Tag: live vaccines

Vaccine-Preventable Diseases

The latest immunization schedule from the CDC and AAP.
The latest immunization schedule from the CDC and AAP.

Today, in the United States, children typically get:

  • 36 doses of 10 vaccines (HepB, DTaP, Hib, Prevnar, IPV, Rota, MMR, Varivax, HepA, Flu) before starting kindergarten that protect them against 14 vaccine-preventable diseases
  • at least three or four more vaccines as a preteen and teen, including a Tdap booster and vaccines to protect against HPV and meningococcal disease, plus they continue to get a yearly flu vaccine

So by age 18, that equals about 57 dosages of 14 different vaccines to protect them against 16 different vaccine-preventable diseases.

While that sounds like a lot, keep in mind that 33% of those immunizations are just from your child’s yearly flu vaccine.

Vaccine-Preventable Diseases

Of course, kids in the United States don’t get all available vaccines and aren’t protected against all possible vaccine preventable diseases. Some vaccines are just given if traveling to a high risk area or in other special situations.

Vaccine-preventable diseases (in the United States, children and teens are routinely protected against the diseases highlighted in bold) include:

  1. adenovirus – a military vaccine
  2. anthrax – vaccine only given if high risk
  3. chicken pox – (Varivax, MMRV)
  4. cholera – vaccine only given if high risk
  5. dengue – vaccine not available in the United States
  6. diphtheria – (DTaP/Tdap)
  7. hepatitis A – (HepA)
  8. hepatitis B – (HepB)
  9. hepatitis E – vaccine not available in the United States
  10. Hib – (Hib)
  11. HPV – (Gardasil)
  12. Haemophilus influenzae type b – (Hib)
  13. measles – (MMR, MMRV)
  14. meningococcal disease – (MCV4 and MenB and MenC)
  15. mumps
  16. pneumococcal disease – (Prevnar13 and PneumoVax23)
  17. pertussis – (DTaP/Tdap)
  18. polio – (bOPV and IPV)
  19. Q-fever – vaccine not available in the United States
  20. rabies – vaccine only given if high risk
  21. rotavirus – (RV1, RV5)
  22. rubella – (MMR, MMRV)
  23. shingles – vaccine only given to seniors
  24. smallpox – eradicated
  25. tetanus – (DTaP/Tdap)
  26. tick-borne encephalitis – vaccine not available in the United States
  27. tuberculosis – (BCG) – vaccine only given if high risk
  28. typhoid fever – vaccine only given if high risk
  29. yellow fever – vaccine only given if high risk

Discontinued vaccines also once protected people against Rocky mountain spotted fever, plague, and typhus.

These vaccine-preventable diseases can be contrasted with infectious diseases for which no vaccines yet exist, like RSV, malaria, norovirus, and HIV, etc., although vaccines are in the pipeline for many of these diseases.

What To Know About Vaccine Preventable Diseases

Available vaccines are helping to eliminate or control a number of vaccine-preventable diseases, like polio, measles, and diphtheria, but a lot of work is left to be done.

More About Vaccine Preventable Diseases

Johns Hopkins Hospital Warns Patients about Vaccine Shedding

The original Johns Hopkins Hospital Patient Guide did warn immunocompromised patients about contact with those who were recently vaccinated.
The original Johns Hopkins Hospital Patient Guide did warn immunocompromised patients about contact with those who were recently vaccinated.

Are recently vaccinated people causing outbreaks of vaccine-preventable diseases?

Should kids be put in quarantine after they get their vaccines?

Of course not, but some anti-vaccine folks continue to push outdated information that hospitals, including Johns Hopkins, warn cancer patients to avoid children who were recently vaccinated.

Although vaccine shedding is a concern with some live vaccines, like the oral polio vaccine and the small pox vaccine, it is important to keep in mind that neither has been used in the United States for some time now.

Hospitals no longer warn patients about restricting exposure to people who have recently been vaccinated.

Were websites scrubbed of information about shedding as part of some conspiracy?

Of course not.

They were simply updated to keep up with the latest guidelines.

Can Immunocompromised Patients Have Visitors?

These guidelines about kids with cancer aren’t that new though.

As far back as 2001, an article in the journal Pediatrics & Child Health, “Practical vaccination guidelines for children with cancer,” recommended that household contacts of immunosuppressed children should receive:

  • all routine, age-appropriate vaccines, including DTaP, IPV, Hib, MMR, and Tdap,  and that no special precautions are necessary because transmission of disease from these vaccines does not occur.
  • the varicella vaccine and that even in the event of a vaccine-associated vesicular rash, the transmission risk is low and the consequences of infection are limited by the attenuated nature of the vaccine virus.
  • an annual flu vaccine

These recommendations for household contacts of immunosuppressed children are based on the 2000 Red Book: Report of the Committee on Infectious Diseases.

The recommendations in latest (2012) edition of the Red Book  state that household contacts of people with an immunologic deficiency should also:

  • receive the rotavirus vaccines if indicated
  • receive either the inactivated influenza vaccine or live attenuated influenza vaccine, giving preference to the inactivated influenza vaccine only if the immunosuppressed person is a hematopoietic stem cell transplant (HSCT) recipient in a protected environment.
The revised Johns Hopkins Hospital Patient Information Guide no longer warns about contact with children who were recently vaccinated.
The revised Johns Hopkins Hospital Patient Information Guide no longer warns about contact with children who were recently vaccinated.

So hospitals should no longer be warning patients about restricting exposure to people who have recently been vaccinated.

In fact, the latest guidelines from the Immune Deficiency Foundation Advisory Committee state that except for the live oral poliovirus vaccine, close contacts can receive other standard vaccines because viral shedding is unlikely and these pose little risk of infection to a subject with compromised immunity.

The Immune Deficiency Foundation also warns that, “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.”

In other words, they are concerned about the risk of disease from intentionally unvaccinated kids and not from those who were recently vaccinated!

So, what about visitors?

“Tell friends and family who are sick not to visit.  It may be a good idea to have visitors call you first.”

The Johns Hopkins Hospital Patient Information Guide

Although you can’t prevent every cough and cold that might keep you from visiting a friend or family member who is being treated for cancer or has another immune system problem, keeping up to date on all vaccines can help to make sure that you don’t spread a vaccine-preventable disease, like measles or chickenpox, to them.

What To Know About The Johns Hopkins Vaccine Warning

Not only is Johns Hopkins Medical Center not telling cancer patients to avoid contact with children who recently received vaccines, they have gone out of their way to correct that misinformation from anti-vaccine websites.

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.

Some folks haven’t gotten the message though and continue to push the idea that Johns Hopkins and other Hospitals warn cancer patients to avoid contact with recently vaccinated children.

Who Is at Risk If You Don’t Vaccinate Your Kids?

Passive immunity doesn't last until 12 months, when infants get their first dose of the MMR vaccine, so they are at risk for disease.
Passive immunity doesn’t last until 12 months, when infants get their first dose of the MMR vaccine, so they are at risk for disease. Photo by Jamie Beverly (CC BY-SA 2.0)

Whenever there is a discussion about folks who intentionally choose to not vaccinate themselves or their kids, one of their arguments invariably is ‘why are you so worried if you and your kids are vaccinated?”

Here is an example:

“My argument is simple. If you are vaccinated, you should not have to fear an outbreak of any preventable disease. That’s what the vaccine is supposed to prevent, right? Therefore, why should anyone butt into someone else’s business and tell them they should vaccinate? If one and one’s dependents are vaccinated, why should they have to worry about my personal decision to not vaccinate?”

I personally don’t believe in vaccines

As most people understand, the argument is far from simple.

Who Is at Risk If You Don’t Vaccinate Your Kids?

There are many people who are at risk from those who are unvaccinated, including those who:

  • are too young to be vaccinated or fully vaccinated – remember, with the latest immunization schedule, kids don’t typically get their first MMR until age 12 months and their second until they are 4 to 6 years old
  • can’t be fully vaccinated and have a true medical exemption – this includes children and adults with some immune system problems, vaccine allergies, or other contraindications to getting one or more vaccines
  • were vaccinated, but later developed an immune system problem and their immunity has worn off – might include children with cancer, AIDS, those receiving immunosuppressive therapy after a transplant, or a condition that requires immunosuppressive doses of steroids, etc.
  • were vaccinated, but their vaccine didn’t work or has begun to wear off (waning immunity) – vaccines work well, but no vaccine is 100% effective

These are the children and adults that can be, and should be, protected by herd immunity. At least they can be when most folks are vaccinated.

“We want to create a ‘protective cocoon’ of immunized persons surrounding patients with primary immunodeficiency diseases so that they have less chance of being exposed to a potentially serious infection like influenza.”

Medical Advisory Committee of the Immune Deficiency Foundation

So while some folks who are against vaccines try to scare others about shedding, those who take care of kids with immune system problems and their families go out of the way to get everyone around them vaccinated so their kids aren’t at risk of getting a vaccine-preventable disease!

“…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.”

Medical Advisory Committee of the Immune Deficiency Foundation

Tragically, not everyone has gotten the message, and we continue to see and hear about kids who are too young to be vaccinated or who couldn’t be vaccinated get exposed to those who got sick because they simply chose to not get vaccinated.

What to Know About Risks from the Unvaccinated

Intentionally unvaccinated children and adults put others at risk for vaccine-preventable diseases.

More Information on Risks from the Unvaccinated

Rabies Vaccines

Rabies is a little different than most vaccine-preventable disease.

While we do have a rabies vaccine, in fact, one of the first vaccines when it was developed in 1885 by Louis Pasteur, it is typically given after you have been exposed to the rabies virus. Most other vaccines are routinely given before you are ever exposed to the diseases they prevent.

And the rabies vaccine has changed a lot since Pasteur’s day.

Instead of getting daily shots for 14-21 days, the rabies vaccine is now given when you are exposed, with human rabies immune globulin (HRIG), with further doses of vaccine on days 3, 7, and 14.

Do you need a rabies vaccine after getting bit by an animal?

It depends on the animal and whether or not the animal can be quarantined (confined and observed for rabies symptoms for 10 days).

And while any mammal can get rabies, the ones that are most worrisome are:

  • raccoons, skunks, bats, foxes, and coyotes
  • cats, dogs, and ferrets
  • livestock, cattle, horses

Most importantly, note that “Recent data suggest that transmission of rabies virus can occur from minor, seemingly unimportant, or unrecognized bites from bats.”

The CDC states that “Small rodents like squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, and mice) and lagomorphs including rabbits and hares are almost never found to be infected with rabies and have not been known to transmit rabies to humans.”

For Information on Rabies Vaccines:

FluMist

FluMist, the live, attenuated influenza vaccine (LAIV) that is given intranasally, instead of like a traditional flu shot, was first approved by the FDA in 2003.

At that time, it could be given to healthy, nonpregnant persons aged 5 to 49 years.

The age indication was lowered to include healthy kids between the ages of 2 to 4 years in 2007, in time for the 2007-08 flu season.

Other changes to FluMist over the years include that:

  • the dose was lowered from 0.5ml to 0.2ml in 2007
  • FluMist stopped being shipped frozen in 2007, instead being shipped at a higher 35°F to 46°F
  • Flu Quadrivalent was approved in 2012, but didn’t become available until the 2013-14 flu season
  • MedImmune, the makers of FluMist, begin to investigate reports of “lower than expected effectiveness” during the 2013-14 flu season and “possible problems with thermostability” are fixed
  • for the 2014-15 flu season, FluMist became the preferred flu vaccine for children between the ages of 2 to 8 years
  • the preferential recommendation for FluMist was removed the next year, for the 2015-16 flu season, when either inactivated flu shots or FluMist were recommended

And of course, for the 2016-17 flu season, the ACIP and AAP recommended that FluMist not be used at all.

About 14 million doses of FluMist would have been available in the United States during the 2016-17 flu season. Although a small percentage of the 171 to 176 million total doses of available flu vaccine, FluMist has been very popular with pediatricians, parents and especially children, as it helps avoid a shot.

Based on data from observational studies showing lower than expected effectiveness of FluMist Quadrivalent from 2013 through 2016, on June 22, 2016, the Advisory Committee on Immunization Practices (ACIP), an advisory committee to the Centers for Disease Control and Prevention (CDC), voted to recommend that FluMist Quadrivalent should not be used during the 2016-2017 influenza season.

There are “discordant results among” studies though and experts aren’t sure why.

If You Need More FluMist Information:

References:
  • MMWR. Notice to Readers: Expansion of Use of Live Attenuated Influenza Vaccine (FluMist®) to Children Aged 2–4 Years and Other FluMist Changes for the 2007–08 Influenza Season. November 23, 2007 / 56(46);1217-1219
  • MMWR. Recommendations of the Advisory Committee on Immunization Practices — United States, 2016–17 Influenza Season. August 26, 2016 / 65(5);1–54.

Vaccines in Pregnancy

Can children get vaccinated when their mother is pregnant?

Yes.

The CDC states that “pregnancy of recipient’s mother or other close or household contact” is not a contraindication to getting vaccinated, even for live vaccines like MMR or Varivax.

Vaccines for Pregnant Women

Since infants can't get a flu shot until they are 6 months old, they rely on their pregnant mothers to get vaccinated and to pass on their protection to them.
Since infants can’t get a flu shot until they are 6 months old, they rely on their pregnant mothers to get vaccinated and to pass on their protection to them.

What about pregnant women?

Are vaccines safe or necessary for them?

While they shouldn’t get live vaccines, like MMR, Varivax, Flumist, or the yellow fever vaccine, or the HPV vaccine, it is safe and necessary for pregnant women to get most other vaccines.

In fact, all pregnant women should get:

Getting vaccinated during pregnancy helps protect newborn babies and infants against the flu and pertussis (whooping cough).

Are Vaccines During Pregnancy Really Safe?

What about the idea that vaccines have never been tested for safety or effectiveness in pregnancy?

“Health care providers and patients should be aware that the reassuring safety data for use of the aforementioned vaccines in pregnancy are compelling, and there is no link to vaccine administration and miscarriage.”

ACOG on Vaccines Routinely Recommended during Pregnancy

The seasonal flu and Tdap vaccines, the two most commonly recommended are safe and effective in pregnancy. And so are the others that are not contraindicated.

In fact, the Vaccine Safety Datalink has published 14 studies “related to pregnancy and vaccination during pregnancy” and is “also able to use data to study the health of children born to women who were vaccinated during pregnancy.”

What About the Association of Flu Shots with Miscarriages?

You may have seen the headlines about a new study in which “Researchers find hint of a link between flu vaccine and miscarriage.”

Published in the journal Vaccine, the study did find that having a miscarriage “was associated with influenza vaccination in the preceding 28 days.”

The “modest” association only held during the 2010-12 flu seasons though and only if:

  • the mother had also received an H1N1 flu vaccine the previous year
  • the flu vaccine was given early in her pregnancy

The association was found by comparing two small groups of women who were pregnant during flu season, including one whose pregnancy ended in a miscarriage. They then compared the two groups to find differences. And the main difference they found was that the group with the miscarriages were more likely to have had a flu shot the previous year. So that is the link, association, or maybe more appropriately named – the correlation.

“This study does not quantify the risk of miscarriage and does not prove that flu vaccine was the cause of the miscarriage.”

CDC on Flu Vaccination & Possible Safety Signal

Interestingly, the study found no association between having a flu shot during the same season and having a miscarriage. The pregnant women in the control group were just as like to have flu shots, even early in their pregnancy.

It is also important to note that several other studies have not found an association between miscarriages and flu shots, including an almost identical study that looked at the 2005-07 flu seasons!

“A recent publication has reported a safety signal concerning influenza vaccination when given very early in the first trimester. In this study, influenza vaccination, when given in very early pregnancy, was associated with an increased risk of a pregnancy loss within the first 28 days following vaccination. Scientifically, it is unclear why this would occur. There was no association seen with a pregnancy loss more than 28 days after vaccination. In the same study, when vaccination was given either later in the first trimester or in the second or third trimester, there was no association seen with pregnancy loss or any other adverse pregnancy outcomes. Additional studies are needed to address the concern raised by this study.”

ACOG statement It is Safe to Receive Flu Shot During Pregnancy

So it is still safe to get a flu shot while you are pregnant, as this possible association continues to be studied. There are already ongoing studies looking at flu shots and pregnancy during the 2012 through 2015 flu seasons that will be completed next year.

“Two other medical journals rejected the article before a third, Vaccine, accepted it. Dr. Gregory Poland, Vaccine’s editor-in-chief, said it was a well-designed study that raised a question that shouldn’t be ignored. But he doesn’t believe flu shots caused the miscarriages. “Not at all,” said Poland, who also is director of vaccine research at the Mayo Clinic.

Though this study may cause worry and confusion, it is evidence “of just how rigorous and principled our vaccine safety monitoring system is,” said Jason Schwartz, a Yale University vaccine policy expert.”

AP report Study prompts call to examine flu vaccine and miscarriage

While most experts don’t think that getting a flu shot while you are pregnant is harmful, even considering this new study, they do know that getting the flu is.

What To Know About Vaccines During Pregnancy

When you are pregnant, getting your Tdap and flu vaccines can help keep you and your baby safe and healthy.

More Information on Vaccines During Pregnancy:

Updated September 13, 2017

Shingles Vaccine

The varicella zoster virus causes chicken pox.

When chicken pox becomes reactivated, people get shingles or herpes zoster. A painful rash that can last for several weeks, shingles can be prevented with Zostavax, the shingles vaccine. Licensed in 2006, it has been recommended that all seniors who are at least 60 years old get the shingles vaccine.

For more information: