Tag: medical exemptions

Dr. Baker Says to Stop Worrying About Measles!

Are you worried about measles?

Are you less worried because a chiropracter on the Internet told you to stop worrying?

Dr. Baker Says to Stop Worrying About Measles!

I have no idea who “Dr” Baker really is, but let’s take a look at his copypasta “evidence” for why you shouldn’t worry about measles.

What’s missing from his list?

All of the studies that say that vaccines aren’t associated with autism!

The study, Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality, which found that measles had an affect on non-measles deaths (causing more of them) through “measles-induced immune damage.”

And lots of other evidence that says that the MMR vaccine is safe, effective, and necessary.

If you really don’t want to have to worry about measles, get your kids vaccinated and protected.

Unfortunately, some folks don’t have that option, as their kids might be too young to get vaccinated or might have a true medical contraindication to getting vaccinated.

They have to worry about measles, no matter what “Dr.” Baker says, mostly because of your unvaccinated kids…

More on Worrying about Measles

Are Parents Faking Their Child’s Vaccine Records?

In 2015, California passed a vaccine law that removed all non-medical exemptions to getting vaccinated.

What was the response?

More kids got vaccinated.

Are Parents Faking Their Child’s Vaccine Records?

Not all of them though.

Shortly after the passage of SB277 we quickly learned of one way that parents were trying to get around the law – fake vaccine exemptions.

That’s right. Some doctors were selling fake vaccine exemptions using bogus medical symptoms, histories, and conditions.

And apparently, now that fake vaccine exemptions are getting harder to come by, some parents are simply trying to fake their child’s immunization records.

While I doubt a lot of people are faking their records, some probably are.

Some have already been caught forging their child’s vaccine records because their intentionally unvaccinated kids (who were supposed to be vaccinated) were involved in outbreaks!

Are those really your only vaccine choices? What about opting to vaccinate and protect your child?

Some others were caught writing fake vaccine exemptions, using forms from one of the doctor’s who notoriously sells fake medical vaccine exemptions!

Surprised?

You shouldn’t be.

This is the modern anti-vaccine movement.

More on Fake Vaccine Records

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

Autoimmunity as a Contraindication to Getting Vaccinated

Can your kids get vaccinated if they have an autoimmune disease?

Can your kids get vaccinated if you or another family member have an autoimmune disease?

Folks shouldn't be using 23andMe DNA testing to justify their not wanting to vaccinate their kids.
Folks shouldn’t be using 23andMe DNA testing to justify their not wanting to vaccinate their kids.

Can your kids get vaccinated if you did one of those 23andMe genetic risk type tests?

“Risks associated with use of the 23andMe GHR tests include false positive findings, which can occur when a person receives a result indicating incorrectly that he or she has a certain genetic variant, and false negative findings that can occur when a user receives a result indicating incorrectly that he or she does not have a certain genetic variant. Results obtained from the tests should not be used for diagnosis or to inform treatment decisions. Users should consult a health care professional with questions or concerns about results.”

FDA allows marketing of first direct-to-consumer tests that provide genetic risk information for certain conditions

Not surprisingly, in almost all cases, the answer is yes.

Autoimmunity as a Contraindication to Getting Vaccinated

That doesn’t mean that there aren’t some true medical reasons that kids shouldn’t be vaccinated.

“Contraindications (conditions in a recipient that increases the risk for a serious adverse reaction) and precautions to vaccination are conditions under which vaccines should not be administered. Because the majority of contraindications and precautions are temporary, vaccinations often can be administered later when the condition leading to a contraindication or precaution no longer exists. A vaccine should not be administered when a contraindication is present; for example, MMR vaccine should not be administered to severely immunocompromised persons. However, certain conditions are commonly misperceived as contraindications (i.e., are not valid reasons to defer vaccination).”

Vaccine Recommendations and Guidelines of the ACIP

Which autoimmune diseases are listed as contraindications to get vaccinated?

None.

Which autoimmune diseases are listed as precautions to get vaccinated?

There are just a few, including Guillain-Barré syndrome (DTaP, Tdap, and flu vaccines) and thrombocytopenic purpura (MMR), but they typically don’t mean that you can’t still get vaccinated. And the general precaution to avoid getting a vaccine during “moderate or severe acute illness with or without fever” would apply to a time when you are acutely sick with your autoimmune disease, but you would get vaccinated once your symptoms were under better control.

Other things about autoimmune diseases are simply misperceived as being contraindications or precautions to getting vaccinated. Or they are pushed as anti-vaccine propaganda to scare you away from getting vaccinated and protected or to help you get a fake medical exemption.

“…vaccines are able to prevent some infections in MS patients known to accelerate the progression of the disease and increase the risk of relapses.”

Mailand et al on Vaccines and multiple sclerosis: a systemic review

For example, not only do vaccines not cause multiple sclerosis, they are recommended because they can prevent vaccine-preventable diseases that can make the disease worse for many people.

And flu shots and other vaccines are highly recommended for kids with diabetes, as they are at high risk for flu complications.

Vaccines are safe and necessary, even, and sometimes especially, if you have an autoimmune disease.

And having a predisposition for an autoimmune disease, either because of your child’s family history, or because of the results of some genetic testing kit you ordered on the internet, certainly isn’t a reason to skip or delay your child’s vaccines and leave them unprotected. You’re not avoiding any of the triggers that can cause autoimmune disease and simply increase the risk that they will get a vaccine-preventable disease and get others sick.

More on Autoimmunity as a Contraindication to Getting Vaccinated

Are Your Kids at High Risk for Flu Complications?

Everyone should get a flu vaccine each year, as long as they are at least six months old and have no true contraindications.

Everyone needs a flu shot. When will you get yours?
Everyone needs a flu shot. When will you get yours? Photo by Gabriel Saldana (CC BY-SA 2.0)

That has been the recommendation since at least the 2010-11 flu season.

And while most kids get vaccinated, not all do.

Are Your Kids at High Risk for Flu Complications?

There are some kids, those at high risk for flu complications, who definitely shouldn’t skip or delay their flu vaccine.

  • all children aged 6 through 59 months (younger than age 5 years);
  • children who have chronic medical conditions, including pulmonary (such as asthma and cystic fibrosis), cardiovascular (excluding isolated hypertension), genetic (Down syndrome), renal, hepatic, neurologic (cerebral palsy, epilepsy, stroke, muscular dystrophy, and spina bifida, etc.), hematologic (sickle cell disease), or metabolic disorders (including diabetes mellitus and mitochondrial disorders);
  • children who are immunocompromised due to any cause (including immunosuppression caused by medications or by HIV infection);
  • teens who are or will be pregnant during the influenza season;
  • children and adolescents (aged 6 months through 18 years) who are receiving aspirin- or salicylate-containing medications (like for Kawasaki disease) and who might be at risk for experiencing Reye syndrome after influenza virus infection;
  • residents of nursing homes and other long-term care facilities;
  • American Indians/Alaska Natives;
  • children who are extremely obese (body mass index ≥40).

You also shouldn’t skip or delay getting a flu vaccine if your:

  • kids are household contacts of children aged ≤59 months (i.e., aged <5 years) and adults aged ≥50 years, particularly contacts of children aged <6 months;
  • kids are household contacts of someone with a medical condition that puts them at higher risk for severe complications from influenza.

Again, since everyone should get a flu vaccine, these higher risk classes shouldn’t determine whether or not you vaccinate your kids, but they might influence the timing.

Again, don’t skip your child’s flu vaccine because they aren’t in a flu high risk group.

In most flu seasons, about 80% of children with the flu who die are not vaccinated. And many of them will be otherwise healthy, without an underlying high risk medical condition.

Get your child vaccinated against the flu. And if they are in a high risk group, make sure you do it well before flu season starts and maybe as soon as flu vaccine becomes available in your area.

More on Being at High Risk for Flu Complications

How Contagious Is Measles?

Did you hear about the folks in New York who got quarantined isolated on the Emirates plane from Dubai?

Turns out that about 10 passengers had the flu or other cold viruses.
Although the worry was likely about MERS, it turns out that about 19 passengers had the flu or other cold viruses.

News like that and folks getting exposed to other infectious diseases, probably has them wondering just how contagious these diseases are. Do you have to be sitting next to someone to get them? In the same row? On the same floor?

Understanding Your Risk of Catching a Disease

Fortunately, most diseases are not terribly contagious.

We worry about some things, like SARS and Ebola, because they are so deadly, not because they are so contagious or infectious.

Wait, contagious or infectious? Aren’t they the same thing?

To confuse matters, some infectious diseases aren’t contagious, like Lyme disease. And some vaccine-preventable diseases are neither infectious nor communicable. Think tetanus. You may have never thought of it that way, but you aren’t going to catch tetanus from another person. Of course, that’s not a good reason to skip getting a tetanus shot!

To understand your risk of getting sick, you want to understand a few terms, including:

  • infectious disease – a disease that can be transferred to a new host
  • communicable – an infectious disease that can be transferred from one host to another
  • non-communicable – a non-infectious disease which can not be transferred from one host to another
  • contagiousness – an infectious disease that is easily transferred from one person to another
  • infectivity – the ability of an infectious agent to cause an infection, measured as the proportion of persons exposed to an infectious agent who become infected. Although this doesn’t sound much different from contagiousness, it is. The Francisella tularensis bacteria is highly infectious, for example, to the point that folks exposed to a culture plate are given antibiotics or put on a fever watch. Few of us get tularemia though, because transmission is through tick bites, hunting or skinning infected rabbits, muskrats, prairie dogs and other rodents, or inhaling dust or aerosols contaminated with F. tularensis bacteria. So if you get exposed, you will probably get sick, but there is a low probability for getting exposed.
  • incubation period – the time it takes to start having symptoms after you are exposed to an infectious disease. A longer incubation period increases the chances that someone will get exposed to a disease and travel home before getting sick. A shorter incubation period, like for influenza, means that a lot of people can get sick in a short amount of time.
  • contagious period- the time during which you can spread the illness to other people and may start before you have any symptoms
  • quarantine – used to separate people who have been exposed to a contagious disease and may become sick, but aren’t sick yet
  • isolation – used to separate people who are already sick with a contagious disease
  • transmission – how the disease spreads, including direct (direct contact or droplet spread) vs indirect transmission (airborne, vehicleborne, or vectorborne)
  • R0 (r nought) – the basic reproductive number or the number of new infections originating from a single infectious person among a total susceptible population
  • Rn – the net reproductive number, which takes into account the number of susceptibles in a community
  • infectious period – how long you are contagious

Got all that?

How Contagious Is Measles?

If not, understanding how easily you can get measles should help you understand all of these terms.

Measles is highly contagious, which is likely why all of the Brady kids got sick.
Measles is highly contagious, which is likely why all of the Brady kids got sick.

Measles is highly contagious, with a very high R0 number of 12 to 18.

That’s because:

  • the measles virus can live for up to two hours on surfaces and in the airspace where an infected person coughed or sneezed
  • infected people are contagious for up to four days before they have a rash and even know that they have measles, so expose lots of people even if they get put in isolation once they get diagnosed
  • infected people continue to be contagious for up to four days after the rash appears, so can continue to expose people if they aren’t put in isolation

So you don’t need to have someone with measles coughing in your face to get sick. If they coughed or sneezed at the grocery store, on the bus, or at your doctor’s office and then you entered the same area within two hours, then you could be exposed to the measles virus and could get sick.

Why don’t we see at least 12 to 18 people in each measles outbreak anymore?

That’s easy. The definition for R0 is for a total susceptible population. Most folks are vaccinated and protected, so even if they are around someone with measles, they typically won’t get sick.

Still, up to 90% of folks who aren’t immune and are exposed to measles will catch it. That includes infants too young to be vaccinated, kids too young to be fully vaccinated, and anyone who has a true medical exemption to getting vaccinated.

The measles has a very high R0 is easier to see when you compare it to those of some other diseases

 

Infection R0
Diphtheria 6-7
Ebola 1.5-2.5
Flu 1.4-4
MERS 2-8
Mumps 4.7
Pertussis 5-17
Polio 2-20
RSV 3
SARS 2-5
Smallpox 5-7
Varicella 8-10

Why such a big range for some diseases?

These are estimates and you are more or less contagious at different stages of each illness.

Fortunately, in most cases you can just get vaccinated and protected and don’t have to worry too much about them.

More on the Contagious Periods of Diseases

Vaccines While Immunosuppressed

It seems to be a big surprise to many folks, but kids can get most vaccines when they are immunosuppressed. In fact, they sometimes get extra some extra vaccines, like Pneumovax, because the  “incidence or severity of some vaccine-preventable diseases is higher in persons with altered immunocompetence.”

They should also get all of their vaccines if they are around someone who is immunosuppressed.

Surprised?

Vaccines While Immunosuppressed

Which vaccines your kids can get while they are immunosuppressed is going to depend greatly on the reason why they are  immunosuppressed.

Are they getting chemotherapy?

Did they just get a stem cell transplant?

Were they born with a specific immunodeficiency, like X-linked agammaglobulinemia, selective IgA deficiency, severe combined immunodeficiency, or chronic granulomatous disease?

Whatever the reason, they likely won’t get a medical exemption to skip all of their vaccines.

“Killed vaccines will not cause infection in immunodeficient or any other children. The fear of increased community-acquired vaccine-preventable diseases should lead to adherence to and completion of recommended immunization schedules in the community to reinforce herd immunity, such that all vaccine-preventable diseases become exceedingly rare.”

Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

In most cases, immunocompromised kids can get all inactivated vaccines. It is only live vaccines that could pose a problem. Even then, it depends on the specific immunodeficiency as to whether avoiding live vaccines is necessary.

For example, after chemotherapy and a stem cell transplant, kids can usually get live vaccines.

Your doctors can review the latest guidelines to come up with a safe vaccination plan for your child with an immune system problem. If necessary, consultation with an infectious diseases or immunology specialist can also be helpful.

Don’t overlook other causes of possible immunosuppression when getting vaccinated, like taking daily oral steroids for more than two weeks, certain biologic immune modulators, or other medications like methotrexate, azathioprine, 6-mercaptopurine.

“Limited evidence indicates that inactivated vaccines generally have the same safety profile in immunocompromised patients as in immunocompetent individuals. However, the magnitude, breadth, and persistence of the immune response to vaccination may be reduced or absent in immunocompromised persons.”

2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host

And keep in mind that just because they can and should get vaccinated, it doesn’t mean that their vaccines are going to work as well as in someone who isn’t immunocompromised.

That’s why herd immunity is so important for these kids.

Vaccines for Close Contacts of Immunocompromised People

What about people who come into contacts with kids and adults who are immunocompromised?

Can they get vaccines?

“Close contacts of patients with compromised immunity should not receive live oral poliovirus vaccine because they might shed the virus and infect a patient with compromised immunity. 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.”

Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

Yes, close contacts can get vaccinated, especially since we don’t use the oral polio vaccine in the United States anymore.

There are some exceptions for the smallpox vaccine, which few people get, and Flumist, but only in very specific situations, including a recent hematopoietic stem cell transplant.

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.

Worried about shedding?

You should be worried about getting a vaccine-preventable disease and giving it to those around you with immune system problems. That’s the real risk!

This is the modern anti-vaccine movement - taking an immoral stand against vaccines and putting sick kids at risk for life-threatening disease.
This is the modern anti-vaccine movement – scaring parents and taking an immoral stand against vaccines and putting sick kids at risk for life-threatening disease.

And no, you are not being selfish to expect those around you to get vaccinated.

Vaccines are safe and necessary – for all of us.

More on Vaccines While Immunosuppressed