Tag: immunization schedule

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

Is Surgery a Contraindication to Getting Vaccinated?

There are some situations in which it is very important to think about vaccines before your child has surgery.

“Pneumococcal conjugate vaccine (PCV13, Prevnar 13, Pfizer), Haemophilus influenzae type b vaccine (Hib), meningococcal conjugate vaccine (MenACWY), and meningococcal B vaccine should be given 14 days before splenectomy, if possible.”

Ask the Experts about Scheduling Vaccines

A splenectomy leaves your child at extra risk for many vaccine-preventable diseases, so it is a good idea to get vaccinated and protected well in advance of a planned splenectomy, if possible.

This doesn’t mean that these vaccines won’t work after the surgery, but just that you don’t want your child to be unprotected while he remains unvaccinated.

Is Surgery a Contraindication to Getting Vaccinated?

What about other surgeries?

Some kids are put on an aspirin regimen after cardiac surgery and it should be noted that taking aspirin is a contraindication for getting FluMist, the nasal spray flu vaccine, and is considered a precaution for getting the chicken pox vaccine.

“(j)No adverse events associated with the use of aspirin or aspirin-containing products after varicella vaccination have been reported; however, the vaccine manufacturer recommends that vaccine recipients avoid using aspirin or aspirin-containing products for 6 weeks after receiving varicella vaccines because of the association between aspirin use and Reye syndrome after varicella. Vaccination with subsequent close monitoring should be considered for children who have rheumatoid arthritis or other conditions requiring therapeutic aspirin. The risk for serious complications associated with aspirin is likely to be greater in children in whom natural varicella develops than it is in children who receive the vaccine containing attenuated VZV. No association has been documented between Reye syndrome and analgesics or antipyretics that do not contain aspirin.”

Vaccine Recommendations and Guidelines of the ACIP

In most other situations, not only is surgery not considered a contraindication to getting vaccinated, but “hospitalization should be used as an opportunity to provide recommended vaccinations.”

“Most studies that have explored the effect of surgery or anesthesia on the immune system were observational, included only infants and children, and were small and indirect, in that they did not look at the immune effect on the response to vaccination specifically. They do not provide convincing evidence that recent anesthesia or surgery significantly affect response to vaccines. Current, recent, or upcoming anesthesia/surgery/hospitalization is not a contraindication to vaccination. Efforts should be made to ensure vaccine administration during the hospitalization or at discharge.”

Vaccine Recommendations and Guidelines of the ACIP

The one possible argument that makes sense to delay a vaccine in few days or weeks before a planned surgery is that if your child has a reaction to the vaccine, even if it is a mild reaction, like a fever or irritability, then it might cause them to delay the surgery.

And you could make the same argument about delaying vaccines in the days or weeks after having surgery. Could mild reactions to a vaccine be confused with complications from the surgery?

Otherwise, your anesthesiologist’s preferences aside, a recent or upcoming surgery is not a true contraindication to getting vaccinated, especially if it is a vaccine that your child is already past due for or needs because of a local outbreak, etc.

nless they are giving these kids the oral polio vaccine or plan on them sharing a room with a bone marrow transplant patient, they don't need to worry about shedding. But that's only one of the reasons that this hospital's recommendations don't follow ACIP guidelines.
Unless they are giving these kids the oral polio vaccine or plan on them sharing a room with a bone marrow transplant patient, they don’t need to worry about shedding. But that’s only one of the reasons that this hospital’s recommendations don’t follow ACIP guidelines.

What happens if you delay getting your child vaccinated because of a planned surgery and they get exposed to someone with measles or chicken pox?

Fortunately, this isn’t usually an issue unless your child is already behind on their vaccines and needs to catch up. After all, there is a lot of flexibility built into the immunization schedule, so that your child could get all of their vaccines on time, even with a planned or unexpected surgery.

More on Surgery and Vaccines

Does Japan have the Lowest Infant Mortality Rate Following a Ban on Mandatory Vaccinations?

Vaccines don’t affect infant mortality rates as much as you would expect, because there are many other things that kill infants besides vaccine-preventable diseases. Things like birth defects, prematurity, injuries and complications during pregnancy.

Unfortunately, that gives anti-vaccine folks lots of opportunities to misuse statistics about infant mortality rates.

Does Japan have the Lowest Infant Mortality Rate Following a Ban on Mandatory Vaccinations?

The latest propaganda about vaccines and infant mortality rates relates to Japan.

“It may come as no surprise to many that the Japanese Government banned a number of vaccines that are currently mandatory in the United States and has strict regulations in place for other Big Pharma drugs and vaccines in general.”

Jay Greenberg on Anti-Vaccine Japan Has World’s Lowest Child Death Rate, Highest Life Expectancy

Most folks will understand why this is simply propaganda.

Japan never banned any vaccines.

The 2016 routine and voluntary immunization schedule in Japan.
The 2016 routine (Hib, Prevnar, hepB, DTaP, IPV, BCG, MR, Varicella, Japanese Encephalitis, DT, and HPV) and voluntary (mumps, rotavirus, hepA, meningococcal) immunization schedule in Japan.

Japan is not anti-vaccine. Although their immunization schedule is certainly a lot more complicated than ours, they give many of the same vaccines as every other developed country.

“Following a record number of children developing adverse reactions, including meningitis, loss of limbs, and even sudden death, the Japanese government banned the measles, mumps, and rubella (MMR) vaccine from its vaccination program, despite facing serious opposition from Big Pharma.”

Was the MMR vaccine banned in Japan?

The MMR vaccine was introduced in Japan in 1989, and four years later, the government withdrew its recommendation for the vaccine.

Why? Reports of aseptic meningitis. This was likely due to the Urabe strain of the mumps component in their MMR vaccine, which was not used in the United States.

“The data up to now have revealed low rates of aseptic meningitis and no cases of virologically proven meningitis following the use of Jeryl–Lynn and RIT 4385 strains.”

WHO on Safety of mumps vaccine strains

They didn’t ban the vaccine or vaccination though.

They returned to giving children separate measles, rubella, and mumps (optional) vaccines. Tragically, because many kids didn’t get vaccinated against mumps, the rate of aseptic meningitis from people who actually got mumps was 25 times higher than the rate from the MMR vaccine!

When comparing risks vs benefits, it clearly favored getting vaccinated.

“Due directly to these gaps in ‘herd’ immunization resulting from politicized transitions in vaccination policy by the government, there were outbreaks of rubella with 17,050 cases reported between the years of 2012 and 2014, and 45 cases of congenital rubella syndrome reported to the National Epidemiological Surveillance of Infectious Diseases from week 1, 2012 to week 40, 2014.”

Yusuke Tanaka on History repeats itself in Japan: Failure to learn from rubella epidemic leads to failure to provide the HPV vaccine

The switch over also lead to outbreaks of rubella and increased cases of congenital rubella syndrome.

That’s no surprise to those who remember what happened in 1975, when routine pertussis vaccinations were halted in Japan following the deaths of two children. That eventually lead to epidemic cases of whooping cough in the country and at least 41 deaths in children (in 1979) before the vaccine was restarted.

Unfortunately, once they moved to DTaP vaccines, they started to see an increase in allergic reactions after kids got their MMR vaccine. Why? Their version of the DTaP vaccine contained poorly hydrolyzed bovine gelatin, which likely sensitized infants, who then developed an allergic reaction after getting an MMR vaccine with gelatin. While gelatin was removed from their DTaP vaccines, these extra side effects likely scared some folks in Japan.

Japan’s Vaccine Problem

Japan has more vaccine-preventable diseases than many other industrial countries.

Is it because Japan is anti-vaccine?

Of course not.

By impulsively halting and withdrawing vaccines, the Japanese government has done a good job of scaring folks though. They have also been very slow to introduce new vaccines, although they are catching up, as hepatitis, B, rotavirus, Hib, pneumococcal, meningococcal, HPV, and the chicken pox vaccine are all now available in Japan.

Have there been any benefits?

Nope.

They might have lower infant mortality rates, but that has nothing to do with vaccines.

There is no correlation between the number of vaccines that a country gives and their infant mortality rate.

If infant mortality rates are linked to vaccines, how do you explain Finland?
If infant mortality rates are linked to vaccines, how do you explain Finland?

Just look at the immunization schedules in Finland, Portugal, and other countries.

What about autism?

Rates of autism have increased in Japan, just as they have in other countries. So much for the idea that the MMR vaccine is associated with autism, right?

It should be obvious now that if anti-vaccine folks did any research at all, they wouldn’t use Japan as an example when they talk about vaccines.

With higher rates of vaccine-preventable disease and deaths from vaccine-preventable diseases, especially right after they impulsively halt a vaccine, Japan’s vaccine history simply demonstrates that vaccines work and that they are still very necessary.

One thing is true though. Japan’s infant mortality rate has been dropping, but then so has the infant mortality rate in almost all other countries, including the United States, which is at record low levels.

It certainly isn’t true that Japan’s infant mortality rate started to drop following a ban on mandatory vaccinations. How do we know that? Like many other countries, Japan has never had mandatory vaccinations. And not surprisingly, their infant mortality rate has continued to drop as they have added more vaccines and improved their immunization rates.

More on Vaccines and Infant Mortality Rates

Is There a Grace Period for Getting Vaccines?

You know about the standard immunization schedule.

Looking at the latest immunization schedule from the CDC and AAP, it should be clear that kids don't get 69 vaccines.
What happens if you get a vaccine a few days too early?

You may even know about the minimum ages or minimum intervals between vaccines, but what happens if your child gets a vaccine just a few days early?

Is There a Grace Period for Getting Vaccines?

Fortunately, in most cases, getting a vaccine just a little early isn’t going to mean that the vaccine dose has to be repeated.

“Doses administered too close together or at too young an age can lead to a suboptimal immune response. However, administering a dose a few days earlier than the minimum interval or age is unlikely to have a substantially negative effect on the immune response to that dose. Known as the “grace period”, vaccine doses administered ≤4 days before the minimum interval or age are considered valid; however, local or state mandates might supersede this 4-day guideline.”

General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP)

That’s because the Advisory Committee on Immunization Practices (ACIP) allows a 4-day grace period for most vaccines. So if your child got their vaccines 3 or 4 days before their 1st birthday, instead of on or after turning 12 months old, they would still count!

It is important to keep in mind that:

  • day 1 is the day before the day that marks the minimum age or minimum interval for a vaccine.
  • the grace period doesn’t apply to the rabies vaccine
  • if a vaccine is given 5 or more days too early, beyond the grace period, then the interval to the next dose starts from the day that invalid dose was given. For example, if the second dose of Hib is given two weeks after the first dose (instead of the minimum 4 weeks), then you don’t repeat this invalid dose in two weeks (four weeks from the first dose), but instead wait an additional four weeks from the invalid second dose
  • you can’t usually add the grace period to an accelerated schedule
  • live vaccines must be given at least 28 days apart if they are not given at the same time and the grace period can not be used to shorten this interval

Most importantly, in place since 2002, the grace period protects kids from having to repeat vaccines because of minor vaccine scheduling errors.

More on the Vaccine Grace Period

Why Isn’t There a Vaccine for Leprosy?

Why do anti-vaccine folks talk about leprosy (Hansen’s disease) so much?

“LEPROSY. I’m curious why there isn’t a vaccine for leprosy. With all the other bazillion vaccines out there, why not one for leprosy?”

We don’t have anywhere near a bazillion vaccines, but did you know that there actually is a vaccine for leprosy?

“Why aren’t you walking around concerned about leprosy every day? Why aren’t you concerned about someone from another country bringing leprosy into Australia or the US and somehow exposing all of our most vulnerable to this illness? I’ll tell you why. Because there’s no vaccine for leprosy. You are afraid of what we vaccinate for because these illnesses are hyped up all of the time. It’s propaganda. ”

Learn the Risk – Why aren’t we afraid of all diseases?

Don’t expect the leprosy vaccine to be added to our immunization schedule any time soon or to increase your fears about leprosy, as leprosy is not highly contagious and it can be treated, and even cured.

And while there are about 150 to 250 cases in the United States each year, most are in folks who used to live in areas of the world where leprosy is more common. Unlike measles, you aren’t likely to get leprosy at school or daycare or going to Disneyland, although you could get it if you have a pet armadillo.

Leprosy Vaccines

A vaccine against leprosy is important though. As with other diseases, we are seeing multi-drug resistant forms of Mycobacterium leprae, the bacteria that causes leprosy.

The new leprosy vaccine that is being developed will hopefully help to finally eliminate leprosy in parts of the Africa, Asia and Latin America where it is still a problem.

Throughout much of the 20th Century, people with leprosy in the United States were treated at the National Leprosarium in Carville, Louisiana.
Throughout much of the 20th Century, people with leprosy in the United States were treated at the National Leprosarium in Carville, Louisiana.

But it isn’t the first leprosy vaccine that we will have had.

Various leprosy vaccines have been developed and tested since the 1980s.

Also, the M. bovis BCG vaccine has been known to provide protection against both Mycobacterium tuberculosis (tuberculosis) and the related Mycobacterium leprae (leprosy) since as early as 1939.

“BCG vaccination is recommended in countries or settings with a high incidence of TB and/or high leprosy burden.”

BCG vaccines: WHO position paper – February 2018

The new leprosy vaccine, a sub-unit vaccine, will hopefully be more effective than previous strategies though, and will work to both prevent and treat leprosy.

Another leprosy vaccine, Mycobacterium indicus pranii (MIP), is being developed and tested in India.

Still, leprosy will never be eradicated, as armadillos serve as an animal reservoir for the Mycobacterium leprae  bacteria.

What to Know About Leprosy Vaccines

At least two leprosy vaccines are being developed and tested to help eliminate leprosy from the areas of Africa, Asia and Latin America where it is still a problem.

More on Leprosy Vaccines

Do Kids Really Get 72 Doses of Vaccines?

Most parents vaccinate their kids according to the recommended immunization schedule.

They know that’s the best way to keep them protected.

Do Kids Really Get 72 Doses of Vaccines?

Saying kids get 72 doses of vaccines is a propaganda too to scare parents.
Saying kids get 72 doses of vaccines is a propaganda tool to scare parents.

While kids do get more vaccines than their parents did, that’s only because we have more vaccines available to protect them from more now vaccine-preventable diseases.

Do they get their kids 72 doses of vaccines?

That sounds like a lot…

It sounds like a lot because it is an inflated number that is meant to scare parents.

Kids today do routinely get:

  • 13 vaccines, including 5 doses of DTaP, 4 doses of IPV (polio), 3 or 4 doses of hepatitis B, 3 or 4 doses of Hib (the number of doses depends on the vaccine brand used), 4 doses of Prevnar, 2 or 3 doses of rotavirus (the number of doses depends on the vaccine brand used), 2 doses of MMR, 2 doses of Varivax (chicken pox), 2 doses of hepatitis A, 1 doses of Tdap, 2 or 3 doses of HPV (the number of doses depends on the age you start the vaccine series), 2 doses of MCV4 (meningococcal vaccine), and yearly influenza vaccines
  • protection against 16 vaccine-preventable diseases, including diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, chicken pox, pneumococcal disease, hepatitis A, hepatitis B, meningococcal disease, HPV, rotavirus, Hib, and flu
  • about 28 doses of those vaccines by age two years (with yearly flu shots)
  • about 35 doses of those vaccines by age five years (with yearly flu shots)
  • as few as 23 individual shots by age five years if your child is getting combination vaccines, like Pediarix or Pentacel and Kinrix or Quadracel and Proquad
  • about 54 doses of those vaccines by age 18 years, with a third of that coming from yearly flu vaccines

How do you get a number like 72?

You can boost your count to make it look scarier by counting the DTaP, MMR, and Tdap vaccines as three separate vaccines each, even though they aren’t available as individual vaccines anymore.

To boost the Vaccine Doses for Children a bit more, they add pregnancy doses too.
To boost the Vaccine Doses for Children a bit more, they add pregnancy doses too.

This trick of anti-vaccine math quickly turns these 8 shots into “24 doses.”

It’s not a coincidence.

Anti-vaccine folks want to scare you into thinking that vaccines are full of toxins, that kids get too many vaccines, that we give many more vaccines than other countries, and that this is causing our kids to get sick.

Can an unvaccinated child really get tetanus after a toe nail injury?
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)

None of it is true.

At age four years, when your preschooler routinely gets their DTaP, IPV, MMR, and chicken pox shots before starting kindergarten, how many vaccines or doses do you think they got? Two, because they got Kinrix or Quadracel (DTaP/IPV combo) and Proquad (MMR/chickenpox combo)? Four, because they got separate shots? Or Eight, because you think you should count each component of each vaccine separately?

Know that even if you do want to count them separately, it really just means that with those two or four shots, your child got protection against eight different vaccine-preventable diseases – diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, and chicken pox.

Vaccine-preventable diseases that have not disappeared, something that the “72 doses” sites don’t ever warn you about.

What to Know About Anti-Vaccine Math

Many websites use anti-vaccine math to inflate vaccine dose numbers and scare parents away from vaccinating and protecting their kids.

More on Anti-Vaccine Math

Did Sweden Ban Mandatory Vaccination?

Have you heard the “news” that Sweden banned mandatory vaccination in their country?

Is that true?

Did Sweden Ban Mandatory Vaccination?

Like most other anti-vaccine myths, this one isn’t true.

Sweden did not ban mandatory vaccination.

“…vaccination coverage is still high and stable, that the diseases covered by the programs are under control…”

Riksdag Social Committee report 2016/17: SoU7

In March 2017, the Riksdag, or Swedish parliament, did vote against a proposal that called for mandatory vaccination. This came as other countries in Europe are seeing lower rates of immunization, rising rates of vaccine-preventable disease, and calls for vaccine mandates. In fact, France and Italy recently implemented vaccine mandates.

“The general vaccination program has a good coverage, and most children are protected against measles and polio, for example. There are, however, skepticism about vaccinations, both the vaccinations included in the basic program and others. In our view, however, it is of societal interest that the vaccination program is implemented in its entirety, and many of the myths and incorrect data circulating about the vaccination program need to be treated and pinned. We therefore consider that the government should provide the appropriate authority with the task of designing an information campaign on the benefits and necessity of the childhood vaccination program.”

Riksdag Social Committee report 2016/17: SoU7

Although the Swedish parliament voted against a motion that would have started a mandatory vaccination plan, there was nothing to ban. Sweden has never had a mandatory vaccination.

The Riksdag passed a motion to add the rotavirus vaccine to the immunization schedule in Sweden.
The Riksdag did pass a motion to add the rotavirus vaccine to the immunization schedule in Sweden.

It is also clear that they see the problem that anti-vax groups are causing in their country and are working to combat them.

That will hopefully keep them from needing a mandatory vaccination program.

What to Know About the Myth of Sweden Banning Mandatory Vaccination

Sweden, with good immunization levels and low rates of vaccine-preventable disease, did not ban mandatory vaccination.

More on the Myth of Sweden Banning Mandatory Vaccination