Tag: immunocompromised

Why Should Medical Exemptions Be Based on CDC Contraindications?

Getting a medical exemption for vaccines isn’t controversial.

Or at least it shouldn’t be.

Why Should Medical Exemptions Be Based on CDC Contraindications?

As many people know though, some people have been taking advantage of the fact that medical exemptions weren’t clearly defined in California’s vaccine law.

Who are the doctors handing out fake medical exemptions in California?
Who are the doctors handing out fake medical exemptions in California?

Are there just a few doctors taking advantage of the California law?

“But at 105 schools in the state, 10% or more of kindergartners had a medical exemption in the school year that ended last month, according to a Los Angeles Times analysis of state data.”

Pushback against immunization laws leaves some California schools vulnerable to outbreaks

Is 10% a lot?

In one recent report, Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year, the median rate of medical exemptions in the US was just 0.2%, with a range of <0.1 to 1.5%.

In West Virginia and Mississippi, states that don’t allow non-medical exemptions and where criteria for medical exemptions are fairly strict, the rates were 0.1 and 0.3% respectively.

And that’s about what you would expect, as there are very few true contraindications or precautions to getting vaccinated.

So yes, 10% is an awful lot and that’s a good sign that it is more than just a few doctors taking advantage of the law.

“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”

Dear Colleague letter regarding guidelines for use of immunization exemptions

Why do most other states have so few medical exemptions?

Mostly because there are very few true medical reasons to skip or delay a child’s vaccines!

They include, but aren’t limited to, the contraindications and precautions listed in the package insert for each vaccine (the contraindications and warnings sections…) and by the Advisory Committee on Immunization Practices.

They don’t include many other things that are “incorrectly perceived as contraindications to vaccination,” such as things in the family medical history of the child, eczema (unless they are getting the smallpox vaccine), colic, sleep apnea, or being a picky eater.

Is everything a vaccine injury?
Is everything a vaccine injury?

It should be obvious.

Medical exemptions for vaccines should be based on CDC criteria because some folks think that everything is a vaccine injury.

More on Medical Exemptions

Why Did Anti-Vaccine Folks Applaud Rand Paul’s Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Wait, what?

Why Did Anti-Vaccine Folks Applaud Rand Paul's Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Anti-vaccine folks actually applauded Rand Paul’s testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Why Did Anti-Vaccine Folks Applaud Rand Paul’s Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Surprisingly, many of the things he said weren’t anti-vaccine.

I guess they ignored those parts…

  • …given the choice, I do believe that the benefits of most vaccines vastly outweigh the risks.
  • I’m not hear to say don’t vaccinate your kids… if this hearing is for persuasion, I’m all for the persuasion. I vaccinated myself. I vaccinated my kids.
  • For myself and my kids, I believe that the benefits of vaccines greatly outweigh the risks…

So why were they cheering?

Because that’s not all he said…

“Today, instead of persuasion, many governments have taken to mandating a whole host of vaccines, including vaccines for non-lethal diseases.”

Sen Rand Paul

While some vaccine-preventable diseases are more deadly than others, they can all be deadly. From rotavirus and HPV to hepatitis A, these diseases can kill people.

Which vaccine-preventable disease does he think is non-lethal?

“Sometimes these vaccine mandates have run amok. As when the government mandated a rotavirus vaccine that was later recalled because it was causing intestinal blockage in children.”

Sen Rand Paul

That’s an interesting example of “the government” that has run amok…

Which “government” mandated that the original rotavirus vaccine be given to children?

As Senator Paul hopefully understands, the Federal government doesn’t mandate vaccines for anyone. And since it must be given at such a young age, even states don’t actually mandate that the rotavirus vaccine be given to children…

Even today, there are no mandates for the rotavirus vaccine.

If there were, it still wouldn’t mean giving up your Liberty, after all, vaccine mandates don’t mean forced vaccination.

“It is wrong to say that there are no risks to vaccines. Even the government admits that children are sometimes injured by vaccines. Since 1988, over $4 billion has been paid out from the Vaccine Injury Compensation Program. Despite the government admitting to and paying $4 billion for vaccine injuries, no informed consent is used or required when you vaccinate your child. This may be the only medical procedure in today’s medical world where an informed consent is not required. “

Sen Rand Paul

No one says that there are no risks to vaccines. That’s a classic anti-vaccine talking point.

What folks actually say is that vaccines are safe, with few serious risks.

And the $4 billion that Rand Paul and anti-vaccine folks often talk about has been paid out over more than 30 years, during a time that we have given nearly 300 million doses of vaccines each and every year!

But what’s that he said about informed consent?

Why wouldn’t informed consent be given or be required before getting a vaccine?

Of course, parents get informed consent before getting vaccines.

They don’t get informed consent if they decide to skip or delay their child’s vaccines after getting bad information.

“Now proponents of mandatory government vaccination argue that parents who refuse to vaccinate their children risk spreading these diseases to the immunocompromised community. There doesn’t seem to be enough evidence of this happening for it to be recorded as a statistic, but it could happen. But if the fear of this is valid, are we to find that next we will be mandating flu vaccine?”

Sen Rand Paul

Lastly, why didn’t Sen Paul find evidence that intentionally unvaccinated kids are spreading disease to the immunocompromised community?

Maybe he didn’t look…

It happens.

Do we need it to happen more often so that it becomes a large statistic before he and others will advocate that folks get vaccinated to attend school?

Do you understand have a better understand now why anti-vaccine folks were cheering after his testimony?

“If you believe in Liberty, that’s fine, don’t get immunized. But I don’t think that you need to necessarily expose others to disease.”

Sen Bill Cassidy

It should give you a better understanding both of Rand Paul’s ideas and those of the anti-vaccine movement.

More on Rand Paul’s Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks

People with Cancer Are at Risk from Unvaccinated Kids

We know that kids with cancer aren’t at risk from shedding if someone has recently been vaccinated.

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

The real risk comes from those who are unvaccinated.

People with Cancer Are at Risk from Unvaccinated Kids

Confused on how that works?

Kids with cancer typically have a compromised immune system, so are at greater risk for getting sick and catching infectious diseases. This includes a risk from vaccine-preventable diseases because they often can’t be vaccinated and any vaccines they had in the past might no longer provide protection.

Don’t believe me?

Want some examples?

  • a 6-year-old girl who was in remission for ALL and had just received her final dose of chemotherapy was admitted with fever and neutropenia, found to have measles, and died after 28 days of intense therapy (1989)
  • an 8-year-old being treated for leukemia developed chicken pox and died two weeks later (1998)
  • a partially vaccinated 4-year-old girl who was being treated for acute lymphoblastic leukemia (ALL) was exposed to a cousin with chicken pox and later developed multi-organ failure and died (2012)
  • a 26-year-old man who was being treated for chronic lymphocytic leukemia died in Switzerland after he became infected with measles (2017)
  • a 6-year-old boy with leukemia died in Italy after catching measles from his intentionally unvaccinated sibling (2017)

Of course, there are many more, including many kids with cancer who get exposed to a vaccine-preventable disease and have to get treated with immunoglobulin and hope they don’t get sick. And many more who do get sick and are treated in the hospital for weeks and months and thankfully, get better.

And there are even more who get caught up in quarantines because they have true medical contraindications to getting vaccinated, and so have to stay home from school with the intentionally unvaccinated kids whenever there is an outbreak of measles or chicken pox, etc.

What can we do about this?

Vaccinate our kids! We have a choice. These kids with cancer don’t.

More on People with Cancer at Risk from Unvaccinated Kids

Is a Family History of Altered Immunocompetence a Contraindication to Getting Vaccinated?

Have you ever wondered why a “family history of altered immunocompetence” is listed as a contraindication to getting varicella and MMR vaccines?

If family members have altered immunocompetence, getting and exposing them to measles isn't a good idea either.
If family members have altered immunocompetence, getting and exposing them to measles isn’t a good idea either.

It’s probably not why you think…

Is a Family History of Altered Immunocompetence a Contraindication to Getting Vaccinated?

Which vaccines are contraindicated if you have a family history of altered immunocompetence?

Typically MMR and Varivax, the chicken pox vaccine.

Is this about side effects?

Kind of.

As they are live vaccines, you don’t usually want to give them to anyone who might be immunocompromised. And since some conditions that cause immune system problems can run in families, if there is a family history of these conditions, you want to make sure your child doesn’t have one before they are vaccinated.

(g) family history of congenital or hereditary immunodeficiency in first-degree relatives (e.g., parents and siblings), unless the immune competence of the potential vaccine recipient has been substantiated clinically or verified by a laboratory.

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

Fortunately, these types of severe immune problems are rare.

They might include:

  • Severe antibody deficiencies (e.g., X-linked agammaglobulinemia and common variable immunodeficiency)
  • Complete defects (e.g., SCID disease, complete DiGeorge syndrome)
  • Partial defects (e.g., most patients with DiGeorge syndrome, Wiskott-Aldrich syndrome, ataxia- telangiectasia)
  • Phagocytic deficiencies that are undefined or accompanied by defects in T-cell and NK cell dysfunction (such as a Chediak-Higashi syndrome, Leukocyte Adhesion Deficiency [LAD], and myeloperoxidase deficiency)

Talk to your pediatrician if your child has a first degree relative with one of these conditions, before they get their MMR or chicken pox vaccines.

Still, by twelve months, infants with a severe congenital or hereditary immunodeficiency or any other severe immunodeficiency will almost certainly have symptoms already.

Most children, for example, had been diagnosed with severe combined immunodeficiency (SCID), in early infancy when they have severe and life-threatening infections and failure to thrive.

And most newborns in the United States are now screened for SCID as a part of their routine newborn screening test, and can be diagnosed and treated before they have symptoms! That’s also long before they might be due for their MMR or chicken pox vaccines.

So, if your child has a family history of congenital or hereditary immunodeficiency, and it is in a first-degree relative, but has no symptoms themselves, then they can get safely vaccinated on schedule.

Not surprisingly, anti-vaccine folks try to abuse their family history of altered immunocompetence as an vaccine exemption, even when their own child isn’t immunosuppressed!

More on Vaccine Contraindications

Why Do Some Folks Wear a Mask During Flu Season?

Wearing a surgical mask is very common when people are sick and want to avoid spreading their germs to others. They are also commonly worn when people are healthy and are just afraid of getting sick.

Why Do Some Folks Wear a Mask During Flu Season?

Is that why you see some folks wearing masks during flu season?

If you are worried about your privacy, why announce something on Facebook?
If you were worried about your privacy, would you talk about it on Facebook?

Maybe, but some folks actually have to wear a mask during flu season.

Well, they have to because they decide they don’t want to get a flu vaccine, but still want to keep their job that could put others at risk if they got sick with the flu. So basically, it is unvaccinated health care personal and others who work around sick and vulnerable people who might have to wear a mask when they are at work.

Why don’t they just get vaccinated and protected against the flu?

That’s a good question…

Some other questions to consider as you think about flu vaccine mandates include:

  • Do unvaccinated health care workers pose a risk to others in the course of their jobs? Of course they do. Health care personal are at high risk to get the flu, since they are often around people who are sick with the flu, and are at higher risk to get the flu if they are unvaccinated.
  • Does wearing a mask protect anyone? – Yes, they actually do and recent studies have concluded that “surgical face masks worn by infected persons are potentially an effective means of limiting the spread of influenza.”
  • Does getting a flu shot prevent you from catching the flu? – Flu shots aren’t the most effective vaccine we have, but they are the best way to avoid catching the flu, being 10 to 60% effective since 2004.
  • Does getting a flu shot prevent you from spreading the flu to others? Yes, and several studies have shown lower rates of nosocomial cases among hospitalized patients as more health care personal get vaccinated!
  • Does getting a flu shot just cause you to have milder symptoms? The flu vaccine does has many benefits besides preventing the flu, but it is certainly not limited to just causing milder symptoms.
  • Does wearing a mask violate your HIPAA rights? No. Unless you announce it, no one knows why you are wearing a face mask. Maybe you have herpes or a cold or are just afraid of getting sick. And the Health Insurance Portability and Accountability Act only protects patients, not employees.

So why don’t all health care personal get a flu vaccine each year?

Most do.

And while some people seem to be against the idea of mandates for health care workers getting flu shots, most think it is a great idea.

“I support this requirement. I think it is a good idea. Ethically, it makes total sense. First, every doctor, nurse, and HCW knows that they are supposed to put patient interests ahead of their own interests. Whatever you think about flu shots, it is good for patients that their healthcare providers are vaccinated against the flu, particularly among patients who cannot themselves be vaccinated, such as some of the elderly, babies, people with immune diseases, and people who just received transplants or are getting cancer treatment. Vaccination does not help them. They are all immunosuppressed.”

Art Caplan on The Law: Get a Flu Shot or Wear a Mask, Healthcare Workers!

In fact, most think that there is both an ethical and a legal rationale for flu vaccine mandates for health care workers.

“Doctors and other healthcare providers have an ethical obligation to make decisions and take actions that protect patients from preventable harm. 5 Many patients are highly vulnerable to flu, so choosing not to be vaccinated is choosing to do harm—a choice that has no place in healthcare.”

Doctors choosing not to be vaccinated is choosing to do harm

It is hard to imagine that some doctors and nurses not only skip getting vaccinated, putting others at risk, but then don’t even want to wear a mask.

More on Wearing Masks During Flu Season

Can I Get Rotavirus from My Recently Vaccinated Baby?

Your two month old recently got her vaccines, including the rotavirus vaccine.

Shedding Season is not a real thing.
Shedding Season is not a real thing.

Now you have diarrhea.

Was it from shedding from your child’s rotavirus vaccine?

Does the Rotavirus Vaccine Shed?

Like some other live virus vaccines, it is well known that the rotavirus vaccine can shed.

And like with most other vaccines, this shedding isn’t usually a cause for concern and definitely isn’t a reason to think about skipping or delaying your child’s vaccines.

Why not?

“All members of the household should wash their hands after changing the diaper of an infant. This minimizes rotavirus transmission, for an undetermined number of weeks after vaccination, from an infant who received rotavirus vaccine.”

General Recommendations on Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP)

If you wash your hands when you change your child’s diapers after they have been vaccinated, just like you hopefully do anyway, you can avoid any possible contact with any rotavirus vaccine virus that might be shed in your child’s stool.

Can I Get Rotavirus from My Recently Vaccinated Baby?

But what would be the risk of your getting sick if you did come into contact with shedding rotavirus vaccine virus in your child’s diaper?

Would you be at risk to get sick?

Did your baby get sick after getting the actual vaccine?

That’s the thing about shedding that many people don’t understand. These live vaccines are made with attenuated or weakened strains of viruses, so they don’t typically get you sick when you are vaccinated. And they don’t typically get you sick when you are exposed through shedding. In fact, this shedding can sometimes help build herd immunity, as more people get exposed to the weakened strain of vaccine virus.

But can they get you sick?

Yes, if you have a problem with your immune system, which is why there are warnings about giving live vaccines to folks who are immunocompromised. And there used to be warnings about giving the oral polio vaccine to kids if they were around anyone with an immune system problem.

Vaccine viruses could also get you sick if they mutated from their attenuated state and became more virulent. Fortunately, that rarely happens with most vaccines.

“The theoretical risk of HRV and PRV shedding, transmission to, and infection of immunocompromised contacts is much lower than the real risk of wildtype rotavirus infection transmitted from unvaccinated children.”

Anderson on Rotavirus vaccines: viral shedding and risk of transmission

And most importantly, since kids are much more likely to shed virus after natural infections, it is much safer for everyone to get vaccinated and protected with these vaccines.

Surprisingly, even children with asymptomatic natural rotavirus infections can shed virus for several weeks, which is likely why these infections used to spread so easily or without known contacts.

Something that will likely surprise some folks even more is the news that just because someone gets diarrhea after being exposed to the rotavirus vaccine, either because they were vaccinated or through shedding, it doesn’t mean that the vaccine was the cause of the diarrhea!

“Of note, among all six AGE cases which possessed Rotarix-derived strains, four (sample No.1, 5, 6 and 7) were suspected to be caused by other pathogens. Most likely, the infants were infected with other pathogens during the shedding period of Rotarix strain.”

Kaneko et al on Identification of vaccine-derived rotavirus strains in children with acute gastroenteritis in Japan, 2012-2015

When vaccine strain rotavirus have been detected in kids with gastroenteritis, they often have other reasons to have diarrhea.

What does this all mean?

Don’t believe all of the hype anti-vaccine folks push about shedding from vaccines.

More on Shedding and Rotavirus Vaccines

Does the FluMist Vaccine Shed?

Anti-vaccine folks like to talk a lot about shedding.

Where do they get the idea that vaccines shed?

Well, there is the fact that some live vaccines, like the rotavirus and oral polio vaccine, do actually shed.

Does the FluMist Vaccine Shed?

Remember, shedding occurs when an infectious agent, typically a virus, can be found in urine, stool, or other bodily secretions. Shedding is not specific to vaccines though. Shedding occurs very commonly after natural infections too, which is one reason they are so hard to control.

So does the Flumist vaccine shed?

Yes, it does, and it isn’t a secret.

There is actually a warning about shedding and Flumist – to avoid contact with severely immunosuppressed persons (e.g., hematopoietic stem cell transplant recipients in a protected enviornment) for seven days after vaccination because of the theoretical risk that their severe immunosuppression might allow the weakened flu strain to somehow cause disease.

This warning obviously doesn’t apply to the great majority of people though.

And it shouldn’t be surprising that it sheds, after all, it is a live virus vaccine that is squirted in your nose!

Why isn’t it usually a problem?

Flumist contains attenuated viral strains of the flu that are temperature-sensitive, so even if you did get infected with the weakened flu strains from Flumist via shedding, they wouldn’t cause disease.

Another way to think about it is that the folks who actually get the Flumist vaccine don’t get the flu, so why would you get the flu if you were simply exposed to the vaccine virus by shedding?

Shedding from the Flumist vaccine doesn't cause disease.
Anti-vaccine folks are sharing this table like they uncovered some secret, but it is important to understand that shedding from the Flumist vaccine doesn’t cause disease. And this table is in package insert for Flumist!

The real concern with shedding is when it leads to folks actually getting sick.

Trying to scare folks about Flumist shedding is just like when they talk about the MMR vaccine, pushing the idea that the rubella vaccine virus might shed into breast milk or measles vaccine virus into urine. Either might happen, but since it won’t cause infection and disease, it certainly isn’t a reason to skip or delay your child’s vaccines.

What to Know About Shedding and Flumist

The Flumist vaccine does indeed shed, but unless you are going to have contact with someone who is severely immunocompromised in a protected environment, this type of shedding isn’t going to get anyone sick and isn’t a reason to avoid this vaccine.

More on Shedding and Flumist