Tag: mandates

Who was Betty Bumpers?

Only when every child has completed his or her series of immunizations will our job be completed.

Even as some schools and communities continue to face outbreaks of measles, chicken pox, and other vaccine-preventable diseases, there is a very good chance that your kids are in a school where you don’t have to worry about them getting sick.

There is also a good chance that you have no idea who made that possible.

Who was Betty Bumpers?

Sure, a lot of it has to do with all of the parents who are making the right choice in vaccinating and protecting their kids.

And of course, there are the folks who actually developed the vaccines.

But there was a time when we had many vaccines and kids still weren’t getting protected.

“I don’t think that there is anything more important than immunizing our children and preventing unnecessary suffering. We’ve seen too much of that and it’s been so exciting now to see immunization rates going up. Betty Bumpers and I have worked on this for a long time, but Betty Bumpers is the real hero. She has done more for immunizations than any one person in this whole country.”

Former First Lady Rosalynn Carter

That changed in the early 1970s, when Betty Bumpers, as the First Lady of Arkansas, worked to raise immunization rates in her state, with the Every Child By ’74 campaign.

The Every Child in '74 immunization program immunized over 300,000 children in Arkansas.
The Every Child in ’74 immunization program immunized over 300,000 children in Arkansas.

She didn’t stop in Arkansas though.

“I believe our program, based upon volunteers and government agencies already in pace, has been tremendously successful.”

Betty Bumpers

In 1975, she told a Senate subcommittee that her immunization program could serve as a model for other states too.

“Measles incidence declined dramatically after large vaccination campaigns, but transmission was not interrupted. The licensure of rubella vaccine in 1969 led to mass campaigns to immunize children to avert an anticipated repeat of the tragic epidemic of 1964–65, which resulted in the births of approximately 20,000 infants with congenital rubella syndrome. The rubella campaigns diverted attention and funding from measles, resulting in a resurgence of measles. Federal funding for Section 317 declined during the early to mid-1970s. Immunization coverage fell, and disease increased.”

Vaccine-Preventable Diseases, Immunizations, and MMWR — 1961–2011

A few years later, President Jimmy Carter announced the National Childhood Immunization Initiative of 1977, a program that was stimulated by the efforts of Betty Bumpers, with Rosalynn Carter.

In addition to increased spending on immunization programs, we soon had laws in every state requiring students to be vaccinated before they could attend school, and not surprisingly, measles cases quickly dropped.

It didn’t last.

Without support for immunization programs from the Reagan administration, vaccination rates dropped and measles cases soared.
The Role of Measles Elimination in Development of a National Immunization Program

In the year’s that followed the Carter administration, Federal support for vaccine programs reached a low point, as rates of children living in poverty and without health insurance also increased.

To help combat this rise in vaccine-preventable disease, Betty Bumpers, again with Rosaylnn Carter, launched Every Child By Two – Carter/Bumpers Champions for Immunization.

Founded in 1991, Every Child By Two, now Vaccinate Your Family, has worked to raise awareness about the importance of getting vaccinated on time and on schedule. This was especially important at the time, when many preschool age kids weren’t getting vaccinated. And it still is, as misinformation about vaccines continues to scare some parents away from vaccinating and protecting their kids.

She also worked with her husband, Senator Dale Bumpers, to encourage Bill Clinton’s administration to develop the Childhood Immunization Initiative, which he proposed in 1993, and to pass the Vaccines for Children Program, which was created by the Omnibus Budget Reconciliation Act of 1993.

The Dale and Betty Bumpers Vaccine Research Center wad dedicated in 1999.

In addition to her work helping get kids vaccinated, Betty Bumpers:

She is truly a hero and should be remembered for all of the work she did.

Whether folks understand it or not, it is because of the work of Betty Bumpers that even as some folks skip or delay their child’s vaccines, the outbreaks they cause are eventually contained before they get out of control.

Betty Bumpers was a champion in our efforts to reduce the burden of vaccine-preventable diseases among children in the United States.  She played a major leadership role as 1st Lady of Arkansas in improving immunization in that state and was inspirational in launching the first major Presidential Initiative on Immunization during the late 1970s.  She continued to be a major immunization advocate through much of her life launching “Every Child By Two (ECBT)” which she chaired along with Mrs. Rosalyn Carter, now “Vaccinate Your Family”.

Walter Orenstein

That work will continue to save the lives of millions of children, at least it will as long as we don’t let folks chip away at it, allowing them to abuse exemptions and spread propaganda, scaring parents away from vaccinating and protecting their kids.

That’s why we all must continue her work

For as Betty Bumpers said, “only when every child has completed his or her series of immunizations will our job be completed.”

More on Betty Bumpers


Vaccine Requirements for College Entry

Most of our kids are up-to-date on their vaccines by the time they are ready to start college.

That’s likely why few of us give college vaccine requirements much thought.

Will this chicken pox outbreak in Ohio spread?
Will this chicken pox outbreak in Ohio spread?

But maybe it is something we should start thinking about more, as it seems that many colleges do not have actually require their students to be vaccinated and protected!

Vaccine Requirements for College Entry

The one vaccine that is the most often associated with going to college is the one that protects our kids against meningococcal disease.

That’s actually two vaccines though:

  • MCV4 – Menactra or Menveo
  • MenB – Bexsera or Trumenba

Which other vaccines should kids get before going to college?

They should get whatever vaccines they might have missed when they were younger, including MMR, chicken pox, hepatitis A, hepatitis B, Tdap, HPV, and polio vaccines.

Plus they should get a flu vaccine every year.

Vaccine Recommendations for College Entry

Unfortunately, in many cases, instead of requirements to attend college, we really just have recommendations that students can choose to ignore.

What’s the likelihood that your fellow students are vaccinated and protected?

How many are unvaccinated?

Which school do you plan on attending?

“Immunizations are recommended to protect your health and the health of others, but they are not required by the university.”

Welcome to the University of Michigan!

Fortunately, most schools do require at least some vaccines.

In addition to either Menactra or Menveo, many require two doses of MMR.

Some also require three doses of hepatitis B vaccine.

A few, like the University of Michigan and the University of Wisconsin don’t require any vaccines though.

These are the ten of the biggest colleges in America, at least in terms of enrollment, and their immunization rules:

TdapMMRVarHepA/BMCV4MenBHPVIPV
OSU12
2X/31XX4
FlaR2RR/31RRR
Minn12XXXXXX
ASUR2XXRXRX
UTRRRR/R1XRX
UCFR2RR/RRRRR
A&MXXXX1XXX
MichRRRR/RRXRR
PSU
R2RR/RRRRX
WiscRRRR/RRX
RR

On the bright side, Ohio State University, with one of the largest combined graduate and undergraduate enrollment, has the strongest immunization requirements.

On the other hand, it is quite sad that many of the others either have weak requirements, only recommend (R), but don’t actually require many common immunizations for enrollment, or don’t even mention them (X).

Why don’t more colleges have stricter immunization requirements for enrollment?

It is likely that they haven’t caught up with the problem of parents skipping or delaying their kids’ immunizations.

“While many infectious diseases such as meningitis are rare, it is not uncommon for hundreds of students at a large university to contract the flu each season.”

Contagious on campus

Which brings us to a problem – how can colleges hope to control outbreaks well if they don’t even know which students are vaccinated or not, and so can’t easily quarantine unvaccinated students? They seem to manage mumps and meningococcal outbreaks, but neither are as contagious as measles or chicken pox. 

Do we really need to wait for more outbreaks on college campuses before we start requiring that kids be vaccinated and protected before going to college?

At the very least, can we at least start tracking vaccine-preventable disease rates in college kids, make flu deaths in college students reportable, and report vaccination exemption rates by college campus?

More on Vaccine Requirements for College Entry

Why Don’t People with HIV or HepB Have to Wear Badges?

There is a very good reason why people with HIV and hepatitis B don’t have to wear distinctive badges.

Have you ever thought that people with HIV should wear badges???
Have you ever thought that people with HIV should wear badges???

And whether or not they work in a hospital, it has nothing to do with the fact that they don’t pose a risk to others, and it has nothing to do with health care workers who refuse to get a flu shot and have to wear a mask.

Confidentiality Rules and Civil Rights

Hopefully we have gotten over a lot of the misinformation and stigma that once kept kids with HIV and hepatitis B out of schools and teens and adults out of work.

“Ryan White confidentiality guidelines have helped allay the fears that many people living with HIV have around unwanted disclosure and HIV discrimination.”

Building Trust: Confidentiality and the Ryan White HIV/AIDS Program

And of course, that’s why people with HIV and hepatitis B don’t have to “wear any distinctive badges or clothing.”

The Americans with Disabilities Act (ADA) is the most powerful law safeguarding the rights of children in public and private schools and daycare centers. The law also prevents any organization or business from discriminating against a person because of a real or perceived disability, such as an infectious disease.

A second law, Section 504 of the Rehabilitation Act, bars schools, colleges and other organizations receiving federal funding from discriminating against children with disabilities. Section 504 identifies chronic liver disease as a “hidden disability.”

Legal Protections for Children with Viral Hepatitis

In fact, laws protect people with HIV/AIDS and other conditions, so that no one would try and make them “wear any distinctive badges or clothing.”

“Almost 30 years after the onset of the epidemic, HIV stigma and discrimination—fed largely by ignorance and animus—persist and continue to have a forceful impact on people living with HIV.”

HIV Stigma and Discrimination Persist, Even in Health Care

Or at least you would hope no one would try and make them wear a badge…

More on Rights of People with HIV and Hepatitis B

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

Measles Deaths in Italy

Breaking News – there are reports of two new deaths in Italy, including a young patient who died of measles encephalitis in 2017 and a young adult with leukemia just last month.

There have been a lot of measles deaths in Europe over the last few years?

How many?

Would you believe over 100?

Measles Deaths in Italy

Among those measles deaths in Europe, there have been at least twelve measles deaths in Italy (five in 2017 and seven in 2018, among just 7,697 cases), all either unvaccinated or partially vaccinated, including:

  • a 6-year-old boy with leukemia who caught measles from an intentionally unvaccinated sibling (2017)
  • an intentionally unvaccinated 9-year-old girl with chromosomopathy, which is not a contraindication to getting vaccinated (2017)
  • a 16-month-old girl with chronic medical problems who caught measles while hospitalized for persistent fever and a subsequent bleeding disorder (2017)
  • a 27-year-old woman (2017)
  • a young patient who died of measles encephalitis (December 2017)
  • a 25-year-old unvaccinated mother
  • a 10-month-old unvaccinated boy who likely caught measles when he had been hospitalized for an RSV infection
  • a 38-year-old
  • a 42-year-old unvaccinated man who was immunocompromised
  • a 51-year-old in Sicily
  • a 29-year-old in Sicily
  • a 23-year-old with leukemia in Trieste who had received one dose of the measles vaccine (October 2018)

Why so many deaths in a developed country with a well-nourished population?

Dr. Bob Sears actually reassured parents that measles wasn't deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe - another well-nourished population with lower vaccination rates than the U.S.
Dr. Bob Sears actually reassured parents that measles wasn’t deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe – another well-nourished population with lower vaccination rates than the U.S.

If you haven’t guessed yet, as in other countries in Europe, we are seeing more deaths from measles simply because folks aren’t vaccinated and more people are getting measles.

Measles is a life-threatening disease, even in an age of modern medicine, indoor plumbing, sewage systems, clean water, whole foods, vitamins and minerals, etc.

Italy, with about 1/5 the population of the United States, but about equal to the size of California, has had over 600 times as many cases of measles as we have had in the United States over the last few years. To put it in perspective, that would be like having 33,000 cases of measles in the United States.

Think it couldn’t happen? During the measles outbreaks from 1989 to 1991, when vaccination rates had dropped, there were 55,622 cases and 123 deaths in the United States.

Measles in Italy

Again, in Italy, as in other places, almost all of the measles cases, about 90%, have been in those who aren’t vaccinated.

In response to a post praising Italy's decision to dilute their new vaccine laws, some folks thought it was funny that people were dying of measles.
In response to a post from Dr. Bob Sears praising Italy’s decision to dilute their new vaccine laws, some folks thought it was funny that people were dying of measles.

That’s why they passed new vaccine laws – to get back to herd immunity levels of vaccination.

But shouldn’t folks have a choice about getting vaccinated?

Of course.

Even with the new vaccine laws, parents have a choice. As with vaccine laws in the United States, Italy’s new vaccine mandates had nothing to do with forced vaccination.

That’s unlike most of the people who died of measles in Italy. Most of them didn’t have a choice about being vaccinated and getting measles. Some were immunocompromised and couldn’t be vaccinated and at least one was too young to be vaccinated.

Parents had been set a July 10th deadline to provide schools with the relevant documentation, but it will now be possible for parents to simply submit their own confirmation that the child has been vaccinated, according to Giulia Grillo, Italy’s Health Minister, who was speaking at a press conference on Thursday.

Mandatory vaccinations: Italian parents will no longer need to provide doctor’s note

And that’s why it’s unfortunate that the a newly elected government severely watered down a vaccine law that had made getting vaccinated mandatory to go to school.

And it’s unfortunate that people continue to push misinformation about vaccines and vaccine-preventable diseases.

What to Know About the Measles Deaths in Italy

A drop in vaccination rates has led to measles outbreaks and a number of measles deaths in Italy.

More on Measles Deaths in Italy

Updated November 7, 2018

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

Why Did France Take the Rotavirus Vaccine off Their Schedule?

Have you heard that France took the rotavirus vaccine off their immunization schedule?

Why?

It was supposedly because two babies died of intussusception after being vaccinated.

Rotavirus Vaccines and Intussusception

Intussusception? Wasn’t that just a risk from RotaShield, the original rotavirus vaccine?

While the risk was higher with RotaShield, the current rotavirus vaccines do have a small risk of intussusception.

france-immunization-schedule
The French immunization schedule is published in the Bulletin épidémiologique hebdomadaire and has never included the rotavirus vaccine.

So did France take the rotavirus vaccine off of their schedule?

Technically, France hadn’t yet added the rotavirus vaccine to their schedule, but it had been available since 2006 and they did formally recommend infants get vaccinated beginning in November 2013.

That recommendation was suspended in April 2015, after they recorded 47 cases of intussusception over an 8 year period. This included 14 cases that required surgery and tragically, two deaths, including one child who died at home without getting any medical care. The other developed intussusception after the third dose of vaccine, which is not usually linked to any increased risk.

It is important to note that at least 80 other countries, including the United States, Finland, Germany, Norway, and the UK, haven’t stopped using the rotavirus vaccine.

Why not?

Because the risks of a natural rotavirus infection are much greater than the risk of intussusception. In other words, the benefits of the vaccine exceed its risks.

In France alone, for example, it is estimated that rotavirus vaccines could prevent 30,000 emergency room visits, 14,000 hospitalizations, and 8 to 17 deaths each year, all in children under the age of three years.

And even without the rotavirus vaccine, there are about 200 to 250 spontaneous intussusceptions each year in France. Fortunately, infants with intussusception can almost always be successfully treated, often without surgery.

Why Did France Take the Rotavirus Vaccine off Their Schedule?

It actually makes no sense that France stopped recommending that infants get vaccinated with one of the rotavirus vaccines.

The decision was widely condemned and there are calls to reassess the decision and put the rotavirus vaccine back on the schedule in France.

“After the surprising decision of the CTV-HCSP of April 2015 to suspend its own recommendation for widespread vaccination against Rotavirus (following a false and misleading pharmacovigilance report) against the international recommendations, we advise you to read the meta-analysis on efficacy (in comparative studies) and the effectiveness (field efficacy) of these vaccines.”

InfoVac Bulletin Novembre 11/2016

The benefits of the rotavirus vaccines far outweigh its risks.

“The estimated benefits of vaccination in our study greatly exceed the estimated risks and our results should contribute to provide further evidence for discussions around rotavirus vaccination in France.”

Larmrani et al A benefit–risk analysis of rotavirus vaccination, France, 2015

Why did France take the rotavirus vaccines off their schedule?

News of the Newark kids going to Paris to get Pasteur's rabies vaccine made the front page of the New York Times.
In 1885, four boys from New Jersey went all of the way to France to get Pasteur’s new rabies vaccine, which wasn’t yet available in the US.

That’s a good question.

Another good question? How many infants have died of rotavirus infections since they did? And when will they put the vaccine back on the schedule? Fortunately, the rotavirus vaccines are still available in France, they weren’t banned as some folks say.

Of course, this isn’t the first time that France impulsively suspended a vaccine.

In 1998, France suspended the routine vaccination of teens against hepatitis B because of the possible association of the vaccine with multiple sclerosis. This was done amid “pressure from anti-vaccine groups and reports in the French media have raised concerns about a link between HBV immunisation and new cases or relapses of MS and other demyelinating diseases,” even though “scientific data available do not support a causal association between HBV immunisation and central nervous system diseases, including MS.”

“In 1998, official concerns were first voiced over a possible association between hepatitis B virus (HBV) vaccination and multiple sclerosis (MS). Despite a number of studies that have demonstrated no such association, ten years on the French population’s confidence in the vaccine remains shaken and immunization rates of infants have stagnated beneath 30%. With a chronic carriage of the virus estimated at 0.68%, it seems unlikely that France will be able to control the circulation of the virus. ”

Marta Balinska on Hepatitis B vaccination and French Society ten years after the suspension of the vaccination campaign: how should we raise infant immunization coverage rates?

Do you know where all of this has left France now?

With high rates of vaccine-preventable disease (15,000 cases of measles in 2011, with 16 cases of encephalitis and 6 deaths) and a move towards vaccine mandates. As of January 2018, all infants and toddlers in France must receive DTaP, Hib, HepB, pneumococcal, MMR, and meningococcal C vaccines.

What to Know About France Taking the Rotavirus Vaccine off Their Schedule

In no longer recommending the rotavirus vaccines, officials in France actually put infants at greater risk for sickness and death.

More on France Taking the Rotavirus Vaccine off Their Schedule