Tag: daycare

How Are Australia’s New Vaccine Laws Working?

Have you heard about the No Jab, No Play / Pay laws in Australia?

Did Australia's new vaccine laws prompt anti-vaccine folks to put up these billboards that eventually got vandalized?
Did Australia’s new vaccine laws prompt anti-vaccine folks to put up these billboards that eventually got vandalized?

Unlike the No Pass, No Play rules that we have in Texas, in which kids can’t participate in extracurricular activities unless they pass all of their classes, No Jab, No Play / Pay has to do with getting kids vaccinated.

They were enacted in 2016 due to an increase in outbreaks of vaccine preventable disease, a rise in the spread of anti-vaccine misinformation, and more parents choosing to delay or skip their child’s vaccines. As in the United States, the real problem has been clusters of unvaccinated children in certain regions of the country, as the great majority of people in Australia vaccinate their kids.

How Are Australia’s New Vaccine Laws Working?

As expected, Australia’s new vaccine laws have been a success.

On the national level, No Jab, No Pay has meant that children need to be fully immunized “as a requirement for parents to be eligible to receive the Family Tax Benefit Part A end of year supplement, Child Care Benefit and Child Care Rebate.”

Five-year-olds in Victoria are now better protected against diseases prevented by vaccination than in any other state in Australia, new data shows.

Victoria Leads The Nation When It Comes To Vaccination Rates

But it is only in New South Wales, Queensland, and Victoria that children need to be immunized to attend childcare – No Jab, No Play. Additionally, children need to be immunized to attend kindergarten in Queensland and Victoria.

An increase in vaccination rates, by 2 to 5%, has been seen nationwide though.

What about the idea that No Jab, No Play has lead to a drop in preschool enrollments?

KATHARINA GORKA, NON-VACCINATING PARENT: I don’t think it is fair, to be honest. It makes me feel like we are a bit excluded from society, yeah.
PETER MCCUTCHEON: Did you ever think, “I’ll get my son vaccinated so I get around this pre-school problem”?
KATHARINA GORKA: No, I never thought about that.
PETER MCCUTCHEON: Why not?
KATHARINA GORKA: Because I have a set opinion on vaccinations and that is not going to change.

Some pre-schools experience drop in enrolments over ‘no jab, no play’ policy

The law about attending daycare and kindergarten just came into effect in New South Wales, in 2018, but has been in effect since 2016 in Victoria.

We will have to wait a few more months for the 2018 numbers, but preschool enrollment in Victoria was way up after they instituted their strict vaccine requirements!

In Australia during 2017, 339,243 children aged 4 or 5 were enrolled in a preschool program, representing an increase of 2.6% on the previous year’s figure. The largest growth rates were in the Australian Capital Territory (6%) and Victoria (5%).

Australian Bureau of Statistics on Preschool Education, Australia, 2017

Maybe folks just don’t want to go to care centers that had been pandering to anti-vaccine parents

Still, some vaccine advocates don’t think that No Jab, No Play / Pay laws are a good idea for Australia. Many also don’t think that it is a good idea that some Australian doctors are starting to refuse to see unvaccinated children, a practice that seems to have been exported from the United States.

Others don’t see alternatives, as they feel that they have been trying for a long time to educate parents that vaccines are safe and necessary, and this is one of the few ways that can reliably improve vaccination rates.

More on Australia’s New Vaccine Laws

Do Vaccine Mandates Force Parents to Vaccinate Their Kids?

Listening to some parents talk about new vaccine laws, you would think that pediatricians are going to start kidnapping babies or simply hold them down to force them to get vaccinated and follow the latest immunization schedule.

Is there any truth to that?

Of course not.

The History of Vaccine Mandates

There have been vaccine mandates in the United States since 1827, when Boston became the first city to require all children attending public schools to be vaccinated against smallpox.

Surprisingly though, it took a long time to get vaccine mandates protecting more children. It wasn’t until the 1980-81 school year that there were laws in all 50 states mandating that children required vaccinations before starting school.

This followed continued measles outbreaks in the mid-1970s and studies showing that states with vaccine mandates had much lower rates of measles than states that didn’t. And it likely explains why there were 10 measles deaths in the United States as late as 1980, even though the first measles vaccine was introduced in 1963.

It took even longer for the vaccine mandates to cover kids in all grades and not just those entering school, to cover kids in daycare, and to cover kids in college. And tragically, it didn’t take long for politicians to chip away at those vaccine mandates. Over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions.

Still, even before the addition of personal belief vaccine exemptions and without the abuse of religious exemptions and medical exemptions, vaccine mandates have never equaled forced vaccination.

Even the Vaccination Act of 1853 in the UK, which required everyone to get a small pox vaccine, didn’t actually force them to get vaccinated. It originally levied fines on people until they got the vaccine, but they soon allowed a conscientious exemption to vaccination, which many people took advantage of. Over the years, so many people were claiming conscientious vaccine exemptions in the UK, that in 1946, they repealed their vaccine requirements altogether.

What Is a Vaccine Mandate?

Since a mandate is typically defined as an official order to do something, a vaccine mandate would be an order to get a vaccine. But it is hardly an order to hold down and force a vaccine on someone.

Likewise, state laws that mandate vaccines aren’t forcing kids to get vaccinated. They are typically mandates to get vaccinated before attending daycare, public and private schools, and/or college.

Is your child going to camp this year? They might mandate certain vaccines if kids want to attend.

Do Vaccine Mandates Force Parents to Vaccinate Their Kids?

Do vaccine mandates take away a person’s choice about getting vaccinated?

Anti-vaccine folks go to great lengths to scare you into thinking that someone is going to force you to vaccinate your kids. They aren't...
Anti-vaccine folks go to great lengths to scare you into thinking that someone is going to force you to vaccinate your kids. They aren’t…

Of course not.

Again. We are not talking about forced vaccination.

For example, if you work in a hospital that requires a yearly flu vaccine, you can decide to work somewhere else. Sure, you no longer simply have the choice between getting vaccinated or leaving yourself unprotected and continuing to work at the same job, but you can still decide to skip the vaccine and look for another job.

These are mandates with a choice.

The same is true with vaccine mandates for kids to attend school or daycare. If you choose to skip one or more vaccines for a non-medical reason, then even if you are in a state that doesn’t allow religious or philosophical vaccine exemptions, you won’t be forced to get vaccinated. While it may not be an option you are happy with, homeschooling is an option for those who don’t want to vaccinate their kids.

That is your vaccine choice.

Public education is a benefit of those who comply with mandates or compulsory vaccination laws.

These state immunization laws and vaccine mandates have nothing to do with forced vaccination. They also don’t take away your informed consent, are not against the Nuremberg Code, and are not unconstitutional.

Have kids ever been forced to get vaccinations?

Not routinely, but there have been cases of health officials getting court orders to get kids vaccinated and protected, usually during outbreaks of a vaccine-preventable disease.

In 1991, for example, a judge ruled that parents of unvaccinated children who were members of the Faith Tabernacle Congregation in Pennsylvania had to get a measles vaccine. As a measles outbreak spread through Faith Tabernacle, an associated church, and the rest of the city, there were at least 486 cases of measles in the church, mostly among children, and 6 deaths.

“Parents are free to become martyrs themselves. But it does not follow that they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.”

Prince v. Massachusetts

In addition to being unvaccinated, these children didn’t get any medical care, as their families instead relied on prayer. Finally, after the order was appealed all the way to the state Supreme Court, only nine children got vaccinated.

When parents disagree about vaccines, a judge might also step in decide that a child be vaccinated over one parent’s objections. A child might also get vaccinated against their parents wishes if they have lost custody for reasons that have nothing to do with the child’s medical issues and so a legal guardian, which might be the state, is making those decisions now.

Still, these are not the usual circumstances we are talking about with state vaccine laws. They are simply laws to get kids vaccinated and protected before they are allowed to attend daycare or school.

What to Know About Vaccine Mandates and Forced Vaccinations

Vaccine mandates do not force parents to vaccinate their kids.

More on Vaccine Mandates and Forced Vaccinations

 

Can MMR Shedding Start a Measles Outbreak?

Have you ever noticed that any time that there is a new outbreak of measles, folks tend to ask the same basic questions.

How did the outbreak start?

Why weren’t they vaccinated?

Was it from shedding?

Wait, what?

Shedding??? Really?

Can MMR Shedding Start a Measles Outbreak?

It seems that the idea that the MMR vaccine sheds and can lead to measles outbreaks is one of those anti-vaccine myths that just won’t go away.

It comes back with each new measles outbreak.

The myth that MMR shedding leads to measles outbreaks is commonly spread on Facebook, like this discussion on a recent outbreak at a Kansas City daycare center.
The myth that MMR shedding leads to measles outbreaks is commonly spread on Facebook, like this discussion on a recent outbreak at a Kansas City daycare center.

While the oral polio vaccine is indeed associated with shedding and vaccine associated disease, that doesn’t happen with MMR. Experts don’t even recommend any restrictions for use of the MMR vaccine for household contacts of people who are immunosuppressed. And yes, your kids can even visit a cancer patient if they just had their MMR, as long as they don’t have RSV, the flu, or some other contagious disease.

What about the fact that a study once found measles virus RNA in the urine of of kids who had recently been vaccinated? Doesn’t that mean that they were shedding the vaccine virus?

No. It doesn’t.

To be considered shedding, those measles virus RNA particles in their urine would have to be contagious. Now, measles is spread by respiratory secretions. So how are measles virus RNA particles in urine going to become airborne and get someone else sick?

They don’t.

Another Facebook post about MMR and shedding.
Most measles outbreaks in daycare centers have been started by an unvaccinated child or worker who traveled out of the country.

But what about that case in Canada? Anti-vaccine folks like to bring this up when they talk about shedding. In 2013, there was a case of vaccine-associated measles. That proves that the vaccine sheds, right?

Absolutely not!

“Of note, only one case report of transmission from vaccine-associated measles has been identified.”

Murti et al. on Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013

That child got measles about 5 weeks after she was vaccinated in the middle of a measles outbreak. Because she had no links to the other cases and she tested positive for vaccine-strain measles, it is thought that she had MMR vaccine-associated measles, which is extremely rare.

Shedding Light on Measles Outbreaks in Daycare

MMR shedding is not causing outbreaks of measles – or rubella and mumps, for that matter.

If shedding from the MMR, by any method, got kids sick, then why aren’t there even more cases of measles?

Daycare centers everywhere have a mix of infants and toddlers, including some who are intentionally unvaccinated, those who are too young to get their first MMR, and those who are just getting vaccinated.

When a case of measles does pop up though, it isn’t because of shedding, it is typically because someone who wasn’t vaccinated traveled out of the country, got measles, and brought it back home, exposing others.

What to Know About MMR and Shedding

Measles outbreaks are not caused by shedding from the MMR vaccine.

More on the MMR and Shedding

What to Do If Your Child Is Exposed to Hepatitis B

Hepatitis B is a vaccine-preventable disease.

“In the United States, based on national health surveys, there are approximately 850,000 persons living with chronic HBV infection. However, estimates based on other methods and data yield estimates as high as 1.29 to 2.2 million persons with chronic HBV infection.”

Manual for the Surveillance of Vaccine-Preventable Diseases

That doesn’t mean that your child can’t be exposed at some point though.

What to Do If Your Child Is Exposed to Hepatitis B

Hepatitis B is mainly spread through blood and body fluids, which is why some folks consider the hepatitis B vaccine an STD vaccine.

“If you are concerned that you might have been exposed to the Hepatitis B virus, call your health professional or your health department. If a person who has been exposed to Hepatitis B virus gets the Hepatitis B vaccine and/or a shot called “HBIG” (Hepatitis B immune globulin) within 24 hours, Hepatitis B infection may be prevented.”

CDC on Hepatitis B FAQs for the Public

It is also possible to get hepatitis B from exposure from an infected family member or caretaker, or much more rarely, in a daycare or school setting.

So what do you do if your child is exposed to hepatitis B?

It depends.

Kids should complete the three dose hepatitis B vaccine series by the time they are 18 months old.
Kids should complete the three dose hepatitis B vaccine series by the time they are 18 months old.

Not surprisingly, one of the biggest factors that will determine what needs to be done is whether or not your child has completed a three dose hepatitis B vaccine series.

First things first though.

Before going any further, you will want to confirm that the person that exposed your child actually has hepatitis B (has a positive HBsAg level).

Next, confirm that it was a real exposure, which the AAP Red Book defines as “a discrete, identifiable percutaneous (eg, needlestick, laceration, bite or nonintact skin), mucosal (eg, ocular or mucous membrane), or sexual exposure to blood or body fluids.”

Keep in mind that the hepatitis B virus is not spread by casual contact, like hugging, kissing, holding hands, or even sharing silverware. It can be spread by having unprotected sex or sharing needles with someone who is infected, but also by coming into contact with open sores, getting bitten, sharing personal-care items, sharing chewing gum, or an unintentional needle stick at a doctor or dentist office or from a needle picked up in the community (park, playground, or street, etc.).

And of course, a newborn baby can be exposed if their mother has hepatitis B.

Biting and Hepatitis B

Young kids, especially toddlers, often go through a biting phase.

Do you have to worry about hepatitis B every time your child gets bit or bites someone?

Fortunately, no.

If any of the kids involved include one that is known to have hepatitis B, then talk to your pediatrician and follow the exposure guidelines.

Keep in mind that one of the reasons we don’t have to worry about these very low risk situations is because most kids are now vaccinated. There were more reports of kids and adults getting hepatitis B in unusual ways in the pre-vaccine era.

What to Do If Your Unvaccinated Child Is Exposed to Hepatitis B

If your unvaccinated child, or incompletely vaccinated child, is exposed to hepatitis B, you should talk to your pediatrician or local health department about starting post-exposure prophylaxis as soon as possible and preferably within 24 hours of the exposure (and not longer than 7), including:

  • a dose of HBIG
  • the first dose of hepatitis B vaccine, with plans to complete the three dose series as quickly as possible over the next 6 months

If you aren’t sure if the person had hepatitis B, then your unvaccinated child should likely just complete the three dose hepatitis B series without getting HBIG.

What to Do If Your Vaccinated Child Is Exposed to Hepatitis B

Unfortunately, if your vaccinated child is exposed to hepatitis B, you can’t simply assume that your child is protected and ignore the exposure. That is, unless your child has already had testing to confirm that he was a responder to the hepatitis B vaccine series – a HBsAb level of 10 or greater.

Since this titer test isn’t routinely done, your child will likely need a booster dose of the hepatitis B vaccine. A dose of HBIG isn’t needed.

If you aren’t sure if the person that exposed your child had hepatitis B, then your fully vaccinated child doesn’t need any additional treatment.

Getting Exposed to Hepatitis B in a Healthcare Setting

It should be noted that the guidelines are a little different and more aggressive if you are exposed in a healthcare setting vs your child having a nonoccupational exposure to hepatitis B.

Why?

There is probably more risk of getting infected from an occupational exposure where patients might be sick with hepatitis B. That’s why post-exposure testing on the exposed person is routinely done.

And since they are at risk for continued exposures, post-treatment testing, if required, to confirm a good response to the hepatitis B vaccine is also usually done.

What to Know About Getting Exposed to Hepatitis B

Hepatitis B exposures can come from more than just having sex or getting stuck with a needle. Learn what to do if your child is exposed to hepatitis B, especially if they aren’t already fully vaccinated and protected.

More on Getting Exposed to Hepatitis B

Immunization Requirements to Start School and Daycare

If you are following the latest immunization schedule and your kids are up-to-date on all of their vaccines, then they will likely be ready to start daycare, kindergarten, high-school, or college.

There aren’t usually any extra vaccines that they will need to start school.

Of course, if you have skipped or delayed any vaccines, then they might have to catch up on some immunizations before starting school.

Another situation where you might need to do some catching up is if you move, and instead of following the CDC schedule, you were just getting the minimum number of vaccines that were required to attend school where you used to live. For example, your kids could have been all set to start kindergarten in Arkansas, but if you suddenly moved to Texas, they might need a second MMR, a booster dose of Varivax, and two doses of hepatitis A vaccine, as none of those are required in Arkansas.

Immunization Requirements to Start Daycare and Preschool

Daycare rules in Idaho give parents a month to stay on schedule with all of the CDC immunization requirements.
Daycare rules in Idaho give parents a month to stay on schedule with all of the CDC immunization requirements.

Since many new parents have to go back to work when their baby is only about two to six weeks old, they won’t have time to get their first set of vaccines at two months.

That won’t keep them out of daycare, but delaying too much longer, usually more than a month, probably will.

To start daycare or preschool, infants and toddlers need to get most of the vaccines on the CDC immunization schedule. This includes DTaP, hepatitis B, Hib, Prevnar, and IPV (polio), and then once they are 12 months old, booster doses of the primary series of vaccines and the MMR, Varivax (chickenpox), and hepatitis A vaccines.

The only vaccine that is missing from many state mandates is the rotavirus vaccine. And that simply has to do with the strict timing requirements of when you need to start (before 15 weeks of age) and finish this vaccine (by 8 months).

Some states do require rotavirus though, and simply state that kids must follow “age appropriate dosing.” That way, if they are too old, they just don’t need to get it.

Immunization Requirements to Start Kindergarten

In addition to most of the vaccines they needed to start daycare or preschool, to start kindergarten, kids need their 4 to 6 year old boosters:

  • the fifth dose of DTaP to protect them against diphtheria, tetanus, and pertussis
  • the fourth dose of IPV to protect them against polio
  • the second dose of MMR to protect them against measles, mumps, and rubella
  • the second dose of Varivax to protect them against chicken pox

If using combination vaccines, these four immunizations can be combined into just two shots – Proquad (MMR + Varivax) and either Kinrix or Quadracel (DTaP + IPV), which your preschooler will appreciate to help reduce the pain from getting these shots.

If your kids were missing any vaccines, they will also need to get caught up on those before starting school.

Immunization Requirements to Start Middle School

Preteens and teens get a few vaccines when they start middle school when they are around 11 to 12 years old, including:

  • a dose of Tdap to protect them against diphtheria, tetanus, and pertussis
  • a dose of Menactra or Menveo to protect them against meningoccocal disease

Although not required by most schools, the HPV vaccine is also usually given around this time.

Immunization Requirements to Start College

And then, before going off to college, at around age 16 years, kids will usually need:

They can also get the MenB vaccine, although it isn’t yet required for all students. This vaccine (Bexsero or Trumenba) has a “permissive” recommendation, in that parents are told they can get it if they want their kids to avoid meningococcal B disease, but it is not required yet.

What about a third dose of MMR?

While an extra dose of the MMR vaccine is now being given in some situations, it is mainly if your child is at high risk because of a current mumps outbreak. A mumps booster shot is not currently recommended just because your child is going off to college.

What to Know About Immunization Requirements for Incoming Students

If you have been following the latest immunization schedule and your kids are up-to-date on all of their vaccines, then they will likely be ready to start daycare, kindergarten, high-school, and college without needing any extra vaccines.

More on Immunization Requirements for Incoming Students

 

Ask Amy About Intentionally Unvaccinated Kids at a Holiday Party

How do you avoid fighting with friends and family when you get together at the holidays?

Some say to talk about whatever you want, but just have empathy for others when you talk about controversial topics.

Other experts say to simply avoid talking about things like politics, religion, and sex.

Going that route, it is easy to imagine that the list of things that you can’t talk about can get pretty long in some families.

Topics Too Dangerous To Avoid

Are some topics too dangerous to avoid talking about?

I’m not talking about in the long-term, what’s going to happen to our world kind of dangerous, but short term dangers to your kids and the rest of your family.

For example, what if you instinctively think that you should avoid talking about guns when visiting your uncle’s house, because you remember seeing all of his Facebook posts about the NRA. But you want to make sure there aren’t any unsecured guns lying around the house that your toddler could find. Do you ASK about guns in the house?

Ask Amy About Intentionally Unvaccinated Kids

What about vaccines?

That’s another topic that’s too important to avoid talking about.

Ask Amy took on the issue of the risk of an intentionally unvaccinated child to the rest of the family.
Ask Amy takes on the risk of an intentionally unvaccinated child at a holiday party.

What’s the problem? Some family members don’t want to come to a family gathering if their sibling is going to bring their intentionally unvaccinated child.

And why is that a problem if they are all fully vaccinated (a common argument posed by anti-vaccine folks)?

It should be clear that they are not all fully vaccinated. At least one of the grandchildren is just 6-months-old, so is too young to be fully vaccinated. She will not get her first dose of MMR and chicken pox vaccine, for example, until she is at least 12 months old.

But she isn’t the only one at risk. The other children and adults could be at risk because no vaccine is 100% effective. Vaccines work and they work very well. They just aren’t perfect.

What Ask Amy Gets Right and Wrong

Ask Amy was smart to turn to a pediatrician for help on this question.

And Dr. Thoele is right, this intentionally unvaccinated child is getting away with hiding in herd (at least so far) and won’t get anyone else sick unless he is exposed first and gets sick himself.

“If you choose to delay some vaccines or reject some vaccines entirely, there can be risks. Please follow these steps to protect your child, your family, and others.”

CDC on If You Choose Not to Vaccinate Your Child, Understand the Risk and Responsibilities

Many of us would take exception to the part that it is “highly unlikely” that this child could get a vaccine-preventable disease though. There are usually one or more outbreaks of chicken pox, mumps, pertussis, and measles, etc., going on in different parts of the United States throughout the year. And because parents who don’t vaccinate their children often cluster together in groups, it increases the chances that their kids will catch something.

Have they traveled out of the country? Have they been exposed to someone who has? That increases their risk too.

And what about the flu?

“(Dr) Thoele and I both hope that everyone attends the family get-together and that all family members should try their best to be nice to one another. There is, fortunately, no vaccine preventing that.”

There is also nothing preventing those parents from vaccinating their child.

Unvaccinated Kids at a Holiday Party

So should this intentionally unvaccinated toddler come to the holiday party?

Should other kids come if the unvaccinated child will be there?

While no one wants a family to be split over such a matter or for grandparents to be put in the middle, it is a much more complicated issue than wishing that everyone play nice.

Not Vaccinated? No Kisses!
A billboard advocating that teens and adults get a Tdap booster.

Not surprisingly, pediatricians get asked about these kinds of situation all of the time:

  • Should new parents allow family members to visit if they won’t get a flu shot?
  • When can they allow a family member to see their new baby if they won’t get a Tdap booster?
  • What do they do about the family members who don’t get vaccinated and don’t even take their kids to the doctor for regular checkups?

And what’s the answer?

Understand that kids aren’t at least partially protected against:

  • pertussis until after the third dose of DTaP at six months
  • the flu until after getting a first flu shot at six months, keeping in mind that they are actually going to need a second flu shot for full protection, since it is the first time that they are being vaccinated against influenza
  • measles, mumps, and chicken pox until they get their first dose of MMR and the chicken pox vaccine when they are 12 months old

And that’s why many parents would not, if they had a choice, expose their children to an intentionally unvaccinated child until after they had at least had their 12 to 15 month vaccines. By this time, they have also gotten 3-4 doses of Hib and Prevnar, and have completed their rotavirus vaccines.

Of course, if the child, or any of the adults, had an immune system problem, were getting treated for cancer, or had any other condition that would put them at higher risk for getting a vaccine-preventable disease, then they would likely never voluntarily expose themselves to someone who was intentionally unvaccinated.

I say voluntarily, because we often don’t have a choice.

In most states, folks are allowed to send their intentionally unvaccinated kids to school and daycare. And those kids put us all at risk.

And yes, there are vaccines to prevent that.

What to Know About Unvaccinated Kids at a Holiday Party

Many parents would avoid voluntarily exposing their kids to an intentionally unvaccinated child until they have at least completed their primary series of vaccines, when they are 12 to 15 months old.

More on Unvaccinated Kids at a Holiday Party