Tag: contraindications

Is Measles Dangerous If You Are Pregnant?

While folks often try and make it seem like measles is a common childhood illness, we know that it can be dangerous.

“One of the patients was a 20-year-old pregnant woman who had rash onset on January 5 following exposure to her 12-year-old brother. After delivering a healthy baby on January 6, the mother developed severe pneumonia that was followed by respiratory arrest. She was resuscitated and transferred to an intensive care unit in a larger hospital nearby in Tennessee.”

Epidemiologic Notes and Reports Transmission of Measles Across State Lines — Kentucky, New Hampshire, Tennessee, Virginia

Rarely do people who have really had measles describe it as just a fever and a rash. They remember that it was called a harmless killer for a reason.

Is Measles Dangerous If You Are Pregnant?

And there are some situations in which measles can be especially dangerous, including if you get sick when you are very young, very old, or have immune system problems.

Pregnant women should be screened for measles immunity.
Pregnant women should be screened for measles immunity.

And what if you are pregnant when you get measles?

“The Health Department announced today that the number of measles cases has grown to 390, including two pregnant women diagnosed with the infection, one diagnosed in mid-April.”

The Number of Measles Cases Grows to 390

If you are pregnant and you are exposed to someone with measles, you can get IVIG post-exposure prophylaxis to prevent you from actually getting measles, but this typically only works if given within six days of the exposure.

“To date, studies have not identified an increased risk for birth defects when pregnant women get the measles during pregnancy. However, studies suggest that measles infection is associated with an increased risk for miscarriage, stillbirth, prematurity and the baby being born with a measles infection.”

When Measles Strike, It’s Not The Happiest Place On Earth For Pregnant Women

Unlike a rubella infection during pregnancy, a measles infection is not thought to cause birth defects. Tragically, it can, like rubella, lead to an increased risk for having a miscarriage.

“Infants who develop congenital measles are at increased risk for mortality and for subacute sclerosing panencephalitis, which is more common when measles is diagnosed in infancy. In addition, subacute sclerosing panencephalitis in newborns infected with measles either congenitally or shortly after birth appears to be more severe, with a shorter latency and rapidly progressive course.”

What Obstetric Health Care Providers Need to Know About Measles and Pregnancy

And if the mother gets measles very late in her pregnancy, it can also lead to a case of congenital measles, or a baby being born with an active measles infection.

“In 52% of cases, measles was likely acquired from a relative. Complications included pneumonia in one child; two pregnant women required hospitalization, including one who miscarried.”

Notes from the Field: Measles Outbreak Among Members of a Religious Community — Brooklyn, New York, March–June 2013

Don’t take the risk that you might get measles while you are pregnant.

Make sure you are vaccinated and protected before you ever start thinking about getting pregnant, as pregnancy is a contraindication to getting the MMR vaccine. And you should wait at least 4 weeks after getting vaccinated before getting pregnant.

More on Measles in Pregnancy

Why Should Medical Exemptions Be Based on CDC Contraindications?

Getting a medical exemption for vaccines isn’t controversial.

Or at least it shouldn’t be.

Why Should Medical Exemptions Be Based on CDC Contraindications?

As many people know though, some people have been taking advantage of the fact that medical exemptions weren’t clearly defined in California’s vaccine law.

Who are the doctors handing out fake medical exemptions in California?
Who are the doctors handing out fake medical exemptions in California?

Are there just a few doctors taking advantage of the California law?

“But at 105 schools in the state, 10% or more of kindergartners had a medical exemption in the school year that ended last month, according to a Los Angeles Times analysis of state data.”

Pushback against immunization laws leaves some California schools vulnerable to outbreaks

Is 10% a lot?

In one recent report, Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year, the median rate of medical exemptions in the US was just 0.2%, with a range of <0.1 to 1.5%.

In West Virginia and Mississippi, states that don’t allow non-medical exemptions and where criteria for medical exemptions are fairly strict, the rates were 0.1 and 0.3% respectively.

And that’s about what you would expect, as there are very few true contraindications or precautions to getting vaccinated.

So yes, 10% is an awful lot and that’s a good sign that it is more than just a few doctors taking advantage of the law.

“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

Why do most other states have so few medical exemptions?

Mostly because there are very few true medical reasons to skip or delay a child’s vaccines!

They include, but aren’t limited to, the contraindications and precautions listed in the package insert for each vaccine (the contraindications and warnings sections…) and by the Advisory Committee on Immunization Practices.

They don’t include many other things that are “incorrectly perceived as contraindications to vaccination,” such as things in the family medical history of the child, eczema (unless they are getting the smallpox vaccine), colic, sleep apnea, or being a picky eater.

Is everything a vaccine injury?
Is everything a vaccine injury?

It should be obvious.

Medical exemptions for vaccines should be based on CDC criteria because some folks think that everything is a vaccine injury.

More on Medical Exemptions

Bob Sears Doubles Down Against California Vaccine Laws

Bob Sears wasn’t a fan of SB 277, the vaccine law that removed non-medical exemptions in California.

Not surprisingly, he is actively rallying folks against a new bill that would close a loophole in that law. It seems that some doctors were writing medical exemptions for anything and everything, from eczema to swollen lymph nodes.

Bob Sears is pushing misinformation that SB 276 takes away all medical exemptions.
Bob Sears is pushing misinformation that SB 276 takes away all medical exemptions.

Of course, the new law wouldn’t take away medical exemptions. It would just take away fake medical exemptions.

Is everything a vaccine injury?
Is everything a vaccine injury?

Yes, take a long hard look at their list…

A very few actually are actually standard contraindications and precautions to commonly used vaccines, so could likely get you a medical exemption to one or more vaccines. GBS within 6 weeks of a flu shot, a precaution, not a contraindication, would be an example. But even in this case, the exemption would be for flu shots, not all vaccines.

“Events or conditions listed as precautions should be reviewed carefully. Benefits of and risks for administering a specific vaccine to a person under these circumstances should be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit of vaccination is believed to outweigh the risk, the vaccine should be administered. “

Vaccine Recommendations and Guidelines of the ACIP

What about all of the rest of the diseases or “severe reactions” on Bob’s list, like pneumonia, palpitations, eczema, hair loss, IBD, difficulty swallowing, skin infections, testicular pain, HSP, Multiple Sclerosis, and Kawasaki disease, etc.

These are not vaccine injuries, even though they are sometimes in a package insert. I’m surprised that he didn’t list SIDS and autism too…

And this is why California needs to fix their vaccine law… Folks, including pediatricians, pushing the idea that everything is a vaccine injury.

More on Bob Sears and California Vaccine Laws

A Legislative Guide to Advocating for Stronger Vaccine Laws

Having to get vaccinated to attend school isn’t a new idea.

In 1827, Boston mandated that all children attending public school must receive the smallpox vaccine.

Believe it or not, it wasn’t until the 1980-81 school year that there were laws in all 50 states mandating that children receive vaccinations before starting school. The smallpox vaccine wasn’t one of them…

A Legislative Guide to Advocating for Stronger Vaccine Laws

Not surprisingly, as vaccines did their job and rates of vaccine-preventable diseases dropped, politicians were able to weaken our vaccine laws.

Over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions!

We are now paying the price, with increases of vaccine-preventable diseases among clusters of intentionally unvaccinated children whose parents claim non-medical vaccine exemptions.

And that’s why we are seeing more and more states work to strengthen their vaccine laws.

Legislators who want to combat vaccine exemption abuse should enact laws that make it clear that:

  • medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence-based medicine – not anecdotes
  • medical exemptions should be reviewed and approved by the State Epidemiologist, Deputy State Epidemiologist, or other designated professionals at the health department
  • religious exemptions, if included at all, should specifically exclude philosophical exemptions and must reflect a sincere religious belief
  • philosophical exemptions, if included at all, should require some degree of education against the myths and misinformation that scares parents away from vaccinating their kids
  • exempted students will be excluded from school during outbreaks
  • exemptions should include a signed affidavit that is notarized
  • exemptions should be recertified each year
  • most exemptions are temporary
  • a separate exemption application should be required for each vaccine
  • exemption rates should be tracked at the school level and should be posted on school websites

Getting an exemption shouldn’t be easier than getting vaccinated!

Become an advocate and help get more kids vaccinated. You can also help stop bad vaccine laws from being enacted in your state, including some that would make it even easier to get an exemption.

More on A Legislative Guide to Stronger Vaccine Laws

How Is California’s New Vaccine Law Working?

As clusters of unvaccinated kids in California grew and so did outbreaks of vaccine-preventable diseases, legislators got ahead of the problem with a series of vaccine laws to get kids vaccinated and protected.

  • AB 2109 – signed into law in 2012, and in effect for the 2014-2015 and 2015-2016 school years, it required parents to get a signed form from a health care provider if they wanted to get a vaccine exemption
  • SB 277 – signed into law in 2015, it eliminated non-medical vaccine exemptions and has been in effect since the 2016-2017 school year

So are all of the kids in California vaccinated now?

How Is California’s New Vaccine Law Working?

Unfortunately, some folks have found a way around the new vaccine laws.

How?

Some California doctors have taken advantage of fearful parents, and instead of doing the work to help parents understand that vaccines are safe with few risks, they are writing unjustified medical exemptions.

And since many of these parents share their fears with their friends, these intentionally unvaccinated kids often attend the same schools and use the same doctors to obtain unwarranted exemptions of their own. That results in the pockets of susceptible children we often talk about.

Some of these doctors have even created an industry out of providing medical exemptions to kids to get them out of getting vaccinated and protected before attending school. It is reported that they are selling fake medical vaccine exemptions for conditions that are not true medical contraindications to getting vaccinated!

Bob Sears is having to post about the latest measles outbreaks from the sidelines. There are very few measles cases in California so far this year.
Bob Sears is having to post about the latest measles outbreaks from the sidelines. There have been very few measles cases in California so far this year.

Still, many others have gotten vaccinated.

In fact, after years of declines, the vaccination rates for kids entering kindergarten in 2017 were at the highest rate since at least 1998!

“The proportion of students attending kindergarten in 2017-2018 reported to have received all required vaccines is 95.1%, a 0.4 percentage point decrease (difference of unrounded values) from the 2016-2017 school year and a 4.7 percentage point increase over the three years since 2014-2015. The 2017-2018 rate of 95.1% is the second highest reported for the current set of immunization requirements for kindergarten, which began in the 2001-2002 school year.”

2017-2018 Kindergarten Immunization Assessment – Executive Summary California Department of Public Health, Immunization Branch

What about the exodus from public schools that many predicted?

Orange County was the site of several large measles outbreaks before SB 277 took effect.
Orange County was the site of several large measles outbreaks before SB 277 took effect.

Or the exodus of folks California?

Neither happened.

“About 130,000 more residents left California for other states last year than came here from them, as high costs left many residents without a college degree looking for an exit, according to a Bee review of the latest census estimates.”

More people left California in 2017 than moved here. Who they are and where they went

While some people are leaving, it is typically for economic reasons.

It isn’t because folks have to vaccinate and protect their kids.

So except for not predicting that folks would try to get fake medical exemptions, California’s new vaccine law is working well!

More on the Effectiveness of California’s New Vaccine Law

What is Eczema Vaccinatum?

Did you know that having eczema is a contraindication to getting a vaccine?

Which vaccine?

The smallpox vaccine!

Yes, smallpox has been eradicated, but the vaccine is sometimes still used in very specific situations, especially in the military.

What is Eczema Vaccinatum?

Not only is eczema a contraindication to getting the smallpox vaccine, you shouldn’t even get it if a household contact has eczema.

Why not?

Shedding.

Yes, although anti-vaccine folks needlessly worry about shedding when kids get routine childhood vaccines and even talk about a shedding season, with the smallpox vaccine, problems with shedding are really a thing.

Since the smallpox vaccine is a live virus vaccine and since it very commonly causes a skin reaction at the injection site, shedding can spread it to others. While that’s a good thing with some vaccines, like the oral polio vaccine, because it increases herd immunity, it isn’t with the smallpox vaccine.

If the weakened smallpox vaccine can cause a skin reaction on your arm where you got the shot, what is it going to do if it gets on a child’s skin that is irritated all over with eczema?

An 8-month-old boy with eczema vaccinatum.
An 8-month-old boy with eczema vaccinatum. Photo by CDC/Arthur E. Kaye

It’s a good thing that we don’t routinely have to use the smallpox vaccine anymore.

“Because persons with eczema are deferred from vaccination, only a single, accidentally transmitted case of EV has been described in the medical literature since military vaccination was resumed in the United States in 2002.”

Reed et al on Eczema vaccinatum.

And that it doesn’t happen with any other vaccines!

More on Eczema Vaccinatum

Can Your Kids Get a Vaccine While They Are Taking Antibiotics?

In general, simply taking an antibiotic would not usually be a reason to not get vaccinated.

“Contraindications and precautions to vaccination generally dictate circumstances when vaccines will not be given. Many contraindications and precautions are temporary, and the vaccine can be given at a later time.”

General Recommendations on Immunization

The reason your child is taking the antibiotic could make you want to think about delaying the vaccine though.

Can Your Kids Get a Vaccine While They Are Taking Antibiotics?

Kids are prescribed antibiotics for a lot of different reasons, from treating ear infections and acne to pneumonia and meningitis.

Since a mild acute illness with or without fever isn’t considered a contraindication or precaution to getting vaccinated, in most cases, being on an antibiotic would not cause you to want to skip or delay your child’s vaccines.

The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.
The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.

In fact, current antimicrobial therapy is listed by the CDC as one of the conditions commonly misperceived as a contraindication or precaution!

There are some exceptions though, including:

  • taking the antibiotic for a moderate or severe acute illness with or without fever (a general precaution to getting a vaccine)
  • antimalarial agents and antibiotics might interfere with the Ty21a oral typhoid vaccine
  • antiviral drugs (acyclovir, famciclovir, or valacyclovir) might interfere with varicella-containing vaccines (Varivax)
  • antiviral drugs (Tamiflu, Relenza) might interfere with LAIV4 (FluMist, the nasal spray flu vaccine)

Is your child taking the antibiotic for a mild illness or a more moderate or severe illness for which they are now recovering? Then the fact that they are still taking an antibiotic likely isn’t a contraindication or a precaution to getting vaccinated.

More on Vaccine Contraindications