Tag: epilepsy

Should Parents Be Concerned About Combination Vaccines and Febrile Seizures?

Anti-vaccine folks have parents worried about everything and anything having to do with vaccines these days.

Unlike most of the ideas that anti-vaxxers push, febrile seizures really can occur after vaccines. Fortunately, they aren’t something to be worried about.

Should Parents Be Concerned About Combination Vaccines and Febrile Seizures?

While febrile seizures can be scary, it is important to know that without other risk factors, kids who develop febrile seizures after a vaccine are at the same small risk for developing epilepsy as other kids.

And know that vaccines aren’t the only cause of febrile seizures. Vaccine-preventable diseases can cause both febrile seizures and more serious non-febrile seizures.

What about the extra risk of febrile seizures following combination vaccines?

“Studies have shown a small increased risk for febrile seizures during the 5 to 12 days after a child has received their first vaccination with the measles, mumps, rubella (MMR) vaccine. The risk is slightly higher with the measles, mumps, rubella, varicella (MMRV) combination vaccine, but the risk is still small. Studies have not shown an increased risk for febrile seizures after the separate varicella (chickenpox) vaccine.”

Childhood Vaccines and Febrile Seizures

The small extra risk of febrile seizures for the measles, mumps, rubella, varicella (MMRV) combination vaccine vs the separate MMR and chicken pox vaccines is just for the first dose of these vaccines, so pediatricians and parents might choose to give the separate vaccines instead. And only use this combination vaccine for the second dose.

Are any other combination vaccines a concern for febrile seizures?

Nope, even though some anti-vaccine sites push that idea and that vaccines can cause epilepsy.

Parents will likely be reassured by one of the studies that anti-vaccine folks like to cite, which states that “vaccination with DTaP-IPV-Hib was not associated with an increased risk of epilepsy.”

We do know that there is a small increased risk for febrile seizures when the influenza vaccine is given at the same time as either the Prevnar13 vaccine or the DTaP vaccine, although “the risk of febrile seizure with any combination of these vaccines is small and CDC’s Advisory Committee on Immunization Practices (ACIP) does not recommend getting any of these vaccines on separate days.”

Is the risk really small though?

After all, an article by Sheri A Marino talks about a 6-fold extra risk in some cases.

Isn’t that a lot?

“Does this mean we should stop giving these vaccines together or stop giving them at all? We say, emphatically, no. With the results of this study, we can accurately calculate the risks and benefits of this practice. The risk is 1 febrile seizure per pediatric practice every 5 to 10 years. Febrile seizures, although frightening to parents, rarely have any long-term sequelae. The benefits of giving these vaccines simultaneously include decreased office visits associated with painful vaccines, decreased episodes of vaccine-associated fussiness, and, most important, the assurance that children will be fully immunized and protected from infections that carry real morbidity and mortality. It is well established that the vaccines we miss when we fail to give all the vaccines we can (simultaneously at each health care visit) may never be administered to some children, thus leaving them at risk for the diseases the vaccines prevent. It goes without saying that influenza, diphtheria, tetanus, pertussis, and pneumococcal infections may result in serious illness. These infections also have the potential to cause fevers and febrile seizures. Without vaccines to prevent these illnesses, pediatricians would see many more than 1 case of most of these infections each decade. In fact, they would see children in their practices with both febrile seizures and life-threatening infections. The risk from these diseases far outweighs the risk from the vaccines.”

Sawyer et al on Vaccines and Febrile Seizures: Quantifying the Risk

Because the risk of febrile seizures is so small, it remains small even with any extra risk.

What’s more concerning? The risks of following anti-vaccine propaganda and leaving your kids unvaccinated and unprotected.

Vaccines are safe, with few risks, and necessary.

More on Vaccines and Febrile Seizures

Fact Checking an Anti-Vaccine Measles Outbreak Quiz

Anti-vaccine folks have gotten pretty good at pushing propaganda to keep you scared to vaccinate and protect your kids.

Now, they even have quizzes to help test how much of that misinformation you remember!

Fact Checking an Anti-Vaccine Measles Outbreak Quiz

A quiz about measles outbreaks by the ironically named Physicians for Informed Consent was recently promoted by Dr. Bob Sears.

How did Dr. Bob get 12 out of 12 correct if most of the answers are really wrong?
How did Dr. Bob get 12 out of 12 correct if most of the answers are really wrong?

Let’s take a look at some of the questions and the anti-vaccine answers

There is only so much that better hygiene, sanitation, and nutrition can do, which is why about 400 to 500 people were dying of measles in the 1950s and early 1960s just before the first measles vaccines were developed.
There is only so much that better hygiene, sanitation, and nutrition can do, which is why about 400 to 500 people were dying of measles in the 1950s and early 1960s just before the first measles vaccines were developed.

While mortality rates did indeed decline for most diseases and conditions in the early part of the 20th century because of advancements in living conditions, nutrition, and health care, that effect had plateaued by the mid-1930s.

Being unvaccinated and unprotected is the main reason why people in underdeveloped countries die from measles, not low vitamin A…

It is true that vitamin A deficiency increases the risk for more severe complications and death from measles, which is why it can be more deadly in undeveloped countries where malnutrition is a big problem.

“Because of gaps in vaccination coverage, measles outbreaks occurred in all regions, while there were an estimated 110 000 deaths related to the disease.”

Measles cases spike globally due to gaps in vaccination coverage

Unfortunately, the other big problem in many of these countries is that these kids are unvaccinated because of a lack of access to vaccines.

This child doesn’t appear to have measles…

Immune globulin is a treatment option if you have been exposed to measles, but it is not actually a treatment once you have measles. And high dose vitamin A mainly benefits those with a vitamin A deficiency, which is unlikely in an industrial country, like the United States.

The only benefit of having measles, which you have to earn by having measles and surviving without complications, is that you will have developed immunity to measles.

In addition to having no other benefits, you will then be at risk for SSPE and may have wiped out your immune system for a few years.

While you are at risk for encephalitis and seizures after a natural infection, after getting a dose of MMR, one risk is a febrile seizure, which is typically thought to be benign.

The risk of having a febrile seizure after the first dose of the MMR vaccine is about 1 in 2,500 doses. There is also a small risk of having a febrile seizure if the flu vaccine is given at the same time as a Prevnar or DTaP vaccine.

It is important to note that vaccines are not the only reason that children have febrile seizures. Many infections, including vaccine preventable infections, can trigger febrile seizures, in addition to causing more serious types of non-febrile seizures.

This is not true.

It is very unlikely that any of the kids who develop febrile seizures after a vaccine will later develop epilepsy.

“Febrile seizures can be frightening, but nearly all children who have a febrile seizure recover quickly, are healthy afterwards, and do not have any permanent neurological damage. Febrile seizures do not make children more likely to develop epilepsy or any other seizure disorder.”

Febrile Seizures Following Childhood Vaccinations, Including Influenza Vaccination

Without any risk factors (parent or sibling with epilepsy, having complex febrile seizures, or abnormal development), a child with febrile seizures has the same risk of developing epilepsy has any other child.

Do anti-vaccine folks really read the inserts?

Like many other vaccines, the package insert for MMR does say that it has “has not been evaluated for carcinogenic or mutagenic potential, or potential to impair fertility.” That doesn’t mean that it hasn’t undergone safety studies for its potential to cause cancer, genetic mutations, and impaired fertility though.

Wait, what? Yeah, all vaccines have preclinical toxicology studies, including single and/or repeat dose, reproductive and developmental, mutagenicity, carcinogenicity, and safety pharmacology. If any issues are found, further studies are done.

The only way to think that a natural measles infection is safer than the MMR vaccine is if you believe that all reports to VAERS have been confirmed as being caused by the vaccine (they aren’t) and you don’t think about the fact that relatively few people get measles any more (so you don’t see or hear about many measles deaths) because most folks are vaccinated and protected!

How did you do on the quiz?

Did you easily spot all of the anti-vaccine propaganda?

More on Fact Checking an Anti-Vaccine Measles Outbreak Quiz

Vaccines – Year in Review 2018

Another year has passed and although anti-vaccine folks keep talking about those 300 vaccines in pipeline, there were few new developments in the vaccine world in 2018.

Bob Sears got in trouble with the Medical Board of California over vaccine exemptions.
This happened in 2018.

Well, maybe that’s not entirely true.

Vaccines – Year in Review 2018

So what can we say about 2018 when it comes to vaccines?

Well, we did get some new ones!

  • approved by the FDA in late 2017, a new hepatitis B vaccine for adults, Heplisav-B, the formal recommendation for its use from the ACIP came on February 21, 2018
  • although it was both approved by the FDA and formally recommended by the ACIP in late 2017, Shingrix, the new shingles vaccine, became more widely available in 2018 – well kind of – there have been a lot of shortages due to high demand for the vaccine
  • Vaxelis, a hexavalent vaccine that combines DTaP-IPV-Hib-HepB into one shot was FDA approved on December 21, 2018, but likely won’t be available for a few more years
  • FluMist, the nasal spray flu vaccine, returned

And we lost one… Last year was the first full year that Menomune, an older meningococcal vaccine, was no longer available. It was discontinued because of low demand, as we began to use the newer vaccines, Menactra and Menveo instead.

In other immunization news:

  • a 2017 shortage of yellow fever vaccine continued into 2018
  • a shortage of monovalent pediatric hepatitis B vaccine will continue into 2019 (doesn’t affect combination vaccines with hepatitis B)
  • Gardasil 9 received an expanded recommendation – women and men between the ages of 27 and 45 years can now get vaccinated and protected with this HPV vaccine
  • the hepatitis A vaccine got a lower age recommendation – at least in special situations – “HepA vaccine be administered to infants aged 6–11 months traveling outside the United States when protection against HAV is recommended.”
  • the recommendation to use a third dose of MMR to control outbreaks of mumps was formally approved
  • the WHO updated its recommendations for use of the dengue fever vaccine (Dengvaxia) to makes sure that only dengue-seropositive persons are vaccinated, as they found an increased risk of severe dengue in seronegative people who were vaccinated
  • Of the 163 million to 168 million doses of flu vaccine that will be distributed in the United States for the 2018-2019 season, more than 80% will be thimerosal free.
  • China had an issue with substandard DTaP vaccines made by one company in one part of the country
  • India had an issue with contaminated polio vaccines made by one company in one part of the country – bivalent oral polio vaccines (two strains) still contained all three strains of polio vaccine virus
  • Measles cases and deaths spiked globally because of gaps in vaccination coverage

If you didn’t hear about any of those things in the news, you may have heard about the death of two young children in Samoa after they received an MMR vaccine. That tragedy almost certainly was caused by an error in administering/mixing the vaccines, and not because there was anything wrong with the vaccines themselves.

Need help getting educated about vaccines? Despite continued outbreaks, 2018 was a good year for vaccine advocates and vaccine education.

Several good books about vaccines were published, including:

And in case you missed it, we found out that:

Of course, for most of us, none of this is really news. We know that vaccines are safe, effective, and necessary.

And sadly, Betty Bumpers died. We can honor her legacy by continuing her work and helping to make sure that every child gets vaccinated and protected.

More on Vaccines Year in Review 2018

Learn the Risks of Falling for Anti-Vaccine Propaganda

If you are on the fence or hesitant to vaccinate your kids, it might not be easy to recognize that the vaccine information that you get on some sites is pure propaganda.

That’s unfortunate, because you can’t make an informed choice about vaccines if you are basing that decision on misinformation.

Learn the Risks of Falling for Anti-Vaccine Propaganda

Take the infographic about the number of vaccine doses children in the United States normally get.

From the 1960s to today, propaganda about vaccine doses is meant to scare you from making an information decision about vaccinating your kids.
From the 1960s to today, propaganda about vaccine doses is meant to scare you from making an information decision about vaccinating your kids.

It is designed into making you think that kids get 72 doses of vaccines, scaring you and trying to reinforce the myth that kids get too many vaccines.

Have you seen and fallen for that trick? Did you ever think to actually count the total vaccine doses they list? As you can see above, it doesn’t come out to 72 doses

But why do  they do it? If they really think their “vaccines contain toxic chemicals” argument is convincing, then would it matter if the number of vaccine doses was 11 or 53 or 72? Why inflate it to make it wound scarier?

Still, however you want to count the number of doses of vaccines kids get today, one thing is crystal clear –  they get protection from more vaccine-preventable diseases.

In 1983, kids may have only have gotten 11 doses of vaccines, but many still died from Hib pneumonia and meningitis, epiglotitis (Hib), pneumococcal pneumonia and meningitis, hepatitis A, hepatitis B, rotavirus, chicken pox, and meningococcemia, etc.

“for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”

Walter Orenstein, MD

Today, unless you decide to skip or delay your child’s vaccines, they are protected from these diseases.

What about the flu? Kids still die with the flu, but it is important to keep in mind that most kids who die with the flu are unvaccinated.

That’s why it is important to get your kids vaccinated. Don’t take the risk of following bad advice.

What to Know About Learning the Risks of Anti-Vaccine Propaganda

It is important to to learn the risks of falling for anti-vaccine propaganda – leaving your kids unvaccinated, unprotected, and at risk for vaccine-preventable diseases.

More on Learning the Risks of Anti-Vaccine Propaganda