Tag: contraindications

Updated Recommendations to Prevent and Control the Flu from the CDC

Every year, we get updated recommendations on how to best prevent and control the flu from the CDC and the Advisory Committee on Immunization Practices.

Updated Recommendations to Prevent and Control the Flu from the CDC

Sometimes that means big changes, but often it doesn’t.

Updated Recommendations to Prevent and Control the Flu from the CDC

What about this year?

“This report includes no substantial changes from the 2018–19 recommendations.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season

No substantial changes. That makes it easy to report!

So as usual, everyone who is at least 6 months old without a contraindication should get a flu vaccine this year.

“Balancing considerations regarding the unpredictability of timing of onset of the influenza season and concerns that vaccine-induced immunity might wane over the course of a season, it is recommended that vaccination should be offered by the end of October.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season

And be sure your kids get vaccinated and protected before flu season starts.

What else is there to know about the upcoming, 2019-20 flu season?

  • flu vaccine is already becoming available in doctor’s offices, pharmacies, and clinics
  • despite some initial delays, up to 169 million doses of flu vaccine will be available for the 2019-20 flu season
  • FluMist will be in short supply this year, but it is available

Anyone have predictions for what kind of flu season we will have?

More on Recommendations to Prevent and Control the Flu

Are There 6 Reasons to Oppose SB276?

Not surprisingly, folks are pushing misinformation in trying to get support in their efforts to oppose SB276, the California bill that will help stop doctors from writing fraudulent medical exemptions.

Are There 6 Reasons to Oppose SB276?

It also shouldn’t be a surprise that none of their “reasons” hold water.

There are no good reasons to oppose SB276.
There are no good reasons to oppose SB276.

Are the guidelines for writing medical exemptions too limited under SB276?

If you consider that true medical exemptions to getting vaccinated are not common, then no, they are not.

Remember, medical exemptions for vaccines should be for kids who can’t be vaccinated, not just because you’re scared or don’t want your child to be vaccinated.

What about the high rates of vaccination and low rates of exemptions in California?

Uh, what about the schools in California where 30 to 50% of students have medical exemptions? These clusters of unvaccinated kids with medical exemptions are the concern, not the overall rates of vaccination and exemptions in the state.

And it is only the doctors writing excessive medical exemptions that will trigger an investigation.

What about the Medical Board of California?

While the system that they have in place has allowed them to investigate some doctors, it has mostly failed. While they do have the authority to investigate physicians, for some reason, they can’t get medical records unless a parent cooperates.

“Ms. Simoes provided background on Senate Bill (SB) 277, which passed in 2015, eliminating the personal belief exemption from the requirement that children receive specific vaccinations for certain infectious diseases prior to being admitted to any school or daycare center. She explained that after the passage of SB 277, the Board has had a difficult time investigating complaints related to medical exemptions since an authorization of medical records needs to be signed and many parents or guardians do not want to sign the authorization since it would identify the doctor that provided the medical exemption. She explained that this causes a barrier to investigation since most medical exemption cases cannot be subpoenaed and medical records are needed to conduct an investigation.”

Discussion and Possible Action on SB 276 (Pan) Immunizations: Medical Exemptions

And the Medical Board of California supports SB276.

Who else supports SB276?

In addition to the Governor of California, supporters include the AAP, California Medical Association, California State PTA, Children’s Defense Fund of California, County of Los Angeles, Infectious Disease Association of California, and the March of Dimes.

What to Know About Reasons to Oppose SB276

It should be clear that there is no reason to oppose SB276, unless you don’t want your kids immunized and you want to find a doctor to write them a fake medical exemption.

More on SB276

What Is Standard of Care?

Anti-vaccine folks who are talking about “standard of care” when deciding who gets a medical exemption for vaccines obviously don’t really understand what it means.

Why are these advocating against keeping kids protected against life-threatening vaccine-preventable diseases?
Why are these advocating against keeping kids protected against life-threatening vaccine-preventable diseases?

Maybe that’s why they put standard of care in quotes in the above infographic against SB276, a new vaccine bill in California that will eliminate fake vaccine exemptions.

What Is Standard of Care?

When we talk about standard of care in medicine, it is important to understand that it is a legal term, with a legal definition:

“That which a minimally competent physician in the same field would do under similar circumstances”

Moffett et al on The Standard of Care: Legal History and Definitions: the Bad and Good News

Does this mean that the minimally competent physicians can choose whatever criteria they want to write fake medical exemptions for vaccines?

Of course not!

“Treatment that is accepted by medical experts as a proper treatment for a certain type of disease and that is widely used by healthcare professionals. Also called best practice, standard medical care, and standard therapy.”

NCI Dictionary of Cancer Terms

Just because a few doctors do something a certain way, that doesn’t make it the proper way for it to be done.

These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.
These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.

And that’s why a doctor making up their own rules for what counts as a vaccine medical exemption, especially when it goes against published guidelines and advice, isn’t standard of care.

More on Standard of Care

Does the CDC Determine Medical Exemptions for Vaccines?

California’s new vaccine law has some folks arguing about medical exemptions again.

Yes, the CDC does not determine medical exemptions for vaccines. That's not news.
Yes, the CDC does not determine medical exemptions for vaccines. That’s not news.

Some want very broad guidelines and are confused about how doctors determine who should get a medical exemption.

Does the CDC Determine Medical Exemptions for Vaccines?

Bob Sears even thinks he has a bombshell revelation that clears everything up.

An email from the CDC!

You can be sure that the "medical provider's prerogative" does not include any reason they think up, even those that have no evidence to back them up.
You can be sure that the “medical provider’s prerogative” does not include any reason they think up, even those that have no evidence to back them up.

The thing is, no one has ever said that ACIP contraindications and precautions to vaccination are the one and only factor that should determine whether or not a child should get a medical exemption.

“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

So no one should really be surprised by an email that says the CDC does not determine medical exemptions.

What Qualifies as a Vaccine Medical Exemption?

What are the other big factors, in addition to ACIP contraindications and precautions?

“A medical exemption is allowed when a child has a medical condition that prevents them from receiving a vaccine.”

What is an Exemption and What Does it Mean?

Medical exemptions for vaccines should be based on AAP and ACIP guidelines, current accepted medical practice, and evidence based medicine.

“Medical exemptions are intended to prevent adverse events in children who are at increased risk of adverse events because of underlying conditions. Many of these underlying conditions also place children at increased risk of complications from infectious diseases. Children with valid medical exemptions need to be protected from exposure to vaccine-preventable diseases by insuring high coverage rates among the rest of the population. Granting medical exemptions for invalid medical contraindications may promote unfounded vaccine safety concerns. Although states may wish to allow parents who make decisions based on poor science or perceptions to withhold vaccines from their children, these exemptions should be distinguished from valid medical exemptions.”

Salmon et al on Keeping the M in Medical Exemptions: Protecting Our Most Vulnerable Children

For example, in addition to kids who may have had a severe allergic reaction to a vaccine, there are often children with immune system problems or who have a moderate or severe illness who can’t get one or more vaccines, at least temporarily.

These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.
These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.

Medical exemptions for vaccines should not be based on anecdotes or simply because a vaccine-friendly doctor has scared a parent away from vaccinating and protecting their kids.

There are very few family history issues that would make a child have to skip or delay getting a vaccine.
There are very few family history issues that would make a child have to skip or delay getting a vaccine.

They should rarely be done based on family history of reactions or what some people think are vaccine reactions.

This is what a fake medical exemption will get you - a life-threatening disease.
The child’s medical exemption was for “cytotoxic allergies secondary to immunization,” without any evidence that it was necessary. In addition to a fake medical exemption, he got tetanus.

In general, they should rarely be given, as the AAP states in their policy statement, Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance, “only a very small proportion of children have medical conditions prohibiting specific immunizations…”

That’s why rates of medical exemptions should be low.

“Between the 2009-2010 and 2016-2017 school years, the national median prevalence of medical exemptions has remained constant, between 0.2% to 0.3%, with state-level ranges showing little heterogeneity over time, never exceeding the range of 0.1% to 1.6% over this period.”

Bednarczyk et al on Current landscape of nonmedical vaccination exemptions in the United States: impact of policy changes

And why you shouldn’t have schools with high rates of medical exemptions or doctors writing a lot of medical exemptions.

More on Vaccine Medical Exemption Guidelines