Tag: travel vaccines

What Should You Do If Your Child Might Have Measles

As you hear more and more about measles outbreaks, eventually you might think that your child has measles.

Why?

Until a child develops the classic measles rash, the symptoms of measles can mimic many other more common viral illnesses, as they include fever, cough, coryza, red eyes, and irritability.

What Should You Do If Your Child Might Have Measles

And while many other viruses can cause a fever and rash, it is really only measles that causes the classic pattern of 3 or 4 days of high fever, followed by the appearance of a rash with continued fever.

Unfortunately, by the time your child has developed the rash, you may have already have gone to the doctor or ER a few times, exposing a lot of people to measles.

If your child has measles, don’t give it to anyone else.

That’s why it’s important to try and recognize measles as early as possible, so that you don’t expose anyone else and get them sick too.

It is especially important to think about measles if your child:

  • traveled out of the country in the past 7 to 21 days, the incubation period for measles
  • recently traveled to or lives in an area that is experiencing measles outbreaks
  • is not yet fully vaccinated, with two doses of MMR, keeping in mind that a small minority of people can get measles even if they are fully vaccinated

So what do you do if your child might have measles?

Ideally, you would call your health care provider, clinic, or emergency room ahead of time and let them know that you are concerned about measles. That allows them to take steps to minimize the risk that your child will expose others to measles.

While the child is isolated, health care professionals can then decide if it is necessary to do further testing for measles. If they do suspect measles, they may even call the local health department for further help.

If necessary, post-exposure prophylaxis might also be provided for the child’s contacts.

What if you aren’t sure if your child has measles? Put a mask on them anyway if there is any doubt! Don’t take a chance on causing a big outbreak.

During some outbreaks, communities have even had to implement universal masking of all patients and all family members to help get their outbreak under control.

And remember that the best way to stop these outbreaks is for everyone to get fully vaccinated on time and on schedule.

More on Measles Exposure Prevention Measures

How to Avoid Getting Caught up in a Measles Outbreak

By now, you have likely heard the news that we are on track for record-breaking numbers of measles cases this year, both in the United States and around the world.

You may also have heard that some of the folks getting caught up in these outbreaks weren’t actually anti-vaccine, but were people who thought they already had measles or thought they were already vaccinated and protected.

How to Avoid Getting Caught up in a Measles Outbreak

Are you and your family protected against measles?

Six ways to avoid measles.

You might be thinking, “of course we are, we get all of our vaccines!”

But you still might want to double check, keeping in mind that:

  • only people born before 1957 are thought to have natural immunity to measles, because measles was very common in the pre-vaccine era
  • the original measles vaccine that was used between 1963 and 1967 was not thought to be effective, so if that’s the only dose you had, it should be repeated
  • a recommendation for a second dose of MMR didn’t come until 1990, so many people born before that time have only had one dose, especially since there was never a catch-up program to make sure older people had two doses. Even now, adults don’t necessarily need two doses of MMR unless they are in a high-risk group (foreign travel, healthcare workers, living with someone who has a compromised immune system, people with HIV, and students).
  • children don’t routinely get their first dose of MMR until they are 12 to 15 months old (one dose is 93% effective at preventing measles), with a second dose at age 4 to 6 years (two doses are 97% effective)
  • a third dose of MMR isn’t typically recommended for measles protection

Still think you and your family are protected?

In addition to routine recommendations, to avoid measles in a more high risk setting (traveling out of the country or during an outbreak), you should:

  • get infants an early MMR, giving them their first dose any time between 6 and 11 months of age (repeating this dose at age 12 to 15 months)
  • get toddlers and preschoolers an early second dose of MMR, giving them their second dose at least 28 days after the routine first dose that they received when they were 12 to 15 months old, instead of waiting until they are 4 to 6 years
  • get older children and adults two doses of MMR if they haven’t already had both doses

What if your baby is exposed to measles before you have a chance to get him vaccinated?

Younger infants who are less than six months old can get a dose of immunoglobulin within 6 days if they are exposed to measles. Older infants, children, and adults can get a dose of MMR within 72 hours if they are not vaccinated and are exposed to someone with measles.

And the very best way to avoid measles is to keep up herd immunity levels of protection in our communities. If everyone is vaccinated and protected, then we won’t have outbreaks and our kids won’t get exposed to measles!

More on Avoiding Measles

We Know What Happens If We Stop Vaccinating

It’s no surprise.

If we stop vaccinating, diseases that are now vaccine preventable will come back.

How do we know?

Because it has happened already.

We Know What Happens If We Stop Vaccinating

It has happened a lot, actually.

Remember when Sweden stopped using the DPT vaccine?

Between 1979 and 1996, Sweden suspended vaccination against pertussis because of concerns about the DPT vaccine.

Justus Ström‘s data was wrong…

And what happened?

“In 1979, the Swedish medical society abandoned whole-cell pertussis vaccine and decided to wait for a new, safer, more effective vaccine – a strategy that was soon adopted as national policy. During 1980-83, annual incidence for children aged 0–4 years increased to 3370 per 100000, with rates of serious complications approaching global rates. In subsequent years, Sweden reported more than 10000 cases annually with an incidence exceeding 100 per 100000, comparable to rates reported in some developing countries.”

Ganarosa et al on Impact of anti-vaccine movements on pertussis control: the untold story.

Pertussis came back.

In fact, endemic pertussis came back.

“Our evaluation of pertussis in the unimmunized child population gave an answer to the question of whether pertussis nowadays is a harmless disease which does not demand general vaccination. The present situation regarding pertussis in Sweden and the low efficacy of the antimicrobial treatment indicate an urgent need to prevent the disease by general vaccination as soon as a safe and effective vaccine is available.”

Romanus et al on Pertussis in Sweden after the cessation of general immunization in 1979.

Of course, they already had a safe and effective vaccine at the time. All of the claims against the whole cell pertussis vaccine ended up being untrue.

The same thing happened when Japan stopped using the MMR vaccine.

“Due directly to these gaps in ‘herd’ immunization resulting from politicized transitions in vaccination policy by the government, there were outbreaks of rubella with 17,050 cases reported between the years of 2012 and 2014, and 45 cases of congenital rubella syndrome reported to the National Epidemiological Surveillance of Infectious Diseases from week 1, 2012 to week 40, 2014.”

Yusuke Tanaka on History repeats itself in Japan: Failure to learn from rubella epidemic leads to failure to provide the HPV vaccine

What happened in Ukraine when immunization rates dropped in the 1990s? There were 17,387 cases of diphtheria and 646 deaths from 1992 to 1997. Also high, were cases of measles (over 23,000 cases in 1993) and pertussis (almost 7,000 cases in 1993).

Remember the measles outbreaks that spread across Europe in 2010 to 11, leading to about 30,000 cases of measles each year, and at least 28 deaths?

That should have been enough to warn folks, but it didn’t.

Things are much worse now, with over 120 measles deaths in Europe over the past few years.

More recently, in Venezuela, shortages of most things have led to ongoing epidemics of measles and diphtheria, a “potential for reemergence of poliomyelitis,” and a risk to neighboring countries.

“Officials say the low coverage rate and widespread transmission of the virus is due to many factors, including transport costs for those in rural areas, a high number of people with weakened immune systems, such people living with HIV and tuberculosis – and vaccine refusal.”

Ukraine: Red Cross deployed to help contain largest measles outbreak in Europe in four years

And once again, there are measles outbreaks in Ukraine. This time, they have spread to many other countries, fueling outbreaks in Israel and the United States.

We know what happens if we stop vaccinating. Get vaccinated and stop the outbreaks.

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

More on What Happens If We Stop Vaccinating

Japan’s Rubella Outbreak Should Be a Warning About What Could Happen Here

Do you remember when we used to have rubella outbreaks in the United States?

There is a level 2 travel alert for Japan because of outbreaks of rubella.

Yeah, me neither, but in the rubella epidemics of the 1960s, rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome.

Japan’s Rubella Outbreak

Thanks to the rubella vaccine, the ‘R’ in the MMR, we rarely hear about rubella anymore.

Tragically, like measles and other vaccine-preventable diseases, rubella is coming back.

RubellaCongenital Rubella Syndrome
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There are still relatively few cases, but most of us would like to keep it that way.

The US had a big spike in rubella cases in the last 1980s.

We remember that with the return of measles in the late 1980s, rubella came back right along with it, causing 13 deaths and 77 cases of congenital rubella syndrome!

And that’s what is happening in many countries right now.

In Japan, for example, in addition to a rise in measles cases this year, they are seeing big outbreaks of rubella, with weekly totals exceeding 100 cases! These are numbers that are close to what they saw during outbreaks in 2013, a year that ended with 14,344 cases of rubella and 32 cases of congenital rubella syndrome.

Japan is on track to have a big rubella year.
Japan is on track to have a big rubella year.

And they are already reporting at least one case of congenital rubella syndrome, a 4 week old, which is not surprising, considering that they had nearly 3,000 cases of rubella last year.

A newspaper article in 1965 warned about the perils of rubella and congenital rubella syndrome.
A newspaper article in 1965 warned about the perils of rubella and congenital rubella syndrome.

Is that what we want to happen here too? Are folks looking forward to having to worry about babies being born with congenital rubella syndrome, a vaccine-preventable disease?

A vaccine-preventable disease that was declared eliminated in the United States in 2004.

More on Japan’s Rubella Outbreak

Did Bob Sears admit that he doesn’t “waste my breath” talking about the benefits of vaccines?

Have you noticed the bias in the anti-vaccine movement?

His advocacy against vaccines??? And what about his "educational" writings?!?
His advocacy against vaccines??? And what about his “educational” writings?!?

It’s hard to miss…

The Bias in the Anti-Vaccine Movement

Yes, that’s it.

You really only get one side from anti-vaccine folks.

But that’s not all.

In addition to never mentioning the benefits of vaccines, they make you think that:

  • you don’t have to worry about getting measles, chicken pox, and rubella, etc., anymore, because these diseases are rare, forgetting to mention that they are still relatively rare in many countries because most people are vaccinated and protected! When more folks skip or delay their vaccines, as they forget what these diseases are like and they listen to anti-vaccine propaganda, we get outbreaks, especially when they aren’t vaccinated and they travel to places where the diseases are more common!
  • everyone else overlooks the risks, when in fact, the risks of getting vaccinated and protected are just small and all of the so-called vaccine-induced diseases and other things anti-vaccine folks blame on vaccines aren’t real vaccine injuries
  • you don’t have to worry about getting measles, pertussis, or pneumococcal disease, etc., because those diseases are all mild, neglecting to mention that some people do have complications and some die when they catch them
  • if you don’t choose to vaccinate your kids on your own, someone is going to force you to get them vaccinated, overlooking that vaccine mandates don’t actually force anyone to vaccinate their kids – they are just about whether or not intentionally unvaccinated kids should be able to attend school
  • your choice to skip or delay your child’s vaccines won’t affect anyone else, failing to mention that most outbreaks are started by someone who is intentionally not vaccinated
  • if there is a risk, there must be a choice, but with their slogan, they overstate the risks of vaccines, never mention the risks of having the disease, and don’t mention the risk of your child getting other people sick, taking away their choice to keep their kids safe and healthy
  • you can always get vaccinated, but you can never get unvaccinated, neglecting to mention that you can indeed wait too long to vaccinate your kids

The biggest bias though, is not that these folks are against vaccines, but rather that everything they do and say scares parents and makes them feel that they should skip or delay their child’s vaccines, leaving them unprotected and at risk.

Stop listening to them and stop spreading their anti-vaccine propaganda.

More on the Bias in the Anti-Vaccine Movement

Measles in Iceland

Have you ever played the game Plague Inc?

If you have, you know it is really hard to infect Iceland!

“An 11-month-old child was diagnosed with measles last weekend. The virus is thought to have entered into the country via a person that came to Iceland from the Philippines last February 14 on an Icelandair flight, the Directorate of Health has stated.”

Eleven Month Old Child Infected by Measles

Not so much in real life…

Measles in Iceland

With the rise of measles cases in so many places in the world, it appears that even Iceland isn’t immune to the virus.

All it takes is someone with measles getting on a plane:

“Since 2016, measles cases have repeatedly occurred on board aircraft passing through Iceland. The first such case occurred on board an Icelandair plane in August 2016 in a child in transit in Iceland on its way from Canada to England. One unvaccinated Icelander on the same plane became ill of measles.

In the spring of 2017, a nine-month-old child became ill after returning to Iceland from Thailand. The baby’s twin brother became ill of measles two weeks later in Iceland. The brothers were unvaccinated because of their young age. By the end of October 2017, an Icelandic resident who had been staying in Bangladesh became ill with mild symptoms after returning to Iceland. He had a history of adequate vaccination against measles and the antibody response was potent, leading to mild non-characteristic morbidity syndrome.

In May of this year, a case of measles was confirmed on board an Icelandair plane flying from Germany to Canada with a transit in Iceland and again, in July, in an individual travelling from England to the United States with WOW air, also transiting in Iceland. No Icelanders became infected in these airplanes.”

EPI-ICE. October 2018

Why aren’t even more cases of measles in Iceland?

Most folks in Iceland are vaccinated and protected!

They likely need to do a better job of getting kids an early MMR if they are going to be traveling out of the country though.

More on Measles in Iceland

Is the Japanese Encephalitis Vaccine the Stupidest Vaccine Known to Man?

You probably aren’t surprised to hear that Japanese encephalitis isn’t very common in the United States.

“Travelers who go to Asia are at risk for getting Japanese encephalitis (See map). For most travelers the risk is extremely low but depends on where you are going, the time of year, your planned activities, and the length of the trip. You are at higher risk if you are traveling to rural areas, will be outside frequently, or will be traveling for a long period of time”

Japanese Encephalitis

Fortunately, if you are one of those travelers who will be at risk, a Japanese encephalitis vaccine is available.

Is the Japanese Encephalitis Vaccine the Stupidest Vaccine Known to Man?

So how many people get Japanese encephalitis in the United States?

Del Bigtree thinks that it is stupid to have a vaccine against a disease that kills up to 20,400 in the world each year.
Del Bigtree thinks that it is stupid to have a vaccine against a disease that kills up to 20,400 in the world each year.

Not many, but that doesn’t mean it isn’t important to have a Japanese encephalitis vaccine if you need it, right?

“Now correct me if I’m wrong, but no one seems to be complaining of the fact that we have two vaccines that injured have injury rates adverse events of over 100 people. Nine serious adverse events. When the disease itself has only infected 12 human beings in 24 years.

That means that both of these vaccines are six times more dangerous than the disease itself, yet no one on this panel seems to want to discuss that. I imagine that you all will pass whatever it is the Japanese encephalitis next – the stupidest vaccine known to man.

Remember 12 people infected in America – 4 million people visiting the Asia every single year – 24 years – 12 people been infected, and yet we are having this conversation. It is clear that this is a money making operation for the vaccine maker and has nothing to do with actual safety.”

Del Bigtree at the ACIP Meeting

Del’s rant was in response to the Advisory Committee on Immunization Practices discussing Japanese encephalitis vaccines…

It is clear that he doesn’t understand how any of this works, so let’s correct him, since he did ask.

First things first.

Why does he think that only 12 people have been infected with Japanese encephalitis in the United States?

“In the United States, in 25-year period following licensure of JE vaccine in 1992, 12 travel-associated cases reported (< 1 case per year)”

Review of Japanese encephalitis (JE) and JE Vaccine Work Group plans

That’s actually the data from the ACIP JE Vaccine Work Group…

Japanese encephalitis is more common in Asia, where it is endemic in 24 countries in the WHO South-East Asia and Western Pacific regions.

Still, since it isn’t on the list of National Notifiable Conditions, it is possible that a low number of cases have been reported to the CDC because few of the cases actually get reported.

It is also possible that there are few cases because folks who are high risk now get vaccinated and protected. Rates were higher in the pre-vaccine era.

But there is also the fact that most travelers are not at risk to get Japanese encephalitis, so maybe there really have only been 12 cases.

“However, given the large numbers of travelers to Asia (>5.5 million U.S. travelers entered JE-endemic countries in 2004), the low risk for JE for most travelers to Asia, and the high cost of JE-VC ($400–$500 per 2-dose primary series), providing JE vaccine to all travelers to Asia likely would not be cost-effective. In addition, for some travelers with lower risk itineraries, even a low probability of vaccine-related serious adverse events might be higher than the risk for disease. Therefore, JE vaccine should be targeted to travelers who, on the basis of their planned travel itinerary and activities, are at higher risk for disease.”

Use of Japanese Encephalitis Vaccine in Children: Recommendations of the Advisory Committee on Immunization Practices, 2013

That doesn’t mean that we shouldn’t have these vaccines or that this is all part of a money-making operation, does it?

If it was a “money-making operation,” wouldn’t the ACIP recommend the Japanese encephalitis vaccines for all travelers?

Or to make even more money, wouldn’t they just add it to the routine immunization schedule and recommended it for all children?

“Travelers to JE-endemic countries should be advised of the risks for JE disease and the importance of personal protective measures to reduce the risk for mosquito bites. For some travelers who will be in a higher-risk setting based on season, location, duration, and activities, JE vaccine can further reduce the risk for infection. JE vaccine is recommended for travelers who plan to spend a month or longer in endemic areas during the JE virus transmission season.”

Use of Japanese Encephalitis Vaccine in Children: Recommendations of the Advisory Committee on Immunization Practices, 2013

Instead, they make recommendations, even with the latest updates, that virtually guarantees a very low market for the vaccine.

But if the disease isn’t common, why have a vaccine at all?

“Although symptomatic Japanese encephalitis (JE) is rare, the case-fatality rate among those with encephalitis can be as high as 30%. Permanent neurologic or psychiatric sequelae can occur in 30%–50% of those with encephalitis.”

Japanese encephalitis

Japanese encephalitis is deadly!

There have been at least 5 deaths, including 2 children, among just 12 cases (if Del's stats are right).
There have been at least 5 Japanese encephalitis deaths, including 2 children, among just 12 cases (if Del’s stats are right).

And since the Japanese encephalitis vaccines are safe, with few risks (Del is talking about VAERS reports when he talks about vaccine injury rates), why wouldn’t you get vaccinated and protected if you were going to be at risk?

“No safety concerns to date in post-licensure surveillance.”

Review of Japanese encephalitis (JE) and JE Vaccine Work Group plans

After all, there is nothing stupid about wanting to reduce your risk of getting sick and dying.

More on Japanese Encephalitis