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