Tag: precautions

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?

Why Should Medical Exemptions Be Based on CDC Contraindications?

Getting a medical exemption for vaccines isn’t controversial.

Or at least it shouldn’t be.

Why Should Medical Exemptions Be Based on CDC Contraindications?

As many people know though, some people have been taking advantage of the fact that medical exemptions weren’t clearly defined in California’s vaccine law.

Who are the doctors handing out fake medical exemptions in California?
Who are the doctors handing out fake medical exemptions in California?

Are there just a few doctors taking advantage of the California law?

“But at 105 schools in the state, 10% or more of kindergartners had a medical exemption in the school year that ended last month, according to a Los Angeles Times analysis of state data.”

Pushback against immunization laws leaves some California schools vulnerable to outbreaks

Is 10% a lot?

In one recent report, Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year, the median rate of medical exemptions in the US was just 0.2%, with a range of <0.1 to 1.5%.

In West Virginia and Mississippi, states that don’t allow non-medical exemptions and where criteria for medical exemptions are fairly strict, the rates were 0.1 and 0.3% respectively.

And that’s about what you would expect, as there are very few true contraindications or precautions to getting vaccinated.

So yes, 10% is an awful lot and that’s a good sign that it is more than just a few doctors taking advantage of the law.

“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

Why do most other states have so few medical exemptions?

Mostly because there are very few true medical reasons to skip or delay a child’s vaccines!

They include, but aren’t limited to, the contraindications and precautions listed in the package insert for each vaccine (the contraindications and warnings sections…) and by the Advisory Committee on Immunization Practices.

They don’t include many other things that are “incorrectly perceived as contraindications to vaccination,” such as things in the family medical history of the child, eczema (unless they are getting the smallpox vaccine), colic, sleep apnea, or being a picky eater.

Is everything a vaccine injury?
Is everything a vaccine injury?

It should be obvious.

Medical exemptions for vaccines should be based on CDC criteria because some folks think that everything is a vaccine injury.

More on Medical Exemptions

Bob Sears Doubles Down Against California Vaccine Laws

Bob Sears wasn’t a fan of SB 277, the vaccine law that removed non-medical exemptions in California.

Not surprisingly, he is actively rallying folks against a new bill that would close a loophole in that law. It seems that some doctors were writing medical exemptions for anything and everything, from eczema to swollen lymph nodes.

Bob Sears is pushing misinformation that SB 276 takes away all medical exemptions.
Bob Sears is pushing misinformation that SB 276 takes away all medical exemptions.

Of course, the new law wouldn’t take away medical exemptions. It would just take away fake medical exemptions.

Is everything a vaccine injury?
Is everything a vaccine injury?

Yes, take a long hard look at their list…

A very few actually are actually standard contraindications and precautions to commonly used vaccines, so could likely get you a medical exemption to one or more vaccines. GBS within 6 weeks of a flu shot, a precaution, not a contraindication, would be an example. But even in this case, the exemption would be for flu shots, not all vaccines.

“Events or conditions listed as precautions should be reviewed carefully. Benefits of and risks for administering a specific vaccine to a person under these circumstances should be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit of vaccination is believed to outweigh the risk, the vaccine should be administered. “

Vaccine Recommendations and Guidelines of the ACIP

What about all of the rest of the diseases or “severe reactions” on Bob’s list, like pneumonia, palpitations, eczema, hair loss, IBD, difficulty swallowing, skin infections, testicular pain, HSP, Multiple Sclerosis, and Kawasaki disease, etc.

These are not vaccine injuries, even though they are sometimes in a package insert. I’m surprised that he didn’t list SIDS and autism too…

And this is why California needs to fix their vaccine law… Folks, including pediatricians, pushing the idea that everything is a vaccine injury.

More on Bob Sears and California Vaccine Laws