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By contactus@priority-pediatrics.com
May 31, 2019
Category: Immunizations
Tags: immunizations   Vaccines   Facts   History   Timeline  

Here's a look at information and statistics concerning vaccines in the United States.

Facts:

There are 14 different vaccines that are recommended for childrenbetween birth and age six, including those for diphtheria, pertussis, tetanus, influenza, measles, mumps and rubella.

For more than 100 years, there has been public discord regarding vaccines based on issues like individual rights, religious freedoms, distrust of government and the effects that vaccines may have on the health of children.

Exemptions to vaccines fall into three general categories: medical, religious and philosophical.


Median immunization coverage for state-required vaccines was approximately 94.3% for children entering kindergarten during the 2017-2018 school year, according to the Centers for Disease Control and Prevention (CDC).

As of May 2019, 47 states and the District of Columbia allow religious exemptions from vaccines, and 16 states allow philosophical (non-spiritual) exemptions.

Timeline:

1855 - Massachusetts mandates that school children are to be vaccinated (only the smallpox vaccine is available at the time).

February 20, 1905 - In Jacobson v. Massachusetts, the US Supreme Court upholds the State's right to compel immunizing against smallpox.

November 13, 1922 - The US Supreme Court denies any constitutional violation in Zucht v. King in which Rosalyn Zucht believes that requiring vaccines violates her right to liberty without due process. The High Court opines that city ordinances that require vaccinations for children to attend school are a "discretion required for the protection of the public health."

1952 -Dr. Jonas Salk and his team develop a vaccine for polio. A nationwide trial leads to the vaccine being declared in 1955 to be safe and effective.

1963 - The first measles vaccine is released.

1983 - schedule for active immunizations is recommended by the CDC.

March 19, 1992 - Rolling Stone publishes an article by Tom Curtis, "The Origin of AIDS," which presents a theory that ties HIV/AIDS to polio vaccines. Curtis writes that in the late 1950s, during a vaccination campaign in Africa, at least 325,000 people were immunized with a contaminated polio vaccine. The article alleges that the vaccine may have been contaminated with a monkey virus and is the cause of the human immunodeficiency virus, later known as HIV/AIDS.

August 10, 1993 - Congress passes the Omnibus Budget Reconciliation Act which creates the Vaccines for Children Program, providing qualified children free vaccines.

December 9, 1993 - Rolling Stone publishes an update to the Curtis article, clarifying that his theory was not fact, and Rolling Stone did not mean to suggest there was any scientific proof to support it, and the magazine regrets any damage caused by the article.

1998 - British researcher Andrew Wakefield and 12 other authors publish a paper stating they had evidence that linked the vaccination for Measles, Mumps and Rubella (MMR) to autism. They claim they discovered the measles virus in the digestive systems of autistic children who were given the measles, mumps and rubella (MMR) vaccine. The publication leads to a widespread increase in the number of parents choosing not to vaccinate their children for fear of its link to autism.

2000 - The CDC declares the United States has achieved measles elimination, defined as "the absence of continuous disease transmission for 12 months or more in a specific geographic area."

2004 - Co-authors of the Wakefield study begin removing their names from the article when they discover Wakefield had been paid by lawyers representing parents who planned to sue vaccine manufacturers.

May 14, 2004 - The Institute of Medicine releases a report "rejecting a causal relationship between the MMR vaccine and autism."

February 2010 - The Lancet, the British medical journal that published Wakefield's study, officially retracts the article. Britain also revokes Wakefield's medical license.

2011 - Investigative reporter Brian Deer writes a series of articles in the BMJ exposing Wakefield's fraud. The articles state that he used distorted data and falsified medical histories of children that may have led to an unfounded relationship between vaccines and the development of autism.

2011 - The US Public Health Service finds that 63% of parents who refuse and delay vaccines do so for fear their children could have serious side effects.

2014 - The CDC reports the highest number of cases at 667 since declaring measles eliminated in 2000.

June 17, 2014 - After analyzing 10 studies, all of which looked at whether there was a link between vaccines and autism and involved a total of over one million children, the University of Sydney publishes a report saying there is no correlation between vaccinations and the development of autism.

December 2014 - A measles outbreak occurs at Disneyland in California.

2015 - In the wake of the theme park outbreak, 189 cases of measles are reported in 24 states and Washington, DC.

February 2015 - Advocacy group Autism Speaks releases a statement, "Over the last two decades, extensive research has asked whether there is any link between childhood vaccinations and autism. The results of this research are clear: Vaccines do not cause autism. We urge that all children be fully vaccinated."

May 28, 2015 - Vermont Gov. Peter Shumlin signs a bill removing the philosophical exemption from the state's vaccination law. Parents may still request exemptions for medical or religious reasons. The law goes into effect on July 1, 2016.

June 30, 2015 - California Gov. Jerry Brown signs legislation closing the "vaccine exemption loophole," by eliminating any personal or religious exemptions for immunizing children who attend school. The law takes effect on July 1, 2016.

January 10, 2017 - Notable vaccine skeptic Robert F. Kennedy Jr. meets with President-elect Donald Trump. Afterwards, Kennedy tells reporters he agreed to chair a commission on "vaccination safety and scientific integrity." A Trump spokeswoman later says that no decision has been made about setting up a commission on autism.

August 23, 2018 -A study published in the American Journal of Public Health finds that Twitter accounts run by automated bots and Russian trolls masqueraded as legitimate users engaging in online vaccine debates. The bots and trolls posted a variety of anti-, pro- and neutral tweets and directly confronted vaccine skeptics, which "legitimize" the vaccine debate, according to the researchers.

October 11, 2018 - Two reports published by the CDC find that vaccine exemption rates and the percentage of unvaccinated children are on the rise.

2019 - As of May 24, the CDC has reported 940 individual cases of measles confirmed in 26 states.

January 2019 - The World Health Organization names vaccine hesitancy as one of 10 threats to global health in 2019.

March 26, 2019 - Rockland County, New York announces the "extremely unusual" step of banning unvaccinated individuals under age 18 from public places. One week later, a judge puts a hold on that and prohibits the county from enforcing the ban.

May 10, 2019 - Washington Gov. Jay Inslee signs legislation removing the philosophical exemption for the MMR vaccine from the state's school immunization requirements.

May 24, 2019 - Maine Gov. Janet Mills signs a bill into law removing all non-medical exemptions to vaccinations. The law will take effect in September 2021, and schoolchildren who claim a non-medical exemption prior to the law taking effect will be allowed to attend school if their parent or guardian provides a written statement from a healthcare professional indicating they've been informed of the risks of refusing immunization.

By contactus@priority-pediatrics.com
June 10, 2018
Category: Immunizations

 

In this period of “alternate facts,” a 24-hour news cycle, and an internet that can provide whatever answer a person seeks, it can be difficult to convince parents and patients using facts alone. Parents may respond using their own “facts” leaving you frustrated and unprepared to dive further into the conversation.

Without further conversation and as more parents become convinced by the counter-arguments, these “alternative facts” become widely held “truths.” Often the counter-arguments are based on fallacies, or errors of logic or reasoning. Different types of logical fallacies have been described in an article by David Ferrer, published on The Best Schools website. The article, which includes some short video examples, describes 15 types of fallacies:

  • Ad hominem attacks — Criticizing the messenger in the absence of a counter-argument related to the fact being discussed.
  • Straw man attacks — Attacking a position or fact that was not actually put forth. For example, oversimplification of a complex subject or statement to make it appear false.
  • Appeal to ignorance — Taking advantage of what is not known. Using the notion that something has never been proven definitively is a common example of this type of fallacy.
  • False dichotomy — Making a position appear to have only one of two possible options when the options are not mutually exclusive or when more than two options exist.
  • Slippery slope — Arguing against a fact by suggesting unlikely, extreme outcomes.
  • Circular argument — Using the preliminary assumption as the basis for arriving at the same conclusion.
  • Hasty generalization — Jumping to conclusions without reviewing all available evidence.
  • Red herring — Using a parallel or seemingly relevant argument to distract from the original point being discussed.
  • Appeal to hypocrisy — Suggesting deception or insincerity of the messenger as a way to neutralize or distract from the issue.
  • Causal fallacy — Incorrectly identifying two things as causally associated either without enough evidence to do so (false cause); solely based on one occurring before the other (post hoc); or because they were found together (correlational fallacy).
  • Fallacy of sunk costs — Continuing with, or suggesting continuation of, a project based on the resources invested to date without consideration of future resources that will be incurred if the project continues.
  • Appeal to authority — Considering something to be true simply because a perceived authority said it is so (without evidence) or because it was said to be true by citing authority figures who are not qualified in that field.
  • Equivocation or ambiguity — Delivering a message that is intentionally deceitful or misleading.
  • Appeal to pity — Evoking emotion to deter or replace the discussion of facts.
  • Bandwagon approach — Suggesting something is true because it is a popular belief; it is accepted by authorities or large numbers of people; or because someone specific, based on their reputation, agrees.

Recognizing these fallacies, and helping your patients and families recognize them may be useful to approaching vaccine-related conversations as well as helping sort out fact from fiction in general. To that end, the VEC recently created a new Special Topics sheet, titled Logical Fallacies and Vaccines: What You Should Know. The new, four-page sheet includes a definition for each type of fallacy, a common example of how the fallacy is used to argue against vaccines, and a “reality check” statement about the related myth.

As with other Special Topics sheets, and most VEC materials, this information can be photocopied for distribution, linked from your website, or shared on social media.

By contactus@priority-pediatrics.com
March 01, 2018
Category: Teens
Tags: teens   Youth   Facts   Vaping   e-cigarettes   e-juice   internet   tobacco   unhealthy   addictive   toxic  
January 30, 2018

5 facts about vaping to talk about with your teen

Trisha KoriothStaff Writer
 

Would you recognize an e-cigarette if you saw it? Not all e-cigarettes look alike, and vaping is easy to hide.

Electronic nicotine devices can look like a pen, a computer memory stick, a car key fob or even an asthma inhaler. Instead of inhaling tobacco smoke from a cigarette, e-cigarette users inhale vapor from liquid “e-juice” that has been heated with a battery-powered coil. This is called vaping. The juice is flavored and usually contains nicotine and other chemicals.

E-cigarettes are unhealthy and addictive. They’re also wildly popular among kids.

Pediatricians have been hearing from patients that they and their friends use e-cigarettes, according to Susanne E. Tanski, M.D., M.P.H., FAAP, a tobacco prevention expert from the American Academy of Pediatrics (AAP).

E-cigarettes are the most commonly used tobacco product among youths. New research estimates that about 3 million adolescents vape.

Electronic nicotine devices can look like a pen, a computer memory stick, a car key fob or even an asthma inhaler.
Electronic nicotine devices can look like a pen, a computer memory stick, a car key fob or even an asthma inhaler.

Here’s what you should know about teen vaping trends:

  • Kids might use different words to talk about e-cigarettes and vaping.For example, “Juuling” is a popular word among Dr. Tanski’s patients to describe using a brand of e-cigarette. About one in four kids who use e-cigarettes also tries “dripping.” Instead of using a mouthpiece to vape, they drip the liquid directly onto a heat coil. This makes the vapor thicker and stronger.
  • Kids can order “e-juice” on the internet. The legal age to buy e-cigarettes is 18 years, but online stores don’t always ask for proof of age.
  • E-cigarette juices are sold in flavors like fruit, candy, coffee and chocolate.Most have the addictive ingredient nicotine. The more kids vape, the more hooked they become. “This is potent stuff,” Dr. Tanski said.
  • Kids who vape just once are more likely to try other types of tobacco.Their developing brains make it easier for them to get hooked, according to a recent study.
  • E-cigarettes may not help people quit using tobacco. Some adults use e-cigarettes when they want to stop smoking tobacco cigarettes. While a recent report found e-cigarettes are “less toxic” than cigarettes, most people who use e-cigarettes do not quit using cigarettes.

The healthiest option is for parents and their children to quit, according to the AAP.

By contactus@priority-pediatrics.com
October 07, 2017
Category: Infectious Disease
Tags: Cough   Facts   Bronchiolitis   RSV   Rhinovirus   Metapneumovirus  

According to a Decision Support in Medicine article published in Pediatric News, reinfections with RSV occur throughout life but generally are limited to the upper airway in healthy individuals.

The younger the child in whom RSV infection occurs, the more likely the disease will be severe, requiring hospitalization or intensive care. In a 2009 study, Hall et al., noted that 1.7% of infants less than 6 months of age in the United States were hospitalized for RSV infection, with considerable variation among communities throughout the country. Despite this high hospitalization rate, only approximately 40 children in the United States die each year from complications of bronchiolitis. Bronchiolitis tends to be more severe when associated with RSV than with other viral causes, such as influenza, parainfluenza, human metapneumovirus, and rhinovirus. Although many older children and young adults are infected with RSV, those infections tend to occur primarily in the upper respiratory tract. RSV becomes a problem again in old age: it is estimated that some 14,000 elderly Americans die of RSV-associated infections each year.

Lance Chilton, MD, FAAP

Professor of Pediatrics

University of New Mexico

 

In children with bronchiolitis, the duration of symptoms has been estimated at 2-3 weeks.

Explanation

According to a Decision Support in Medicine article published in Pediatric News, “[r]ecovery from bronchiolitis can require weeks; the median duration of symptoms has been estimated at 12 days, but up to 20% of children continued to have intermittent cough at 3 weeks after onset of illness. A long-term association with increased risk for asthma in later childhood has been demonstrated for infants with severe bronchiolitis requiring hospitalization, although it is unclear if this is a complication of bronchiolitis or an underlying characteristic of the child.”

Knowing the prolonged course of RSV infection is helpful to those caring for young children who have suffered the disease in helping everyone understand the persistence of symptoms and the likelihood of eventual recovery from them. Counseling on the expected course and the lack of available therapy to avoid or treat prolonged cough, increased nasal secretions, and respiratory distress will avoid impossibly optimistic predictions of quick relief.  Those caring for children—parents and health care providers alike—should be aware that cough medications have severely limited effectiveness; codeine-containing preparations should be avoided in children.

Lance Chilton, MD, FAAP

Professor of Pediatrics

University of New Mexico

RSV spreads by large droplet transmission directly from patient to patient or by contact with viral particles on surfaces, which remain infectious for several hours

 

The clinical course of human metapneumovirus (HMPV) and RSV appear to be similar. HMPV is “another paramyxovirus that has infectious characteristics similar to those of RSV in regard to seasonal characteristics and mode of infection. HMPV was relatively recently described, but studies of banked specimens show it consistently has accounted for 3% to 19% of bronchiolitis cases,” according to a Decision Support in Medicine article published in Pediatric News.

 
Rhinovirus is a common coinfecting agent with RSV or human metapneumovirus.
Rhinovirus, a cause of the common cold, is a common coinfecting agent with RSV or human metapneumovirus. “Rhinovirus has an emerging role as a cause of bronchiolitis and is more common in children older than 6 months of age. Rhinovirus is known as a common trigger of wheezing in older children with chronic lung disease and asthma,” according to a Decision Support in Medicine article published in Pediatric News.
 
 
By contactus@priority-pediatrics.com
October 07, 2017
Category: Immunizations

Correcting Robert F. Kennedy Jr.’S Vaccine ‘Facts’

 

September 22, 2017Original Article  By Paul A Offit

When people misrepresent facts on the record, journalists are in a tough spot — especially when that information can be harmful.

Which brings me to STAT’s recent interview with Robert F. Kennedy Jr., conducted by Helen Branswell. STAT wanted to interview Kennedy about his claim in January 2017 that Donald Trump would soon appoint him to head a commission on vaccine safety and scientific integrity. Seven months had passed since Kennedy had made the claim and no announcement had been made. STAT wanted to find out where things stood.

Branswell began her interview by asking Kennedy eight different times and in eight different ways where things stood on his commission. Each time, he failed to confirm or deny whether the White House was about to appoint him.

That clearly wasn’t what Kennedy wanted to talk about. Instead, he wanted to talk about his belief that mercury in vaccines is poisoning America’s children and that no one in the federal government seems to care. By insisting that the interview be conducted in the question-and-answer format, Kennedy effectively tied STAT’s hands, which had to print what he said without editorial comment or opposing views.

I feel compelled to oppose Kennedy’s claims.

During the interview, Kennedy said that some babies were being injected with 25 micrograms of ethylmercury, which is part of a preservative called thimerosol that is used in multi-dose vials of influenza vaccine. He claimed that amount to be “100 times” greater than the amount considered to be safe.

As an environmentalist, Kennedy should know that mercury is a natural part of the Earth’s crust. As a consequence, methylmercury (environmental mercury) is contained in water and anything made from water, like breast milk and infant formula. The human body eliminates ethylmercury from vaccines far more efficiently than it eliminates naturally occurring methylmercury.

Babies typically ingest about 360 micrograms of methylmercury during the first 6 months of life, well before they will ever receive their first dose of influenza vaccine. If the 25 micrograms of ethylmercury in vaccines is 100 times greater than what Kennedy claimed is safe, then simply by living on Earth, by 6 months of age babies will have ingested an amount of mercury that is 1,440 times greater than Kennedy’s safety limit.

According to Kennedy’s calculations, all of us are massively intoxicated with mercury. The only way to avoid this would be to move to another planet.

Kennedy also said that he wanted to ensure “that vaccines are subject to the same kind of safety scrutiny and safety testing that other drugs are subject to.” In fact, vaccines are subjected to greater scrutiny than drugs. Much greater. For example, the CDC spends tens of millions of dollars every year on the Vaccine Safety Datalink, a system of linked computerized medical records from several major health maintenance organizations that represents about 7 million Americans, 500,000 of whom are children. Nothing like this exists on the drug side. Frankly, if a Drug Safety Datalink existed, the problem with Vioxx as a cause of heart attacks might have been picked up much sooner.

Kennedy said, “We need to, prior to licensing vaccines, do gold standard safety testing, like every other drug approval requires. We need to do double-blind placebo testing.” Branswell knew that the FDA does require placebo-controlled trials before licensure. So she pushed back. “Sir, that’s done all the time,” she said. “That is done all the time.”

Branswell was right. Here’s an example of the kind of testing that vaccines are put through. One of the currently licensed vaccines against rotavirus was tested in a placebo-controlled, prospective, 11-country, four-year trial of more than 70,000 infants before being approved. That’s fairly typical of most pre-licensure trials. But STAT was stuck having to report Kennedy’s remarks as is, even though Branswell knew they were false. That was the deal. The interview had to be printed without contradiction.

Perhaps most outrageous was Kennedy’s claim that “the hepatitis B vaccines that are currently approved had fewer than five days of safety testing. That means that if the child has a seizure on the sixth day, it’s never seen. If the child dies, it’s never seen.” Safety monitoring for the hepatitis B vaccine, like all vaccines tested before being licensed, involved determining side effects in the vaccinated and unvaccinated group for weeks after each dose. Indeed, some subsets of vaccinated individuals have been monitored for 30 years after hepatitis B vaccination.

Throughout the interview, Kennedy never adequately addressed the new commission. Creating such a commission doesn’t make sense to me for two main reasons.

First, a vaccine safety commission already exists. It’s called the Centers for Disease Control and Prevention. Staffed by epidemiologists, microbiologists, virologists, statisticians, molecular biologists, and clinicians, the CDC supervises the Vaccine Safety Datalink, which I described earlier. Whenever a new vaccine is licensed, this system quickly determines who’s been vaccinated and who hasn’t and detects any side effects that might be occurring more frequently in the vaccinated group.

Second, a commission for scientific integrity also already exists. Independent of the CDC, it’s called the Office for Research Integrity, and is housed in the Department of Health and Human Services.

It’s unfortunate that our culture, and our media, sometimes give celebrities a chance to comment without opposition on subjects about which they are often misinformed. It’s invariably the listener or reader who suffers this advice. Maybe journalists could at the very least add a cigarette-style caution to interviews like the one that STAT did with Robert F. Kennedy, Jr. Something like “CAUTION: Reading this article might be dangerous to your health.”

Paul A. Offit, M.D., is a professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. His most recent book is “Pandora’s Lab: Seven Stories of Science Gone Wrong” (National Geographic Press, April 2017).