As most folks know, Ethan Lindenberger is the Ohio teen who got himself vaccinated over the objections of his mother, who had always believed that vaccines are dangerous.
He recently testified in Washington, D.C. before the Senate Health, Education, Labor, and Pensions Committee Hearing, Vaccines Save Lives: What Is Driving Preventable Disease Outbreaks?
Who Is Ethan Lindenberger?
Not surprisingly, Ethan Lindenberger is getting a lot of attention lately.
Unfortunately, not all of it has been good.
Along the way to getting vaccinated and a trip to Capitol Hill, he has been attacked on social media from anti-vaccine folks who must see him as some kind of threat.
I remember speaking with my mother about vaccines, and at one point in our discussion she claimed a link existed between vaccines and autism. In response, I presented evidence from the CDC which claimed directly in large bold letters, “There is no link between vaccines and autism.” Within the same article from the CDC on their official website, extensive evidence and studies from the institute of medicine (IOM) were cited. Most would assume when confronted with such strong proof, there would be serious consideration that your views are incorrect. This was not the case for my mother, as her only response was, “that’s what they want you to think.”
Now that she sees that “they” have made up conspiracy theories about her own son, will Ethan’s mother understand how the anti-vaccine movement works?
“Conversations like these were what reaffirmed the evidence in defense of vaccinations and proved to me, at least on an anecdotal level, that anti-vaccine beliefs are deeply rooted in misinformation. Despite this, a necessary clarification must be made when discussing this misinformation: anti-vaccine individuals do not root their opinions in malice, but rather a true concern for themselves and other people. Although it may not seem to be true because of the serious implications of choosing not to vaccinate, the entire anti-vaccine movement has gained so much traction because of this fear and concern that vaccines are dangerous.”
“My story highlights this misinformation and how it spreads. Between social media platforms, to using a parent’s love as a tool, these lies cause people to distrust in vaccination, furthering the impact of a preventable disease outbreak and even contributing to the cause of diseases spreading. This needs to change and I only hope my story contributes to such advancements.”
We are lucky that Ethan told his story.
It’s an important story and hopefully everyone who is thinking about skipping or delaying their child’s vaccines will listen to it.
Knowing when to give or get a vaccine doesn’t usually cause any confusion.
You simply have to check the immunization schedule.
Take the meningococcal vaccines, for example. Most parents and pediatricians understand that kids get them before entering middle school and again before going off to college. And some high risk kids should get them even earlier, as infants.
At What Age Should Kids Get a Meningococcal Vaccine?
Actually, there are some things that make it a little more complicated than it should be…
some overnight and summer camps are actually starting to require a dose of meningococcal vaccine for younger kids, even though this is not a formal recommendation of the CDC or AAP
some parents might request a dose of meningococcal vaccine for younger kids going to overnight and summer camps, even though this is not a formal recommendation of the CDC or AAP
some folks are misunderstanding recommendations that campers be up-to-date on all immunizations as a recommendation that they get an early meningococcal vaccine
getting an early dose, before age 10 years won’t count as the middle school dose, and will need to be repeated
some states have very strict laws on timing, like that kids have to get their meningococcal vaccine before starting 6th grade, but only after they turn 11 years old, which creates a problem for those kids who start 6th grade before they are 11 years old
It is not to skip or delay your child’s meningococcal vaccine, of course.
Instead, states should likely institute their meningococcal vaccine laws to require a dose before entering 7th grade, that way, most will have plenty of time to get it while they are in 6th grade. Or at least keep to the standard minimum age of 10 years for a dose to count towards middle school requirements.
What about a meningococcal vaccine for campers?
“In New York State, PHL Article 21, Title 6, Section 2167 also requires the notification of campers and parents about recommendations for and the availability of meningococcal vaccine for all campers attending overnight camps for a period of 7 or more consecutive nights. Meningococcal ACWY (MenACWY) vaccine is recommended at age 11 or 12 years, with a booster dose at age 16 years. Please note that the NYSDOH does not recommend that campers receive either dose of MenACWY vaccine before the recommended ages. Students who are vaccinated before the recommended ages may need to have the doses repeated in order to attend school.”
Recommended Immunizations for Campers
Unless they are in a high risk group, folks should likely stick to the standard ages of the immunization schedule to get their kids vaccinated.
And keep in mind that if your child does get an early dose, it won’t count as part of the routine series and will have to be repeated.
“Doses of quadrivalent meningococcal vaccine (either MPSV4 or MenACWY) given before 10 years of age should not be counted as part of the routine 2-dose series. If a child received a dose of either MPSV4 or MenACWY before age 10 years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16 years.”
Ask the Experts Meningococcal ACWY
Talk to your pediatrician about an early dose if the extra coverage is important to you though. It will protect your child, but isn’t a general recommendation because younger kids have a lower risk for disease and vaccinating everyone likely wouldn’t impact disease rates that much.
Another situation in which getting an extra dose may be required is if you are traveling to a high risk part of the world. In this case, the extra dose is essential, even if it has to be repeated later.
A lot of folks, even some pediatricians, are still confused about the recommendations for the meningococcal B vaccines.
Remember, two vaccines, Bexsero and Trumenba, are approved to protect against serogroup B meningococcal disease.
The Men B Vaccine for High Risk Kids
There is no confusion about the recommendation that high risk kids should get vaccinated against meningococcal B disease.
“Certain persons aged ≥10 years who are at increased risk for meningococcal disease should receive MenB vaccine.”
ACIP on Use of Serogroup B Meningococcal Vaccines in Persons Aged ≥10 Years at Increased Risk for Serogroup B Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices, 2015
Who’s high risk?
In addition to microbiologists who work with the Neisseria meningitidis bacteria, you are considered to be high risk if you are at least 10 years old and:
have a persistent complement component deficiency, including inherited or chronic deficiencies in C3, C5–C9, properdin, factor D, or factor H
have anatomic or functional asplenia, including sickle cell disease, children with congenital asplenia, and children who’s spleen was removed (splenectomy) to prevent complications of other conditions, such as ITP, hereditary spherocytosis, pyruvate kinase deficiency, Gaucher disease, and hypersplenism, etc.
are taking the medication eculizumab (Soliris), which is used to treat two rare blood disorders, atypical hemolytic uremic syndrome (aHUS) and paroxysmal nocturnal hemoglobinuria (PNH)
And, if high risk, you should either get a 3 dose series of Trumenba or a 2 dose series of Bexsero.
Keep in mind that traveling is not usually a risk factor for Men B, but can be for the other meningococcal vaccines.
The Men B Vaccine for Healthy Teens
But what if you aren’t at high risk?
While teens should routinely get vaccinated with other meningococcal vaccines, Menactra or Menveo, that provide protection against serogroups A, C, W, Y, the recommendation for Men B vaccination is more permissive.
“A MenB vaccine series may be administered to adolescents and young adults aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16–18 years.”
ACIP on Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015
When given to healthy teens who are not at high risk for meningococcal disease, both Bexsero and Trumenba can be given as a two dose series.
A Permissive Recommendation for Men B Vaccines
This permissive recommendation for Men B is what has got folks confused…
“The recommendation is labeled as “Category B,” meaning that individual clinical decision-making is recommended. A Category A recommendation means a vaccine is recommended for everyone in an age-group or risk factor group.”
ACIP endorses individual choice on meningitis B vaccine
So there is a recommendation for older teens to get vaccinated with the Men B vaccines, it just isn’t the clear cut, get the vaccine, kind of recommendation that we are used to. The recommendation instead says that you can get the vaccine if you want to be vaccinated and protected against meningococcal B disease.
And that’s where the confusion comes from, as over 75% of doctors don’t even know what a category B recommendation really means! That’s not surprising though, as the Advisory Committee on Immunization Practices doesn’t often make category B recommendations for vaccines.
Things that factored into the decision for a permissive recommendation seemed to include that:
routine vaccination of all teens would prevent about 15 to 29 cases of Men B and two to five deaths each year, as there are about 50 to 60 cases and five to 10 deaths each year in children and young adults between the ages of 11 and 23 years, and giving it only to kids going to college would only prevent about nine cases and one death each year
there are some concerns about how effective the MenB vaccines might be, but only because vaccine effectiveness “was inferred based on an immunologic marker of protection,” as it is difficult to otherwise test how well the vaccine works because the disease has a low prevalence and there is no data yet about how long the protection will last, as they are new vaccines. Still, from 63 to 88% of people get protective levels of antibodies after getting the MenB vaccines and the protection should last for at least two to four years.
data on safety was limited, but there were no “no concerning patterns of serious adverse events”
the vaccine likely won’t reduce the nasopharyngeal colonization by MenB bacteria, so might not contribute to herd immunity
If you are still confused, you will hopefully be reassured that a combination, pentavalent MenABCW-135Y meningococcal vaccine is in the pipeline and once available, will almost certainly be recommended for all teens, replacing the need to get separate meningococcal vaccines for protection.
Making a Decision About the MenB Vaccines
So do you get your kids the Men B vaccine series?
“Pediatricians are encouraged to discuss the availability of the MenB vaccines with families.”
AAP on Recommendations for Serogroup B Meningococcal Vaccine for Persons 10 Years and Older
The one thing that is very clear is that you should make your decision after talking to your pediatrician about the risks and benefits of getting vaccinated.
Although many people think that there is no recommendation for healthy teens to get a Men B vaccine, that isn’t really true. There just isn’t a recommendation for routine vaccination of all teens.
It is true that the Men B vaccines aren’t required by most colleges, although some are starting to require them, just like they do Menactra or Menveo.
“The treating clinician should discuss the benefits, risks, and costs with patients and their families and then work with them to determine what is in their best interest.”
AAP on Recommendations for Serogroup B Meningococcal Vaccine for Persons 10 Years and Older
What are the benefits? Your child doesn’t get Men B disease, a disease that is often life-threatening.
What are the risks? In addition to extremely rare risks that you can see with any vaccine, like anaphylaxis, there are the risks that the vaccine doesn’t work, as no vaccine is 100% effective, pain from the shot, or that your child is never exposed, so didn’t actually need the shot, since Men B disease is pretty rare.
“The CDC has estimated the risk of anaphylaxis is 1.3 cases/1 million doses following administration of any vaccine. Thus, the vaccine benefit from prevention of death from MenB disease is approximately equal to the risk of anaphylaxis from MenB vaccine administration.”
H. Cody Meissner, MD on MenB vaccines: a remarkable technical accomplishment but uncertain clinical role
Although thinking about it this way, the risk of anaphylaxis vs the benefit of preventing Men B deaths seems to be equal, remember that anaphylaxis is often treatable.
What are the costs? Men B vaccines are expensive, but are covered by insurance and the Vaccines for Children Program. Still, someone is always paying for them.
What other factors come into play? Some teens are getting caught up on their HPV vaccines and are getting a booster dose of the other meningococcal vaccine at around this same time. While they can certainly all be given together, some pediatricians prioritize getting kids vaccinated and protected with Gardasil and Menactra or Menveo, and so don’t focus on the Men B vaccines.
Still, the vaccine is safe and it works, so the question really may come down to – is it necessary? Or is Men B so rare, that it is worth taking a chance and skipping this vaccine.
What to Know About the Recommendations to Get a Men B Vaccine
Talk to your pediatrician and see if your child should get the Men B vaccine series.
More on Understanding the Recommendations to Get a Men B Vaccine
Another situation where you might need to do some catching up is if you move, and instead of following the CDC schedule, you were just getting the minimum number of vaccines that were required to attend school where you used to live. For example, your kids could have been all set to start kindergarten in Arkansas, but if you suddenly moved to Texas, they might need a second MMR, a booster dose of Varivax, and two doses of hepatitis A vaccine, as none of those are required in Arkansas.
Immunization Requirements to Start Daycare and Preschool
Since many new parents have to go back to work when their baby is only about two to six weeks old, they won’t have time to get their first set of vaccines at two months.
That won’t keep them out of daycare, but delaying too much longer, usually more than a month, probably will.
To start daycare or preschool, infants and toddlers need to get most of the vaccines on the CDC immunization schedule. This includes DTaP, hepatitis B, Hib, Prevnar, and IPV (polio), and then once they are 12 months old, booster doses of the primary series of vaccines and the MMR, Varivax (chickenpox), and hepatitis A vaccines.
The only vaccine that is missing from many state mandates is the rotavirus vaccine. And that simply has to do with the strict timing requirements of when you need to start (before 15 weeks of age) and finish this vaccine (by 8 months).
Some states do require rotavirus though, and simply state that kids must follow “age appropriate dosing.” That way, if they are too old, they just don’t need to get it.
Immunization Requirements to Start Kindergarten
In addition to most of the vaccines they needed to start daycare or preschool, to start kindergarten, kids need their 4 to 6 year old boosters:
the fifth dose of DTaP to protect them against diphtheria, tetanus, and pertussis
the fourth dose of IPV to protect them against polio
the second dose of MMR to protect them against measles, mumps, and rubella
the second dose of Varivax to protect them against chicken pox
If using combination vaccines, these four immunizations can be combined into just two shots – Proquad (MMR + Varivax) and either Kinrix or Quadracel (DTaP + IPV), which your preschooler will appreciate to help reduce the pain from getting these shots.
If your kids were missing any vaccines, they will also need to get caught up on those before starting school.
Immunization Requirements to Start Middle School
Preteens and teens get a few vaccines when they start middle school when they are around 11 to 12 years old, including:
a dose of Tdap to protect them against diphtheria, tetanus, and pertussis
a dose of Menactra or Menveo to protect them against meningoccocal disease
Although not required by most schools, the HPV vaccine is also usually given around this time.
Immunization Requirements to Start College
And then, before going off to college, at around age 16 years, kids will usually need:
They can also get the MenB vaccine, although it isn’t yet required for all students. This vaccine (Bexsero or Trumenba) has a “permissive” recommendation, in that parents are told they can get it if they want their kids to avoid meningococcal B disease, but it is not required yet.
While an extra dose of the MMR vaccine is now being given in some situations, it is mainly if your child is at high risk because of a current mumps outbreak. A mumps booster shot is not currently recommended just because your child is going off to college.
What to Know About Immunization Requirements for Incoming Students
If you have been following the latest immunization schedule and your kids are up-to-date on all of their vaccines, then they will likely be ready to start daycare, kindergarten, high-school, and college without needing any extra vaccines.
More on Immunization Requirements for Incoming Students