My Blog

Posts for: September, 2018

September 02, 2018
Category: Infectious Disease
Tags: measles   Rubeola   Outbreaks   Hotspots   CDC NME   Exemptions  


CDC Reports 107 Measles Cases Already This Year, Here Are Potential Outbreak Hotspots


Will signs like this become more and more common? (AP Photo/Amy Forliti, file)

Harrison Ford once said in the movie Six Days and Seven Nights, "I decided my life is too simple, I wanna complicate the hell out of it." Here's one way to do that. Go against established medical advice. Stop using vaccines that have been preventing a potentially deadly disease and watch the disease return. 

A study published in the journal PLOS Medicine found that over the past decade more and more parents have been opting out of school requirements to get their kids vaccinated in the 18 states that allow such non-medical exemptions (NME).  In other words, more and more parents are taking the option to increase their kids' (and other kids') risk for getting measles, a highly contagious and potential deadly disease.

That's because there is nothing even close to the measles vaccine in preventing the measles. No supplement, food, oil, body position, app, or chant is going to be able to replace the vaccine.

Keep in mind that NMEs are not medical exemptions, otherwise they'd be called medical exemptions. In other words, parents seeking NMEs aren't doing so because a real doctor said that their kids shouldn't get the vaccine because of an immune system disorder or a severe allergy to vaccine components. They are "opting out" because of their beliefs.



Nikki Craven from Grass Valley joins protestors during a rally in opposition to a bill mandating that California schoolchildren be vaccinated. (AP Photo/Steve Yeater)

If you've pushed for your state to allow NME's, take a look at the PLOS Medicine study to find out what you would be causing. For the study, a research team from the National School of Tropical Medicine (Jacqueline K. Olive, Peter J. Hotez, MD, PhD , Ashish Damania, and Melissa S. Nolan, PhD, MPH) analyzed data from these 18 states and the Centers for Disease Control and Prevention (CDC).  The study found that in 12 of the states that allow NMEs (Arkansas, Arizona, Idaho, Maine, Minnesota, Missouri, North Dakota, Ohio, Oklahoma, Oregon, Texas, and Utah) the number of NMEs has been steadily increasing since 2009. (Colorado, Louisiana, Michigan, Pennsylvania, Washington, and Wisconsin round out the rest of the 18 states that allow NMEs).

The research team also found that that higher NME rates correlated with lower measles-mumps-rubella (MMR) vaccination rate. In other words, MMR vaccination rates tended to be lower, the higher the number of NMEs. This is concerning because scientific studies (and common sense) have showed how locations with lower measles vaccination rates are more likely to have measles outbreaks.

And this week, as this ABC15 news segment reports, health officials are warning about potential measles exposure in Arizona, one of the states that has NMEs:

As Hotez explained, "while national immunization rates may not have changed much over the years, we are seeing a rise in non-medical vaccine exemptions in 18 states that still allow them for reasons of personal belief. These hotspots of antivaccine activity are at risk for breakthrough measles and other childhood infectious diseases."

This study essentially showed the consequences of states offering NMEs. And declining vaccination rates are going against what has been one of the biggest successes in the history of public health and has saved millions upon millions of lives and prevented lots upon lots of suffering. Typically schools will require kids to have the full set of routine vaccinations before entering. That's because schools can be germ buffets. You may think that your kid can stay clear of others and others' bacteria and viruses, but in schools it's "snot" reality. Little kids are constantly smearing things such as snot on themselves, their things, their classmates, and everything else.

Requiring kids to get routine vaccinations has helped control of number of diseases that used to be a lot more commonplace up to the earlier part of the 1900's. It helped eradicate smallpox, control polio, and make measles practically non-existent in the United States, at least at the beginning of this century. When it came to vaccine -preventable infectious diseases such as measles, mumps, and pertussis, life by the end of 1990's had become simple. Just keep the population vaccinated to prevent outbreaks.

Enter the Harrison Ford quote. In 1998, British gastroenterologist Andrew Wakefield claimed that measles, mumps, and rubella (MMR) vaccine may be linked to autism and in 2004 published a study in the Lancet in support of his claims. Wakefield sparked an anti-vaccination movement in England that subsequently spread to the United States. However, when investigations revealed evidence that he may have had a financial motive for making such claims and falsified data, the Lancet subsequently retracted the paper and Wakefield lost his license to practice medicine.

Despite these revelations and lack of scientific evidence connecting vaccines with autism, the anti-vaccination movement has continued. So has Wakefield, as he continues to speak at conferences such as the International Chiropractors Association's Annual Conference on Chiropractic and Pediatrics as I described previously for Forbes. The growing number of NMEs has suggested that the anti-vaccination movement has been picking up steam over the past decade.

This steam has included a lot of hot air because many of the anti-vaccination movement's claims have lacked scientific backing. Plus, the anti-vaccination movement has offered no viable alternative to vaccines to protect people against life-threatening diseases such as the measles. Some anti-vaccination proponents have offered supplements and alternative medicine methods as options (without providing adequate scientific evidence), which makes you wonder what the motivations may be behind attempts to discredit vaccines.

So what does a more complicated life look like compared to the late 1990's when measles was virtually non-existent in the U.S? According to the Centers for Disease Control and Prevention (CDC), as of July 14, 2018, at least 107 people from 21 states (Arkansas, California, Connecticut, Florida, Illinois, Indiana, Kansas, Louisiana, Maryland, Michigan, Missouri, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, and Washington) and the District of Colombia had measles since the start of this year. The majority were unvaccinated. Here are the numbers of reported cases by year so far in this decade:

Year Cases
2010 63
2011 220
2012 55
2013 187
2014 667
2015 188
2016 86
2017* 118
2018** 107

Still want to complicate the heck out of life?


September 02, 2018
Category: Poison
Tags: Fever   pain   Advil   Pfizer   Errors   Dose   Syringe   cup  

(CNN )If you have children's Advil in your medicine cabinet, check the bottle.

Pfizer, which makes the children's fever reducer and pain reliever, issued a voluntary recall of 4-ounce bottles of the bubble gum-flavored liquid. 
The recall was issued after customer complaints identified that the dosage cup provided is marked in teaspoons while the instructions on the label are given in milliliters (mL).
Consumers should discontinue use of recalled children's Advil.
Consumers should discontinue use of recalled children's Advil.
"Pfizer concluded that the use of the product with an unmatched dosage cup marked in teaspoons rather than milliliters has a chance of being associated with potential overdose," the company said in its announcement.
Ibuprofen is the active ingredient. Symptoms of an overdose of this medication may include dizziness, drowsiness, vomiting, nausea, headache and blurred vision.
A 2016 study found that 80% of caregivers made an error when dispensing medicine, and the most common mistake was measuring too much of the medicine.
The researchers found that using oral syringes rather than cups reduces those errors.
"When parents used dosing cups, they had four times the odds of making a dosing error, compared to when they used an oral syringe," said Dr. Shonna Yin, an associate professor at NYU Medical School who co-authored that study.
The recall affects one lot, R51129, which was distributed to retailers, wholesalers and distributors across the country between May and June. The expiration date of the recalled medicine is November 2020, and the UPC code is 3-0573-0207-30-0. The NDC code is 0573-0207-30.
Consumers should discontinue use of the medication, Pfizer said, and retailers should not sell it.
Anyone who has experienced a problem from this medication should contact their care provider or report it to the US Food and Drug Administration.

September 01, 2018
Category: Safety
Tags: guidelines   car seats   update   car safety   toddler   rear facing   2018  

Key takeaways for parents in preparation for Child Passenger Safety Week is 

Sept. 23-29, 2018

  • Children should ride properly restrained on every trip, in every type of transportation, beginning from birth.
  • Rear-facing is the safest way to ride. Parents should keep children rear-facing as long as possible until they fit within the weight and height limits set by the manufacturer of their car safety seat.
  • While parents look forward to children moving from one milestone to another, car seats are one area where delayed transitions are best. Each transition – from rear-facing to forward-facing, forward-facing to booster – lowers the child’s protection in the event of a crash.
  • When a child rides rear-facing, the head, neck, and spine are all supported by the hard shell of the car safety seat and all move together, with little relative movement between body parts. When children ride forward-facing, their bodies are restrained by the harness straps, but their heads – which for toddlers are disproportionately large and heavy – are thrown forward, possibly resulting in spine and head injuries.


What is the change in recommendations?

  • Previously, the AAP recommended children should remain rear-facing at least to age 2; the new recommendation removes the specific age milestone.
  • The prior recommendation to keep children rear-facing to age 2 was based in part on a study that found lower risks of injury among children ages 1 to 2 years who were rear-facing. That data was supported by biometric research, crash simulation data and experience in Europe where children ride rear facing for longer periods. However, in 2017, questions arose about the original study, and it was retracted by the journal Injury Prevention. A re-analysis of the data found that while rear-facing still appeared to be safer than forward-facing for children younger than 2, the injury numbers were too low to reach statistical significance.
  • This means we don’t have a large enough set of data to determine with certainty at what age it is safest to turn children to be forward-facing. If you have a choice, keeping your child rear-facing as long as possible is the best way to keep them safe.
  • The AAP decided to update its recommendations to reflect how the science has evolved.
  • Fortunately, car seat manufacturers have created car seats that allow children to remain rear-facing until they weigh 40 pounds or more, which means most children can remain rear-facing past their second birthday.


Facts about car seats and motor vehicle injuries:

  • Motor vehicle injuries are the leading cause of death among children in the United States. (CDC)
  • In the United States, 633 children ages 12 years and younger died as occupants in motor vehicle crashes during 2015 and more than 132,000 were injured. (CDC)
  • Of children ages 12 years and younger who died in a crash in 2015, 35 percent were not buckled up. (CDC)


  • Child safety seats are often used incorrectly. Approximately 59 percent of car seats and 20 percent of booster seats are installed or used incorrectly. (CDC)


  • Car seats reduce the risk of death in car crashes by 71 percent for infants and 54 percent for toddlers ages 1 to 4.  Booster seats reduce the risk for serious injury by 45 percent for children ages 4 to 8 years.  (CDC)


Child Passenger Safety Week culminates with National Seat Check Saturday Sept. 29. Certified child passenger safety technicians will be available at car seat events nationwide to provide safety tips and car seat installation instructions to parents and caregivers.


Car Seats: Product Listing for 2018


My bottom line and practical advice is to let your toddler ride in an appropriate rear facing car seat until he/she doesn't fit any more (knees are almost in your child's face).


Dr. T