Entries in Immunizations (8)


Non-Medical Vaccination Opt-Outs on the Rise

Joe Raedle/Getty Images(NEW YORK) -- An increasing number of parents are getting state approval to allow their children to opt out of school-mandated vaccinations for non-medical reasons, according to a new analysis published Wednesday.

Dr. Saad Omer, author of the correspondence published in the New England Journal of Medicine, warned that this trend is leaving large populations of children at risk for developing potentially deadly illnesses that haven't been seen in the United States in many years.

"Rates of exemption are substantially higher today than several years ago," said Omer, assistant professor of global health, epidemiology and pediatrics at Emory University in Atlanta. "Previously, rates were only rising in states with easy exemption policies, but now they are even rising in states that make it more difficult."

Exemption policies vary from state to state and can range from not allowing any non-medical exemptions to allowing opt-outs for religious or philosophical reasons. Some states make it very difficult to get approval for exemptions by requiring notarized letters from clergymen, letters written by parents with specific wording, or completion of standardized forms that can only be obtained from special locations such as health departments. Others make it very simple to skip vaccinations: Parents need only check a box on a short, standardized form.

Omer and his colleagues analyzed data compiled by the U.S. Centers for Disease Control and Prevention on vaccination exemption rates for school years 2005 to 2011. They compared vaccine opt-out rates in each state to the ease with which exemptions could be obtained.

They found that parents were 2.5 times more likely to opt out in states that permit philosophical reasons compared with states that require religious objections. They were also more than two times more likely to opt out in states with easy exemption processes.

In most cases, fears among parents over vaccines -- many of them unfounded -- may be at play.

"The CDC and health departments are doing a good job of increasing vaccine coverage," Omer said. "Therefore, rates of vaccine-preventable disease are going down substantially. Parents aren't seeing the actual diseases, so when they hear about real or perceived adverse effects of vaccines, their perception of the risks versus benefits is shifted."

Dr. William Schaffner, chair of preventive medicine at Vanderbilt University, agreed.

"Parents are just more skeptical about benefits of vaccines," he said. "Most young parents today have never seen a case of polio or measles, and they didn't learn about the seriousness of these diseases and importance of the vaccinations in school."

Schaffner added that he finds it interesting that some states do not allow exemptions while others "really oblige parents wishing to opt out."

Past research has shown, though, that in states with a substantial proportion of unimmunized or incompletely immunized children, many kids are susceptible to these classic diseases. A 2006 study showed a 50 percent higher incidence of pertussis -- commonly known as whooping cough -- in states where it is easier to get exemptions. There have been similar findings with respect to measles.

Schaffner said he is very concerned that unvaccinated children who go abroad will bring back diseases, such as measles, that are still a major problem in other parts of the world. Not only will they suffer, but they will spread the illnesses to children who are unable to be vaccinated for medical reasons.

Schaffner said that part of the solution to the problem is that "states with easier process need to tighten up." However, he said, this is not a fool-proof approach. He said some research has shown an increase in medical exemptions in states that have tightened up their policies -- suggesting that parents are pressuring doctors to give medical exemptions. He encourages doctor to not let themselves be "brow-beaten into providing dubious excuses."

Copyright 2012 ABC News Radio


Are Doctors Improperly Storing Vaccines?

Joe Raedle/Getty Images(NEW YORK) -- As many moms do, Julie Dilensky of Washington, D.C., takes her 1-year-old daughter to the doctor for her recommended vaccinations.

"It's protective and preventative in my mind and anything I can do to keep her as safe and healthy as possible," Dilensky said.

But a new government report obtained exclusively by ABC News has her a bit worried about the efficacy of the immunizations her daughter is getting.

An investigation by the Department of Health and Human Services' Office of the Inspector General (HHS OIG) found that many providers of immunizations meant for low-income children don't store the vaccines at proper temperatures, potentially rendering them ineffective and placing children at risk for contracting serious diseases.

Inspectors visited the offices of 45 providers in five states who offered free immunizations as part of the government's Vaccines for Children (VFC) Program.  Nationwide, about 44,000 offices and clinics participate in the program.  The Centers for Medicare & Medicaid Services pay for the vaccines, and the Centers for Disease Control and Prevention distribute them.

The investigation found that 76 percent of the providers stored the vaccines at temperatures that were either too hot or too cold.  They also found that 13 providers stored expired vaccines along with nonexpired vaccines.  In addition, they said they found that none of the providers properly managed the vaccines according to VFC program requirements.

"As a result, the 20,252 VFC vaccine doses that we observed during site visits may not provide children with maximum protection against preventable diseases and may be vulnerable to fraud, waste and abuse," according to the report.  "These doses were worth approximately $800,000."

The storage problem could potentially lead to less effective vaccines, but doesn't pose a safety risk, the HHS OIG said.

In 2010, about 40 million children received 82 million VFC vaccines at a cost of approximately $3.6 billion, and providers must meet certain requirements for storage and management.

While the report is concerned with vaccines offered under the VFC program, doctors say the government's investigation is an important reminder to all clinicians about the need to properly and carefully store all vaccines.

"The temperature has to be monitored throughout the entire time, from the time it leaves the manufacturer to the time it spends in transit to the time it's delivered to the clinic and it's used in the clinic," said Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center.  "We want every dose given to every child to provide the optimum protection as it's intended."

Dr. Anne Schuchat, director of CDC's National Center for Immunization for Immunization and Respiratory Diseases, told ABC News the vaccination program has helped protect many children from preventable diseases, but acknowledged there was a breakdown in the vaccine management process.

"We're doing our root cause analysis right now to try and understand the key factors that lead up to these issues," she said.  "There have been changes in the equipment, the refrigerators.  There are many vaccines recommended now, and maybe there are more doses being stored in the average office than there used to be."

The CDC says disease rates haven't gone up because of vaccines affected by temperature problems, but they are investigating a rare whooping outbreak in the state of Washington.

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Copyright 2012 ABC News Radio


Study: Mandatory Vaccines Lead to Higher Immunization Levels

Joe Raedle/Getty Images(WASHINGTON) -- States that require immunizations for students entering middle school have significantly higher numbers of adolescents who actually get recommended vaccinations compared with states that simply require that parents be informed about the vaccinations, according to a new study.

The Advisory Committee on Immunization Practices currently recommends pre-teens and teens receive the tetanus-diphtheria-pertussis vaccine, the vaccine against meningitis and the HPV vaccine.

Researchers from the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases (NCIRD) wanted to determine if state requirements and parental education had an impact on vaccination rates, so they analyzed data from 13- to 17-year-olds who participated in a national survey.

The vaccination coverage in states requiring immunization against meningitis was 71 percent compared with 53 percent in states with no requirements and 51 percent in states with education-only requirements.  The rate of tetanus-diphtheria-pertussis vaccination was 80 percent in states requiring the shot and 70 percent in states with no requirements.  There were no states reported that only required education about the tetanus vaccine.  There was no difference in vaccination rates for the HPV vaccine.

"The education finding was interesting.  I think that it didn't really have any effect," said Shannon Stokley, a co-author and researcher at NCIRD.  "That doesn't mean that education isn't working, but education materials may not be reaching its audience.  They may not be getting to parents."

This study comes just days after Washington State tapped into emergency funds to help get a whooping cough outbreak under control.

Washington Gov. Chris Gregoire freed up $90,000 of emergency money to ramp up vaccination awareness efforts.

"Pertussis is very serious, especially for babies.  It's vital that teens and adults are current on their immunizations because they're often the ones who give whooping cough to babies," state Secretary of Health Mary Selecky said in a statement.

Oregon, Washington and Vermont all have high exemption rates, and all three states have had outbreaks of whooping cough.

Copyright 2012 ABC News Radio


Vermont Debates Vaccines: Should Parents Be Able to Opt Out?

Jeffrey Hamilton/Thinkstock(MONTPELIER, Vt.) -- The debate over a bill that would make vaccines mandatory for school-aged children by eliminating "philosophical exemption" as a reason to opt out of the shots, has divided Vermont's families over the benefits and risks of vaccines. 

It has also pitted the state House -- whose majority voted down the bill -- against the state Senate, which voted to approve it.

Twenty states, including Vermont, currently allow philosophical exemptions for those who object to vaccines for personal or moral reasons.

"It's been clearly demonstrated that the broader (the) exemptions, the more loosely it's applied -- and the less likely children will get vaccinated," said Dr. William Schaffner, chair of preventive medicine at Vanderbilt University School of Medicine in Nashville, Tenn.

Fewer than 70 percent of children in Vermont between the ages of 18 months and 3 years received all of the recommended vaccines, according to a 2010 National Immunization Survey by the Centers for Disease Control and Prevention -- a rate lower than the 73 percent national average.  Vermont has one of the highest philosophical exemption rates among those 20 states, Dr. Harry Chen, health commissioner for Vermont's Department of Public Health, told ABC News.

Measles and pertussis, also known as whooping cough, are the fastest growing vaccine-preventable diseases nationwide.  Just last year, Vermont had an outbreak of pertussis.  And other states with high philosophical exemption rates, including Washington and Oregon, have also seen a revival of pertussis.

According to the Vermont Coalition for Vaccine Choice, an advocacy group of parents, health care providers and others lobbying to stop the bill from passing, many people are naturally immune to communicable diseases without the need for vaccines.

The group also maintains that mass vaccinations will lower the risk of infection among people who decline the vaccinations, a phenomenon known as "herd immunity."

"There is no need to allow the state to strip parents of their rights to make medical decisions for their own kids," the group's website reads.  "Given that vaccines have known risks associated with them, it seems only prudent to continue the philosophical exemption, and to make sure that we are not divided by fear mongering."

Schaffner said it's impossible to know who would have natural immunity, adding that herd immunity works only if the majority of the population is vaccinated, which stresses the importance of getting vaccinated.

In addition, he said, some children have medical conditions that preclude them from receiving vaccinations.

"The way we protect them is for all the rest of us to be protected," Schaffner said. 

Copyright 2012 ABC News Radio


An End to Infant Crying at the Doctor's Office?

iStockphoto/Thinkstock(NORFOLK, Va.) -- A technique that doctors have commonly recommended to parents to deal with the pain of baby colic now shows promise in easing the crying associated with infant vaccinations at the doctor's office.

In a paper published Monday in the journal Pediatrics, researchers examined the techniques promoted in Dr. Harvey Karp's book Happiest Baby on the Block.  They looked at five tactics intended to elicit the calming reflex in infants -- tight swaddling in a blanket, holding the baby on his/her right side face down, shushing with a loud "ssh," gentle swinging of the baby, and giving the baby something on which to suck, such as a pacifier.  According to Karp, these actions -- which he terms "the 5 S's," cause instant relaxation for the infants as they are reminded of being in the womb.

Lead study author Dr. John Harrington of Children's Hospital of The King's Daughters says the idea for the study was conceptualized around the time that a study revealed Tylenol, often used for pain relief ahead of immunization, blunted the immune response to several different vaccines.  He had attended a lecture delivered by Karp, but was skeptical the idea would work in this setting.

He and a team of researchers in Virginia tested the 5 S's approach in more than 200 infants undergoing routine immunizations at two and four months.  Some received the 5 S's approach, while others received the comfort measures normally provided by their parents after vaccines.  Half of the infants also received a sugar solution prior to vaccination, while the other half received only water.

As the babies were receiving their shots, the researchers looked for certain telltale signs of pain, as indicated by a common pain scoring system known as the Modified Riley Pain Score.

The infants who received the 5 S's had less pain than infants who did not and scored just as well on the pain scale as infants who received sugar along with the 5 S's approaches.  One minute following immunization, 30 percent of the infants who received sugar but not the 5 S's techniques were still crying, while nearly none of the infants in the 5 S's group were crying.

"The parents noted a difference," Harrington says.  "A lot of the parents wanted to learn the technique when they found their child calm quicker than usual."

Karp says the techniques can be applied in situations other than just at the doctor's office -- indeed, anywhere your infant might be crying.  And Karp says that there are broader implications to a baby's crying than many parents realize.

"Crying infants is a much more serious public health problem," he says.  "It turns out that babies crying, and the fatigue and demoralization are leading triggers for an entire spectrum of very serious public health issues, like marital stress and postpartum depression."

Studies are underway that investigate the 5 S's in treating baby colic, preventing postpartum depression and as part of an intervention to reduce childhood obesity.

Copyright 2012 ABC News Radio


Study Questions Effectiveness of Flu Shot

iStockphoto/Thinkstock(MINNEAPOLIS) -- A new review of the flu shot’s effectiveness has found considerable room for improvement. But the vaccine is still our best defense against the virus for now, experts say.

The trivalent flu shot, which is the one offered at most doctors’ offices and pharmacies, reduced the risk of illness 59 percent of the time, according to the review of 10 studies that spanned 12 flu seasons. The vaccine is designed to guard against the three most popular flu strains each season, which in 2012 include H1N1, H3N2 and influenza B.

“The ongoing public health burden caused by seasonal influenza and the potential global effect of a severe pandemic suggests an urgent need for a new generation of more highly effective and cross-protective vaccines that can be manufactured rapidly,” Michael Osterholm at the University of Minnesota and colleagues reported Tuesday in Lancet Infectious Diseases. “In the meantime, we should maintain public support for present vaccines that are the best intervention available for seasonal influenza.”

The ever-evolving flu virus complicates the development of vaccines, which are strain-specific.

“That’s why we need a new vaccine every year,” said Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University Medical Center. But scientists are working toward a stronger, more universal vaccine that could be a one-shot deal -- with the occasional booster.

Schaffner said the current vaccines are good but not great. But paraphrasing French philosopher Voltaire, he warned that waiting for perfect is the greatest enemy of the current good.

“While we hope and wait for a perfect vaccine, we’ve got a good one that’s capable of preventing influenza and its complication,” Schaffner said. “It can’t prevent every instance, but it can prevent many. And that’s a good thing.”

The 59-percent effectiveness of the vaccine suggested by the review challenges previous estimates, which range from 70 to 90 percent. In a commentary also published in Lancet Infectious Diseases, Heath Kelly at the Victorian Infectious Diseases Reference Laboratory in Melbourne, Australia, and Marta Valenciano at EpiConcept in Paris argue those estimates should be revisited.

“Now might also be an appropriate time to use revised estimates of the most probable effectiveness of influenza vaccines to re-examine the effectiveness and cost-effectiveness of some policy options,” they wrote.

The U.S. Centers for Disease Control and Prevention recommends that anyone older than 6 months get a flu shot every year. But only one-third of eligible Americans got vaccinated last year.

“There’s still time to get vaccinated,” said Schaffner. “It’s widely available and absolutely everybody should go out and get it.”

Copyright 2011 ABC News Radio


Major New Vaccine Initiative to Save Millions of Children

Paul Tearle/Stockbyte/Thinkstock(WASHINGTON) -- Rotavirus, pneumonia, meningitis and other childhood illnesses claim the lives of 1.7 million children annually -- almost all of them in developing countries.  Countless other children survive, but suffer from stunting, malnourishment and other chronic illnesses.

On Tuesday, GAVI Alliance, a public-private partnership of the world’s main players in immunization, announced a $3.4 billion investment over the next four years in vaccinations against childhood diseases in 37 countries.  Two dozen of the participating countries are in Africa.

“Our goal,” said GAVI CEO Dr. Seth Berkley, ” is to make sure that where a child is born doesn’t influence their right to have access to these modern miracles of medicine.”

Of the 37 countries that will participate in the program, about half plan to introduce pneumococcal vaccines, the other half will introduce rotavirus vaccines.

“We are targeting the two largest killers of children in the world,” said Berkley, at the GAVI announcement Tuesday morning, via a web conference for media.

Rotavirus alone kills more than 500,000 children a year and about half of those are from African countries.

Some of the countries participating in the GAVI program will also receive vaccinations for measles, meningitis A, and the pentavalent vaccine, which inoculates against five diseases simultaneously: iphtheria, tetanus, whooping cough, hepatitis B, and flu.

The vaccines will be supplied by Merck & Co. and GlaxoSmithKline at a deep discount.

The target cost of the vaccine preventing pneumonia, for example, will cost GAVI $3.50 at most.  The same vaccine in the U.S. costs $90. Other pharmaceutical companies will be incentivized to participate in the supply chain as the program expands over the next four years.

Copyright 2011 ABC News Radio


Health Reminders Before Sending Your Kids Back to School

Creatas Images/Thinkstock(NEW YORK) -- Summer vacation is coming to an end, and many students will be headed back into the classroom.  But before sending children off to school, ABC News has some last-minute reminders for parents, particularly about the right vaccinations.
Experts say to make sure your child gets the correct immunizations before going back to school.  It's important to be aware of the proper immunizations necessary at different grade levels.

For pre-school, youngsters should receive DTaP for diptheria, tetanus and pertussis; polio; a booster for measles, mumps and rubella; and a final chicken pox vaccine.

The meningococcal vaccine and a tetanus booster should be administered to pupils at the middle school level.

And for high schoolers, the checklist includes screening for substance abuse, screening for depression and a yearly physical. Some experts say teens should have the chance to speak to their doctors alone.

Also, fall means flu season, so experts also say to make a flu shot part of your child's back-to-school routine.

Some young people may be embarrassed to admit they can't see the blackboard when in school.  This is why parents should not overlook eye exams.  

Lasty, parents should remind kids about classroom hygiene -- they need to wash their hands and cover up their coughs.  A recent Danish study published in the American Journal of Infection Control found that frequent hand washing can help students cut down on days missed from school.

Copyright 2011 ABC News Radio

ABC News Radio