Tag: herd immunity

Five Things to Know About the Reporting on California’s New Vaccine Law

California has a new vaccine law, and based on the media coverage, a lot of folks still don’t understand what it does or how to report about vaccines and the anti-vaccine movement…

“Other opponents say the law tries to solve a problem that doesn’t exist.”

Elizabeth Aguilera on Five Things to Know About California’s New Vaccine Law

As is typically the case, the problem is false balance.

Five Things to Know About the Reporting on California’s New Vaccine Law

Before we talk about what California’s new vaccine law does, let’s remind folks about what it doesn’t do.

What does the new law do?

It doesn’t eliminate all exemptions, stop doctors from writing medical exemptions, require all exemptions to be reviewed, or revoke all medical exemptions.

It simply helps stop providers who are writing inappropriate vaccine exemptions – or at least keep them from writing more than four inappropriate vaccine exemptions.

How did we get here?

It is no surprise how California ended up passing two vaccine laws in four years.

The state has a problem with clusters of unvaccinated kids. Unfortunately, the first vaccine law, SB277, didn’t fix the issue, as some providers found that they could get around it by writing unnecessary medical exemptions.

Some even found that they could make money writing these exemptions!

The vast majority of kids are vaccinated, so what’s the big deal?

While it is great if a state has high immunization rates, that doesn’t mean as much if half the kids in your child’s school are unvaccinated.

This is known as a breakdown of herd immunity.

It puts kids at risk to get a vaccine-preventable disease, especially if they have a true medical exemption.

Are vaccines dangerous, as some critics say?

Vaccines are safe, with few risks.

What is dangerous, are the folks who push misinformation about vaccines that scare parents away from vaccinating and protecting their kids. Why don’t we hear more stories about them in the media?

So is this fight over now?

While this should be a time when everyone starts to learn about why vaccines are safe and necessary, unfortunately, some are doubling down and still don’t want to vaccinate and protect their kids.

Did the opposition write this article in the Valley News?
Did “the opposition” write this article in the Valley News?

That might change if instead of simply printing what the opposition says in the spirit of being balanced, the media ever actually fact checks what the opponents to SB 276 and other vaccine laws have been doing and saying…

More On Reporting About Vaccines

About That Johns Hopkins Protocol of Immunocompromised Kids…

We know that immunocompromised kids are especially at risk from vaccine preventable diseases, both because they are immunocompromised and because they often can’t get vaccinated or fully vaccinated.

That why herd immunity is important and there are immunization protocols for immunocompromised kids.

About That Johns Hopkins Protocol of Immunocompromised Kids…

One of the most commonly followed protocols, 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host, was recently published by the Infectious Diseases Society of America.

“Healthy immunocompetent individuals who live in a household with immunocompromised patients should receive the following live vaccines based on the CDC annual schedule: combined measles, mumps, and rubella (MMR) vaccines; rotavirus vaccine in infants aged 2–7 months; varicella vaccine (VAR); and zoster vaccine (ZOS). Also, these individuals can safely receive the following vaccines for travel: yellow fever vaccine and oral typhoid vaccine.”

2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host

There are also guidelines from the Medical Advisory Committee of the Immune Deficiency Foundation, the ACIP, and the American Academy of Pediatrics.

All of the protocols support kids getting vaccinated and protected, unless they have a medical exemption, and that their contacts get vaccinated and protected.

Is it any wonder that some parents are scared to vaccinate their kids after listening to these folks speak at these rallies?

That’s why it is surprising to hear what Robert F. Kennedy, Jr had to say about the protocol he reviewed from Johns Hopkins.

“So I went to the Johns Hopkins protocols for immunocompromised children. And I read it. And when I read it, it’s a long, dense document, but there’s no place in that entire document that said immunocompromised children should be kept away from unvaccinated children. Do you know what there is? Ah! It says that the real danger to immunocompromised children is vaccinated children, because, whatever you do, don’t let your immunocompromised child near a child who has recently, meaning six weeks, had a chickenpox vaccine. Don’t let your child anywhere near a child who has had a polio vaccine. Or a pertussis vaccine. And that’s the worst one. Because the child with pertussis has no knowledge that he has pertussis. He is an asymptomatic carrier. But he can pass it to your child. And he is more likely to pass it to your child if he is vaccinated!”

Robert F. Kennedy, Jr

Where is this Johns Hopkins protocol that Kennedy read?

Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and the The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.
Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and the The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.

He can’t be referring to the old version of the Johns Hopkins Hospital Patient Information Guide for the Immunocompromised Patient, can he? The revised Johns Hopkins Hospital Patient Information Guide no longer routinely warns about contact with children who were recently vaccinated.

Although anyone with a severe immunodeficiency should avoid those who have recently received the oral polio vaccine, that vaccine hasn’t been used in the United States since 2000. Also, you don’t have to avoid folks who have received the chickenpox vaccine, unless they get a rash and it is uncovered. And you certainly don’t have to avoid anyone who has received the pertussis vaccine, as it is not a live vaccine.

The Johns Hopkins Hospital Patient Information Guide does warn those who are immunocompromised to “Tell friends and family who are sick not to visit.”

Who’s more likely to get sick with things like measles, chickenpox, and pertussis?

Folks who are unvaccinated!

“The threat of pertussis and other childhood communicable diseases to children with immunodeficiency is particularly alarming. The increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children. The immunosuppressed subject is particularly at risk in crowded living conditions because of the spread of these diseases by aerosol droplets or through the oral-fecal route.”

Medical Advisory Committee of the Immune Deficiency Foundation on Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

Has Kennedy read the protocols from the Immune Deficiency Foundation? They do warn of the risk from intentionally unvaccinated kids!

Has he read the Johns Hopkins Hospital Patient Information Guide, which was updated at least two years ago?

Have you, especially if you are thinking about skipping or delaying your child’s vaccines?

More on the Johns Hopkins Protocol of Immunocompromised Kids…

Who Are the Medically Fragile Children?

As SB 276 becomes law in California, one thing we have been hearing about from some folks is how it will affect medically fragile children.

No one is coming to take the medical exemptions from medically fragile children.
No one is coming to take the medical exemptions from medically fragile children…

Will SB 276 or vaccine laws in other states take away the medical exemptions from medically fragile children?

Of course not!

Who Are the Medically Fragile Children?

The first thing to understand is that when folks like Rob Schneider talk about medically fragile children, they are using the term differently than when medical professionals and most parents do.

“Medically fragile” means having an acute or chronic health problem which requires therapeutic intervention and skilled nursing care during all or part of the day. Medically fragile problems include, but are not limited to, HIV disease, severe lung disease requiring oxygen, severe lung disease requiring ventilator or tracheostomy care, complicated spina bifida, heart disease, malignancy, asthmatic exacerbations, cystic fibrosis exacerbations, neuromuscular disease, encephalopathies, and seizure disorders.

2005 California Health and Safety Code Sections 1760-1761.8 FACILITIES HEALTH AND SAFETY CODE SECTION 1760-1761.8

The medically fragile kids as defined by the California Health and Safety Code, who require skilled nursing care, are not typically the kids who are getting routine medical exemptions.

Sure, some of them might need one. A child with severe HIV disease or a malignancy being treated with chemotherapy would likely get a medical exemption for live vaccines, etc.

A child with an acute encephalopathy or uncontrolled seizures would also qualify for a medical exemption.

And since vaccines aren’t 100% risk free, there might be some kids with a vaccine injury among these medically fragile kids. It is likely not a high number though, as severe reactions to vaccines are very rare.

“CMC {children with medical complexity} are likely increasing in prevalence because of increased survival rates of infants born prematurely, those born with various congenital anomalies, and/or those with chronic conditions, as well as improved treatments for acute illnesses in fields such as intensive care and oncology.”

Cohen et al on Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

In most other cases, medically fragile kids wouldn’t need a medical exemption and would greatly benefit from being vaccinated and protected!

They would also greatly benefit if everyone around them was vaccinated and protected, especially if they did have a medical exemption.

Again, no one is coming to take their necessary medical exemptions if they have one though.

More on Medically Fragile Children

Which Part of the Herd Gets Protected by Community Immunity?

You are a part of the herd.

“I don’t care that you call people a herd. And I don’t care that some people consider themselves to be part of a herd. I am not in a herd. I am not a farm animal.”

Del Bigtree

Of course, we are talking about herd immunity.

Which Part of the Herd Gets Protected by Community Immunity?

What if you aren’t vaccinated and protected?

Del Bigtree is a "free thinking human being," who whether he appreciates it or not, benefits from herd immunity protections.
Del Bigtree is a “free thinking human being,” who whether he appreciates it or not, benefits from herd immunity protections.

Then you are protected by those who are!

“A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community.”

CDC Vaccine Glossary of Terms

That’s what herd immunity is all about.

In a community, “the herd” includes those with immunity and those trying/needing to “hide in the herd:”

  • those with natural immunity
  • folks who are vaccinated and protected
  • some people who are too young to be vaccinated or fully vaccinated
  • the people who’s vaccines didn’t work
  • anyone who can’t be vaccinated, because they have a medical contraindication

And it also includes those who are intentionally unvaccinated. The free-riders. Those who could be vaccinated, but simply choose not to, often because they have been scared by things they have heard or read about vaccines.

Baby deer need protection from the adults in the herd, but that doesn't mean that they aren't a part of the herd too.
Baby deer need protection from the adults in the herd, but that doesn’t mean that they aren’t a part of the herd too.

This all makes even more sense when you think about it as community immunity, the term that is more commonly used today.

Don’t want to think that you are in the herd?

That’s OK.

The herd still protects you. At least it does if enough folks in the herd are vaccinated and protected.

More on Community Immunity