Tag: rotavirus vaccines

Do Anti-Vaccine Pediatricians Lose Millions Not Vaccinating Kids?

Paul Thomas is upset…

He thinks that Willamette Week, an alternative weekly newspaper in Portland, is trying to discredit him.

How are they using their platform “to try to discredit an ethical top Pediatrician in the community?”

An “ethical top pediatrician” who made up his own immunization schedule???

Paul Thomas was barred from the Vaccines for Children Program.
Paul Thomas was barred from the Vaccines for Children Program.

Willamette Week published a story about how Paul Thomas was kicked out of the Vaccines for Children Program.

“VFC (Vaccines for Children) does not provide any funding (no real dollars) just free vaccines for the underprivileged. What I lost was the ability to provide this free federal program to my patients who qualify for this program. This is simply a major inconvenience to those affected. Financially it is neutral to me.

My clinic had actually stocked the vaccines Rachel mentions – we just didn’t comply in a timely manner, so you got this part right “I didn’t jump through their hoops fast enough.”

Paul Thomas

To make a long story short, he got kicked out of the Vaccines for Children Program because he didn’t follow the rules of the program.

What about the idea that he “just didn’t comply in a timely manner?”

This all started over two and a half years ago???

Although Paul Thomas says in his post that his “clinic had actually stocked the vaccines Rachel mentions,” the order kicking him out of the VFC program says otherwise.

“Dr. Thomas submitted a Declaration signed under penalty of perjury stating his office does not keep stock of HPV vaccines and instead sends patients to pharmacies.”

Default Order Terminating Integrative Pediatrics from VFC

He also did not have any rotavirus vaccine in his office.

Not exercising medical judgement in accordance with accepted medical practice? Where is the Oregon Medical Board???

To get to the point of being terminated and which Paul Thomas characterizes as “I didn’t jump through their hoops fast enough,” actually involved:

  • ignoring an offer for a probationary agreement (August 2018)
  • asking for a contested case hearing (October 2018) which was scheduled for July 12, 2019
  • withdrawing his request for a contested case hearing on July 10, 2019

I’m surprised they gave him that much time!

Did he lose Medicaid funding?

I’m not sure he even takes Medicaid, but he did lose the ability to give his patients vaccines that he didn’t have to pay for.

“One huge misconception, and I see the comments on this, is that pediatricians don’t make money on vaccines or that they are not financially incentivized to vaccinate. There are profits from vaccine mark-ups and huge profits from vaccine administration fees. The average admin fee is about $35 per vaccine. For the 715 patients born into my practice who have refused to give any vaccines (each child would have had 28 vaccines by age 2 and over 60 vaccines in their childhood) amounting to income of $700,000 for the 2 years and $1.5 million over their childhood. Those are real dollars lost for Integrative Pediatrics. The money lost when considering that we serve over 15,000 patients, with most being selective about how they vaccinate would have driven most practices out of business.

There are also built in incentives in many contracts with health plans. Vaccines are a quality measure (if your practice does not reach a bench mark in numbers vaccinated) you loose a % on all services provided to patients under that insurance contract.

Is it any wonder most of my peers discharge patients from their practices who won’t follow the CDC schedule? Often these patients are told to call Dr. Thomas (Integrative Pediatrics).

Let us be clear. It is not a good business decision to allow families not to vaccinate or to permit selective vaccination.”

Paul Thomas

Let us be clear. He certainly doesn’t understand vaccine administration fees…

Some things he gets wrong?

  • pediatricians might charge $35 as an admin fee, but they are lucky if insurance companies pay them 1/3 or 1/2 that or even less. Your average vaccine administration fee is only going to be $35 if you don’t take insurance and can set your own fees!
  • you get a lower vaccine administration fee for the second vaccine component given (you use a different CPT code – 90461) vs the first (90460), and it pays less, so doctors make less when they give multiple vaccines at the same visit. Is that why many vaccine friendly doctors recommend giving one vaccine at a time?

And he misses the whole point behind vaccine administration fees.

It costs pediatricians money to order, stock, monitor, and give vaccines!

“This study shows that the variable costs of vaccine administration exceeded reimbursement from some insurers and healthplans.”

Glazner et al on Cost of Vaccine Administration Among Pediatric Practices

Do they make any money?

Hopefully they do, as health care is a business in the United States, but they certainly aren’t making millions in net profit as Paul Thomas suggests. And if they aren’t very careful, after considering all of the factors that go into giving a vaccine, it is very easy to lose money.

How Do Anti-Vaccine Pediatricians Make Money?

Which brings us back to the business decision of being a pediatrician who scares parents away from vaccinating and protecting their kids.

Is there any money in that?

Paul Thomas doesn't mention that he gets a big cut of the sales for a "free" summit that costs $197 as he promotes his anti-vaccine lecture.
Paul Thomas doesn’t mention that he gets a big cut of the sales for a “free” summit that costs $197 as he promotes his anti-vaccine lecture.

Books, seminars, supplements, essential oils – there are lots of things to sell parents who don’t vaccinate their kids.

Compared to these pediatricians in California, Paul Thomas is a bargain at just $295/year.

Don’t forget the annual membership fees that many of these pediatricians charge for the privilege of skipping or delaying vaccines and at extra risk to get a vaccine-preventable disease.

And the vaccine exemptions that some of them sell…

More on Do Anti-Vaccine Pediatricians Lose Millions Not Vaccinating Kids?

St. Jude Inpatient Visiting Guidelines

How do anti-vaccine folks get away with using St. Jude inpatient visiting guidelines to convince people that shedding from vaccines is a problem?

Outdated information anti-vaccine folks push as the latest St. Jude Inpatient Visiting Guidelines.
Outdated information anti-vaccine folks push as the latest St. Jude Inpatient Visiting Guidelines.

They keep sharing guidelines that are out-of-date.

St. Jude Inpatient Visiting Guidelines

What does St. Jude tell visitors these days?

The latest Patient Visitor Guidelines from St Jude
The latest Patient Visitor Guidelines from St. Jude.

They mostly emphasize that folks should get vaccinated and protected so that they don’t get a vaccine-preventable disease, which would increase the chances that others could get sick too.

What about shedding?

It is rarely a problem.

“…the increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children.”

Medical Advisory Committee of the Immune Deficiency Foundation

More folks not getting vaccinated? That is a problem

More on St. Jude Inpatient Visiting Guidelines

Why Did Anti-Vaccine Folks Applaud Rand Paul’s Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Wait, what?

Why Did Anti-Vaccine Folks Applaud Rand Paul's Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Anti-vaccine folks actually applauded Rand Paul’s testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Why Did Anti-Vaccine Folks Applaud Rand Paul’s Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks?

Surprisingly, many of the things he said weren’t anti-vaccine.

I guess they ignored those parts…

  • …given the choice, I do believe that the benefits of most vaccines vastly outweigh the risks.
  • I’m not hear to say don’t vaccinate your kids… if this hearing is for persuasion, I’m all for the persuasion. I vaccinated myself. I vaccinated my kids.
  • For myself and my kids, I believe that the benefits of vaccines greatly outweigh the risks…

So why were they cheering?

Because that’s not all he said…

“Today, instead of persuasion, many governments have taken to mandating a whole host of vaccines, including vaccines for non-lethal diseases.”

Sen Rand Paul

While some vaccine-preventable diseases are more deadly than others, they can all be deadly. From rotavirus and HPV to hepatitis A, these diseases can kill people.

Which vaccine-preventable disease does he think is non-lethal?

“Sometimes these vaccine mandates have run amok. As when the government mandated a rotavirus vaccine that was later recalled because it was causing intestinal blockage in children.”

Sen Rand Paul

That’s an interesting example of “the government” that has run amok…

Which “government” mandated that the original rotavirus vaccine be given to children?

As Senator Paul hopefully understands, the Federal government doesn’t mandate vaccines for anyone. And since it must be given at such a young age, even states don’t actually mandate that the rotavirus vaccine be given to children…

Even today, there are no mandates for the rotavirus vaccine.

If there were, it still wouldn’t mean giving up your Liberty, after all, vaccine mandates don’t mean forced vaccination.

“It is wrong to say that there are no risks to vaccines. Even the government admits that children are sometimes injured by vaccines. Since 1988, over $4 billion has been paid out from the Vaccine Injury Compensation Program. Despite the government admitting to and paying $4 billion for vaccine injuries, no informed consent is used or required when you vaccinate your child. This may be the only medical procedure in today’s medical world where an informed consent is not required. “

Sen Rand Paul

No one says that there are no risks to vaccines. That’s a classic anti-vaccine talking point.

What folks actually say is that vaccines are safe, with few serious risks.

And the $4 billion that Rand Paul and anti-vaccine folks often talk about has been paid out over more than 30 years, during a time that we have given nearly 300 million doses of vaccines each and every year!

But what’s that he said about informed consent?

Why wouldn’t informed consent be given or be required before getting a vaccine?

Of course, parents get informed consent before getting vaccines.

They don’t get informed consent if they decide to skip or delay their child’s vaccines after getting bad information.

“Now proponents of mandatory government vaccination argue that parents who refuse to vaccinate their children risk spreading these diseases to the immunocompromised community. There doesn’t seem to be enough evidence of this happening for it to be recorded as a statistic, but it could happen. But if the fear of this is valid, are we to find that next we will be mandating flu vaccine?”

Sen Rand Paul

Lastly, why didn’t Sen Paul find evidence that intentionally unvaccinated kids are spreading disease to the immunocompromised community?

Maybe he didn’t look…

It happens.

Do we need it to happen more often so that it becomes a large statistic before he and others will advocate that folks get vaccinated to attend school?

Do you understand have a better understand now why anti-vaccine folks were cheering after his testimony?

“If you believe in Liberty, that’s fine, don’t get immunized. But I don’t think that you need to necessarily expose others to disease.”

Sen Bill Cassidy

It should give you a better understanding both of Rand Paul’s ideas and those of the anti-vaccine movement.

More on Rand Paul’s Testimony at the Senate Health Committee Hearing on Vaccines and Outbreaks

Can I Get Rotavirus from My Recently Vaccinated Baby?

Your two month old recently got her vaccines, including the rotavirus vaccine.

Shedding Season is not a real thing.
Shedding Season is not a real thing.

Now you have diarrhea.

Was it from shedding from your child’s rotavirus vaccine?

Does the Rotavirus Vaccine Shed?

Like some other live virus vaccines, it is well known that the rotavirus vaccine can shed.

And like with most other vaccines, this shedding isn’t usually a cause for concern and definitely isn’t a reason to think about skipping or delaying your child’s vaccines.

Why not?

“All members of the household should wash their hands after changing the diaper of an infant. This minimizes rotavirus transmission, for an undetermined number of weeks after vaccination, from an infant who received rotavirus vaccine.”

General Recommendations on Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP)

If you wash your hands when you change your child’s diapers after they have been vaccinated, just like you hopefully do anyway, you can avoid any possible contact with any rotavirus vaccine virus that might be shed in your child’s stool.

Can I Get Rotavirus from My Recently Vaccinated Baby?

But what would be the risk of your getting sick if you did come into contact with shedding rotavirus vaccine virus in your child’s diaper?

Would you be at risk to get sick?

Did your baby get sick after getting the actual vaccine?

That’s the thing about shedding that many people don’t understand. These live vaccines are made with attenuated or weakened strains of viruses, so they don’t typically get you sick when you are vaccinated. And they don’t typically get you sick when you are exposed through shedding. In fact, this shedding can sometimes help build herd immunity, as more people get exposed to the weakened strain of vaccine virus.

But can they get you sick?

Yes, if you have a problem with your immune system, which is why there are warnings about giving live vaccines to folks who are immunocompromised. And there used to be warnings about giving the oral polio vaccine to kids if they were around anyone with an immune system problem.

Vaccine viruses could also get you sick if they mutated from their attenuated state and became more virulent. Fortunately, that rarely happens with most vaccines.

“The theoretical risk of HRV and PRV shedding, transmission to, and infection of immunocompromised contacts is much lower than the real risk of wildtype rotavirus infection transmitted from unvaccinated children.”

Anderson on Rotavirus vaccines: viral shedding and risk of transmission

And most importantly, since kids are much more likely to shed virus after natural infections, it is much safer for everyone to get vaccinated and protected with these vaccines.

Surprisingly, even children with asymptomatic natural rotavirus infections can shed virus for several weeks, which is likely why these infections used to spread so easily or without known contacts.

Something that will likely surprise some folks even more is the news that just because someone gets diarrhea after being exposed to the rotavirus vaccine, either because they were vaccinated or through shedding, it doesn’t mean that the vaccine was the cause of the diarrhea!

“Of note, among all six AGE cases which possessed Rotarix-derived strains, four (sample No.1, 5, 6 and 7) were suspected to be caused by other pathogens. Most likely, the infants were infected with other pathogens during the shedding period of Rotarix strain.”

Kaneko et al on Identification of vaccine-derived rotavirus strains in children with acute gastroenteritis in Japan, 2012-2015

When vaccine strain rotavirus have been detected in kids with gastroenteritis, they often have other reasons to have diarrhea.

What does this all mean?

Don’t believe all of the hype anti-vaccine folks push about shedding from vaccines.

More on Shedding and Rotavirus Vaccines