Tag: delaying vaccines

Why Are You Still Worried About the MMR Vaccine?

We know why most folks got scared of the MMR vaccine.

Who's to blame for low immunization rates and continuing outbreaks?
Who’s to blame for low immunization rates and continuing outbreaks?

And most of us remember when most folks welcomed the MMR vaccine the end of endemic measles in the United States.

Why You Were Worried About the MMR Vaccine

Of course, that all changed when Andrew Wakefield spoke at the press conference for his 1998 Lancet paper and said:

“And I have to say that there is sufficient anxiety in my own mind of the safety, the long term safety of the polyvalent, that is the MMR vaccination in combination, that I think that it should be suspended in favour of the single vaccines, that is continued use of the individual measles, mumps and rubella components… there is no doubt that if you give three viruses together, three live viruses, then you potentially increase the risk of an adverse event occurring, particularly when one of those viruses influences the immune system in the way that measles does. And it may be, and studies will show this or not, that giving the measles on its own reduces the risk of this particular syndrome developing… the risk of this particular syndrome developing is related to the combined vaccine, the MMR, rather than the single vaccines…. People have been saying for some time, people on the periphery of autism, have been saying for some time that this may well be related to bowel damage.”

Although there was no evidence for any of that, vaccination rates went down and measles rates went up – the Wakefield Factor.

MMR vaccination rates had dropped below 80% by 2003, when the first measles outbreaks in the UK began. They didn't fully recover until 2012.
MMR vaccination rates had dropped below 80% by 2003, when the first measles outbreaks in the UK began. They didn’t fully recover until 2012.

But no, it wasn’t one person at a press conference that us lead down a decade of worry about the MMR vaccine.

“And then the nurse gave my son that shot. And I remember going, “Oh, God, no!” And soon thereafter I noticed a change. The soul was gone from his eyes.”

Jenny McCarthy on Oprah

Andrew Wakefield had plenty of help!

Not only from anti-vaccine celebrities, but from the media and their scare stories.

Why Are You Still Worried About the MMR Vaccine?

But that is all old news.

Over and over again, we see new studies that show that the MMR vaccine is safe and is not associated with autism.

Andrew Wakefield’s work was never replicated.

The MMR vaccine never contained thimerosal and doesn’t even contain aluminum, which I mention only because those are ingredients that some folks get scared about, not because they are harmful.

Vaccines are safe. The MMR vaccine is safe.

And more and more, as predicted, we are seeing why vaccines are necessary – more and more outbreaksOutbreaks that are proving to be deadly.

Why are you still worried about the MMR vaccine?

Because anti-vaccine folks are still scaring you away from vaccinating and protecting your kids!

Don’t listen to them!

More on MMR Vaccine Fears

Catch-Up Immunization Plans for Adults

It isn’t hard to figure out how to catch-up kids when they fall behind on their vaccines.

After all, the CDC publishes catch-up immunizations schedules for both younger kids and teens.

Catch-Up Immunization Plans for Adults

What happens when an unvaccinated adult needs to get caught up?

Adults need vaccines too, especially if they have never been vaccinated before.
Adults need vaccines too, especially if they have never been vaccinated before.

They essentially follow the catch-up immunization plan for teens, with a few exceptions:

Are you an adult that needs to get caught up because you have never been vaccinated, your parents skipped or delayed some vaccines, or you lost your immunization records?

Get caught up! It’s likely easier than you think.

More on Catch-Up Immunization Plans for Adults

Vaccine Signs You Might See at Your Pediatricians Office

Does your pediatrician have any signs or posters up on the doors or walls?

If they do, it is probably just a sign alerting you that flu vaccines are available or a reminder to cover their cough when they are sick.

Or maybe they have some educational posters up to educate parents about the overuse of antibiotics, how to wash your hands, or when to call poison control.

Vaccine Signs You Might See at Your Pediatricians Office

Some pediatricians also have signs and posters about vaccines and vaccine preventable diseases:

Do your kids get a lollipop after their vaccines, or just protection against life-threatening diseases?
Do your kids get a lollipop after their vaccines, or just protection against life-threatening diseases?
Thank vaccines and herd immunity.
Thank vaccines and herd immunity.
Skipping some vaccines? Are you going to say sorry if your kids get a vaccine-preventable disease?
Skipping some vaccines? Are you going to say sorry if your kids get a vaccine-preventable disease?
Does your pediatrician have separate waiting rooms for unvaccinated kids?
Does your pediatrician have separate waiting rooms for unvaccinated kids?
There is no benefit, just extra risks, if you delay your child's vaccines.
There is no benefit, just extra risks, if you delay your child’s vaccines.
Vaccine preventable diseases are just a plane ride away.
Vaccine preventable diseases are just a plane ride away. Get vaccinated before you travel.
Parents of Earth, are your children fully immunized?
Long ago, everyone vaccinated their kids.
Unvaccinated children exposed to measles are quarantined for at least 21 days.
Hopefully you will never see a quarantine sign at your pediatrician’s office.

Got questions about vaccines?

Get your answers before your pediatrician puts up a sign that they are firing all unvaccinated kids.

More Vaccine Signs and Posters

Personal Stories About Vaccine-Preventable Diseases

Parents these days seem to get bombarded with vaccine injury stories and videos on Facebook.

Is that because vaccines cause so many bad reactions?

Of course not.

It’s because some folks think that everything that happens to their kids is a vaccine injury.

Personal Stories About Vaccine-Preventable Diseases

If you are going to watch those videos and listen to their stories, getting scared in the process, be sure to also listen to the stories of parents who’s kids have suffered through actually getting a vaccine-preventable disease.

While it’s great that these diseases are much less common because most people vaccinate and protect their kids, one side effect of that progress is that we don’t have many reminders of just how terrible these diseases are anymore.Have you ever seen a baby with congenital rubella syndrome?

Or a child with tetanus or diphtheria?

Have you ever even seen photos of these diseases?

Will you read these stories of parents who have lost a child to a vaccine-preventable disease.

“Kimberly Coffey was buried three days before her high school graduation in the prom dress she didn’t get to wear. She didn’t have the opportunity to be vaccinated against Meningitis B.”

Kim’s Meningitis Story

In Kimberly‘s case, the Men B vaccine wasn’t yet available, but in many other cases, parents have shared their stories of unvaccinated children who suffered with a disease that was vaccine preventable at the time.

“From 2010 to 2016, young children continued to be at the greatest risk for influenza-associated pediatric deaths. Children without preexisting medical conditions accounted for half of all deaths. Vaccination coverage was low among influenza-associated pediatric deaths.”

Shang et al. on Influenza-Associated Pediatric Deaths in the United States, 2010–2016

Tragically, there are also many flu stories.

But the flu isn’t the only vaccine-preventable disease that still harms children.

This family didn't have a choice about their son getting sick - he was too young to be vaccinated when he was exposed to an unvaccinated child with measles.
This family didn’t have a choice about their son getting sick – he was too young to be vaccinated when he was exposed to an unvaccinated child with measles

There are other diseases. Other stories.

Read these stories.

Listen to these parents.

Are the stories supposed to scare you into vaccinating your kids?

Of course not. Just like you shouldn’t let the myths and propaganda from the anti-vaccinate movement scare you away from vaccinating and protecting your kids.

Instead of being motivated by fear, you should make your decision because you understand that the many benefits of vaccines are far greater than their small risks.

What to Know About Vaccine-Preventable Disease Stories

Reading stories of vaccine-preventable diseases are a good reminder that these diseases are not so mild as some folks suggest, and they are instead life-threatening diseases that are best avoided by getting fully vaccinated.

More Vaccine-Preventable Disease Stories

Avoiding the Most Common Vaccine Errors

Although it would be great if mistakes never ever happened, the best we can do is to understand that mistakes do sometimes happen and take steps to avoid them.

How can we avoid mistakes and errors about vaccines?

Avoiding Vaccine Errors

It can help to:

  • understand the 7 Rights of vaccine administration, including that you give the Right vaccine to the Right patient at the Right time by the Right route at the Right injection site and then follow it with the Right documentation
  • use a 2d barcoding  system with your EMR to help catch vaccine errors before administration
  • use a screening checklist to help avoid giving vaccines that are contraindicated
  • double check vaccines that look alike or have names that sound like, such as DTaP and Tdap
  • double check expiration dates
  • make sure you aren’t giving live vaccines within 28 days of each other, unless they are given at the same time
  • make sure you aren’t giving the wrong dosage amount for the patient’s age, as some vaccines have different formulations depending on the age of the patient, including flu shots, hepatitis A, and hepatitis B vaccines
  • be careful so that you don’t give a combination vaccine, such as Pediarix, Pentacel, Kinrix, Quadracel, or ProQuad, inappropriately

That we are have a 4-day grace period does help avoid the need to revaccinate some kids when vaccines are given a little too early.

“With the exception of rabies vaccine, ACIP allows a grace period of 4 days (i.e., vaccine doses administered up to 4 days before the recommended minimum interval or age can be counted as valid). However, if a dose was administered 5 or more days earlier than the recommended minimum interval between doses, it is not valid and must be repeated. The repeat dose should be spaced after the invalid dose by the recommended minimum interval.”

Ask the Experts About Scheduling Vaccines

In many cases, as long as vaccine doses were administered less than or equal to 4 days before the minimum interval or age, then they can still be counted and are considered valid.

Common Vaccine Errors

It’s easier than you think to prevent vaccine errors.

Especially if there are more than one child in the room getting vaccines, either the tray itself or the vaccines should be labeled with each child's name so that they don't get the wrong vaccines.
Especially if there is more than one child in the room getting vaccines, either the tray itself or the vaccines should be labeled with each child’s name so that they don’t get the wrong vaccines. Photo by Vincent Iannelli, MD

When are you most likely to make a vaccine error?

When you are doing something that isn’t routine, which most commonly happens when folks delay or skip some vaccines and are now playing catch-up.

In addition to the tips above, remember that:

  • the first dose of the rotavirus vaccines must be given by 15 weeks
  • the rotavirus vaccine series must be completed by 8 months (32 weeks)
  • ProQuad, the MMR and chicken pox combination vaccine, is not licensed for kids who are older than 12 years, although if a teen or adult did get ProQuad, it could be considered an off-label dose and could still count.
  • Kinrix and Quadracel, the DTaP and polio combination vaccines are only licensed for the 5th dose of DTaP and 4th dose of polio in children who are 4 to 6 years old, so wouldn’t be appropriate for an 18-month-old, even if he needs both (DTaP and polio) vaccines. Earlier doses can sometimes count as off-label doses though.
  • the combination vaccines Pediarix and Pentacel are only licensed up through age six years, but don’t necessarily need to be repeated if given to older kids.
  • children and adolescent’s get a pediatric dose (0.5ml) of the hepatitis A vaccine, while older teens, who are at least 19-years-old, get an adult (1.0ml) dose. Since most kids get vaccinated when they are younger, many pediatricians may not have the adult version of the hepatitis A or even realize that there is a different version.
  • children and adolescent’s get a pediatric dose (0.5ml) of the hepatitis B vaccine, while older teens, who are at least 20-years-old, get an adult (1.0ml) dose. Since most kids get vaccinated when they are younger, many pediatricians may not have the adult version of the hepatitis B vaccine or even realize that there is a different version.

Most importantly, even when giving vaccines on schedule, be sure to triple check everything. This is especially important if multiple kids in the same room are getting immunizations.

Also remember that vaccine errors should be reported to the ISMP National Vaccine Errors Reporting Program (VERP) or VAERS, with the correct dose repeated if necessary.

What to Know About Common Vaccine Errors

Although none of these vaccine errors are very common (hundreds of millions of doses of vaccines are given in the United States each year), understanding which ones occur the most often can help to make sure that they don’t happen in your office.

More on Common Vaccine Errors

Updated September 16, 2018

Why Can’t My 9-Month-Old Get the Rotavirus Vaccine?

The rotavirus vaccines are typically given when infants are two to six months old.

The first dose can be given as early as 6 weeks or as late as 15 weeks though.

The rotavirus vaccines are given between 6 weeks to 32 weeks.

And the final dose can be given as late 8 months (32 weeks).

Why Can’t My 9-Month-Old Get the Rotavirus Vaccine?

What happens if your child didn’t get their rotavirus vaccine on time?

While these vaccines are usually given on either a two and four month (Rotarix) or two, four, and six month (RotaTeq) schedule, as you can see above, there is some flexibility in that timing.

Still, the first dose of the rotavirus vaccine can’t be given any later than 15 weeks and the final dose can’t be given any later than 8 months though, so there is no way that a nine-month-old would be able to get vaccinated.

What would happen if your child did?

“Vaccination should not be initiated for infants aged 15 weeks and 0 days or older because of insufficient data on safety of dose 1 of rotavirus vaccine in older infants. The minimum interval between doses of rotavirus vaccine is 4 weeks; no maximum interval is set. All doses should be administered by age 8 months and 0 days.”

Prevention of Rotavirus Gastroenteritis Among Infants and Children Recommendations of the Advisory Committee on Immunization Practices

The rotavirus vaccines are only licensed at these specific ages, so were not studied in older infants and toddlers. If your 9-month-old did receive a rotavirus vaccine, it would be considered a vaccination error and should be reported.

So why not study them in older kids?

Since severe rotavirus infections mostly occur in younger children between the ages of 4 and 23 months, it doesn’t make any sense to wait until they are older to get them vaccinated.

“To minimize potential risk of intussusception, the World Health Organization (WHO) recommends that rotavirus immunization should be initiated by age 15 weeks and completed before age 32 weeks.”

Age restrictions for rotavirus vaccination: evidence-based analysis of rotavirus mortality reduction versus risk of fatal intussusception by mortality stratum

Also, although the risk is low, a small risk of intussusception after getting the rotavirus vaccine is thought to increase with increasing age of the first dose.

What does all of this mean?

It means that you should follow the immunization schedule and get your kids vaccinated and protected on time.

What to Know About Rotavirus Vaccine Timing

Don’t delay getting your child’s rotavirus vaccine or you may not be able to get it at all, as unlike most other vaccines, these vaccines have strict upper limits for when they can be given.

More on Rotavirus Vaccine Timing

Vaccinated vs Unvaccinated – Smallpox Edition

Anti-vaccine folks really like comparing vaccinated and unvaccinated kids.

Why?

They think that unvaccinated kids are healthier, even though we know that they aren’t, they simply get more vaccine-preventable diseases.

Vaccinated vs Unvaccinated – Smallpox Edition

And we have known it for a long time. In Leicester, for example, it was known that folks weren’t vaccinated were much more likely to die of smallpox than those who were. In fact, the fatality rate in Leicester in the late 19th century and early 20th century was 1 to 2% for those who were vaccinated. What was it for folks who were unvaccinated? It was 8 to 12%!

And like many other diseases, if they did get sick, those who were vaccinated against smallpox often got a very mild case, especially as compared to those who were unvaccinated. We can see that even now thanks to photographs taken by Dr. Allan Warner, the Resident Medical Officer to the Isolation Hospital in Leicester.

Vaccinated vs unvaccinated with smallpox.

Dr. Warner’s photos have been published time and again, but they can originally be found in the New Sydenham Society’s Atlas of 1904.

Vaccinated vs unvaccinated sisters with smallpox.

There are many photos and many stories from the time that were testament to the fact that vaccines work.

“A boy, aged 14 years, unvaccinated, sickened with small pox on April 14th. He was removed to hospital on April 18th, where he had a severe confluent attack. The father consented to his wife and three children being vaccinated, stating that personally he would not be vaccinated, but would be a “test,” to see if there was anything in it.

Ten days later his daughter, aged three years, developed a small-pox eruption she had less than one hundred spots and never appeared ill. No other person in the house suffered from small-pox except the father, vaccinated in infancy, his eruption appearing fourteen days after the son had been removed to hospital. A photograph of the father and daughter, taken on the twelfth day of the father’s eruption, may be seen in Plate VI. [see below] and requires no comment.”

This father was the only one in the family who skipped getting vaccinated, and he got smallpox.
This father was the only one in the family who skipped getting vaccinated, and he got smallpox.

And there are also stories of folks skipping vaccines already. Remember, the anti-vaccine movement is even older than the first vaccines. It started with variolation. By the time these photos were taken, anti-vaccine folks had already marched on Leicester. A march that didn’t turn folks away from getting vaccinated.

The Vaccination of Contacts part of the Leicester Method is usually left out by anti-vaccination folks.
Folks were still getting vaccinated using the Leicester Method in Leicester.

For those who think getting smallpox was all about poor nutrition and hygiene, how do you explain these photos? Why such different outcomes for people in the same family, if it wasn’t their vaccine?

The smallpox vaccine clearly worked.
It was the vaccine, as this report on an outbreak of smallpox in 1903 clearly showed.

And that’s why the anti-vaccine movement “slowly faded from view” in the early 20th century.

Too bad we let them come back…

What to Know About Vaccinated vs Unvaccinated with Smallpox

It should be clear that in the era of smallpox, like with other vaccine-preventable diseases, you clearly wanted to be vaccinated.

More on Vaccinated vs Unvaccinated with Smallpox