Do you have a scar on your arm and you aren’t sure why it is there?
Is it from the smallpox vaccine?
Recognizing Old Vaccine Scars
Classically, there are two vaccines that can leave a scar – the ones that protect us against smallpox and tuberculosis.
“BCG scar is a surrogate marker of vaccination and an important index in the vaccination program.”
Dhanawade et al on Scar formation and tuberculin conversion following BCG vaccination in infants: A prospective cohort study
And there are a few easy ways to tell if you have a smallpox scar.
When were you born? Remember, the smallpox vaccine hasn’t been used in the United States since the early 1970s and its use stopped everywhere in 1986.
And where were you born?
The BCG (bacille Calmette-Guerin) vaccine, on the other hand, is still in use in many countries, and is given at birth to prevent tuberculosis disease, including meningitis and disseminated tuberculosis. It isn’t routinely used in the United States though “because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine’s potential interference with tuberculin skin test reactivity.”
In general though:
the BCG vaccine scar has a raised center
the smallpox vaccine scar is depressed, with lines that radiate to the edges
Complicating matters is the fact that you can have multiple scars from each vaccine…
“In 1972, the National Advisory Committee on Immunization in Canada recommended that routine immunization of infants for smallpox be stopped. Very few Canadians born after 1972 have been immunized against smallpox. Those, like me, who were immunized prior to that date have little or no immunity left. Nothing, but a small scar as testimony to a grand global achievement.”
It’s because some folks think that everything that happens to their kids is a vaccine injury.
Personal Stories About Vaccine-Preventable Diseases
If you are going to watch those videos and listen to their stories, getting scared in the process, be sure to also listen to the stories of parents who’s kids have suffered through actually getting a vaccine-preventable disease.
While it’s great that these diseases are much less common because most people vaccinate and protect their kids, one side effect of that progress is that we don’t have many reminders of just how terrible these diseases are anymore.Have you ever seen a baby with congenital rubella syndrome?
“Kimberly Coffey was buried three days before her high school graduation in the prom dress she didn’t get to wear. She didn’t have the opportunity to be vaccinated against Meningitis B.”
Kim’s Meningitis Story
In Kimberly‘s case, the Men B vaccine wasn’t yet available, but in many other cases, parents have shared their stories of unvaccinated children who suffered with a disease that was vaccine preventable at the time.
“From 2010 to 2016, young children continued to be at the greatest risk for influenza-associated pediatric deaths. Children without preexisting medical conditions accounted for half of all deaths. Vaccination coverage was low among influenza-associated pediatric deaths.”
Shang et al. on Influenza-Associated Pediatric Deaths in the United States, 2010–2016
Are the stories supposed to scare you into vaccinating your kids?
Of course not. Just like you shouldn’t let the myths and propaganda from the anti-vaccinate movement scare you away from vaccinating and protecting your kids.
Instead of being motivated by fear, you should make your decision because you understand that the many benefits of vaccines are far greater than their small risks.
What to Know About Vaccine-Preventable Disease Stories
Reading stories of vaccine-preventable diseases are a good reminder that these diseases are not so mild as some folks suggest, and they are instead life-threatening diseases that are best avoided by getting fully vaccinated.
It’s easy to be anti-vaccine when you are hiding in the herd. You don’t get vaccinated and you don’t vaccinate your kids, and instead, you simply rely on the fact that everyone else around you is vaccinated to protect you from vaccine-preventable diseases.
Of course, this is a terrible strategy, as we are seeing with the increase in cases of measles and pertussis, etc. It is much better to learn about the importance and safety of vaccines, get fully vaccinated, and stop these outbreaks.
But as they continue to tell you that vaccines don’t work, how about asking what they would do in these ten high-risk situations?
Amazingly, some folks continue to try and justify skipping vaccines and accept the risk of disease, even when that risk is much higher than usual and they could be putting their child’s life in immediate danger!
How will you do with our quiz?
Would you choose to vaccinate in these situations?
1. Baby born to mother with hepatitis B.
You are pregnant and have chronic hepatitis B (positive for both HBsAg and HBeAg). Should your newborn baby get a hepatitis B shot and HBIG?
Many anti-vaccine experts tell parents to skip their baby’s hepatitis B shot, saying it is dangerous, not necessary, or doesn’t work (typical anti-vax myths and misinformation).
However, it is well known that:
from 10 (HBeAg negative) to 90% (HBeAg positive) of infants who are born to a mother with chronic hepatitis B will become infected
90% of infants who get hepatitis B from their mother at birth develop chronic infections
25% of people with chronic hepatitis B infections die from liver failure and liver cancer
use of hepatitis B immune globulin (HBIG) and hepatitis B vaccine series greatly decreases a newborn’s risk of developing a hepatitis B infection (perinatal transmission of hepatitis B), especially if HBIG and the first hepatitis B shot is given within 12 hours of the baby being born
Would your newborn baby get a hepatitis B shot and HBIG?
2. Your child is bitten by a rabid dog.
Your toddler is bitten by a dog that is almost certainly rabid. Several wild animals in the area have been found to be rabid recently and the usual playful and well-mannered dog was acting strangely and died a few hours later. The dog was not vaccinated against rabies and unfortunately, the owners, fearing they would get in trouble, disappeared with the dead dog, so it can’t be quarantined. Should your child get a rabies shot?
Although now uncommon in dogs, rabies still occurs in wild animals, including raccoons, skunks, bats, and foxes. These animals can then expose and infect unvaccinated dogs, cats, and ferrets, etc.
To help prevent rabies, which is not usually treatable, in addition to immediately cleaning the wound, people should get human rabies immune globulin (RIG) and rabies vaccine.
The rabies vaccine is given as a series of four doses on the day of exposure to the animal with suspected rabies and then again on days 3, 7, and 14.
Although rare in the United States, at least 1 to 3 people do still die of rabies each year. The rabies vaccine series and rabies immune globulin are preventative, however, without them, rabies is almost always fatal once you develop symptoms. A few people have survived with a new treatment, the Milwaukee protocol, without getting rabies shots, but many more have failed the treatment and have died.
Although the first MMR vaccine is routinely given when children are 12 months old, it is now recommended that infants get vaccinated as early as age six months if they will be traveling out of the country.
Since the endemic spread of measles was stopped in 2000, almost all cases are now linked to unvaccinated travelers, some of whom start very large outbreaks that are hard to contain.
Would you both get vaccinated before making the trip?
4. Tetanus shot.
Your unvaccinated teen gets a very deep puncture wound while doing yard work. A few hours later, your neighbor comes by to give you an update on his wife who has been in the hospital all week. She has been diagnosed with tetanus. She had gotten sick after going yard work in the same area and has been moved to the ICU. Do you get him a tetanus shot?
Most children get vaccinated against tetanus when they receive the 4 dose primary DTaP series, the DTaP booster at age 4-6 years, and the Tdap booster at age 11-12 years.
Unlike most other vaccine-preventable diseases, tetanus is not contagious. The spores of tetanus bacteria (Clostridium tetani) are instead found in the soil and in the intestines and feces of many animals, including dogs, cats, and horses, etc.
Although the tetanus spores are common in soil, they need low oxygen conditions to germinate. That’s why you aren’t at risk for tetanus every time your hands get dirty. A puncture wound creates the perfect conditions for tetanus though, especially a deep wound, as it will be hard to clean out the tiny tetanus spores, and there won’t be much oxygen at the inner parts of the wound.
These types of deep wounds that are associated with tetanus infections might including stepping on a nail, getting poked by a splinter or thorn, and animal bites, etc. Keep in mind that some of these things, like a cat bite, might put you at risk because you simply had dirt/tetanus spores on your skin, which get pushed deep into the wound when the cat bites you.
Symptoms of tetanus typically develop after about 8 days and might include classic lockjaw, neck stiffness, trouble swallowing, muscle spasms, and difficulty breathing. Even with treatment, tetanus is fatal in about 11% of people and recovery takes months.
Would you get your teen a tetanus shot?
5. Cocooning to protect baby from pertussis.
Both of your unvaccinated teens go to school with a personal belief vaccine exemption. You are due in a few months and are a little concerned about the new baby because there have been outbreaks of pertussis in the community, especially at their highschool. Should everyone in the family get a Tdap shot?
Pertussis, or whooping cough, classically causes a cough that can last for weeks to months.
While often mild in teens and adults, pertussis can be life-threatening in newborns and infants. In fact, it is young children who often develop the classic high-pitched whooping sound as they try to breath after a long coughing fit.
In a recent outbreak of pertussis in California, 10 infants died. Almost all were less than 2 months old.
Since infants aren’t protected until they get at least three doses of a pertussis vaccine, usually at age 6 months, experts recommend a cocooning strategy to protect newborns and young infants from pertussis. With cocooning, all children, teens, and adults who will be around the baby are vaccinated against pertussis (and other vaccine-preventable diseases), so that they can’t catch pertussis and bring it home.
There is even evidence that a pregnancy dose of Tdap can help protect infants even more than waiting until after the baby is born to get a Tdap shot.
Would everyone in your family get a Tdap shot?
6. Nephew is getting chemotherapy.
Your nephew was just diagnosed with leukemia and is going to start chemotherapy. Your kids have never been vaccinated against chicken pox and haven’t had the disease either. Your brother asks that you get them vaccinated, since they are around their cousin very often and he doesn’t want to put him at risk.
Do you get your kids vaccinated with the chicken pox vaccine?
Kids with cancer who are getting chemotherapy become very vulnerable to most vaccine-preventable diseases, whether it is measles, flu, or chicken pox.
According to the Immune Deficiency Foundation, “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.”
Would your get your kids vaccinated with the chicken pox vaccine?
7. Outbreak of meningococcemia at your kid’s college.
Background information: Neisseria meningitidis is a bacteria that can cause bacterial meningitis and sepsis (meningococcemia).
Depending on the type, it can occur either in teens and young adults (serogroups B, C, and Y) or infants (serogroup B).
Although not nearly as common as some other vaccine-preventable diseases, like measles or pertussis, it is one of the more deadly. Meningococcemia is fatal in up to 40% of cases and up to 20% of children and teens who survive a meningococcal infection might have hearing loss, loss of one or more limbs, or neurologic damage.
Meningococcal vaccines are available (Menactra and Menveo) and routinely given to older children and teens to help prevent meningococcal infections (serogroups A, C, Y and W-135). Other vaccines, Bexasero and Trumenba, protect against serogroup B and are recommended for high risk kids and anyone else who wants to decrease their risk of getting Men B disease.
Would you encourage her to get vaccinated against meningococcemia?
8. Cochlear implants.
Your preschooler has just received cochlear implants. Should he get the Prevnar and Pneumovax vaccines?
Cochlear implants can put your child at increased risk for bacterial meningitis caused by the Streptococcus pneumoniae bacteria (pneumococcus).
Your child is going to have his spleen removed to prevent complications of hereditary spherocytosis. Should he get the meningococcal and pneumococcal vaccines first?
Without a spleen, kids are at risk for many bacterial infections, including severe infections caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis bacteria.
In addition to their routine vaccines, kids with asplenia might need Menveo or Menactra, Bexsero or Trumenba (Men B), and Pneumovax 23.
Would your child get these vaccines that are recommended for kids with asplenia?
Ebola is returning, but this time an experimental vaccine is available.
There were nearly 30,000 cases and just over 11,000 deaths during the 2014-16 Ebola outbreak in West Africa.
You are in an area that is seeing an increasing number of Ebola cases and there is still no treatment for this deadly disease. An experimental vaccine is being offered.
Do you get the vaccine?
How Anti-Vaccine Are You?
It’s easy to be anti-vaccine when you are hiding in the herd – seemingly protected by all of the vaccinated people around you.
Meningitis is classically defined as an inflammation of the membranes that cover the brain and spinal cord, and it can be caused by:
viruses – also called aseptic meningitis, it can be caused by enteroviruses, measles, mumps, and herpes, etc.
bacteria – Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, Haemophilus influenzae type b (Hib), Group B strep
a fungus – Cryptococcus, Histoplasma
parasites – uncommon
amebas – Naegleria fowleri
Surprisingly, there are even non-infectious causes of meningitis. These might be include side-effects of a medication or that the child’s meningitis is a part of another systemic illness.
What to Do If Your Child Is Exposed to Meningitis
While meningitis can be contagious, it greatly depends on the type of meningitis to which they are exposed as to whether or not your child is at any risk.
So while the general advice is to “tell your doctor if you think you have been exposed to someone with meningitis,” you should try and gather as much information as you can about the exposure.
This information will hopefully include the type of meningitis they were exposed to, specifically if it was bacterial or viral, the exact organism if it has been identified, and how close of an exposure it was – were they simply in the same school or actually sitting next to each other in the same room.
For example, while the CDC states that “people who are close contacts of a person with meningococcal or Haemophilus influenzae type b (Hib) meningitis are at increased risk of getting infected and may need preventive antibiotics,” they also state that “close contacts of a person with meningitis caused by other bacteria, such as Streptococcus pneumoniae, do not need antibiotics.”
And you often don’t need to take any preventive measures if you are exposed to someone with viral meningitis.
While that might sound scary, it is basically because you typically aren’t at big risk after this kind of exposure. You could get the same virus, but the chances that it would spread and also cause meningitis are very unlikely.
Other types of meningitis, like primary amebic meningoencephalitis (PAM) and fungal and parasitic meningitis aren’t even contagious.
The Histoplasma fungus spreads from bird or bat droppings, for example, not from one person to another.
And parasites typically spread from ingesting raw or undercooked food, or in the case of Baylisascaris procyonis, from ingesting something contaminated with infectious parasite eggs in raccoon feces.
What to Do If Your Unvaccinated Child Is Exposed to Meningitis
Vaccines can prevent a number of different types of meningitis.
You should immediately call your pediatrician or local healthy department, because they might need:
antibiotics (usually rifampin, ciprofloxacin, or ceftriaxone) if the meningitis was caused by Neisseria meningitidis
antibiotics (rifampin) if the meningitis was caused by Haemophilus influenzae type b (Hib)
The availability of these antibiotics isn’t a good reason to skip or delay getting vaccinated though, as you won’t always know when your kids have been exposed to meningitis and not all types of vaccine-preventable meningitis can be prevented with antibiotics.
Of course, getting fully vaccinated on time is the best way to prevent many of these types of meningitis and other life-threatening diseases.
What to Do If Your Vaccinated Child Is Exposed to Meningitis
Even if your child is vaccinated, they might still need preventative antibiotics if they are exposed to someone with Hib or meningococcal meningitis, as vaccines are not 100% effective.
“Regardless of immunization status, close contacts of all people with invasive meningococcal disease , whether endemic or in an outbreak situation, are at high risk of infection and should receive chemoprophylaxis.”
AAP Red Book on Meningococcal Infections
This is especially true if they are not fully vaccinated.
Remember, to be fully vaccinated against Haemophilus influenzae type b, kids get a 2 or 3 dose primary series of the Hib vaccine when they are infants and a booster dose once they are 12 months old.
In the case of exposure to Hib meningitis, antibiotic prophylaxis would be recommended if:
the child is fully vaccinated, but there is a young child, under age 4 years, in the house who is unvaccinated or only partially vaccinated
the child is fully vaccinated, but there is another child in the house who is immunocompromised
the child is only partially vaccinated and under age 4 years
there is an outbreak in a preschool or daycare, with 2 or more cases within 60 days
And anyone exposed to someone with meningococcal meningitis should likely get antibiotics (chemoprophylaxis), even if they are fully vaccinated.
Talk to your pediatrician or local health department if your child is exposed to meningitis and you aren’t sure what to do, whether or not your child has been vaccinated.
What to Know About Getting Exposed to Meningitis
Learn what to do if your child is exposed to someone with meningitis, especially if they are unvaccinated, or have been exposed to someone with Hib meningitis or meningococcal disease.
Menactra and Menveo – meningococcal conjugate vaccines that protect against serogroups A, C, W, Y
Bexsero and Trumenba – meningococcal conjugate vaccines that only protect against serogroup B
And while children routinely get their first dose of either Menactra or Menveo when they are 11 to 12 years old and a booster at age 16 years, the MenB vaccines only have a “permissive” recommendation.
That means that there isn’t a formal recommendation that all kids get Bexsero or Trumenba. Instead, older teens and young adults between the ages of 16 and 23 years can get vaccinated if they want to protect themselves from most strains of serogroup B meningococcal disease.
Meningococcal Disease Outbreaks
Although the CDC reports that the incidence of menB disease is low, there have been at least ten outbreaks of menB disease on college campuses since 2013, including:
University of California, Santa Barbara – four cases – one student had both his feet amputated (2013)
Princeton University – nine cases and one death – a student at Drexel University (2013-14)
Providence College – two cases (2015)
University of Oregon – seven cases and one death (2016)
Santa Clara University – three cases (2016)
Rutgers University- New Brunswick – two cases (2016)
University of Wisconsin-Madison – three cases (2016)
The latest outbreak is at Colgate University. One students has been diagnosed with meningococcal meningitis disease and the school “will be offering vaccination clinics for all students who have not already received two doses of the serogroup B immunization.”
What to Know About Meningococcal Disease Outbreaks
Meningococcal disease is not common, but the effects of this vaccine-preventable disease disease can be devastating, which is why experts work to quickly get outbreaks under control.