Tag: precautions

Will SB276 Revoke Legitimate Medical Exemptions?

Bob Sears has already said that SB276 will eliminate medical exemptions and stop doctors from writing medical exemptions.

ITP after MMR is not a reason to get a medical exemption for all vaccines…

What is he saying now?

Will SB276 Revoke Legitimate Medical Exemptions?

Bob Sears is saying that SB276 will revoke legitimate medical exemptions from children who have had “seizures, nerve injuries, and severe allergic reactions after vaccines.”

He also says that they “will be forced to continue just to stay in school.”

To be clear, neither SB276 nor any other vaccine law in the United States forces anyone to get vaccinated.

Yes Bob Sears, what do you mean forced to stay in school?
Yes Bob Sears, what do you mean forced to stay in school?

Although implying forced vaccination is a common anti-vaccine tactic, even his own followers called him out on it…

What else can you see from reading the comments to Bob’s post?

Some medical exemptions might be revoked under SB276, but it isn’t because they are legitimate.

ITP would not be a reason to get a medical exemption to all vaccines.
ITP would not be a reason to get a medical exemption to ALL VACCINES.

A rash that turned in ‘purple blobs’ after the MMR vaccine sounds like it could be ITP, which is actually a table injury.

Since the ACIP lists that as a precaution to getting another dose of MMR, you would almost certainly get a medical exemption, but not to all vaccines!

While scary for parents, ITP typically goes away on its own without treatment in about two weeks to six months.

Anyway, SB276 doesn’t revoke legitimate medical exemptions.

If you actually read SB276, as amended, what it does do is trigger a review by medical professionals to “identify those medical exemption forms that do not meet applicable CDC, ACIP, or AAP criteria for appropriate medical exemptions” if:

  • a school’s immunization rate drops below 95%
  • a doctor writes five or more medical exemptions in a single year (although that doesn’t sound like a lot, keep in mind that true medical exemptions are not very common, so the average doctor who is only writing medical exemptions for their own patients likely won’t write that many each year)
  • a school doesn’t report it’s immunization rates

And once reviewed, inappropriate medical exemptions can be revoked, although that process can be appealed by a parent who thinks that their child does indeed have a legitimate medical exemption.

Keep in mind that just because a doctor writes more than 5 exemptions in a single year, that doesn’t mean that they will automatically be revoked. That simply triggers a review. Even if the doctor writes 10 or 20, if they are legitimate exemptions, then they will be allowed.

Again, SB276 doesn’t revoke legitimate medical exemptions.

Why does Bob Sears think that it does?

Maybe because many of things that Bob Sears considers to be legitimate medical exemptions actually aren’t, which is why he is already under investigation, even before SB276 is enacted…

More on Legitimate Medical Exemptions

What Is Standard of Care?

Anti-vaccine folks who are talking about “standard of care” when deciding who gets a medical exemption for vaccines obviously don’t really understand what it means.

Why are these advocating against keeping kids protected against life-threatening vaccine-preventable diseases?
Why are these advocating against keeping kids protected against life-threatening vaccine-preventable diseases?

Maybe that’s why they put standard of care in quotes in the above infographic against SB276, a new vaccine bill in California that will eliminate fake vaccine exemptions.

What Is Standard of Care?

When we talk about standard of care in medicine, it is important to understand that it is a legal term, with a legal definition:

“That which a minimally competent physician in the same field would do under similar circumstances”

Moffett et al on The Standard of Care: Legal History and Definitions: the Bad and Good News

Does this mean that the minimally competent physicians can choose whatever criteria they want to write fake medical exemptions for vaccines?

Of course not!

“Treatment that is accepted by medical experts as a proper treatment for a certain type of disease and that is widely used by healthcare professionals. Also called best practice, standard medical care, and standard therapy.”

NCI Dictionary of Cancer Terms

Just because a few doctors do something a certain way, that doesn’t make it the proper way for it to be done.

These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.
These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.

And that’s why a doctor making up their own rules for what counts as a vaccine medical exemption, especially when it goes against published guidelines and advice, isn’t standard of care.

More on Standard of Care

Does the CDC Determine Medical Exemptions for Vaccines?

California’s new vaccine law has some folks arguing about medical exemptions again.

Yes, the CDC does not determine medical exemptions for vaccines. That's not news.
Yes, the CDC does not determine medical exemptions for vaccines. That’s not news.

Some want very broad guidelines and are confused about how doctors determine who should get a medical exemption.

Does the CDC Determine Medical Exemptions for Vaccines?

Bob Sears even thinks he has a bombshell revelation that clears everything up.

An email from the CDC!

You can be sure that the "medical provider's prerogative" does not include any reason they think up, even those that have no evidence to back them up.
You can be sure that the “medical provider’s prerogative” does not include any reason they think up, even those that have no evidence to back them up.

The thing is, no one has ever said that ACIP contraindications and precautions to vaccination are the one and only factor that should determine whether or not a child should get a medical exemption.

“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”

Dear Colleague letter regarding guidelines for use of immunization exemptions

So no one should really be surprised by an email that says the CDC does not determine medical exemptions.

What Qualifies as a Vaccine Medical Exemption?

What are the other big factors, in addition to ACIP contraindications and precautions?

“A medical exemption is allowed when a child has a medical condition that prevents them from receiving a vaccine.”

What is an Exemption and What Does it Mean?

Medical exemptions for vaccines should be based on AAP and ACIP guidelines, current accepted medical practice, and evidence based medicine.

“Medical exemptions are intended to prevent adverse events in children who are at increased risk of adverse events because of underlying conditions. Many of these underlying conditions also place children at increased risk of complications from infectious diseases. Children with valid medical exemptions need to be protected from exposure to vaccine-preventable diseases by insuring high coverage rates among the rest of the population. Granting medical exemptions for invalid medical contraindications may promote unfounded vaccine safety concerns. Although states may wish to allow parents who make decisions based on poor science or perceptions to withhold vaccines from their children, these exemptions should be distinguished from valid medical exemptions.”

Salmon et al on Keeping the M in Medical Exemptions: Protecting Our Most Vulnerable Children

For example, in addition to kids who may have had a severe allergic reaction to a vaccine, there are often children with immune system problems or who have a moderate or severe illness who can’t get one or more vaccines, at least temporarily.

These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.
These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.

Medical exemptions for vaccines should not be based on anecdotes or simply because a vaccine-friendly doctor has scared a parent away from vaccinating and protecting their kids.

There are very few family history issues that would make a child have to skip or delay getting a vaccine.
There are very few family history issues that would make a child have to skip or delay getting a vaccine.

They should rarely be done based on family history of reactions or what some people think are vaccine reactions.

This is what a fake medical exemption will get you - a life-threatening disease.
The child’s medical exemption was for “cytotoxic allergies secondary to immunization,” without any evidence that it was necessary. In addition to a fake medical exemption, he got tetanus.

In general, they should rarely be given, as the AAP states in their policy statement, Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance, “only a very small proportion of children have medical conditions prohibiting specific immunizations…”

That’s why rates of medical exemptions should be low.

“Between the 2009-2010 and 2016-2017 school years, the national median prevalence of medical exemptions has remained constant, between 0.2% to 0.3%, with state-level ranges showing little heterogeneity over time, never exceeding the range of 0.1% to 1.6% over this period.”

Bednarczyk et al on Current landscape of nonmedical vaccination exemptions in the United States: impact of policy changes

And why you shouldn’t have schools with high rates of medical exemptions or doctors writing a lot of medical exemptions.

More on Vaccine Medical Exemption Guidelines

Why Is Lying About Vaccines Not Criminal?

We are in the middle of the largest measles outbreaks in over 25 years.

Measles cases and deaths are on the rise all over the world.

Much of that rise, especially in the developed world, is because parents believe the misinformation that the vocal anti-vax folks are pushing.

Why Is Lying About Vaccines Not Criminal?

Which has to make you wonder – why is lying about vaccines and scarring parents into skipping or delaying vaccines not criminal?

A sociopath wrote this... Is that the one true statement in Kennedy's rant?
A sociopath wrote this… Is that the one true statement in Kennedy’s rant?

For example, take the above Instagram post by Robert F Kennedy, Jr.

His claim that the “guidelines stipulate that a child would need to experience anaphylactic shock — a life threatening reaction — to EVERY vaccine-requiring eight near death experiences — to qualify for an exemption” simply isn’t true.

A severe allergic reaction is a contraindication to getting vaccinated.

If a child had a severe allergic reaction, anaphylaxis, to a previous dose of any vaccine or to a vaccine component, then they would get an medical exemption to that vaccine. They could also easily get a medical exemption to all other vaccines that used those same components, such as gelatin, eggs, or yeast, etc.

It is silly to think that you would have to have an anaphylactic reaction to each and every vaccine, as Kennedy claims, to get a medical exemption to getting vaccinated.

Did the CDC publish new guidelines in 2019 changing what is considered to be a contraindication, another Kennedy claim?

Mild to moderate local reactions and low-grade or moderate fever were removed as a condition commonly mispercieved as a contraindication or precaution, but that was done last January. There were no big changes recently!
Mild to moderate local reactions and low-grade or moderate fever were removed as a condition commonly mispercieved as a contraindication or precaution, but that was done last January. There were no big changes recently!

Nope.

And the thing is, these things are incorrectly perceived as contraindications or precautions to vaccination because they are not a problem with vaccination!

You would have to be a sociopath to put kids at risk for a vaccine-preventable disease for no good reason!

For example, why skip the HPV vaccine just because a child is already infection with HPV? Are they infected with all of the strains of HPV that the vaccine protects against? There is no extra risk of cervical cancer from the vaccine if you are already infected, just the fact that you might get cervical cancer because you were already infected before you got protected from the vaccine!

Why is it not homicide to scare someone away from getting vaccinated and protected with a vaccine that prevents cancer by spreading this type of misinformation?

Why is lying about vaccines not criminal?

More on Why Is Lying About Vaccines Not Criminal?