Tag: propaganda

Is the Polio Vaccine Linked to Outbreaks of Hand Foot Mouth Disease?

Wait, why would anyone think that the polio vaccine could be linked to outbreaks of hand, foot, and mouth disease?

“Scientific researchers have discovered that the infectious disease Hand,Foot and Mouth Disease is vaccine-induced and then spread to others through shedding from the Polio Vaccine. Enterovirus 71 (EV71) causes Hand, Foot, and Mouth Disease. The polio vaccine (OPV and IPV) is contaminated with EV71. It, along with EV-D68 and several other enteroviruses and coxsackie viruses are used in the manufacturing of the polio vaccines, which are given to children three times in the first year of life, and again between 4-6 years of life. Bottom line: children recently vaccinated with the polio vaccine are shedding the EV71 that causes the most serious complications of HFMD. ”

Health Freedom Idaho

Shedding

Is the Polio Vaccine Linked to Outbreaks of Hand Foot Mouth Disease?

Health Freedom Idaho makes some very serious claims and even links to a research article, which in most cases, you would expect to support their claims.

Not surprisingly, the article, A Dominant EV71-Specific CD4+ T Cell Epitope Is Highly Conserved among Human Enteroviruses, says absolutely nothing about contamination of vaccines and nothing about shedding.

“Recognizing disingenuous claims made by the anti-vaccination movement is essential in order to critically evaluate the information and misinformation encountered online.”

Anna Kata Anti-vaccine activists, Web 2.0, and the postmodern paradigm – An overview of tactics and tropes used online by the anti-vaccination movement

What about a link between polio vaccines and hand, foot, and mouth disease?

It is sad that anti-vaccine propaganda gets shared so quickly among parenting groups.
It is sad that anti-vaccine propaganda gets shared so quickly among some parenting groups, who’s members obviously don’t read the articles when they do their research.

Well, hand, foot, and mouth disease is typically caused by the coxsackievirus A16 and EV71, which are enteroviruses. So is the polio virus. In fact, the Enterovirus genus is made up of 15 different species and 100s of different viruses. And they are all in the same Picornavirus family.

And that’s likely why researchers have found that “the most dominant epitope is highly conserved among enterovirus species, including HFMD-related coxsackieviruses, HFMD-unrelated echoviruses and polioviruses.”

Epitope?

“An epitope refers to the specific target against which an individual antibody binds.”

What is an Epitope?

So basically, this research isn’t saying that the polio vaccines are contaminated or that they cause hand, foot, mouth disease.

What it is saying, is that if you have been vaccinated with the polio vaccine, then you might have some protection against other enteroviruses!

“As shown here, poliovirus vaccination may have an impact on subsequent severity of HFMD disease. Cross-reactivity between EV71 A3 epitope and the A3v epitope of poliovirus 3 Sabin strain, may lead to the stimulation of protective, cross-reactive T cell responses, limiting the severity of subsequent HFMD.”

Wei et al. on A Dominant EV71-Specific CD4+ T Cell Epitope Is Highly Conserved among Human Enteroviruses

Yay for cross-reactivity!

“Cross-reactivity between antigens occurs when an antibody directed against one specific antigen is successful in binding with another, different antigen. The two antigens in question have similar three-dimensional structural regions, known as epitopes, which allow the antibody for one antigen to recognize a second antigen as being structurally the same antigen.”

Stephen J. Chadwick, MD

So you get antibodies from the polio vaccine and these antibodies cross react with the viruses that cause hand, foot, and mouth disease, which could lead to milder symptoms, because it is like you already have some antibodies to that virus too!

“HFMD outbreaks could occur where polio vaccination has failed, due to lack of refrigeration or other breaks in the cold chain that (might) go unreported.”

Exploring the Link between Polio Vaccination and Hand Foot Mouth Disease

In China, where outbreaks of hand, foot, and mouth disease are much more severe than they are in the United States, often leading to life-threatening disease, there has been a concern that the increased number of outbreaks could be linked to a failure of their polio vaccines, since getting vaccinated could be protective.

That’s the link the research is talking about…

I actually asked one of the researchers about what anti-vaccine folks were saying about their study and they told me:

“Well, that’s actually totally backwards. Our article suggests that FAILURE to get vaccinated with polio vaccine might set you up for Hand Food Mouth disease (EV71).”

Bottom line: polio vaccines are not contaminated and children recently vaccinated with the polio vaccine are not shedding the EV71 that causes the most serious complications of HFMD. Health Freedom Idaho made the whole thing up.

More on Linking the Polio Vaccine to Hand Foot Mouth Disease

Why Do We Only Worry About Measles?

Anti-vaccine folks often claim that health officials only worry about measles and measles outbreaks.

They can’t understand why anyone gets concerned by a few measles cases here and there, not understanding that a lot of work goes into containing measles outbreaks and making sure that they don’t grow beyond a few cases.

And health officials don’t just worry about measles. They work to control outbreaks of mumps, pertussis, hepatitis A, and all other diseases too.

Why We Worry About Measles Outbreaks

We do get concerned about measles outbreaks though.

“Whenever measles strikes, it’s more than just an outbreak of a single disease, or an indication that children aren’t receiving their measles shots; it’s also a warning that immunization coverage in general, for all vaccine-preventable diseases, is lower than it should be.

To put it another way: When rates of routine vaccination—children receiving all their shots on schedule, as a preventive measure rather than a reaction to an outbreak—start to fall, the first sign is usually a measles outbreak.”

Seth Berkley on Measles Outbreaks Are a Sign of Bigger Problems

The measles vaccine is among the most effective vaccines we have, so if we are seeing outbreaks, even though measles is very contagious, it means there is a problem.

“A focus on measles surveillance can help detect populations unreached by immunization systems and, by extension, program weaknesses. Measles serves as the ‘canary in the coal mine’ for detecting problems with immunization programs, a characteristic whose importance has recently been highlighted in the context of global health security.”

Orenstein et al on Measles and Rubella Global Strategic Plan 2012–2020 midterm review

In the late 1980s, when we had large outbreaks between 1989 to 1991, with 55,622 cases and 123 deaths, it meant that we weren’t vaccinating enough kids because Federal support for vaccine programs had dropped.

As much as anti-vaccine folks like to try and minimize how serious measles can be, it is easy to see that measles is indeed a serious, life-threatening disease. We had good nutrition, proper sanitation, and modern health care in 1990, and still, a lot of people died with measles. Rates of subacute sclerosing panencephalitis (SSPE), a late complication of measles, went up too, in the years after these outbreaks.

“Measles is a wholly preventable disease, and it was almost eradicated from the country in 1983, when only 1,497 cases were reported. But by 1990, after Federal budget cuts and the end of the Government’s monitoring of immunization programs, more than 30,000 cases of measles and more than 60 deaths were reported.”

Panel Ties Measles Epidemic to Breakdown in Health System

Those outbreaks were fixed, as we improved access to help kids get vaccinated and protected. Unfortunately, the issue with outbreaks today isn’t about access to vaccines, at least not in the developed world. It is about parents intentionally skipping or delaying vaccines.

How do you fix that?

Hopefully with education.

Why You Should Worry About Measles Outbreaks

Did you know that after the measles outbreaks of 1989, we also saw outbreaks of rubella and congenital rubella syndrome?

  • 396 cases of rubella, 4 deaths, and 2 cases of congenital rubella syndrome in 1989
  • 1,125 cases of rubella, 8 deaths, and 32 cases of congenital rubella syndrome in 1990
  • 1,401 cases of rubella, 1 death, and 34 cases of congenital rubella syndrome in 1991

Did you know that because they have overall lower vaccination rates, measles outbreaks in Europe grow far larger, into the tens of thousands of cases, with dozens of deaths?

“We must not tolerate a world in which a child dies from a disease that can be easily prevented with a low-cost vaccine.”

Dr Tedros, WHO Director-General on World Immunization Week 2018

We worry about measles outbreaks, because we don’t want to go back to anti-vaccine folks push us back to pre-vaccine era levels of disease and deaths.

We know what happens when vaccine levels drop too low.

A measles epidemic hit New York City in 1951, as this front page NYTimes article reports.
A measles epidemic hit New York City in 1951, as this NY Times article reports.

We know that vaccines are safe and necessary.

You should know that anti-vaccine propaganda that scares parents away from vaccinating and protecting their kids is rooted in myths and misinformation. They often get away with it because most parents today ahve never seen how devastating measles and other diseases can really be, so they believe stories about the Brady Bunch, instead of the advice of real experts.

You hopefully understand that’s a mistake.

More on Worrying About Measles Outbreaks

Learn the Risks of Following Bad Advice

Who do you turn to for health advice?

Even if it’s your pediatrician, with the rise of holistic pediatricians, that doesn’t mean that you are getting good advice.

In general, if the advice you are getting lacks evidence that it is safe and effective, relies on anecdotes and testimonials, and is labeled as ‘alternative,’ then it is a safe bet that it is bad advice.

Learn the Risks of Following Bad Advice

Some folks seem to be drawn to this type of advice though.

Kat Von D has decided that she will be raising a vegan child, without vaccinations.
Kat Von D has decided that she will be raising a vegan child, without vaccinations.

As long as they think it is natural, holistic, and is the opposite of what mainstream health experts say to do, some parents will jump at the chance of trying the latest fad, even if it has no benefits and lots of extra risks.

Take giving your kids raw milk for example. Health experts have been warning about the dangers of drinking raw milk for years and even work to keep selling it outlawed in most communities, but some parents still give it to their young children. This is despite the fact that it has no health benefits and isn’t even fortified with vitamin D!

Would you give your kids raw milk if you knew it could make them critically ill?
Would you give your kids raw milk if you knew it could make them critically ill?

What’s worse than giving your kids raw milk? How about skipping your baby’s vitamin K shot? Although it has no major risks, parents of many anti-vaccine and holistic type Facebook groups on the internet are often encouraged to skip this shot.

The article, translated from Polish, describes anti-vaccine parents and their baby (Maluszek), who died of vitamin K deficiency bleeding.
The article, translated from Polish, describes anti-vaccine parents and their baby (Maluszek), who died of vitamin K deficiency bleeding because they skipped his vitamin K shot.

How come they never warn folks that their baby might die in agony if they skip the shot? After all, there is a very good reason that we started to give all babies vitamin K shots – to stop vitamin K deficiency bleeding.

Just like there is a reason that we started to pasteurize milk – to keep us all from getting critically ill from contaminated milk.

And why we take antibiotics for severe infections, and not essential oils.

“If one gets a cancer diagnosis, they need to detox the toxins that have accumulated in the body, minimize further exposure and boost the immune system to fight the cancer. This is done NATURALLY. Traditional medical approaches (drugs, chemo, radiation) only FURTHER damage the body and immune system.”

Brandy Vaughan for Learn the Risk

And why we take chemotherapy for cancer, and not coffee enemas.

Mud wraps don't cure liver cancer.
Mud wraps don’t cure liver cancer.

And why most of us don’t think to try chiropractic, acupuncture, Ayurveda, homeopathy, Reiki, reflexology, or other non-evidenced based therapies when our kids are sick.

Could someone search for advice on Google on treating a bite from a rabid animal and come away thinking their child doesn't need rabies shots from an anti-vaccine website?
Could someone search for advice on Google on treating a bite from a rabid animal and come away thinking their child doesn’t need rabies shots from an anti-vaccine website?
Can an unvaccinated child really get tetanus after a toe nail injury?
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)

Why don’t people get rabies very often any more? It’s not because folks are no longer at risk, although the risk is less because dogs and cats are now vaccinated. It is because the vast majority of people get treated if they are exposed to an animal that might have rabies.

Remember when the six-year-old boy in Florida didn’t after touching a rabid bat? He died.

It’s just like the reason kids don’t get stuck by lightning very often. It’s not because lightning doesn’t happen anymore. It’s because we get a lot of warnings about thunderstorms and we know to go inside at the first sign of lightning in the area. Lightning strikes are rare because we take steps to reduce our risk of getting hit.

Why don’t folks get tetanus that much anymore? Again, most people are vaccinated, and they get boosters if they have wounds that puts them at extra risk. While we know what happens when unvaccinated kids are exposed to tetanus and don’t get treated, that isn’t a risk that you will read about on anti-vaccine websites or Facebook groups.

They also don’t tell you that kids in the US still die of diseases like Hib and rotavirus. And there are still measles deaths in the US.

That’s why the great majority of us get vaccinated, because we understand that vaccines are safe and necessary, and that skipping or delaying any vaccines simply puts our kids at risk to catch one of the diseases the vaccines are designed to prevent.

What to Know About the Risks of Following Bad Advice

You might get lucky and have a good outcome when you follow bad advice, but you should at least understand the risks of what might go wrong if you truly think you are making an informed decision.

More on the Risks of Following Bad Advice

Comparing Lightning Strikes to Measles Deaths

Have you ever heard that your child has more of a chance of getting hit by lightning than getting measles?

Since getting struck by lightning is rare, folks like to use it in comparisons to other things that they also think are low risk when trying to make a point.

There are problems with this type of argument though.

Understanding Risk Perception

In an age when many folks are overly anxious about things, it is important to understand the difference between real and perceived risks. Unfortunately, our biases often lead us to worry about the wrong things, sometimes with tragic consequences.

“No intervention is absolutely risk free. Even the journey to a physician’s office with the intention to receive a vaccination carries the risk of getting injured in an accident. With regards to risks of vaccination per se, one has to distinguish between real and perceived or alleged risks.”

Heininger on A risk–benefit analysis of vaccination

Vaccines have risks, but they are small risks, as we know that vaccines are safe and necessary and the decision to skip or delay your child’s vaccines carries with it a much greater risk.

Comparing Lightning Strikes to Vaccine Preventable Diseases

How common or rare do you think it is to get hit by lightning?

  • odds of being hit by lightning – 1 in 1,171,000 (each year)
  • odds of ever being hit by lightning – 1 in 14,600 (lifetime risk)
  • on average, 26 people die after being struck by lightning each year (since 2007), which is down from a recent historical average of 45 deaths per year (30 year average) and way down from when we used to see 400 lightning strike deaths each year before 1950
  • on average, 252 people are injured after being struck by lightning each year
Actually, just since 2000, at least 5 people have died of measles in Canada.
Actually, just since 2000, at least 6 people have died of measles in Canada.

Although 26 people dying after lightning strikes sounds like way too many to me, especially since one recent death was a 7-year-old boy in Tennessee playing under a tree, with 1 in 1,171,000 odds of getting hit, it sounds like we are pretty safe.

But is it fair to use those odds to justify your decision to keep your kids unvaccinated?

Of course not!

Why is our risk of getting struck by lightning so low?

What happens when we hear thunder or see lightning?

When Thunder Roars, Go Indoors!

What happens when a thunder storm approaches and you are at your kids soccer or baseball game?

“Postpone or suspend activity if a thunderstorm appears imminent before or during an activity or contest (irrespective of whether lightning is seen or thunder heard) until the hazard has passed. Signs of imminent thunderstorm activity are darkening clouds, high winds, and thunder or lightning activity.”

UIL on Lightning Safety

Many ball fields now have lightning detectors to alert officials of nearby storms. And just about everyone has access to weather apps on a smart phone that can alert them to an approaching thunder storm or nearby lightning strikes.

The point is that most of us understand that lightning is dangerous, so we go far out of our away to avoid getting hit. The risk of getting hit by lightning isn’t 1 in 1,171,000 with folks running around outside waving golf clubs in the air during thunder storms or sitting on their roofs under an umbrella watching the storm.

The risk of getting hit by lightning is 1 in 1,171,000 because most of us go inside once we know lightning is nearby.

“Based on the media reports of the fatal incidents, many victims were either headed to safety at the time of the fatal strike or were just steps away from safety. Continued efforts are needed to convince people to get inside a safe place before the lightning threat becomes significant. For many activities, situational awareness and proper planning are essential to safety.”

A Detailed Analysis of Lightning Deaths in the United States from 2006 through 2017

And the same is true with measles and other vaccine-preventable diseases. They aren’t as common as they once were because most of us are vaccinated and protected.

If you skip or delay your child’s vaccines, you will increase the risk that they will get one of these vaccine-preventable diseases. And you will increase the risk that they will get someone else sick.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

And if enough people don’t get vaccinated, herd immunity fails, and we will see a return of pre-vaccine era levels of disease.

What to Know About Vaccines and Risk Perception

Folks often misuse lightning strikes when they think about risks, not understanding that the risk of getting hit by lightning is low because we take a lot of precautions to avoid getting hit by lightning.

More on Vaccines and Risk Perception

Can Vaccines Cause Kawasaki Disease?

Kawasaki disease is rare and there is a good chance that you have never even heard of it, even though the first case was diagnosed in 1961.

Kids with this condition are typically irritable and can develop high fever, swollen glands in their neck, red eyes, red, cracked lips, red, swollen hands and feet, and a rash.

If you have heard of it, there is a good chance it is because anti-vaccine folks are using Kawasaki disease to scare you away from vaccinating and protecting your kids. Lately, talk about Kawasaki disease and the meningococcal B vaccines have been going around.

What Causes Kawasaki Disease?

Kawasaki disease is a type of vasculitis.

Kids who develop Kawasaki disease, who are typically under age 5 years, develop inflammation of their blood vessels, which leads to many of the symptoms and complications we see.

What causes this inflammation?

“Evidence suggests that Kawasaki disease may be linked to a yet-to-be identified infectious agent, such as a virus or bacteria. However, despite intense research, no bacteria, virus, or toxin has been identified as a cause of the disease.”

AAP on Kawasaki disease

We don’t know.

Can Vaccines Cause Kawasaki Disease?

Ask about Kawasaki disease if your child has a fever for five days and other symptoms of Kawasaki disease.
Courtesy of the kdfoundation.org

Because the cause of Kawasaki disease is unknown, that leads some folks to think that it could be vaccines.

Could it?

That vaccine clinical trial data sometimes finds a higher, although not statistically significant risk for Kawasaki disease, gets some of those folks thinking about it even more, except they don’t seem to think about the fact that the risk is never statistically significant.

But aren’t there case reports of kids getting Kawasaki disease after getting a hepatitis A, yellow fever, hepatitis B, or flu vaccine?

Yes, but getting a case report published about one patient who you think got Kawasaki disease soon after getting a vaccine isn’t strong evidence that it wasn’t a coincidence.

“Childhood vaccinations’ studied did not increase the risk of Kawasaki disease; conversely, vaccination was associated with a transient decrease in Kawasaki disease incidence. Verifying and understanding this potential protective effect could yield clues to the underlying etiology of Kawasaki disease.”

Abrams et al. on Childhood vaccines and Kawasaki disease, Vaccine Safety Datalink, 1996-2006.

And not surprisingly, several studies have shown that there isn’t any extra risk for Kawasaki disease after routine vaccines.

One even showed that getting vaccinated could be protective! Another benefit of vaccines and another reason you shouldn’t skip or delay your child’s immunizations.

What to Know About Vaccines and Kawasaki Disease

While anti-vaccine folks often list Kawasaki disease among their vaccine-induced diseases, several studies have shown that vaccines are not associated with Kawasaki disease, except to maybe have a protective effective if you are fully vaccinated.

More on Vaccines and Kawasaki Disease

8 Myths About Pediatricians Who Fire Families Who Don’t Vaccinate Their Kids

What actually happens when a pediatrician has a vaccine policy that requires parents to vaccinate their kids or face dismissal from the practice?

Not surprisingly, there are a lot of myths about the controversial issue of pediatricians dismissing families who don’t vaccinate their kids.

1 ) It is a myth that the American Academy of Pediatrics has a policy encouraging pediatricians to dismiss families who don’t vaccinate their kids.

There is no such policy.

Instead, in 2016, about 400 leaders from AAP chapters, committees, councils, and sections voted on a resolution at the 2016 AAP Annual Leadership Forum (ALF) to support pediatricians who dismissed families who didn’t vaccinate their kids.

RESOLVED, that the Academy support, in their policy statements and clinical guidelines about immunizations, pediatricians who decide to discharge patients after a reasonable, finite amount of time working with parents who refuse to immunize their children according to the recommended schedule or who fail to abide by an agreed-upon, recommended catch-up schedule, and be it further RESOLVED, that the Academy continue to support pediatricians who continue to provide health care to children of parents who refuse to immunize their children.

Resolution #80.81SB Supporting Pediatricians Who Discharge Families Who Refuse to Immunize

The resolution also voiced support for pediatricians who didn’t dismiss these patients.

2)  It is a myth that pediatricians dismissing families who don’t vaccinate their kids is a new thing.

Although it is getting a lot more attention now, since that 2016 resolution and a report on Countering Vaccine Hesitancy that soon followed, dismissing or firing families who don’t vaccinate their kids is not new.

A 2005 AAP report, Responding to Parental Refusals of Immunization of Children, discusses the issue.

“In general, pediatricians should avoid discharging patients from their practices solely because a parent refuses to immunize his or her child. However, when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists, the pediatrician may encourage the family to find another physician or practice.”

Responding to Parental Refusals of Immunization of Children

And a study, Dismissing the Family Who Refuses Vaccines, also published in 2005, made it clear that many pediatricians “would discontinue care for families refusing some or all vaccines.”

3)  It is a myth that dismissing families who don’t vaccinate their kids is an evidence based policy.

There is nothing beyond anecdotal evidence that families, when faced with the decision of getting vaccinated or getting dismissed from an office, will choose to get vaccinated.

Again, the latest resolution supporting the idea of dismissing families came because it was voted on and became an official Annual Leadership Forum resolution. In general, only the top 10 ALF resolutions are acted upon urgently by the AAP.

At the time, many pediatricians felt constrained by the previous statements from the AAP that discouraged dismissing these families.

4)  It is a myth that pediatricians dismiss families who don’t vaccinate their kids because they don’t want to be bothered talking about vaccine safety.

Although few pediatricians would want to talk to a parent who is arguing that vaccines are poison, aren’t necessary, and never work, fortunately, most vaccine-hesitant parents don’t actually talk like that. They are usually on the fence or simply scared because of all of the anti-vaccine propaganda they are exposed to and need a little extra time to understand that vaccines are safe and necessary.

A typical vaccine policy gives a parent plenty of time to get their child caught up on vaccines before they might be dismissed from the office.
A typical vaccine policy gives a parent plenty of time to get their child caught up on vaccines before they might be dismissed from the office.

And most pediatricians give them that extra time and do talk to them about their concerns. Despite the perception from some of the headlines you might see, families typically don’t get fired after one visit because they refused one or more vaccines.

5) Pediatricians who don’t dismiss unvaccinated families are supporting the use of alternative vaccine schedules.

While this is certainly true for some providers who actually advertise that they are “vaccine-friendly” and encourage parents to follow a non-standard, parent-selected, delayed protection vaccine schedule, most others understand that there is no evidence to support these alternative schedules and they are simply tolerated until the child can get caught-up with all of his vaccines.

6) It is illegal to dismiss a family who doesn’t want to vaccinate their kids.

While some pediatricians think that it is a bit of an ethical dilemma, the legal issues are very clear.

Physicians can’t simply abandon a patient so that they go without care, but they are typically free to end the physician-patient relationship after giving them formal, written notification, and continuing to provide care (at least in emergency situations) for a reasonable amount of time, giving the family time to find a new physician.

Of course, state and federal civil rights laws protect families from being terminated because of sex, color, creed, race, religion, disability, ethnic origin, national origin, or sexual orientation.

7)  It is a myth that dismissing families who don’t vaccinate their kids will protect those families who do vaccinate and protect their kids.

This is often the main reason that pediatricians use to justify dismissing families who don’t vaccinate their kids. After all, it isn’t fair to the families who come to your office, those who do get vaccinated and protected, if someone who is intentionally not vaccinated gets measles and exposes them all, right?

There seem to be several problems with this idea though:

  • relatively few exposures during outbreaks actually occur in a pediatrician’s office. Looking at most recent measles outbreaks, for example, exposures were more likely to occur while traveling out of the country, in an urgent care center, emergency room, somewhere in the community, or in their own home.
  • infants who get pertussis are usually exposed by a family member
  • while measles is very contagious and the virus can linger in an exam room for hours, other vaccine-preventable diseases are far less contagious. Mumps, for example, typically requires prolonged, close contact, which is why you are unlikely to get mumps at your pediatrician’s office.
  • when dismissed by their pediatrician, there is a concern that families might cluster together in the offices of a vaccine-friendly doctor or holistic pediatrician, making it more likely for outbreaks to erupt in their community if any of them get sick

And that’s the key point. Just because families get dismissed from a pediatrician’s office, it doesn’t mean that they leave the community. Your patients might still see them at daycare, school, at the grocery store, or walking down their street.

Pediatricians who don’t dismiss families who don’t vaccinate their kids often feel that it is better to keep working to help them understand that vaccines are safe and necessary, so that they eventually do get vaccinated and protected.

What about the extra risk in their own offices?

With RSV, strep, cold viruses, and everything else that kids have in the average pediatrician’s office, it is best to take steps to reduce the chances that kids are exposed to all of them. How do you do that? Don’t have a waiting room full of kids that are exposing each other to germs!

8) Most families don’t vaccinate their kids because they don’t trust their pediatrician.

While this is likely true for some, those families who want to see a pediatrician and don’t refuse any other treatments, like their newborn’s vitamin K shot and eye ointment, likely do trust their pediatrician.

Then why don’t they vaccinate and protect their kids?

“In today’s world, smallpox has been eradicated due to a successful vaccination program and vaccines have effectively controlled many other significant causes of morbidity and mortality. Consequently, fear has shifted from many vaccine-preventable diseases to fear of the vaccines.”

Marian Siddiqui et al on the Epidemiology of vaccine hesitancy in the United States

They are likely afraid.

What are they afraid of?

More and more these day, if you ask them, they will likely tell you that they don’t know. It would be much easier if they were afraid of something specific, like the myth that a baby’s immune system is too immature to handle any vaccines, that there are hidden ingredients in vaccines, or that vaccines are somehow associated with autism.

You can answer specific questions about vaccines, but it is harder when they are afraid because they see anecdotal vaccine scare videos or because friends and family members are feeding them misinformation.

“With all the challenges acknowledged, the single most important factor in getting parents to accept vaccines remains the one-on-one contact with an informed, caring, and concerned pediatrician.”

“…nearly half of parents who were initially vaccine hesitant ultimately accepted vaccines after practitioners provided a rationale for vaccine administration.”

“Developing a trusting relationship with parents is key to influencing parental decision-making around vaccines.”

“Pediatricians should keep in mind that many, if not most, vaccine-hesitant parents are not opposed to vaccinating their children; rather, they are seeking guidance about the issues involved, beginning with the complexity of the schedule and the number of vaccines proposed.”

“Because most parents agree to vaccinate their children, this dialogue, which can be started as early as the prenatal interview visit if possible, should be an ongoing process.”

AAP on Countering Vaccine Hesitancy

Whatever their vaccine policy, pediatricians should all work to counter vaccine misinformation and propaganda, so that our families get vaccinated and protected and our communities are safe.

It is also clear that we need new ways to talk about vaccines.

And we definitely new more ways to help everyone learn to think critically, be more skeptical about the things they see and read, and overcome their biases.

What to Know About Pediatricians Who Discharge Families Who Refuse to Immunize Their Kids

Whether they have a vaccine policy that dismisses families who don’t vaccinate their kids or they continue seeing them, pediatricians want to do what is best for their kids.

More on Pediatricians Who Discharge Families Who Refuse to Immunize Their Kids

Why Does the FDA Warn About Mercury in Fish, but Not Mercury in Flu Shots?

The FDA and EPA began to warn certain high risk groups about eating fish that might be contaminated with high levels of mercury in 2004.

Although it was known that “nearly all fish and shellfish contain traces of mercury,” this wasn’t thought to be a health concern for most people. Higher levels of mercury in certain fish could be though, especially for young children, nursing mothers, pregnant women, and women who might become pregnant.

That’s why the EPA and FDA recommended that those high risk groups not eat Shark, Swordfish, King Mackerel, or Tilefish (have highest levels of mercury) and limit eating other fish that are lower in mercury.

Why Does the FDA Warn About Mercury in Fish, but Not Mercury in Flu Shots?

So why do experts warn about mercury in fish, but don’t warn about mercury in vaccines?

Trace Amounts on “Ten Lies” Told About Mercury in Vaccines
Trace Amounts thinks that they have uncovered “Ten Lies” about mercury in vaccines

While that is a good question, the most obvious answer is that there are a very limited number of vaccines that you can get that contain any mercury (thimerosal), while if there was no warning, you could theoretically eat a ton of fish that are contaminated with at least some mercury.

And since 2001, thimerosal-free versions of non-flu vaccines have been available. There has also been an increasingly large supply of thimerosal-free flu vaccines available since 2003.

So how much mercury from vaccines could pregnant women and young children really be getting?

Remember, the only routine vaccines that pregnant women get are Tdap (never contained thimerosal) and the flu vaccine. And all of the routine vaccines young children receive are now thimerosal-free, including DTaP, Hib, IPV, Rotavirus, and Prevnar. All children should also get a flu vaccine once they are six months old, but like the flu vaccines for pregnant women, thimerosal-free flu vaccines are available.

Still, if they didn’t get a thimerosal-free flu shot, it would mean that they got the amount of mercury from one flu shot each year, or 25mcg. Some children could get up to 50mcg if it was their first season getting a flu vaccine, as they might need two doses of the flu vaccine.

The FDA and EPA offer very specific recommendations on how much fish to eat to avoid mercury.
The FDA and EPA offer very specific recommendations on how much fish to eat to avoid mercury.

How much mercury do you ingest when you eat fish? It depends on the fish, which is why the recommendations on which fish to eat and avoid are so specific. In general, it can range from 4mcg for salmon, 60mcg for canned albacore tuna and 170 mcg for swordfish.

While you are supposed to avoid the fish with the highest mercury levels, you might be eating the other fish each week, so unless you don’t like to eat fish, it is almost certainly going to quickly add up to much more than you get from your yearly flu vaccine, which you likely avoided anyway by getting a thimerosal-free flu shot.

And with fish, the mercury is in the form of methymercury, 95% of which is absorbed into your bloodstream. In contrast, thimerosal in vaccines breaks down to ethylmercury and is eliminated from your body quicker than methylmercury.

But if fish contains mercury, why not just tell people to avoid eating fish?

“Most fish are an excellent source of high quality protein. Fish are also important sources of selenium, zinc, iodine, iron, and other minerals needed by the body. Fish are natural sources of many B vitamins, and oily fish provide vitamins A and D. Studies with pregnant women have found that the nutritional benefits of fish, like other protein-rich foods, are important for their children’s growth and development during pregnancy and childhood. Most fish are low in fat, and most of the fat that is present in fish is healthy polyunsaturated fat. The polyunsaturated omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are also present in many types of fish. Research is still underway to determine the health benefits of omega-3 fatty acids.”

Questions & Answers from the FDA/EPA Advice on What Pregnant Women and Parents Should Know about Eating Fish

Fish have a lot of important nutrients, so are good to eat. So you balance the benefits of eating fish with the risks of mercury contamination and we get the sensible advice to limit the amount of fish you eat.

When you do the same kind of analysis of the risks and benefits of vaccines, even those with thimerosal, the benefits are still greatly in favor of getting vaccinated to prevent life-threatening infections. Remember, thimerosal was removed from vaccines as a precautionary measure and not because it was proven to be dangerous. In fact, many studies have shown that thimerosal in vaccines is not harmful.

What to Know About Mercury in Fish and Vaccines

Comparing mercury in fish and vaccines is like comparing conventionally grown apples and pears, at least it would be if someone figured out how to make an edible vaccine in the form of a pear.

More on Mercury in Fish and Vaccines