Tag: mandates

Is the MMR Safe for 6-Month-Old Babies?

Most parents understand that the first dose of the MMR vaccine is routinely given to children when they are 12 to 15 months old, at least in the United States.

In some other countries, the first dose is routinely given as early as 8 to 9-months of age.

And in high-risk situations, the MMR can safely be given to infants as early as age 6-months.

Is the MMR Safe for 6 Month Old Babies?

An early MMR, is that safe?

This type of pure anti-vaccine propaganda is what caused the measles outbreaks in New York in the first place...
This type of pure anti-vaccine propaganda is what caused the measles outbreaks in New York in the first place…

Yes, it is safe.

What about the package insert?

“Local health authorities may recommend measles vaccination of infants between 6 to 12 months of age in outbreak situations. This population may fail to respond to the components of the vaccine. Safety and effectiveness of mumps and rubella vaccine in infants less than 12 months of age have not been established. The younger the infant, the lower the likelihood of seroconversion (see CLINICAL PHARMACOLOGY). Such infants should receive a second dose of M-M-R II between 12 to 15 months of age followed by revaccination at elementary school entry.”

MMR II Package Insert

The package insert says to give infants who get an early dose another dose when they are 12 to 15 months old! It doesn’t say to not protect these babies!

But what about the idea that the safety and effectiveness of MMR hasn’t been proven for infants under 12 months of age?

In general, the package insert is only going to list studies that the manufacturer used to get FDA approval for their vaccine. Since it is an off-label recommendation of the ACIP, they would not include the studies that show that an early MMR is safe and effective.

“In conclusion, this study indicated that the MMR was well tolerated and immunogenic against measles, mumps and rubella with schedule of first dose both at 8 months and 12 months age. Our findings strongly supported that two doses of MMR can be introduced by replacing the first dose of MR in current EPI with MMR at 8 months age and the second dose at 18 months in China.”

He et al on Similar immunogenicity of measles-mumps-rubella (MMR) vaccine administrated at 8 months versus 12 months age in children.

Before 8 months, an early MMR isn’t likely to be as effective as giving it later. That’s because some maternal antibodies might linger in a baby’s system and can interfere with the vaccine working, even after six months. How many antibodies and how much interference?

It’s almost impossible to tell for any one child, but the risk that this maternal protection has begun to wear off and these infants are at risk to develop measles is too great. That’s the reason that they get an early MMR, even though we know it won’t be as effective as a dose given later and we know it will have to be repeated.

Is this early dose safe?

“This review did not identify any major safety concerns. These findings may facilitate discussions about the risks and benefits of vaccinating infants who are potentially exposed to this life-threatening disease.”

Woo et al on Adverse Events After MMR or MMRV Vaccine in Infants Under Nine Months Old

Of course! Although the complications of measles can be serious, even deadly, we aren’t going to recommend something that is even worse.

“Early MMR vaccination is well tolerated, with the lowest AE frequencies found in infants aged 6-8 months. It is a safe intervention for protecting young infants against measles.”

van der Maas et al on Tolerability of Early Measles-Mumps-Rubella Vaccination in Infants Aged 6-14 Months During a Measles Outbreak in The Netherlands in 2013-2014.

So an early MMR is safe, with few risks, and is likely effective at preventing measles.

And by now you know what’s not safe. That’s right, getting measles.

More on Early MMR Vaccines

Timeline of the Measles Outbreak in Brooklyn

Breaking News – there are 31 new cases in Brooklyn, as a judge upholds the order, and more parents face penalties (see below).

There have been several big outbreaks of measles in the United States this year, but until recently, the biggest hadn’t gotten much attention.

As the outbreak in Brooklyn kept getting bigger and bigger, most people focused on the outbreaks in Clark County, Washington and Rockland County, New York.

Timeline of the Measles Outbreak in Brooklyn

Of course, with the emergency order in Brooklyn, the focus is now shifting.

So what do we now about the Brooklyn measles outbreak?

  • the outbreak began in October 2018 and was started by a traveler returning from Israel, where there is a large outbreak
  • as of early April, there have been 285 cases (we rarely see that many cases in an entire year, even when combining all of the cases in the whole country!)
  • most cases are in the Orthodox Jewish community, even though this is not a religious issue, except that this community has been targeted by an antivaccine group
  • 246 cases have been in children
  • the youngest case was an infant who was only 4 weeks old!
  • 21 people have been hospitalized
  • 5 have been admitted to the ICU!

What else do we know?

Although the outbreak is in its 5th month, which is very long for a measles outbreak in the post-vaccine era, there have been 152 new cases in just the past month!

There were 133 measles cases in Brooklyn in early March.

So at a time when cases should have already stopped (most outbreaks only last a few months), or at least be decreasing, the Brooklyn outbreak has more than doubled in size!

There have been 285 cases of measles in the Brooklyn outbreak.

There is no sign of it stopping either, with news reports of more than 20 to 40 cases each week.

And that’s what brought on the April 9 declaration of an emergency order.

“IT IS HEREBY ORDERED that any person who lives, works or resides within the 11205, 11206, 11221 and/or 11237 zip codes and who has not received the MMR vaccine within forty eight (48) hours of this Order being signed by me shall be vaccinated against measles unless such person can demonstrate immunity to the disease or document to the satisfaction of the Department that he or she should be medically exempt from this requirement. “

ORDER OF THE COMMISSIONER to All persons who reside, work or attend school in the neighborhood of Williamsburg, Brooklyn, New York and to the parents and/or guardians of any child who resides, works or attends school in the neighborhood of Williamsburg, Brooklyn, New York

Does this mean that they will be forcing everyone in Williamsburg to get vaccinated? And arresting those that don’t?

“I want to do the common sense point. We are trying to get people vaccinated. Our goal is not to find anyone. Our goal is not to shut down schools. Our goal is to get people vaccinated.”

Mayor Bill De Blasio

It should be clear that they are just trying to end the outbreak.

“People in violation of the order will be identified through identification of exposures. Disease detectives will check for immunization status or immunity when tracing the contacts of a person who has developed the illness. “

Oxiris Barbot, M.D. Commissioner of Health

And no one will be forced to get a vaccine. You might be fined if you insist on not getting vaccinated and you have been exposed to someone with measles, but you still won’t be forced to get the vaccine.

Why did it come to this?

Couldn’t they just quarantine folks who are exposed?

Well, they have been trying that…

And it hasn’t been working.

Williamsburg press conference with NYC Mayor Bill De Blasio, with Herminia Palacio, MD, NYC Deputy Mayor of Health and Human Services, and Oxiris Barbot, MD, NYC Commissioner of Health
Williamsburg press conference with NYC Mayor Bill De Blasio, with Herminia Palacio, MD, NYC Deputy Mayor of Health and Human Services, and Oxiris Barbot, MD, NYC Commissioner of Health

In addition to schools continuing to let in unvaccinated students, the health department is concerned that people in the community might actually be having measles parties!

“So we have not used a public health emergency to mandate vaccine in recent history. The circumstance of the combination of a large anti-vax movement in combination with a large outbreak has not happened in the way that it has happened right now.”

Dr. Herminia Palacio, NYC Deputy Mayor of Health and Human Services

As in Rockland, there is also an aggressive anti-vaccine campaign in Brooklyn that is pushing misinformation and is scaring parents away from vaccinating their kids.

30 new cases this week

The case count jumped again on April 24, to 390 cases.

“The Health Department announced today that the number of measles cases has grown to 390, including two pregnant women diagnosed with the infection, one diagnosed in mid-April… Twelve individuals have received summonses for being non-compliant with the Emergency Order since the City began issuing summonses last week. “

If you are upset that this is happening in Brooklyn, the outbreaks and the response to the outbreaks, just remember that it is the anti-vaccine groups working in the community are to blame.

Vaccines are safe, with few risks, and are very obviously necessary.

Get vaccinated. Stop the outbreaks.

Timeline of the Measles Outbreak in Brooklyn

Updated April 18, 2019

Why Is a Kentucky Teen Who Refused to Get Vaccinated Suing His School?

One extra consequence of the rise in cases of vaccine-preventable diseases we have been seeing lately, in addition to the fact that more kids are getting sick, is that we are seeing more kids being quarantined and kept out of school.

“The parents of 42 children affected by the ban at the school, the Green Meadow Waldorf School, sued the Rockland County health department, asking a federal judge to issue an injunction to allow the children to return.”

Parents Wanted Their Unvaccinated Children in School, but a Judge Said No.

And in a few cases, we are seeing lawsuits trying to get some of these kids, mostly intentionally unvaccinated kids, back into school.

Why Is a Kentucky Teen Who Refused to Get Vaccinated Suing His School?

While most outbreaks are related to measles, in Kentucky, a large outbreak of chickenpox at Our Lady of the Sacred Heart/Assumption Academy in Walton has led to the quarantine of a number of unvaccinated students.

A chickenpox quarantine sign

One student, a senior and the starting center on the school basketball team, is suing to get him back in school.

“The Kunkels filed their lawsuit Thursday in the Boone County Circuit Court alleging that the Northern Kentucky Health Department had violated Jerome’s First Amendment rights. Accepting the chickenpox vaccine would be “immoral, illegal and sinful,” they said, according to their Catholic beliefs. The lawsuit also alleges that the health department violated due process when officials enacted the extracurricular and school attendance bans without declaring an official emergency, which would have triggered the involvement of the state legislature.”

God, country and chickenpox: How an outbreak entangled one school in a vaccine showdown

So they are actually suing the health department, not his school, to get him back into school…

Wait a minute though?

Is the Catholic Church against vaccines?

“Since there is no Catholic teaching that the use of these vaccines is sinful, schools cannot allow Catholic parents to claim a religious exemption from the requirement of immunization.”

National Catholic Bioethics Center on Vaccines and Exemptions Granted by Schools

Are they against the chickenpox vaccine?

“One is morally free to use the vaccine regardless of its historical association with abortion. The reason is that the risk to public health, if one chooses not to vaccinate, outweighs the legitimate concern about the origins of the vaccine. This is especially important for parents, who have a moral obligation to protect the life and health of their children and those around them.”

National Catholic Bioethics Center

No, they aren’t, which is why most Catholics vaccinate and protect their kids.

“In the event that the county health department or state health department declares an outbreak of a vaccine-preventable disease for which proof of immunity for a child cannot be provided, he or she may not be allowed to attend childcare or school for up to three (3) weeks, or until the risk period ends.”

Kentucky Parent or Guardian Declination on Religious Grounds to Required Immunizaitons

A judge will have to decide the merits of the case, but from a moral standpoint, it seems like they are on shaky ground.

More on Quarantines for Intentionally Unvaccinated Kids

False Balance About Vaccines at the Chicago Tribune

As more folks are calling out vocal vaccine deniers, many are also learning the role of the media in helping fuel the anti-vaccine movement.

“Whatever you think about Andrew Wakefield, the real villains of the MMR scandal are the media.”

Ben Goldacre on The MMR story that wasn’t

Believe it or not, there likely would not have been a big scare over the DPT vaccine in the 1970s and 80s or concerns about the MMR vaccine if the media hadn’t given so much attention to the anti-vaccine players involved.

False Balance About Vaccines at the Chicago Tribune

Folks in the media have learned their lesson though, right?

“Balance? There is no balance. There is mainstream, superstrong consensus about the value of vaccination, and on the other side … nothing else, since there is no other side. The media have made parents worry about vaccines in a lame effort to provide balance and all points of view.”

Arthur Caplan on There is no other side to the vaccine debate

Well, apparently not all of them…

If you are quoting anti-vaccine activists, then you are doing something wrong...
If you are quoting anti-vaccine activists, then you are doing something wrong…

Why would the Chicago Tribune devote nearly 20% of an article to a parent who is against vaccines, especially without correcting her misinformation?

Why haven’t they learned that spreading this kind of misinformation is what scares parents away from vaccinating and protecting their kids in the first place?

Are vaccinations about parent choice or public safety? That’s the title of the Chicago Tribune article. And maybe that’s why Illinois is among top 5 states for measles as debate heats up, the rest of the title…

How about we give parents a chance to make informed choices without being influenced by propaganda and misinformation?

More on False Balance About Vaccines at the Chicago Tribune

Did Bob Sears admit that he doesn’t “waste my breath” talking about the benefits of vaccines?

Have you noticed the bias in the anti-vaccine movement?

His advocacy against vaccines??? And what about his "educational" writings?!?
His advocacy against vaccines??? And what about his “educational” writings?!?

It’s hard to miss…

The Bias in the Anti-Vaccine Movement

Yes, that’s it.

You really only get one side from anti-vaccine folks.

But that’s not all.

In addition to never mentioning the benefits of vaccines, they make you think that:

  • you don’t have to worry about getting measles, chicken pox, and rubella, etc., anymore, because these diseases are rare, forgetting to mention that they are still relatively rare in many countries because most people are vaccinated and protected! When more folks skip or delay their vaccines, as they forget what these diseases are like and they listen to anti-vaccine propaganda, we get outbreaks, especially when they aren’t vaccinated and they travel to places where the diseases are more common!
  • everyone else overlooks the risks, when in fact, the risks of getting vaccinated and protected are just small and all of the so-called vaccine-induced diseases and other things anti-vaccine folks blame on vaccines aren’t real vaccine injuries
  • you don’t have to worry about getting measles, pertussis, or pneumococcal disease, etc., because those diseases are all mild, neglecting to mention that some people do have complications and some die when they catch them
  • if you don’t choose to vaccinate your kids on your own, someone is going to force you to get them vaccinated, overlooking that vaccine mandates don’t actually force anyone to vaccinate their kids – they are just about whether or not intentionally unvaccinated kids should be able to attend school
  • your choice to skip or delay your child’s vaccines won’t affect anyone else, failing to mention that most outbreaks are started by someone who is intentionally not vaccinated
  • if there is a risk, there must be a choice, but with their slogan, they overstate the risks of vaccines, never mention the risks of having the disease, and don’t mention the risk of your child getting other people sick, taking away their choice to keep their kids safe and healthy
  • you can always get vaccinated, but you can never get unvaccinated, neglecting to mention that you can indeed wait too long to vaccinate your kids

The biggest bias though, is not that these folks are against vaccines, but rather that everything they do and say scares parents and makes them feel that they should skip or delay their child’s vaccines, leaving them unprotected and at risk.

Stop listening to them and stop spreading their anti-vaccine propaganda.

More on the Bias in the Anti-Vaccine Movement

The History of Vaccine Exemptions

As we are starting to see some states get rid of their exemptions with new vaccine laws, it is important to understand that many non-medical exemptions came on the scene relatively recently.

After vaccine mandates to start school helped eliminate measles in the United States, over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions. Texas and Arkansas added theirs a little later, during the 2003-04 school year.

The History of Vaccine Exemptions

What happened in 1998 that made state lawmakers in 15 states allow parents to use personal belief vaccine exemptions to opt out of vaccinating and protecting their kids?

Andrew Wakefield happened in 1998...
Andrew Wakefield happened in 1998…

Oh yeah, that’s when Andrew Wakefield published his infamous paper in Lancet that was later retracted.

That’s right, these exemptions had their origins in perhaps the biggest anti-vaccine myth of them all!

Not that there weren’t warnings. Many of us knew adding the exemptions was a bad idea at the time…

The Austin American Statesman published an editorial in 2003 urging Legislators to fix the mess they had just created.
The Austin American Statesman published an editorial in 2003 urging Legislators to fix the mess they had just created.

And now, here we are with rising rates of vaccine-preventable disease as folks use and abuse their exemptions.

So while you are thinking about whether or not your state legislators should be taking away your personal belief vaccine exemption, a better question would likely be why they added them in the first place.

More on the History of Vaccine Exemptions

What Did Benjamin Franklin Say About Vaccines?

Wait, we had vaccines when Ben Franklin was around?

You can learn what Benjamin Franklin thought about vaccines from his autobiography.
You can learn what Benjamin Franklin thought about vaccines from his autobiography.

That was a long time ago.

What Did Benjamin Franklin Say About Vaccines?

Well, we had variolation…

“Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety.”

Benjamin Franklin

The Benjamin Franklin quote many anti-vaccine folks are using these days (do anti-vaccine folks get daily talking points to use?) doesn’t really have anything to do with vaccines though, at least not in the way that they think it does.

“The Franklin quote he nodded to on Tuesday, ironically, means the opposite of what Paul was arguing. When Franklin said, “Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety,” he was opposing the Penn family’s attempt to carve out an exception for themselves from the Pennsylvania General Assembly’s attempt to tax their lands for the collective good of frontier defense. The liberty Franklin was defending was the liberty the rest of us deserve now, too — liberty to choose to protect ourselves.”

Saad B Omer on Rand Paul is wrong: Vaccines are no threat to liberty

It should be clear that Ben Franklin’s quote shouldn’t be used to attack vaccine mandates. If anything, it can be used to attack free-riders and those who skip or delay vaccines and try to hide in the herd!

“It is a quotation that defends the authority of a legislature to govern in the interests of collective security. It means, in context, not quite the opposite of what it’s almost always quoted as saying but much closer to the opposite than to the thing that people think it means.”

Benjamin Wittes onBen Franklin’s Famous ‘Liberty, Safety’ Quote Lost Its Context In 21st Century

Interestingly, Benjamin Franklin did famously talk about vaccines, or at least smallpox variolation.

“In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.”

Benjamin Franklin

He got a little temporary safety, avoiding the side effects of variolation, but what were the consequences? What did he lose?

What do you lose when you make decisions about vaccines based on vaccine misinformation?

What do folks like Rand Paul have to gain by speaking out against vaccines?

More on Benjamin Franklin and Vaccines