Entries in Vaccines (7)


Medical Opt-Out Rates for Vaccines Vary by State

iStockphoto/Thinkstock(ATLANTA) -- Rates of medical exemptions from vaccination requirements are higher in states where exemptions are easier to get, potentially compromising immunity and posing a threat to other children, according to public health experts at Emory University.

In addition, states with stringent standards for non-medical exemptions found a higher rate of medical exemptions. In other words, parents may be seeking medical exemptions when it is harder to receive non-medical exemptions.

The researchers evaluated medical exemptions from kindergarten entry requirements for every state between 2004 and 2010, and came up with a total of 87,631 medical exemptions nationwide. Standards allowing medical exemptions from school immunization requirements were inconsistent from state to state.

The study was published Thursday in the Journal of Infectious Disease.

The investigators concluded that medical exemptions should be monitored and evaluated continually to ensure they are used appropriately.

"The appropriate use of medical exemptions is important to maintaining sufficient herd immunity," Saad Omer, assistant professor of global health, epidemiology, and pediatrics at Emory University Schools of Public Health and Medicine, writes in the study. Herd immunity refers to the resistance to the spread of infectious disease in a group because susceptible members are few. It explains how non-vaccinated people are protected when a significant portion of a population is vaccinated. "More importantly, they add to existing pockets of susceptibility. It is known that immunizations exemptors cluster geographically, increasing the possibility for local areas of increased disease incidence."

With herd immunity, infections are unlikely to transfer from person to person because most people are immune. This then disrupts the chain of transmission that could infect a person who did not receive a vaccine or did not respond to it.

People with compromised immune systems, such as infants, the elderly, cancer patients, or people with other immune disorders, are typically protected by herd immunity. Also protected are those who, for one reason or another, can't, for medical reasons, get vaccinated.

"Children with valid medical exemption need to be protected ... by insuring high coverage rates among the rest of the population," write Daniel Salmon and Dr. Neal Halsey at the Johns Hopkins Bloomberg School of Public Health, in an editorial that accompanies the article.

However, a certain threshold is required to establish herd immunity -- and the exemptions to school immunizations may compromise the ability of a community to attain this level of vaccination.

Most doctors urge parents to weigh very seriously their decision to opt for non-medical exemptions, especially in light of the agreement among physicians about their safety and effectiveness. The widely discredited theory of an association between vaccinations and autism, though debunked, persists in the culture today.

While experts recognize the autonomy of parents to make decisions regarding their children's healthcare, doctors believe that counseling may alleviate parents' concerns.

"I think all eligible children should receive recommended vaccines, but I also recognize the right of parents to make this choice -- to the extent that it does not cause harm in others," said Dr. Gregory Poland, professor of medicine, infectious disease, molecular pharmacology and experimental therapeutics at Mayo Clinic and Foundation. "For this reason, I think it is imperative that anyone seeking an exemption for any reason should be required to have adequate education and counseling about vaccines and have an opportunity to have questions answered and misperceptions debunked."

"Many children have been terribly harmed and families and communities scarred by the oft times capricious and uninformed rejection of vaccines based on false information."

Experts agree that physicians should pay strict attention to the guidelines set forth by the Centers for Disease Control and Prevention, the American Academy of Pediatrics and the American Academy of Family Physicians.

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


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


Chemicals Found in Manufacturing Affect Some Childhood Vaccines

Joe Raedle/Getty Images(ROCHESTER) -- New research finds that chemicals commonly found in non-stick cookware, microwave popcorn bags and other manufactured goods may make childhood vaccines less effective, perhaps making it easier for certain diseases to spread through the population.

A study published Tuesday in the Journal of the American Medical Association suggests that exposure to perfluorinated compounds, called PFCs, before and after birth may lower a child's ability to make disease-fighting antibodies for tetanus and diphtheria later in life.

Researchers studied nearly 600 children and their mothers from the Faroe Islands, a small nation in the North Atlantic between Iceland and Scotland. The researchers tested the levels of PFCs in the blood of the mothers when they were pregnant and in the children at age 5 and 7. The researchers also measured the children's immune system responses to vaccines for tetanus and diphtheria.

The study found that higher levels of PFCs in both mothers and children meant lower numbers of disease-fighting antibodies in the children. Mothers who had twice the level of PFC in their blood had children with a 40-percent decrease in the number of antibodies formed after getting the diphtheria vaccine. The 7-year-old children who had doubled PFC levels had nearly a 50-percent reduction in their antibody levels.

Study author Philippe Grandjean said very few chemicals are known to have such an effect on the body's immune system.

"The PFCs make the immune system more sluggish, so that it doesn't respond as vigorously against micro-organisms as it should," Grandjean said. "If vaccinations don't work, there may be an increased risk of epidemics."

Experts say a weaker vaccine can still be effective in fighting disease. But Paige Lawrence, director of the toxicology training program at the University of Rochester School of Medicine, said a vaccine's reduced effectiveness may affect people differently.

"For some people, a 40 percent reduction in immune response might not matter at all. For others, it could matter tremendously," Lawrence said. "What we can't do is predict who will be most affected. We don't have the ability to look at individuals and know who will get sick and who won't."

The study authors said the marine diet of Faroese people may have influenced the levels of PFCs in the children in the study, since the chemical is commonly found throughout the environment, even in polar bears that live far from pollution sources.

But exposure to the chemicals is also high in the United States. In 2004, the Centers for Disease Control and Prevention tested the blood of more than 2,000 Americans and found certain types of PFCs in nearly 98 percent of them.

And it's no wonder. PFCs are everywhere. They're found in Teflon cookware and some food wrappings, such as microwave popcorn bags and pizza boxes. Cleaning products, like the original Scotchgard, some shampoos, floor wax and carpet treatments are a common source of PFCs.

Industrial waste from some chemical plants has also dispersed PFCs in air and water, though the Environmental Protection Agency has been strengthening its regulation of the use of the chemicals in manufacturing in the past decade. In 2010, the agency announced new regulations requiring companies to submit notices when they intend to make PFCs. Eight companies are voluntarily phasing out the use of PFCs in their products as part of an EPA program.

"Certainly, this study begs to have further testing done on PFCs so, if in fact, subsequent studies demonstrate an impact on the immune system, this product is at least taken out of use going forward," said Dr. Ari Brown, co-author of Baby 411 and a developmental pediatrician in in Austin, Texas.

This isn't the first study to find potential negative health effects of PFCs. A 2009 study linked exposure to the chemicals to potential delays in getting pregnant for a group of more than 1,200 women.

Lawrence said scientists need a better understanding of just how these chemicals affect humans.

"Often when we think about pollutants and how they affect our health, we think about important and scary diseases like cancer," Lawrence said. "That is very important, but as a society we often tend to overlook more subtle adverse effects, such as how a chemical affects our ability to fight infections."

Copyright 2012 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


$4.3 Billion Vaccine Pledge to Save Children's Lives

Jeffrey Hamilton/Thinkstock(LONDON) -- Their mission is simple: get kids in poor countries the vaccines that are available for kids in rich countries. On Monday, the Global Alliance for Vaccines and Immunization (GAVI) announced a major milestone in global health by exceeding their goal of securing $3.7 billion in commitments from world leaders.

A historic achievement, the funds in this pledge campaign will go towards immunizing more than 250 million of the world's poorest children against life-threatening diseases by 2015 and preventing more than four million premature deaths.

Major public and private donors committed $4.3 billion, enabling GAVI to reach more children faster than planned and to accelerate the introduction of new vaccines. A portion of the pledges are conditional upon GAVI raising additional funds from new donors in the future. Monday's pledges bring GAVI's total available resources for 2011 to 2015 to $ 7.6 billion.

Hosted by UK Prime Minister David Cameron, the meeting convened prime ministers, ministers and high-level officials from donor and developing countries, leaders of U.N. agencies, CEOs from private companies and senior civil society leaders to make commitments to support GAVI's life-saving work.

By successfully meeting their goal, GAVI will have the ability to continue funding their immunization programs in developing countries and also to address two new important vaccines that will be made available for countries in need: one against pneumonia the other immunizing against severe diarrhea. Pneumonia and diarrhea account for roughly 40 percent of child deaths under the age of five across the planet and particular in developing, poor countries.

One of the Millennium Development Goals (MDG) is to reduce child mortality by two-thirds by the year 2015. When it comes to addressing child mortality, immunization plays a pivotal role. Nearly two million children die and in the case of pneumonia and diarrhea, one child dies every 20 seconds from a vaccine-preventable disease. Since 2001, GAVI has been on the frontlines by enabling 288 million children to be vaccinated and in doing so, averting five million deaths.

Copyright 2011 ABC News Radio

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