Again, don’t skip your child’s flu vaccine because they aren’t in a flu high risk group.

In most flu seasons, about 80% of children with the flu who die are not vaccinated. And many of them will be otherwise healthy, without an underlying high risk medical condition.

Get your child vaccinated against the flu. And if they are in a high risk group, make sure you do it well before flu season starts and maybe as soon as flu vaccine becomes available in your area.

More on Being at High Risk for Flu Complications

How to Breastfeed Your Child During Vaccinations

Can you breastfeed while your child is getting their vaccines?

Sure.

How to Breastfeed Your Child During Vaccinations

While the smallpox vaccine and yellow fever vaccine are contraindicated for moms who are breastfeeding, there are no contraindications on vaccinating kids while they are breastfeeding.

Why breastfeed while your kids are getting their vaccines?

While some moms just breastfeed immediately afterwards,  others understand that breastfeeding at the same time as the shots are being given can help decrease any pain associated with getting those vaccines even more.

“If you are breastfeeding, feed your baby before, during and after immunization. The physical closeness and familiar taste of breast milk will calm your baby. Breastfeeding during immunization is safe for babies, even newborns. There is no evidence that babies will choke or associate their mothers with pain.”

Tips For Parents For A Positive Immunization Experience

Will it make it harder for health professionals to hold your child while the shots are being given? Not usually, especially if you help hold your child.

But how can infants get the oral Rotavirus vaccine if they are breastfeeding?

In general, infants should get the least painful vaccine first. And oral vaccines are typically given before shots. So they can get their Rotavirus vaccine before you begin breastfeeding and get prepared for the rest of their vaccines.

The Be Sweet to Babies videos can help you see the benefits of breastfeeding while your kids get their vaccines.
The Be Sweet to Babies videos can help you see the benefits of breastfeeding while your kids get their vaccines.

And while it might depend on the age and size of your child, in general, to breastfeed your child while they are getting their vaccinations, once everything is prepared and ready, you should:

  • hold your child on your lap, understanding that until age three years, most shots will be given in your child’s thighs, although toddlers can sometimes get them in their arms
  • once you have your child well positioned, have a good latch and have started nursing, make sure your child’s arm or leg remains exposed (wherever the shot will be going) and help hold your child securely so that they don’t move while getting their vaccines. For example, you might hold an arm or leg with your free hand and anchor their legs between your thighs or your other hand if possible
  • continue nursing after your child has gotten their vaccines, keeping in mind that you may have to switch positions if they are getting multiple shots

Also understand that it might not always be a good idea to nurse while getting vaccines. Is your baby a distracted eater? Is it going to be hard to hold your child while they are nursing and getting their shots? Does your health care provider not have experience giving vaccines to a child while they are breastfeeding? Does your health care provider have a lot of experience giving vaccines, and they think that giving them while you are nursing will just make the whole process take a lot longer?

“Breastfeeding moms may wish to breastfeed baby during vaccination or immediately after to lessen pain and stress.”

AAP on How can I comfort my baby during vaccinations?

In general though, especially as it is recommended by the WHO and the AAP, consider breastfeeding your child while they are getting their vaccines.

More On Breastfeeding Your Child During Vaccinations

Vaccines While Immunosuppressed

It seems to be a big surprise to many folks, but kids can get most vaccines when they are immunosuppressed. In fact, they sometimes get extra some extra vaccines, like Pneumovax, because the  “incidence or severity of some vaccine-preventable diseases is higher in persons with altered immunocompetence.”

They should also get all of their vaccines if they are around someone who is immunosuppressed.

Surprised?

Vaccines While Immunosuppressed

Which vaccines your kids can get while they are immunosuppressed is going to depend greatly on the reason why they are  immunosuppressed.

Are they getting chemotherapy?

Did they just get a stem cell transplant?

Were they born with a specific immunodeficiency, like X-linked agammaglobulinemia, selective IgA deficiency, severe combined immunodeficiency, or chronic granulomatous disease?

Whatever the reason, they likely won’t get a medical exemption to skip all of their vaccines.

“Killed vaccines will not cause infection in immunodeficient or any other children. The fear of increased community-acquired vaccine-preventable diseases should lead to adherence to and completion of recommended immunization schedules in the community to reinforce herd immunity, such that all vaccine-preventable diseases become exceedingly rare.”

Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

In most cases, immunocompromised kids can get all inactivated vaccines. It is only live vaccines that could pose a problem. Even then, it depends on the specific immunodeficiency as to whether avoiding live vaccines is necessary.

For example, after chemotherapy and a stem cell transplant, kids can usually get live vaccines.

Your doctors can review the latest guidelines to come up with a safe vaccination plan for your child with an immune system problem. If necessary, consultation with an infectious diseases or immunology specialist can also be helpful.

Don’t overlook other causes of possible immunosuppression when getting vaccinated, like taking daily oral steroids for more than two weeks, certain biologic immune modulators, or other medications like methotrexate, azathioprine, 6-mercaptopurine.

“Limited evidence indicates that inactivated vaccines generally have the same safety profile in immunocompromised patients as in immunocompetent individuals. However, the magnitude, breadth, and persistence of the immune response to vaccination may be reduced or absent in immunocompromised persons.”

2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host

And keep in mind that just because they can and should get vaccinated, it doesn’t mean that their vaccines are going to work as well as in someone who isn’t immunocompromised.

That’s why herd immunity is so important for these kids.

Vaccines for Close Contacts of Immunocompromised People

What about people who come into contacts with kids and adults who are immunocompromised?

Can they get vaccines?

“Close contacts of patients with compromised immunity should not receive live oral poliovirus vaccine because they might shed the virus and infect a patient with compromised immunity. Close contacts can receive other standard vaccines because viral shedding is unlikely and these pose little risk of infection to a subject with compromised immunity.”

Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

Yes, close contacts can get vaccinated, especially since we don’t use the oral polio vaccine in the United States anymore.

There are some exceptions for the smallpox vaccine, which few people get, and Flumist, but only in very specific situations, including a recent hematopoietic stem cell transplant.

Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and the The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.
Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and the The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.

Worried about shedding?

You should be worried about getting a vaccine-preventable disease and giving it to those around you with immune system problems. That’s the real risk!

This is the modern anti-vaccine movement - taking an immoral stand against vaccines and putting sick kids at risk for life-threatening disease.
This is the modern anti-vaccine movement – scaring parents and taking an immoral stand against vaccines and putting sick kids at risk for life-threatening disease.

And no, you are not being selfish to expect those around you to get vaccinated.

Vaccines are safe and necessary – for all of us.

More on Vaccines While Immunosuppressed

Measles Deaths in Italy

There have been a lot of measles deaths in Europe over the last few years?

How many?

Would you believe over 100?

Measles Deaths in Italy

Among those measles deaths in Europe, there have been at least eight measles deaths in Italy (four in 2017 and another four in 2018, among just 6,601 cases), including:

Why so many deaths in a developed country with a well-nourished population?

Dr. Bob Sears actually reassured parents that measles wasn't deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe - another well-nourished population with lower vaccination rates than the U.S.
Dr. Bob Sears actually reassured parents that measles wasn’t deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe – another well-nourished population with lower vaccination rates than the U.S.

If you haven’t guessed yet, as in other countries in Europe, we are seeing more deaths from measles simply because folks aren’t vaccinated and more people are getting measles.

Measles is a life-threatening disease, even in an age of modern medicine, indoor plumbing, sewage systems, clean water, whole foods, vitamins and minerals, etc.

Italy, with about 1/5 the population of the United States, but about equal to the size of California, has had over 600 times as many cases of measles as we have had in the United States over the last few years. To put it in perspective, that would be like having 33,000 cases of measles in the United States.

Think it couldn’t happen? During the measles outbreaks from 1989 to 1991, when vaccination rates had dropped, there were 55,622 cases and 123 deaths in the United States.

Measles in Italy

Again, in Italy, as in other places, almost all of the measles cases, about 90%, have been in those who aren’t vaccinated.

In response to a post praising Italy's decision to dilute their new vaccine laws, some folks thought it was funny that people were dying of measles.
In response to a post from Dr. Bob Sears praising Italy’s decision to dilute their new vaccine laws, some folks thought it was funny that people were dying of measles.

That’s why they passed new vaccine laws – to get back to herd immunity levels of vaccination.

But shouldn’t folks have a choice about getting vaccinated?

Of course.

Even with the new vaccine laws, parents have a choice. As with vaccine laws in the United States, Italy’s new vaccine mandates had nothing to do with forced vaccination.

That’s unlike most of the people who died of measles in Italy. Most of them didn’t have a choice about being vaccinated and getting measles. Some were immunocompromised and couldn’t be vaccinated and at least one was too young to be vaccinated.

Parents had been set a July 10th deadline to provide schools with the relevant documentation, but it will now be possible for parents to simply submit their own confirmation that the child has been vaccinated, according to Giulia Grillo, Italy’s Health Minister, who was speaking at a press conference on Thursday.

Mandatory vaccinations: Italian parents will no longer need to provide doctor’s note

And that’s why it’s unfortunate that the a newly elected government severely watered down a vaccine law that had made getting vaccinated mandatory to go to school.

And it’s unfortunate that people continue to push misinformation about vaccines and vaccine-preventable diseases.

What to Know About the Measles Deaths in Italy

A drop in vaccination rates has led to measles outbreaks and a number of measles deaths in Italy.

More on Measles Deaths in Italy

Who Is Dr. Taz?

Dr. Taz is on a mission “to transform the way we do medicine and empower and equip you with the best tools so you can live your healthiest life.”

While that sounds very nice, it doesn’t take too long to figure out that she seems like every other anti-vaccine quack we run across these days.

Who Is Dr. Taz?

Dr. Tasneem Bhatia MD (Dr. Taz) describes herself as a nationally recognized “wellness expert” who became a “pioneer and trailblazer” after overcoming her own personal health problems.

With multiple office locations and membership packages, Dr. Taz is pleased to offer many non-evidenced based services for you and your child, and she will even file your claim forms from your insurance company, although, as expected, she doesn’t actually participate in any insurance plans.

What about vaccines?

“My journey in medicine began with pediatrics, so I am well aware of the importance of vaccines and the incredible history and success of vaccination programs in reducing infant and child mortality.

Yet as my journey continues, I have had to listen to patient after patient describe a change or a shifting in their children once vaccines were administered. I experienced this as a parent. I will never forget the day that my son received a combination vaccine. Within 24 hrs., his mild reflux became severe, his weight gain over the next few months slowed and we continue to play catch up, trying to analyze our next steps. My son, however, is not autistic. He is brilliant, hilarious, and an absolute charmer.

My patients and my own children have forced me to rethink this vaccine controversy.”

Dr. Taz on Back to School Survival Series Part Two, The Vaccine Debate Continues

Of course, there is no vaccine controversy, except the one that folks like Dr. Taz have created. Like many other vaccine-friendly pediatricians, anecdotes became evidence and quickly overcame years of learning.

And shame on Dr. Taz for implying that autistic kids are not brilliant, hilarious and charmers!

That’s the vaccine controversy. Continuing to push the idea that autistic kids are vaccine damaged and not understanding the simple concept that correlation doesn’t imply causation.

“Red flags for parents that may justify an alternative schedule include”

Dr. Taz on Back to School Survival Series Part Two, The Vaccine Debate Continues

While there are true contraindications to getting vaccinated, she doesn’t list any of them, instead pushing anti-vaccine talking points about skipping or delaying vaccines if your child has reflux, colic, or delayed milestones, etc.

But there’s more.

During a visit with Dr. Taz, you can also get your child:

  • a Zyto scan
  • Meridian testing
  • a brain boost evaluation
  • sports optimization testing

And parents can get a detox screen “which will directly correlate with your child’s early ability to detox and process chemicals.”  That’s probably just MTHFR testing, which you don’t need and which doesn’t correlate with much of anything, besides homocystinuria.

Selling supplements is big business for integrative, holistic, and anti-vaccine folks.
Your diagnostic tests and evaluation, whether it is the Zyto scan or detox screen, likely helps them scare convince you into buying more supplements.

Dr. Taz also offers:

  • acupuncture and Chinese medicine
  • aromatherapy
  • Ayurveda (Indian medicine)
  • energy healing
  • essential oils
  • craniosacral therapy (osteopathy)
  • homeopathy
  • IV therapy

Now, I understand that these types of holistic docs push the idea of “pulling from conventional, integrative, holistic, functional and Chinese medicine to create the best customized treatment plans possible,” but if any of these alternative therapies worked, whether it was acupuncture or Ayurveda, or homeopathy, then why do they need to integrate them all?

So what services does Dr. Bhatia offer to bring her patients to “whole health”? It’s a veritable cornucopia of quackery. Homeopathy? Check. Acupuncture? Check. (Obviously.) IV vitamin therapy? Check. Oh, and of course Dr. Bhatia offers thermograms. She even offers mobile thermograms. Never mind that thermography remains an unvalidated test for the early detection of breast cancer, much less for all the other conditions for which Dr. Bhatia recommends it, such as arthritis, fibromyalgia, back injuries, digestive disorders, “and more…”

A commercial for acupuncture masquerading as news

And how does someone go from teaching medical students and residents at Emory University to being one of Gwyneth Paltrow’s Goop experts, along with Kelly Brogan?

Dr. Taz was a pediatrician who said that vaccines were safe and necessary.
It wasn’t so long ago that Dr. Taz was a pediatrician who said that vaccines were safe and necessary.

Or from saying vaccines are safe and necessary and that parents shouldn’t expose their kids at chicken pox parties to a few years later saying that we shouldn’t judge Kristin Cavallari because we need more vaccine research.

What motivates these folks?

What to Know About Dr. Taz Bhatia

Dr. Taz promotes herself as an integrative medicine expert who pushes many unproven treatments and has alternative and dangerous views about vaccines and autistic kids.

More on Dr. Taz Bhatia

Vaccines and Hemophilia

Kids with hemophilia bleed.

The Medical and Scientific Advisory Council of the National Hemophilia Foundation recommends "that patients with bleeding disorders continue to follow the American Academy of Pediatrics’ and CDC’s vaccine recommendation route and schedule for their age."
The Medical and Scientific Advisory Council of the National Hemophilia Foundation recommends “that patients with bleeding disorders continue to follow the American Academy of Pediatrics’ and CDC’s vaccine recommendation route and schedule for their age.”

They bleed into their joints, into their skin (hematoma), and from their mouth and gums. They can bleed after surgery and even after getting their vaccinations.

Vaccines and Hemophilia

Having hemophilia is certainly not a contraindication to getting vaccinated though.

“Your child should get regular immunizations with necessary precautions to prevent bleeding from the injection sites.”

Hemophilia FAQs

There are some precautions that are recommended before giving vaccines to a child with hemophilia, including:

  • using a 23-gauge or smaller caliber fine-gauge needle – consider a 25- or 27-gauge needle
  • when possible, giving the vaccine SQ instead of IM – for example, although the IPV (polio), hepatitis A, and hepatitis B vaccines are usually given IM, studies have shown that they can be given SQ to kids with hemophilia
  • applying firm pressure, without rubbing, after the vaccine is given for at least two minutes and up to 5 to 10 minutes
  • giving acetaminophen for pain relief, if necessary, instead of ibuprofen
  • warning about the risk of a hematoma developing at the injection site

Most importantly, if the child with hemophilia is already getting routine prophylaxis to prevent bleeding, schedule their vaccines around the same time to decrease the risk of bleeding.

Your child’s hematologist will likely give you specific instructions to provide to your pediatrician regarding immunization precautions.

What to Know About Vaccines and Hemophilia

Kids with hemophilia should get all of their vaccines on schedule, but precautions should be taken to decrease the chance of bleeding after getting an immunization.

More About Vaccines and Hemophilia

Abuse of Vaccine Exemptions

Every state has laws mandating vaccines to attend school and daycare.

Every state also allows exemptions to those mandates, including:

The way that  these laws and exemptions are set up leaves a lot of room for abuse though.

Abuse of Religious Exemptions

How many religions are actually against kids getting vaccinated?

That’s right, almost none.

So why are there so many religious vaccine exemptions in most states, especially in states that don’t have a personal belief exemption?

Right again.

Folks who don’t want to vaccinate their kids, and can’t use a personal belief exemption, just say that vaccinating them would be against their religion.

Abuse of Medical Exemptions

There are some children who shouldn’t be vaccinated.

These children can get a true medical exemption to one or more vaccines because they have a real contraindication or precaution to getting vaccinated.

“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”

Dear Colleague letter regarding guidelines for use of immunization exemptions

Fortunately, these medical reasons to skip or delay vaccines are not very common and are often temporary. They can include the contraindications and precautions listed in the package insert for each vaccine and by the Advisory Committee on Immunization Practices, with the most common medical exemptions being:

  • a severe allergic reaction to a previous dose
  • a severe allergic reaction to a vaccine component
  • a known severe immunodeficiency and live vaccines
  • a moderate or severe acute illness with or without fever (precaution)
  • a progressive neurologic disorder (precaution)
A family history of these conditions would not be a reason to skip or delay any vaccines.
Although it will get you a medical exemption for just $120 in California, a family history of these conditions would not be a reason to skip or delay any vaccines.

Most other things are “incorrectly perceived as contraindications to vaccination” and should not be a medical exemptions, including having :

  • a mild acute illness with or without fever
  • a mild to moderate local reaction
  • relatives with allergies
  • a family history of seizures
  • a stable neurologic condition
  • an autoimmune disease
  • a family history of an adverse event after DTP or DTaP administration

A medical exemption can also exist if your child already had the disease and so has natural immunity. In most cases, except for chicken pox disease, titers will likely need to be done to prove that your child already has immunity.

Stopping the Abuse of Vaccine Exemptions

We know that vaccine exemptions are being abused.

How do you stop it?

“Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence.”

Omer et al on Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence.

You likely have to make it harder to get a vaccine exemption.

Strong exemption laws, which are needed in many states, make it clear that:

  • many exemptions are temporary
  • medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence based medicine – not anecdotes
  • religious exemptions specifically exclude philosophical exemptions and must reflect a sincere religious belief
  • exempted students will be excluded from school during outbreaks
  • exemptions should include a signed affidavit that is notarized
  • exemptions should be recertified each year
  • a separate exemption application will be needed for each vaccine

Getting an exemption shouldn’t be easier than getting vaccinated! And it should include some degree of education against the myths and misinformation that scares parents away from vaccinating their kids.

“Because rare medically recognized contraindications for specific individuals to receive specific vaccines exist, legitimate medical exemptions to immunization requirements are important to observe. However, nonmedical exemptions to immunization requirements are problematic because of medical, public health, and ethical reasons and create unnecessary risk to both individual people and communities.”

AAP on Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance

You could also get rid of nonmedical vaccine exemptions.

Of course, for that to work, you can’t allow just anything to count as a medical exemption.

“Review of all medical exemption requests will be conducted at the Mississippi State Department of Health by the State Epidemiologist or Deputy State Epidemiologist.”

Mississippi Medical Exemption Policy

In Mississippi, for example, where medical exemptions are reviewed and approved by the State Epidemiologist or Deputy State Epidemiologist, there were just 208 medical exemptions in the whole state during the 2016-17 school year.

In some states, rates of medical exemptions might be six or seven times higher. This is mostly seen in states that don’t allow personal belief exemptions and make it difficult to get a religious exemption.

That seems to be the case in Nebraska, where there are no personal belief exemptions and you have to submit a notarized statement to get a religious exemptions. Their high rates of medical exemptions likely reflect some abuse and the fact that medical exemptions aren’t reviewed or approved by anyone, they just reflect “that, in the health care provider’s opinion, the specified immunization(s) required would be injurious to the health and well – being of the student or any member of the student’s family or household.”

As we are seeing, that simply invites vaccine exemption abuse.

Very few states currently require that exemption applications go to the health department for review. Those that do include Alabama, Arkansas, Michigan, Minnesota, Mississippi, and West Virginia.

California is notably absent. I guess they didn’t see the potential for abuse when they passed their latest vaccine law. I mean, who could have guessed that doctors would actually be selling medical exemptions to parents based on unrelated conditions, like a family history of diabetes, celiac disease, or autism?

The non-medical vaccine exemption form in Colorado includes information on the risks of each vaccine-preventable disease.
The non-medical vaccine exemption form in Colorado includes information on the risks of each vaccine-preventable disease.

At the very least, until we have stronger exemption laws, parents who want to get a nonmedical exemption should acknowledge that they understand the risks they are taking when they skip or delay their child’s vaccines.

What to Know About Abuse of Vaccine Exemptions

While medical exemptions are necessary for kids who have true contraindications to getting vaccinated, stronger laws can help decrease the abuse we see in medical, religious, and personal belief vaccine exemptions.

More Information on Abuse of Vaccine Exemptions