Tag: delaying vaccines

How Often Should You Do Vaccine Titer Testing?

We sometimes hear about folks doing vaccine titer testing.

A vaccine titer is a blood test that can determine whether or not you are immune to a disease after you get a vaccine.

While that sounds good, after all, why not check and be sure, it has downsides. Chief among them is that the results aren’t always accurate.

That’s right. You can sometimes have a negative titer test, but still be immune because of memory B cells and the anamnestic response.

How Often Should You Do Vaccine Titer Testing?

So how often should you do vaccine titer testing?

It depends, but most folks might never have it done!

Why not?

Vaccines work very well, so you would typically not need to routinely check and confirm that you are immune after being vaccinated. And, this is also important, the vaccine titer tests don’t always work that well, titer testing isn’t available for all vaccines (you can’t do titer testing for Hib and pertussis), and the testing can be expensive.

So we usually just do the testing (a quantitative titer) for folks that are in high risk situations, including:

  • pregnancy – rubella titer only (HBsAg is also done, but that’s not a vaccine titer test, but rather to see if you are chronically infected with hepatitis B)
  • healthcare workers – anti-HBs (antibody to the hepatitis B surface antigen to confirm immunity after being vaccinated)
  • students in nursing school and medical school, etc. – anti-HBs
  • children and adults exposed in an outbreakmeasles, chicken pox, mumps, etc., but only if we are unsure if they were previously vaccinated and protected
  • after a needlestick injury, etc. – to confirm immunity to hepatitis B
  • babies born to a mother with hepatitis B – to confirm that their hepatitis B vaccine worked

Vaccine titer testing might also be done for:

  • internationally adopted children – to confirm that they are immune if we unsure about all of the vaccines the child got in other countries
  • children and adults with lost vaccine records – to confirm that they are immune, since we are unsure about all of the vaccines they got
  • evaluation of children and adults with immune system problems – to help identify what immune system problems they might have – typically involves checking pneumococcal titers, giving Prevnar, and then checking pneumococcal titers again
  • people at continuous or frequent risk for rabies – rabies titer testing every 6 months to 2 years
  • patients with inflammatory bowel disease, before starting immunosuppressive therapy – hepatitis A and hepatitis B titers, as they might be at increased risk for hepatitis

While checking titers is easy, it is sometimes harder to know what to do with the results you get.

Of all of these different titers, only one tells you that you are immune due to vaccination.
Of all of these different titers, only one tells you that you are immune due to vaccination.

It is especially important to know that:

  • most people don’t need to have their titers checked routinely if they are not in one of the high-risk groups noted above
  • it isn’t practical to get titers tested as a method of potentially skipping one or more doses of your child’s vaccines, after all, if the titer is negative, then you are still going to have to get vaccinated
  • a healthcare provider with a negative measles titer after two doses of the MMR vaccine does not need another dose of vaccine
  • a healthcare provider who has anti-HBs <10 mIU/mL (negative titer) after three doses of the hepatitis B vaccine should get another dose of vaccine and repeat testing in 1 to 2 months – if still <10 mIU/mL, they should then get two more doses of hepatitis B vaccine (for a total of 6 doses) and repeat testing. If still negative, these documented nonresponders will need HBIG as post-exposure prophylaxis for any future hepatitis B exposures, but no further doses of hepatitis B vaccine.
  • vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine, with a maximum of three doses, and should not be tested again
  • postvaccination titer testing is not recommended after the chicken pox vaccine
  • in addition to not being able to test titers for pertussis and Hib immunity, it is becoming difficult to test poliovirus type 2 titers, as the test uses a live virus that isn’t routinely available anymore (type 2 polio has been eradicated)

Still think you need vaccine titer testing?

More on Vaccine Titer Testing

Do Vaccines Cause Mastocytosis?

Children with mastocytosis have extra mast cells, a normal type of cell that we all have that release histamine and other chemicals when activated.

As you can imagine, having too many mast cells, which release too much histamine, isn’t a good thing.

What Causes Mastocytosis?

Mastocytosis, some forms of which have been known since 1869, is caused by spontaneous mutations that aren’t passed on to future generations (somatic mutations).

“Most forms of mastocytosis are caused by a mutation of the KIT gene on the 4q12 chromosome – a mutation that increases cellular reproduction. The c-KIT gene mutation creates an overgrowth of one cell line of mast cells.”

What is mastocytosis?

And the symptoms you have with mastocytosis depends on the type you have, which can include localized (solitary, maculopapular cutaneous, diffuse cutaneous) vs systemic mastocytosis.

“The severity of the symptoms associated with mastocytosis may vary from mild to life-threatening. In general, symptoms occurring in mastocytosis are mainly due to the release of chemicals from the mast cells and thus produce symptoms associated with an allergic reaction.”

Mastocytosis – Rare Disease Database

Localized mastocytosis is usually present at birth or early infancy.

Do Vaccines Cause Mastocytosis?

Since it is caused by spontaneous mutations and is often present at birth or early infancy, there is no reason to think that vaccines could cause mastocytosis.

Vaccines and Mastocytosis

That’s not to say that you shouldn’t think about vaccines if your child has mastocytosis.

Although almost anything can be a trigger for kids with mastocytosis, from insect stings, skin rubbing, antibiotics, aspirin, cough medications, exposure to heat or cold, and stress, there have been a few reports of vaccines being a trigger.

“In childhood, the risk for anaphylactic episodes was limited to children with extensive skin disease, but nonexistent for children with mastocytoma or limited macular lesions. This is in good agreement with the literature, where children with anaphylaxis were described as having clinically severe skin involvement of mastocytosis, although the levels of skin involvement were not given and tryptase concentrations not determined. Children with fatal anaphylaxis, described in three case reports, all had suffered from extensive blistering skin disease…”

Brockow et al on Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients.

It is important to note that these are kids with severe disease though and not the more typical type of localized disease that the average child will have.

An infant with diffuse cutaneous mastocytosis. Lange et al. (CC BY-NC 3.0)
An infant with diffuse cutaneous mastocytosis. Lange et al. (CC BY-NC 3.0)

It should also be noted that viral and bacterial infections with fever, some of which are vaccine preventable, can also be a trigger.

Still, if your child has extensive skin disease, your specialist will likely talk about premedication before vaccines and watching your child closely afterward in case they have an anaphylactic reaction.

Should they get fewer vaccines at a time?

Surprisingly, it depends on who you ask, but it should be noted that all of the discussions about vaccines are for kids with diffuse cutaneous mastocytosis (DCM), a rare form of cutaneous mastocytosis.

“Although patients with mastocytosis can be vaccinated according to the standard schedule, precautions to prevent MC activation and degranulation have been formulated by experts, particularly in cases of diffuse skin manifestations”

And none say to skip vaccines, although some say to use an alternative immunization schedule, getting one vaccine at a time perhaps, especially for the initial doses.

It should be clear that kids with mastocytosis can and should be vaccinated though and vaccines do not actually cause mastocytosis.

More on Vaccines and Mastocytosis

How Do You Provide Informed Consent to Vaccination?

When you take your child to their pediatrician, you expect to be given all of the information you need to help you make good decisions about their care.

Whether it is about an antibiotic to treat an ear infection, the need for an MRI if your child is having severe headaches, or weaning off an asthma medication, etc., you deserve to be well informed of the risks and benefits of any and all procedures they have.

How Do You Provide Informed Consent to Vaccination?

Of course, informed consent also applies to vaccinations.

It's not an "informed consent form," but the Vaccine Information Statement can help you get informed consent before getting vaccines.
It’s not an “informed consent form,” but the Vaccine Information Statement can help you get informed consent before getting vaccines.

How do you provide informed consent to vaccination?

  1. Provide the latest edition of the appropriate Vaccine Information Statement (VIS) before a vaccination is given. Although these aren’t actually “informed consent forms,” they are required to be given by federal law and because “cover both benefits and risks associated with vaccinations, they provide enough information that anyone reading them should be adequately informed”
  2. Give parents/guardians the chance to take the VIS home to review later.
  3. Answer any questions about the vaccine that their child is about to get.

Hopefully you always get informed consent before your child is vaccinated.

You should also get informed consent before skipping or delaying any of your child’s vaccines, as it risks their getting a life-threatening vaccine-preventable disease and puts others at risk, all without any extra benefit.

“At trial, the parent and physician both acknowledged that the vaccine was recommended, but the parent stated that the risk of death wasn’t mentioned during the discussion.”

Document ‘informed refusal’ just as you would informed consent

Believe it or not, a pediatrician in California was successfully sued after a parent refused to vaccinate their child with Prevnar and their infant died of pneumococcal sepsis, which the vaccine could have prevented.

Although they realized that their pediatrician had recommended the vaccine and they refused it, they claimed that they didn’t realize that their baby could die without it. He did…

Myths About Informed Consent and Vaccines

Not surprisingly, many folks get the idea of informed consent to vaccination wrong.

For one thing, unless it is required by state law, no one has to sign a consent form before getting vaccinated. Many pediatricians and clinics do have you sign that you received the VIS, although federal law does not require this signature.

And informed consent doesn’t come from reading a vaccine’s package insert, as the parts pushed by anti-vaccine folks are just things included from voluntary reports and have not actually been proven to be caused by the vaccine.

“Now that case one is settled, I can go back to being loud and proud about my belief that every single patient should receive complete informed consent prior to vaccinations. This two-year period of silence has been tough. I will not rest until every single family has been given access to full, complete, objective, and un-doctored information that makes every parent fully aware of the risks they accept if they don’t vaccinate their child, and all the risks they take if they do vaccinate their child. Period. And I will fight against mandatory vaccination laws until they are no more. When every single person on this planet has access to informed consent, and can make a free choice, I will then be able to say my work is done.”

Dr. Bob Sears

When Dr. Bob talks about vaccines, do you think he mentions the parents who skipped the Prevnar vaccine and then successfully sued their pediatrician for not warning them that their baby would die? 

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.

Overstating the side effects and risks of getting vaccinated, rarely or ever mentioning the benefits of vaccines, and underestimating the complications and risks of life-threatening vaccine-preventable diseases isn’t informed consent.

It is actually misinformed consent.

It is propaganda.

It is a tool that some folks use to scare you away from making the right decision to vaccinate and protect your kids.

Parents deserve informed consent about vaccines. Unfortunately, that’s not what they are getting from the modern anti-vaccine movement.

More on Providing Informed Consent to Vaccination

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:

  • the polio vaccine isn’t typically given to teens over age 18
  • the HPV vaccines aren’t typically given to young adults over age 26, although they are now approved to be given through age 45 years
  • Hib and Prevnar are only typically given to adults with specific conditions that put them at high risk for disease

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