Leaving the Anti-Vaccine Movement

The anti-vaccine movement had me in its grips after the early birth of my first child In 2008. My son's lungs were not fully developed, and he needed the NICU. My husband and I had signed up for a "natural" childbirth class where epidurals were evil and rupture of membranes did not mean go to the hospital. We were also told to forgo the hepatitis B vaccine for our newborns because "babies don't have sex or do illicit drugs by injection." I am a hospital pharmacist and was falling for it all.

Jenny McCarthy and Dr. Andrew Wakefield were regularly in the news for the connection between vaccines and autism, and I was fearful for my son. After all, Dr Wakefield was a physician with a research paper in support of the connection between vaccines and autism. Also it was a little bit popular to be anti-vax.

Herd immunity is a form of immunity that results when the vaccination of a significant portion of the population provides a measure of protection for those who have not developed immunity. Herd immunity disrupts normal transmission of diseases covered by vaccination. The anti-vax movement directly compromises this immunity resulting in less people becoming vaccinated and increases in diseases that were virtually eradicated.

Measles is on the rise. Dr. Mark Grabowsky, a health official with the United Nations, wrote last year in the Journal of the American Medical Association-Pediatrics. “Many measles outbreaks can be traced to people refusing to be vaccinated; a recent large measles outbreak was attributable to a church advocating the refusal of measles vaccination.” Measles was once considered eradicated. For every 1,000 children who get the measles, one or two will die from it, and one will get brain swelling so severe it can lead to convulsions and leave the child deaf or mentally impaired, the U.S. Centers for Disease Control and Prevention said. In contrast the fears parents have to vaccinate in relation to autism and MMR according to the Wakefield study continues to rise even though the study was proven false. Wakefield was stripped of his license to practice medicine, and numerous conflicts of interest surrounding the study were discovered. Once upon a time before vaccinations, nearly everyone in the U.S. got measles before there was a vaccine, and hundreds died from it each year. Today, most doctors have never seen a case of measles, but cases keep popping up, the latest starting in Disneyland.

Still the anti-vax movement continues. 

Mumps have also made a comeback. Before widespread vaccination, there were about 200,000 cases of mumps and 20 to 30 deaths reported each year in the USA. Mumps can in some cases lead to encephalitis and deafness. Herd immunity is important because the mumps vaccine is just 88% effective, explaining why someone can easily contract the disease even if they have been vaccinated as I did back in 9th grade from a foreign exchange student. I was vaccinated, but for whatever reason was infected from someone overseas. The CDC reports that the number of mumps cases doubled in the past year - affecting more than 1,000 people nationwide.

Mumps in the United States from 1970-2005

Mumps in the United States from 1970-2005

Mumps in the United States from 1980-2005

Mumps in the United States from 1980-2005

Pertussis or whooping cough was a universal disease in the pre-vaccination era was almost always seen in children. Between 1940 and 1945, before widespread vaccination, as many as 147,000 cases of pertussis were reported in the USA each year, with approximately 8,000 deaths caused by the disease. It is estimated that at the beginning of the 20th century as many as 5 of every 1000 children born in the USA died from pertussis.

Pertussis in the US from 1940-2000

Pertussis in the US from 1940-2000

Pertussis in the US from 1980-2005 (on the rise)

Pertussis in the US from 1980-2005 (on the rise)

Why don't parents vaccinate today? Parents today did not grow up with these diseases and see the thousands of children die. We are not afraid of these diseases because they have not been a part of our lives and take for granted how these diseases can cause death or severe consequences. Parents hear celebrities like Jenny McCarthy, Alicia Silverstone and Kristin Cavallari cite fear as a reason not to vaccinate. But what many don't realize is that those against vaccines and not vaccinating their children depend on the rest of us to vaccinate to stay safe. The more people that join in the crusade that vaccines are evil, the higher the risk their own children will succumb to diseases that were virtually gone just a few years ago. 

Side effects of vaccines are mild according to the CDC. And while there are very rare cases of vaccine-related issues, the benefit far outweighs the risk if you compare the numbers pre-vaccination era vs. after vaccinations were introduced.

Why should parents vaccinate? Parents should vaccinate because vaccines are preventing complications from preventable childhood illnesses that can cause deafness, blindness, hospitalization, other life altering effects and death. Parents should become informed and become critical thinkers about the decisions made to increase the risk of these diseases to their children and others who are unable to fight infection (elderly, immunodeficiencies, and the very young). Parents should not, as I did, make decisions by fear and paranoia and look at the facts. We should also as a society consider public health and realize that vaccines are safe and very effective and not vaccinating is irresponsible.

Fortunately, I woke up from the "anti-vax movement" before endangering my son further. Although his vaccines were spaced out individually and further apart, he ended up receiving them all. My daugther, on the other hand, received them all on time as outlined by the CDC. I do have much greater peace of mind knowing the numbers don't lie, vaccines save lives and have since they were first introduced years ago. I am glad I did not let the fear of the unknown and debunked guide my choices to put them in harm's way.

 

 

 

 

 

 

BCPS 2013: Vaccines

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vaccinationsVaccines:  the memorization of when and what and when not to if the patient has certain conditions.  Imagine questions that are simple but complicated.  For example, perhaps an age is given and you need to know what vaccinations were due by that age or if the child had never had vaccines what could be given as catch-up?  It is really not complicated and again if you are a parent this may be an easier topic if you are of the pro-vax crowd (as I am). Below see the schedule from the CDC that is also approved by the American Pediatric Association along with the recommended schedule for catching up on vaccines if missed.

vaccine0-6

 

vaccine7-18yrs

 

vaccinecatchup

Special Population Considerations

1. Preterm infants

  • Immunize on the basis of chronologic age.
  • Do not reduce vaccine doses.
  • If birth weight is less than 2 kg, delay HepB vaccine because of reduced immune response until the patient is 30 days old or at hospital discharge if it occurs before 30 days of age (unless the mother is positive for HepB surface antigen).

2. Children who are immunocompromised

  • No live vaccines
  • Inactivated vaccines and immune globulins are appropriate
  • Household contacts should not receive oral polio vaccine
  • MMR, influenza, varicella, and rotavirus vaccines are recommended

3. Patients receiving corticosteroids

a. Live vaccines may be administered to patients receiving the following:

  • Topical corticosteroids
  • Physiologic maintenance doses
  • Low or moderate doses (less than 2 mg/kg/day of prednisone equivalent)

b. Live vaccines may be given immediately after discontinuation of high doses (2 mg/kg/day or more      of prednisone equivalent) of systemic steroids given for less than 14 days.

c. Live vaccines should be delayed at least 1 month after discontinuing high doses (2 mg/kg/day or more      of prednisone equivalent) of systemic steroids given for more than 14 days.

4.  HIV Positive Patients

 

a. MMR should be administered unless patient is severely immunocompromised. b. Varicella should be considered for asymptomatic or mildly symptomatic patients. c. Inactivated vaccines should be administered routinely.

 

BCPS 2013: Pediatrics

I feel I have a bit of insight into the test and can attest to what is needed to know in each section.  Keep in mind the guidelines could change between 2012 and 2013 along with the test questions, but for the most part I found the test to be incredibly fair though stressing areas more than others that I would have not expected. I want you to pass!  First attempt!

So what do you need to do to pass?  Start now.  I especially am talking to those with families and/or children and very little time to spare for sitting down and studying the traditional way.  Again, I did fail this past year, so I will disclose that immediately, but I do believe I have insight into the test and very much plan to pass it this fall.  It's a goal at this point for my own personal development.

So, ahead I will have some material presented that does come from the ACCP study material though reworded and simplified in more study form and perhaps some hints as to what was important on the test in each particular section.  I am hoping to not get in any sort of trouble by doing this as far as with the BPS, so if this is not appropriate, would someone from there contact me?  I do not plan on giving test questions per se' and I couldn't if I tried as there were far too many to memorize.

After two children I am convinced parts of my brain were delivered with the children as it is.

First up!  PEDIATRICS!BCPS pediatrics

This was always the topic that would terrify me prior to having children, but at this point besides missing one of the most common concepts of children and the very small amount of data on the test regarding pediatrics (at least in my opinion), pediatrics just doesn't seem so daunting.

Know the common pathogens of children in sepsis and meningitis.

0–1 month  

  • Group B streptococcus
  • Escherichia coli
  • Listeria monocytogenes
  • Viral (e.g., herpes simplex virus)
  • Coagulase-negative staphylococcus—nosocomial
  • Gram (−) bacteria (e.g., Pseudomonas spp., Enterobacter spp.)
  • nosocomial

1–3 months

  • Neonatal pathogens (see above)
  • Haemophilus influenzae type B
  • Neisseria meningitidis
  • Streptococcus pneumoniae

3 months–12 years

  • H. influenzae type Ba
  • N. meningitidis
  • S. pneumoniae

> 12 years

  • N. meningitidis
  • S. pneumonia

Not to hard to figure out correct?  Keep in mind that H. flu is less and less due to immunizations.  I suppose if you live in an area where vaccination is the devil, you may find more of this organism.

 

Potential Antibiotic Regimens

Age                                                                         Regimen

0–1 month                                                            Ampicillin + gentamicin OR ampicillin + cefotaxime

1–3 months                                                          Ampicillin + cefotaxime/ceftriaxone

3 months–12 years                                             Ceftriaxone ± vancomycina

> 12 years                                                             Ceftriaxone ± vancomycina

**Addition of vancomycin should be based on the regional incidence of resistant S. pneumoniae.

                               

Regimens for Chemoprophylaxis  (I will have to reformat this later)

Drug                      Neisseria meningitidis                                                                       Haemophilus influenzae

Rifampin            < 1 month old: 5 mg/kg/dose PO every 12 hours × 2 days                       20 mg/kg/dose (maximum 600 mg)

> 1 month old: 10 mg/kg/dose PO every 12 hours × 2 days                   daily x 4 days

Adults: 600 mg PO every 12 hours × 2 days

 

 

Ceftriaxone             < 15 years old: 125 mg IM × 1 dose                                                               Not indicated

> 15 years old: 250 mg IM × 1 dose

 

**Ciprofloxacin and azithromycin are possible alternatives although not routinely recommended.

 

RSV - Identify the drugs available for preventing and treating respiratory syncytial virus.

Prophylaxis

  1. Nonpharmacologic: Avoid crowds during RSV season and conscientiously use good hand-washing practice.
  2. RSV IVIG (RespiGam): No longer marketed in the United States (didn't see on the test ;))
  3. Palivizumab (Synagis)
  • a. Dosing: 15 mg/kg/dose intramuscularly; given monthly during RSV season
  • b. Effects on outcomes

i. A 55% reduction in hospitalizations for RSV

ii. Safe in patients with cyanotic congenital heart disease

iii. No reduction in overall mortality

iv. Does not interfere with the response to vaccines

v. Not recommended for the prevention of nosocomial transmission of RSV

Know this:  Supportive care.  Treatment is supportive care only.

 

American Academy of Pediatrics Palivizumab approval:  (you WILL see this)

 

i. Premature infants born before 32 weeks’ gestation (i.e., 31 weeks, 6 days or earlier) who are 6 months old or younger at the beginning of RSV season

(a) Infants born at less than 28 weeks’ gestation may benefit up to 12 months of age.

(b) Eligible for a maximum of five doses of palivizumab during RSV season

 

ii. Infants with chronic lung disease who are 2 years or younger and who required medical management of their chronic lung disease in the previous 6 months – Eligible for a maximum of five doses of palivizumab during RSV season

 

iii. 32 and 35 weeks’ gestation (i.e., 32 weeks, 0 days through 34 weeks, 6 days) who are 3 months or younger at the beginning of RSV season

(a) With at least one of the following risk factors may benefit: infant attends childcare or sibling younger than 5 yo in same household

(b) Eligible for a maximum of three doses of palivizumab during RSV season

 

iv. Infants 24 months and younger with hemodynamically significant congenital heart disease

(a) Eligible for a maximum of five doses of palivizumab during RSV season

(b) There is a 58% decrease in palivizumab serum concentration after cardiopulmonary bypass; therefore, a postoperative dose of palivizumab is recommended as soon as the patient is medically stable.

 

v. Infants 12 months and younger with congenital abnormalities of the airway or neuromuscular disease that compromises the handling of respiratory tract secretions – Eligible for a maximum of five doses of palivizumab during RSV

 

Tomorrow will continue with otitis media...

 

 

Pertussis and New Recommendation

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It is a well know fact that I support vaccinations. I become irritated when I think about the cases of pertussis that takes the life of an infant because herd immunity is losing its protection. These gaps allow these vaccine preventable diseases to find their way back into the general population. Just the other day on my Facebook wall, there was a comment from someone who is against vaccines. They were told their insurance would no longer cover well visits because she doesn't vaccinate her children. I believe this is the directions insurance companies will go. Vaccinate or no coverage. I do not agree with taking away choice. But truly, if we didn't need insurance and paid for our own healthcare (who does that?) we could make our own decisions.

The CDC now recommends that pregnant women get a dose of the Tdap every time they are pregnant rather than the one time booster if they had not previously received the vaccine. Dr. William Schaffner, who is the chair of the department of preventative medicine at Vanderbilt School of Medicine, suspects that a proportion of babies who die of Sudden Infant Death Syndrome are caused by pertussis.

Arizona Academy of Family Physicians

Laura Hahn, the director of the Arizona Academy of Family Physicians is spearheading the argument against the Arizona Pharmacy Alliance's attempt to allow pharmacies to dispense vaccinations without the need of a prescription.  Unbelievably, the pharmacists won the first round.  Both sides are using public health as their argument.  The pharmacists are arguing that the rates of the public health actually getting the flu vaccine (among others) are lower than the CDC recommends due to the lack of health insurance.  Doctors are arguing that pharmacists would be putting people at risk. It's quite ironic to me that the very people preaching about vaccinations and compliance are the ones who just want to make an extra dollar.  It's not about public health.  One point:

Hahn said her doctors have no problem with pharmacists administering routine flu or pneumonia vaccines without a prescription.

“But certain vaccines, for the safety of the public, need to be given in a medical (or) home situation,” she said.

Some of that, she said, is because a doctor would be more familiar with a patient’s family history and the possibility of allergic reactions. And some of it, Hahn said, is that giving a vaccine involves more than just injecting it.

She specifically mentioned the HPV vaccine being marketed to teen girls designed to prevent a type of virus transmitted by sexual contact. Hahn said a doctor who might prescribe this would tell a patient that the vaccine prevents neither pregnancy nor other sexually transmitted diseases, “not things that would be discussed (with a patient) by a pharmacist.”

“Patient safety has to come first,” Hahn said.

Patient safety has to come first?  You are telling me that it is assumed a pharmacist cannot tell a patient that the HPV virus won't protect them from STDs?

What is coming first here is the Almighty Dollar yet again.  Doctors don't want to lose more money to pharmacists.

And YES.  We did take years of pharmacology vs. a semester by most physicians.  Do we claim that the patients' health is at risk because a doctor accidentally gives two drugs that interact with one another together because he/she didn't know?

Article here.