Tag: risks

Who’s Getting Measles?

We will soon pass the last record high number of measles cases – 963 cases – set in 1994.

We will soon pass the last record high number of measles cases - 963 cases - set in 1994.

With 839 cases as of mid-April, it’s hard to believe that only 55 cases were reported during all of 2012!

Who’s Getting Measles?

So what do we know about the people who are getting measles?

More importantly, the thing that most parents want to know – are their families at risk?

We know that of the 839 cases right now:

  • 442 are in Brooklyn among the Orthodox Jewish community, where only 4% of cases have been fully vaccinated
  • 125 are in Rockland County, New York, among the Orthodox Jewish community, where only 3% of cases have been fully vaccinated
  • 78 were in the Pacific Northwest Outbreak (Washington and Oregon), where none were fully immunized – (ended)
  • 43 are in Michigan, mostly among Oakland County’s Orthodox Jewish community, triggered by a man who had recently traveled from New York

So just over 80% of cases are associated with four outbreaks, one of which has been declared over, and mostly among children and adults who were intentionally not vaccinated.

The rest of the 200 cases?

Among 45 cases in California, are 30 cases in these four outbreaks.
Among 45 cases in California, are 30 cases in these four outbreaks.

They are spread out in smaller outbreaks in other states, including Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Mississippi, Missouri, Nevada, New Hampshire, New Jersey, Oklahoma, Pennsylvania, Tennessee, and Texas.

Does that mean that you don’t have to worry about measles?

It means that you don’t have to panic about measles.

Get your kids vaccinated and protected, which might include an early dose of MMR, learn the signs and symptoms of measles, and keep up on news of outbreaks in your area.

That should help decrease the risk that they get caught up in an outbreak.

And double check your own vaccine records! Have you had an MMR vaccine? Have you had two doses?

Unfortunately, not everyone can get vaccinated and protected, which is causing some folks to panic. This includes those who are too young to be vaccinated, or fully vaccinated, and those with immune system problems.

That’s not fair.

Let’s stop the outbreaks so we don’t get to the point that measles truly is everywhere and even more high-risk people are put at risk.

More on Who’s Getting Measles

Why Can’t You Give Blood After Getting a Vaccine?

If you are like most people, you have heard so much anti-vaccine misinformation that you figure it is safe to assume that everything these folks say isn’t true.

Yes, go research shedding

If you are a true skeptic, you will still do your research on any new claims just to make sure.

Why Can’t You Give Blood After Getting a Vaccine?

Although you may not have heard of any restrictions on donating blood after getting vaccinated before, it makes sense once you think of it.

You actually have to wait:

  • for up to 8 weeks after getting the smallpox vaccine
  • for up to 4 weeks after getting the MMR (because of the rubella component), chickenpox, and Zostavax vaccines.
  • for up to 3 weeks after getting the hepatitis B vaccine
  • for up to 2 weeks after getting the measles, mumps, oral polio, or yellow fever vaccines

If you notice that these are almost all live vaccines, it becomes very easy to see why you can’t donate blood shortly after being vaccinated.

Blood donation is “Acceptable if you were vaccinated for influenza, tetanus or meningitis, providing you are symptom-free and fever-free. Includes the Tdap vaccine. Acceptable if you received an HPV Vaccine (example, Gardasil).”

American Red Cross Eligibility Criteria: Alphabetical

Live vaccines can create a temporary viremia (virus particles in the blood), which could then be transferred to someone else in donated blood.

Could you get an infection this way?

Probably not.

Remember, you would only be getting the attenuated or weakened vaccine virus strain and even then, it would be a very small amount. If the person getting the vaccine doesn’t get sick from getting the vaccine, why would someone who was getting a much smaller dose through a blood donation.

Still, there is a theoretical risk, especially if the person who received the blood donation had an immunodeficiency, so people aren’t supposed to donate blood shortly after getting these vaccines.

But what about the hepatitis B vaccine. It isn’t a live virus vaccine.

The risk with this vaccine is that a very recently vaccinated donor might test positive for HBsAg (this only happens temporarily), leading the donation center to actually think that they had a hepatitis B infection, disqualifying them from ever donating blood again.

Does any of this mean that vaccines aren’t safe?

Of course not!

Just consider some of the other restrictions on donating blood:

  • You are not eligible to ever donate if you ever tested positive for hepatitis B, even if you were never sick.
  • You must wait 12 months after your last contact if you were exposed to someone with hepatitis B and you want to donate blood.
  • If you are unvaccinated, you must wait at least 4 weeks after being exposed to someone with measles.

So yes, that means that you will be much more likely to be eligible to donate blood if you are fully vaccinated and protected.

More on Donating Blood After Getting Vaccinated

What’s Your Chance of Getting Measles Right Now?

It shouldn’t be a surprise that a lot of folks are thinking about their risk of getting measles right now.

But with record levels of measles cases this year, some of us are thinking about our level of risk much differently than others.

rIf you are unvaccinated and exposed to someone with measles, you risk is actually 1,000,000 times higher…

While most of us simply want to make sure we are vaccinated and protected, anti-vaccine folks are taking every opportunity to downplay their risks.

What’s Your Chance of Getting Measles Right Now?

So what’s your chance of getting measles?

“Measles is one of the world’s most contagious diseases. It is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The virus remains active and contagious in the air or on infected surfaces for up to 2 hours. It can be transmitted by an infected person from 4 days prior to the onset of the rash to 4 days after the rash erupts.”

WHO on Measles

That’s actually not that simple to figure out, but depends on:

Those who have had two doses, with no plans to travel, and who live in an area with no reported cases, are at extremely low risk to get measles – the risk won’t be zero until measles is eradicated.

In this kind of low risk situation, kids don’t need early doses of MMR vaccines and most adults can probably get away with just having one dose of MMR.

“Measles is highly contagious and spreads through the air when an infected person coughs or sneezes. It is so contagious that if one person has it, 9 out of 10 people of all ages around him or her will also become infected if they are not protected.”

CDC on Measles is Highly Contagious

On the other hand, if you are unvaccinated and were at the AMC Theater on Lemon Street in Fullerton, between 11 p.m. and 4 a.m. on April 25, then your chance of getting measles is about 90%!

Wait! That’s a little more than the 0.000092% chance that anti-vaccine folks are throwing around…

The odds of being hit by lightning are low because we practice storm safety and don’t run around outside when we see lightning!

To think of it another way, if you knew that your chances of getting hit by lightning were a little over 1 in a million, would that make you think it is okay to go outside and play golf during a severe thunderstorm?

Would you think the risk is so low that you could let your kids play outside if you heard thunder and saw lightning flashes nearby, or would you all rush inside?

That’s right! The risk of getting hit by lightning is low because most of us don’t take chances when we hear thunder or see lightning.

It’s the same with measles and other vaccine-preventable diseases.

The overall risk is low because most people are vaccinated and protected!

If you aren’t vaccinated and protected, as we see more and more cases, your risk of getting sick, and getting others sick, is going to continue to get higher and will always be much higher than someone who is fully vaccinated, no matter how much you want to believe in shedding, mild measles, or whatever myths help you justify keeping your kids unvaccinated and unprotected during an outbreak.

Remember, you can’t hide in the herd if you are scaring away too much the herd

Vaccines are safe, with few risks, and are obviously necessary.

You can avoid getting measles.
You can greatly reduce your family’s risk of getting measles.

Make sure your family is protected so they don’t get caught up in a measles outbreak

More on Your Chance of Getting Measles


Remembering the Measles Epidemics of the 1990s

A lot of folks are talking about how we are seeing record numbers of measles cases this year, the most since we declared the end to the endemic spread of measles in the United States in 2000.

Believe it or not though, the record goes back further than that.

We have already seen the most cases since 1994.

That’s a 25 year record!

Remembering the Measles Epidemics of the 1990s

Do not leave your child unprotected!

And trust me, we don’t want to surpass any records beyond that!

If we do break those records, reaching thousands of cases this year, then we will reach epidemic levels of measles.

And many of us who know what that means, remembering that there were 55,622 cases of measles and 123 deaths in the United States between 1989 and 1991, a time when we had good nutrition, hygiene, sanitation, and health care…

What else did we have?

A lot of unvaccinated kids!

But we learned our lesson, got more kids vaccinated, and eliminated the endemic spread of measles.

We even got to a record low of measles cases, just 37 cases in 2004!

Will we ever beat that record?

Remember when our state Legislatures worked to protect us from infectious diseases, instead of trying to pass laws that make it easier for kids to skip or delay their vaccines?

And then parents forgot how bad measles could be and that made it easier to believe in all of the misinformation of people like Andrew Wakefield, Bob Sears, Jenny McCarthy, and the new breed of anti-vaccine social media influencers who are scaring parents away from vaccinating and protecting their kids.

Long story short, measles is back

Fortunately, there are many people who remember and won’t let us repeat the mistakes of the past.

Many parents remember and they vaccinate and protect their kids.

Most pediatricians remember.

We remember and know that vaccines are safe, with few risks, and are obviously necessary. And we don’t want to wait until people start to die before more parents vaccinate their kids.

If you don’t remember what it was like when everyone had measles, read some of the stories below…

More on the Measles Epidemics of the 1990s

Is Measles Dangerous If You Are Pregnant?

While folks often try and make it seem like measles is a common childhood illness, we know that it can be dangerous.

“One of the patients was a 20-year-old pregnant woman who had rash onset on January 5 following exposure to her 12-year-old brother. After delivering a healthy baby on January 6, the mother developed severe pneumonia that was followed by respiratory arrest. She was resuscitated and transferred to an intensive care unit in a larger hospital nearby in Tennessee.”

Epidemiologic Notes and Reports Transmission of Measles Across State Lines — Kentucky, New Hampshire, Tennessee, Virginia

Rarely do people who have really had measles describe it as just a fever and a rash. They remember that it was called a harmless killer for a reason.

Is Measles Dangerous If You Are Pregnant?

And there are some situations in which measles can be especially dangerous, including if you get sick when you are very young, very old, or have immune system problems.

Pregnant women should be screened for measles immunity.
Pregnant women should be screened for measles immunity.

And what if you are pregnant when you get measles?

“The Health Department announced today that the number of measles cases has grown to 390, including two pregnant women diagnosed with the infection, one diagnosed in mid-April.”

The Number of Measles Cases Grows to 390

If you are pregnant and you are exposed to someone with measles, you can get IVIG post-exposure prophylaxis to prevent you from actually getting measles, but this typically only works if given within six days of the exposure.

“To date, studies have not identified an increased risk for birth defects when pregnant women get the measles during pregnancy. However, studies suggest that measles infection is associated with an increased risk for miscarriage, stillbirth, prematurity and the baby being born with a measles infection.”

When Measles Strike, It’s Not The Happiest Place On Earth For Pregnant Women

Unlike a rubella infection during pregnancy, a measles infection is not thought to cause birth defects. Tragically, it can, like rubella, lead to an increased risk for having a miscarriage.

“Infants who develop congenital measles are at increased risk for mortality and for subacute sclerosing panencephalitis, which is more common when measles is diagnosed in infancy. In addition, subacute sclerosing panencephalitis in newborns infected with measles either congenitally or shortly after birth appears to be more severe, with a shorter latency and rapidly progressive course.”

What Obstetric Health Care Providers Need to Know About Measles and Pregnancy

And if the mother gets measles very late in her pregnancy, it can also lead to a case of congenital measles, or a baby being born with an active measles infection.

“In 52% of cases, measles was likely acquired from a relative. Complications included pneumonia in one child; two pregnant women required hospitalization, including one who miscarried.”

Notes from the Field: Measles Outbreak Among Members of a Religious Community — Brooklyn, New York, March–June 2013

Don’t take the risk that you might get measles while you are pregnant.

Make sure you are vaccinated and protected before you ever start thinking about getting pregnant, as pregnancy is a contraindication to getting the MMR vaccine. And you should wait at least 4 weeks after getting vaccinated before getting pregnant.

More on Measles in Pregnancy

Peanut Butter or the Plague?

There are plenty of good arguments that parents make when advocating for vaccines.

This meme about peanut butter isn’t one of them.

Vaccinate your kids or I’ll expose them to a potentially deadly allergen?

Anyway, it’s Jif peanut butter.

Does jiffy pop make peanut butter flavored popcorn?

There is no such thing as Jiffy peanut butter.

Peanut Butter or the Plague?

And since it isn’t just unvaccinated kids who have peanut allergies, the whole idea of this meme really makes no sense.

Well, maybe the first part does. After all, sometimes we do things to protect others from getting sick.

Getting vaccinated and protected to promote herd immunity is one of them. In addition to protecting ourselves from life-threatening vaccine-preventable diseases, if we don’t get sick, we avoid exposing those who can’t be protected by vaccines, including those who are too young to be vaccinated and those with immune system problems.

Of course, there is another reason the meme doesn’t make sense.

A peanut allergy is a medical condition. Sending your intentionally unvaccinated kid to school is a choice.

Stop sharing this meme.

It’s insulting to parents of kids with severe food allergies and does nothing to advocate for vaccines.

More on Peanut Butter or the Plague

Is the MMR Safe for 6-Month-Old Babies?

Most parents understand that the first dose of the MMR vaccine is routinely given to children when they are 12 to 15 months old, at least in the United States.

In some other countries, the first dose is routinely given as early as 8 to 9-months of age.

And in high-risk situations, the MMR can safely be given to infants as early as age 6-months.

Is the MMR Safe for 6 Month Old Babies?

An early MMR, is that safe?

This type of pure anti-vaccine propaganda is what caused the measles outbreaks in New York in the first place...
This type of pure anti-vaccine propaganda is what caused the measles outbreaks in New York in the first place…

Yes, it is safe.

What about the package insert?

“Local health authorities may recommend measles vaccination of infants between 6 to 12 months of age in outbreak situations. This population may fail to respond to the components of the vaccine. Safety and effectiveness of mumps and rubella vaccine in infants less than 12 months of age have not been established. The younger the infant, the lower the likelihood of seroconversion (see CLINICAL PHARMACOLOGY). Such infants should receive a second dose of M-M-R II between 12 to 15 months of age followed by revaccination at elementary school entry.”

MMR II Package Insert

The package insert says to give infants who get an early dose another dose when they are 12 to 15 months old! It doesn’t say to not protect these babies!

But what about the idea that the safety and effectiveness of MMR hasn’t been proven for infants under 12 months of age?

In general, the package insert is only going to list studies that the manufacturer used to get FDA approval for their vaccine. Since it is an off-label recommendation of the ACIP, they would not include the studies that show that an early MMR is safe and effective.

“In conclusion, this study indicated that the MMR was well tolerated and immunogenic against measles, mumps and rubella with schedule of first dose both at 8 months and 12 months age. Our findings strongly supported that two doses of MMR can be introduced by replacing the first dose of MR in current EPI with MMR at 8 months age and the second dose at 18 months in China.”

He et al on Similar immunogenicity of measles-mumps-rubella (MMR) vaccine administrated at 8 months versus 12 months age in children.

Before 8 months, an early MMR isn’t likely to be as effective as giving it later. That’s because some maternal antibodies might linger in a baby’s system and can interfere with the vaccine working, even after six months. How many antibodies and how much interference?

It’s almost impossible to tell for any one child, but the risk that this maternal protection has begun to wear off and these infants are at risk to develop measles is too great. That’s the reason that they get an early MMR, even though we know it won’t be as effective as a dose given later and we know it will have to be repeated.

Is this early dose safe?

“This review did not identify any major safety concerns. These findings may facilitate discussions about the risks and benefits of vaccinating infants who are potentially exposed to this life-threatening disease.”

Woo et al on Adverse Events After MMR or MMRV Vaccine in Infants Under Nine Months Old

Of course! Although the complications of measles can be serious, even deadly, we aren’t going to recommend something that is even worse.

“Early MMR vaccination is well tolerated, with the lowest AE frequencies found in infants aged 6-8 months. It is a safe intervention for protecting young infants against measles.”

van der Maas et al on Tolerability of Early Measles-Mumps-Rubella Vaccination in Infants Aged 6-14 Months During a Measles Outbreak in The Netherlands in 2013-2014.

So an early MMR is safe, with few risks, and is likely effective at preventing measles.

And by now you know what’s not safe. That’s right, getting measles.

More on Early MMR Vaccines