Tag: seizures

Who Are the Medically Fragile Children?

As SB 276 becomes law in California, one thing we have been hearing about from some folks is how it will affect medically fragile children.

No one is coming to take the medical exemptions from medically fragile children.
No one is coming to take the medical exemptions from medically fragile children…

Will SB 276 or vaccine laws in other states take away the medical exemptions from medically fragile children?

Of course not!

Who Are the Medically Fragile Children?

The first thing to understand is that when folks like Rob Schneider talk about medically fragile children, they are using the term differently than when medical professionals and most parents do.

“Medically fragile” means having an acute or chronic health problem which requires therapeutic intervention and skilled nursing care during all or part of the day. Medically fragile problems include, but are not limited to, HIV disease, severe lung disease requiring oxygen, severe lung disease requiring ventilator or tracheostomy care, complicated spina bifida, heart disease, malignancy, asthmatic exacerbations, cystic fibrosis exacerbations, neuromuscular disease, encephalopathies, and seizure disorders.

2005 California Health and Safety Code Sections 1760-1761.8 FACILITIES HEALTH AND SAFETY CODE SECTION 1760-1761.8

The medically fragile kids as defined by the California Health and Safety Code, who require skilled nursing care, are not typically the kids who are getting routine medical exemptions.

Sure, some of them might need one. A child with severe HIV disease or a malignancy being treated with chemotherapy would likely get a medical exemption for live vaccines, etc.

A child with an acute encephalopathy or uncontrolled seizures would also qualify for a medical exemption.

And since vaccines aren’t 100% risk free, there might be some kids with a vaccine injury among these medically fragile kids. It is likely not a high number though, as severe reactions to vaccines are very rare.

“CMC {children with medical complexity} are likely increasing in prevalence because of increased survival rates of infants born prematurely, those born with various congenital anomalies, and/or those with chronic conditions, as well as improved treatments for acute illnesses in fields such as intensive care and oncology.”

Cohen et al on Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

In most other cases, medically fragile kids wouldn’t need a medical exemption and would greatly benefit from being vaccinated and protected!

They would also greatly benefit if everyone around them was vaccinated and protected, especially if they did have a medical exemption.

Again, no one is coming to take their necessary medical exemptions if they have one though.

More on Medically Fragile Children

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

How Long Do Side Effects of Immunizations Last?

Immunizations are safe, but they can have some risks and side effects.

Vaccine side effects can be reported to VAERS online or using a downloadable form.
Vaccine adverse events can be reported to VAERS online or using a downloadable form.

Fortunately, most are fairly mild, like pain and fever.

How Long Do Side Effects of Immunizations Last?

And most vaccine side effects go away quickly.

For example, fever and fussiness, two of the most common vaccine reactions, typically only lasts a day or two.

Others can last a little longer, but still usually go away on their own:

  • when kids get a rash after their MMR vaccine, it might last three or four days
  • even when kids get swelling of an entire arm or leg after the DTaP shot is given, it might last for 1–7 days
  • pain at the injection site typically only lasts a few days
  • shoulder injury related to vaccine administration (SIRVA) can last months and sometimes doesn’t go away
  • arthritis after a rubella containing vaccine, which mostly occurs in adults, typically only lasts a few days
  • febrile seizures are usually brief and rarely lead to non-febrile seizures
  • immune thrombocytopenic purpura (ITP) after a measles containing vaccine resolves in two weeks to six months, typically without any treatment
  • intussusception after a rotavirus vaccine resolves with treatment, either an air contrast enema or surgery
  • Guillain-Barré Syndrome after a seasonal flu vaccine, which is very rare, resolves in the majority of people over a period of years

Do any have more long lasting effects?

VAPP or vaccine-associated paralytic polio after the oral polio vaccine might not resolve. Fortunately, it only occurs in about 1 in every 1.27 million children receiving their first dose of OPV. It is even less common after bOPV, which is oral polio vaccine that is now being used. And won’t happen at all once we stop using oral polio vaccines.

Encephalitis or encephalopathy after a pertussis or a measles, mumps, and rubella virus containing vaccine might also lead to long lasting effects.

And some, like anaphylaxis, are life-threatening.

Fortunately, most long-term vaccine studies have shown that immunizations are safe, rarely causing severe reactions, and don’t have many long term side effects.

What to Know About How Long Immunization Side Effects Last

Most vaccine side effects are mild and only last a few days.

More on Immunization Side Effects

Did the AAP Say That Vaccines Cause Severe Brain Injury?

Bob Sears is telling folks that the American Academy of Pediatrics says severe brain injuries are caused by vaccines.

Bob Sears doesn't mention that measles is much more likely to cause severe brain injury and death, or more recent studies that counter his post.
Bob Sears doesn’t mention that measles is much more likely to cause severe brain injury and death, or more recent studies that counter his post.

Did the AAP say that?

“A causal relationship they say.”

Bob Sears

No, they didn’t.

The researchers in Pediatrics didn’t even say that…

Did the AAP Say That Vaccines Cause Severe Brain Injury?

What did they say?

“This clustering suggests that a causal relationship between measles vaccine and encephalopathy may exist as a rare complication of measles immunization.”

Weibel et al on Acute Encephalopathy Followed by Permanent Brain Injury or Death Associated With Further Attenuated Measles Vaccines: A Review of Claims Submitted to the National Vaccine Injury Compensation Program

The study was about reports to VAERS…

Over 23 years, the researchers (in 1998) found reports of 48 cases of acute encephalopathy among about 75,000,000 children who were vaccinated, some clustered in the second week after they received a measles containing vaccine.

Does that mean that those measles containing vaccines caused the encephalopathy?

“In the absence of a specific test to determine vaccine causation, these 48 cases may include some nonvaccine cases representing background rates.”

Weibel et al on Acute Encephalopathy Followed by Permanent Brain Injury or Death Associated With Further Attenuated Measles Vaccines: A Review of Claims Submitted to the National Vaccine Injury Compensation Program

No, it doesn’t.

It was a signal that got some attention though.

And as it has been further investigated, there has been no evidence that measles containing vaccines cause encephalitis, at least not above 1 in a million background rates.

What does cause encephalitis?

“About 1 child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability.”

Complications of Measles

Measles.

Measles, a life-threatening vaccine-preventable disease, causes encephalitis.

Are your kids vaccinated and protected with two doses of MMR?

More on Vaccines and Severe Brain Injury