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Daily Dose

Measles Exposure on an Airplane

Public health officials are warning passengers of possible exposure to measles on an airplane. Dr. Sue talks about how infectious diseases are just a plane ride away. I know you have read previous blogs on immunizations.  I have re-iterated many times, that despite the perception of some, many vaccine preventable diseases have not been eradicated from the United States and some may just be a “plane ride away”.

This is now the issue with a recent case of measles that occurred  in an unimmunized woman from New Mexico who was returning from a trip. The woman developed an illness, later confirmed to be measles, as she returned from London and subsequently travelled through no less than 4 different airports in the United States. The issue is that this one traveler, exposed many individuals on multiple airplane flights, as well as in 4 different airports.  As Dr. William Schaffner, an infectious disease specialist at Vanderbilt University stated, “the potential exposure of so many travelers in airport terminals is a cause for concern”. While most Americans have been immunized against measles (with the MMR vaccine), there are still those who remain unimmunized either due to the fact that they are too young, or because they choose not to be vaccinated (as had this woman who developed the “index case” of measles). Children do not receive their MMR vaccine until after their first birthday, and then receive a booster dose of MMR between the ages of 4–6 years. Therefore, a child who is less than 12 months of age, who may be up-to-date on all of their immunizations but is too young for MMR, may have been exposed to measles if they had been sitting within 5 airline rows of the woman who had undiagnosed measles. The same holds true for infants who might have been next to the woman in a security line, or at a Starbucks, or in the newsstand as she passed through these 4 various airports. It is also possibly an exposure for anyone of any age, who has never been immunized against measles, or who has not had the disease (older individuals). All of these exposures would have been accidental and never even noticed unless an exposed person subsequently develops measles. The incubation period for developing measles after an exposure is between 8-12 days, and measles will present with symptoms of fever, cough, runny nose, red eyes, and a body rash. So….here is just another example of the spread of an infectious disease.  This case involves travelers in airports from London, England, to Washington D.C., to Baltimore, to Denver, and ultimately to Albuquerque.  Now we need be alert for any further cases of measles in next several days and weeks.  Remember, measles is a respiratory virus, and it is spread via coughs and sneezes, and the virus may last in the air for up to 2 hours, without any one suspecting they are being exposed. If your child has not been immunized, this is a good reminder, run don’t walk, and get that MMR. That’s your daily dose for today.  We’ll chat again tomorrow.

Your Toddler

Long-Term Study Confirms Measles Vaccines Safe

1:30

Researchers in a 12-year-study, investigating the safety of two measles-containing vaccines have found them safe and effective.

The study included children between the ages of 12 to 23 months. Some of the children received the MMRV vaccine (measles –mumps-rubella-varicella). The others were administered the MMR + V vaccine (measles, mumps. rubella and varicella), but they received both the MMR and the V vaccines on the same day.

In total, the researchers at the Kaiser Permanente Vaccine Study Center in California looked at almost 125,000 MMRV doses and nearly 600,000 MMR + V doses.

Many parents are still concerned that there may be long-term health issues that are either introduced or triggered by the vaccines. Dr. Nicola Klein, co-director of the vaccine study center, said parents should feel confident in the vaccines’ safety.

"Our findings offer reassurance that adverse outcomes of measles-containing vaccines are extremely rare and unlikely, and that parents of 1-year-old children can choose MMR + V instead of MMRV vaccines to reduce the low risk of fever and febrile seizures," Klein said in a Kaiser Permanente news release.

The vaccines didn't increase children's risk of seven types of neurological, blood or immune system disorders. No other safety concerns were identified with either vaccine, according to the researchers.

Previous studies have suggested that the two vaccines are associated with fever and fever-related (febrile) seizures in one-year-old children. The study confirmed these previous findings. These types of seizures usually happen seven to 10 days after vaccination. The study also found that the MMRV is more likely to cause febrile seizures than MMR + V.

Febrile seizures, which happen during a fever, can be common in toddlers and young children. Although frightening to witness, seizures often don’t cause serious health problems. Having said that, anytime a child has an unexpected seizure, you should seek emergency help just in case.

The researchers emphasized the risks of febrile seizures from the vaccines is small; occurring in less than one of every 1,000 vaccine injections.

"This level of safety monitoring for vaccines can give the public confidence that vaccine surveillance is ongoing and that if a safety problem existed, it would be detected," Klein said in the news release.

The study was published online in the journal Pediatrics.

Source: Robert Preidt, http://www.webmd.com/children/news/20150107/long-term-study-finds-measles-vaccines-safe

Your Child

CDC, White House Urge Measles Vaccinations

2:00

In 2002, when measles were essentially declared eliminated in the U.S., scientists didn’t expect parents would begin to opt out of the MMH vaccinations for their children during the next 5 years. The vaccine is safe and effective, so who wouldn’t want their child protected from a painful and potentially fatal disease?

Turns out that there are American parents who fear vaccines and children who visit from other countries where the vaccine is not available, widely distributed or required for travel.  Measles hasn’t been eliminated around the world and has reared its ugly head again the states.

So far, more than 90 people have been diagnosed in California and the disease has spread to 13 other states including Arizona, Colorado, Illinois, Minnesota, Michigan, Nebraska, New York, Oregon, Pennsylvania, South Dakota, Texas, Utah and Washington as well as Mexico.

According to public health officials, the current outbreak has been linked to 58 cases that began when an infected person from outside the United States visited Disneyland in Anaheim between Dec. 15 and Dec. 20.

Dr. Anne Schuchat, director of the Centers for Disease Control and Prevention’s (CDC) National Center for Immunization and Respiratory Diseases, said a traveler could still easily bring in the disease from abroad.

"This is a wake-up call to make sure we keep measles from getting a foothold in our country," she said.

The measles vaccine is part of a grouping of vaccines known as MMH (measles, mumps and rubella.) These diseases spread from person to person through the air. They are highly contagious. You can easily catch them by being around someone who is already infected, but not showing symptoms.

The MMH vaccine can protect children (and adults) from all three of these diseases.

There are valid medical reasons why some people should not receive the vaccine that include:

·      Anyone who has had life-threatening allergic reaction the antibiotic neomycin or any other component of the MMH vaccine.

·      People who are sick at the time the vaccine is scheduled. They should wait till they recover before getting the vaccine.

·      Pregnant women should not get the vaccine until after giving birth. Women should avoid getting pregnant for 4 weeks after vaccination with the MMR vaccine.

·      People with compromised immune systems .You should tell your doctor if you have or are being treated for or with:

o   HIV/AIDS

o   Steroids

o   Cancer

o   A low platelet count

o   Have received another vaccine within the past 4 weeks

o   A transfusion or received other blood products.

The outbreak has renewed debate over the so-called anti-vaccination movement in which fears about potential side effects of vaccines, fueled by now-debunked theories suggesting a link to autism, have led a small minority of parents to refuse to allow their children to be inoculated.

Schuchat called it "frustrating" that some Americans had opted out of the vaccine for non-medical reasons, saying it was crucial that they be given good information about the safety and reliability of inoculations.

There is no specific treatment for measles and most people recover within a few weeks. But in poor and malnourished children and people with reduced immunity, measles can cause serious complications including blindness, encephalitis, severe diarrhea, ear infection and pneumonia and even death.

The White House said on Friday that parents should be “listening to our public health officials,” who urge vaccinations against measles, as it emerged the disease has now infected more than 100 people in the U.S.

White House Press Secretary Josh Earnest said that President Obama thinks parents should ultimately make their own decision whether or not to vaccinate their children, Reuters reports, but added that the science clearly points to vaccinating.

“People should evaluate this for themselves with a bias toward good science and toward the advice of our public health professionals,” said Earnest.

Measles is preventable. We live in a country where the MMH vaccine is affordable and easy to get. We’re fortunate that way.

Children should get 2 doses of MMH vaccine. The first dose when they 12-15 months of age and the second dose 4-6 years of age. Some infants younger than 12 months can receive a dose if they are travelling outside the United States. Children between 1 and 12 years of age can get a "combination" vaccine called MMRV, which contains both MMR and varicella (chickenpox) vaccines.

If you have any concerns about the MMH vaccine, talk with your pediatrician or family doctor about its safety and effectiveness. If you received the MMH vaccine when you were a child, you might want to consider a booster shot.

Sources: http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html

Dan Whitcomb, http://www.reuters.com/article/2015/01/30/us-usa-measles-disneyland-idUSKBN0L302120150130

Mandy Oaklander, http://time.com/3691079/measles-vaccinations-white-house/

Daily Dose

Measles Outbreak Getting Worse

1:30 to read

How can it be possible that we have over 100 cases of measles in this country and I bet there will still be more to come.  Why?  The real reason boils down to decreased vaccination rates for the MMR (mumps, measles, rubella) vaccine, most of which is driven by the choice “to not vaccinate”.

This is definitely a public health issue for all of us but particularly for young children.  There are truly some children who are either too young to receive the MMR shot (under 12 months) or have underlying health reasons which makes it impossible for them to receive the MMR vaccine. For everyone else vaccinating children is imperative in order that “herd immunity” continues to protect everyone.

While this should not be a political issue even President Obama weighed in during a recent interview on the need for families to vaccinate their children as he said, “the science is there to prove that vaccines are safe”, “parent’s need to have their children immunized”.

The issue of choosing not vaccinate or to follow an alternative vaccine schedule has been a hot topic provoking a lot of emotion and very heated discussions. Some of the discussions revolved around the fact that vaccine preventable diseases, while not prevalent, had not been eradicated. If “we” don’t see the disease...why vaccinate our children. This in fact turns out to be short sighted.

Do those who believe in their “right to not vaccinate”  not feel at all “guilty” that their choices are putting other people at risk, not just their own children. Is that fair?  For years this has been a hypothetical question...but as vaccine rates in certain areas have dropped, this is no longer hypothetical.  There are many analogies that come to mind...but if an infant should die due to a vaccine preventable disease such as measles, which they were exposed to by an unvaccinated child..is this any different than a drunk driver killing an innocent person on the road?

Lots to think about. To date there have not been any measles deaths.  Surely we can get people to get their child their MMR vaccine before there are cases throughout the country.

Daily Dose

Should your child get their MMR ahead of schedule?

1:30

Most of the discussion about the current measles outbreak revolves around those who choose NOT to vaccinate. But on the other side of the story anxious parents have called me and are wanting to make sure their children’s MMR vaccine is up to date. In fact some are so anxious they want to vaccinate their children “ahead of schedule”.  

One mother has an almost 4 year old, who had their first MMR on schedule when her son was 1 year.  She called and asked if she could bring him in 3 months before his 4th birthday, “just to make sure he is okay”. I assured here that there was not an indication to vaccinate him early and that I would see him later this spring for his routine check up.  She was relieved...as was he.  (he is not looking forward to that 4 year old visit!)

Several other parents have called and asked if they should bring their 6, 7 or 8 month old child in to have their MMR even before their 1 year check up. The current recommendations have not changed and the MMR vaccine is still being given at 12 months of age and then a “booster” dose at 4-6 years of age. There are recommendations to immunize children between 6-12 months of age who are traveling internationally. Many countries have far more measles cases than what we currently seeing in the United States.  For information on travel and measles vaccine go to www.cdc.gov.

I do remember being a young physician in the late 80’s when there was an epidemic of measles. The first time I saw a case of measles was in 1990 and I myself had a young baby at the time. There were over 55,000 cases of measles in the U.S. and over 120 deaths. Due to the extent of this measles “epidemic” a recommendation was then made to give any infant over 6 months of age a measles vaccine, knowing that they were not getting fabulous protection, but better than none. This group, including my now 25 year old son, then received MMR vaccine between 12-15 months, and again at 4-6 years.  

So...stay tuned, with new cases now cropping up in infants in a day care center in Chicago, and several more suspected cases in other areas...this story is unfortunately not over.

If you do NOT know you or child’s vaccination status.....it doesn’t “hurt” to get another MMR.  

Your Child

More Myths About the Measles Vaccine

2:00

As measles cases continue to climb, people are taking notice. Public health officials as well as a growing list of politicians are asking parents to make sure that their child or children get the MMR vaccine.

While support is growing to have all children immunized against the highly contagious disease, anti-vaccination groups are also speaking out through media outlets, emails, social media and blogs.

In the 1990s, a now discredited study linked the MMR vaccine to autism. Parents reacted with fear throughout world and began opting out of getting their children vaccinated against measles, mumps and rubella.

Since that time, dozens of medical studies have been conducted and found no connection between the vaccine and autism. The doctor, Andrew Wakefield, was stripped of his license and the British Medical Journal called his research “fraudulent.”

That hasn’t stopped people from continuing to quote his discredited findings.

With so much attention being given to measles these days, new myths have popped up from people who continue to spread fear about the MMR vaccine.

Two myths in particular are making the rounds:

1. The vaccine doesn’t work because it protects against a different strain.

The first concern, which has been posted on anti-vaccination blogs, is that the vaccine protects against an “A” type of measles virus, while the kind that’s making everyone sick is a “B”-type virus. Therefore, the vaccine doesn’t protect against the kind of measles that’s making everyone sick.

It’s true that are different strains of the measles virus, but it doesn’t act like the flu virus – where different strains can overpower a particular vaccine. Each measles virus is given a letter and a number, for example B3 or D4. They refer to the genetic fingerprint of the virus. Since 1990, 19 different strains, or fingerprints, have been identified, according to the CDC, and scientists use these fingerprints to link infections during an outbreak.

However, the measles virus doesn’t change as much as the flu virus. Once the current vaccine and boosters are in the body’s system – the vaccine protects against all strains of measles.

2. It’s vaccinated people who are spreading measles, not those that are unvaccinated.

The thought behind this myth is that the measles shot, which contains a weakened but live form of the virus, can give people infections that allow them to pass on the disease to others.

It’s an interesting twist according to William Schaffner, MD, an infectious disease specialist at Vanderbilt University in Nashville, TN.

“The vaccine virus, can, on occasion, spread to others,” Schaffner says. “That gives them protection. It doesn’t give them disease.”

But, he says, to be clear: "On occasion" means the possibility is so remote that it’s highly unlikely.

If that were to happen, Schaffner says, it would actually be a good thing because the person who “caught” the vaccine virus would get the protection, but not the illness. Most likely, they wouldn’t even know it occurred. Other experts say this is more theory than anything else.

Some parents believe measles is a somewhat minor disease that may cause a short period of illness and doesn’t have any long-term effects. There are even groups that have “measles parties” so their children can build a “natural” immunity.

Measles can be fatal to children, adults with suppressed immune systems and the elderly – that’s a very long-term side effect. It can cause encephalitis (an inflammation of the brain) and require intensive care in the hospital. Complications from measles can cause permanent hearing loss. Measles is not something you want to mess with. Medical experts agree that parents need to get the real facts and have their children vaccinated. 

Source: Brenda Goodman MA, http://www.webmd.com/children/vaccines/news/20150210/measles-vaccine-myths

Your Child

Measles Vaccine May Help Prevent Other Diseases

2:00

The measles vaccine may provide additional benefits beyond protecting children from the highly contagious and sometimes fatal disease.

According to a new study, by blocking the measles infection the vaccine may also prevent measles-induced immune system damage that makes children much more vulnerable to other infectious diseases for two to three years after immunization.

The immune system has the advantage of having “cellular memory” for previous infections to help fight invading microbes.

The study focused on a phenomenon called "immune amnesia" in which the measles infection destroys cells in the immune system that remembers previously encountered pathogens.

Prior research had suggested that “immune amnesia” typically lasted a month or two. The new study, based on decades of childhood health data from the United States, Denmark, England and Wales, showed the measles-induced immune damage persisted on average for 28 months.

Because of the long-term damage to the immune system by the measles infection, children that were not vaccinated and got the measles were more likely to die from other infections.

"The work demonstrates that measles may have long-term insidious immunologic effects on the immune system that place children at risk for years following infection," said Princeton University infectious disease immunologist and epidemiologist Michael Mina, whose study appears in the journal Science.

"The work also demonstrates that, in these highly developed countries prior to the introduction of measles vaccine, measles may have been implicated in over 50 percent of all childhood infectious disease deaths."

Measles was declared eliminated in the United States in 2000, but increasing numbers of cases have been reported in recent years, as more people remain unvaccinated. Last year's 668 U.S. measles cases were the most since 1994, the Centers for Disease Control and Prevention said.

"Our work reiterates the true importance of preserving high levels of measles vaccine coverage as the consequences of measles infections may be much more devastating than is readily observable," Mina said.

The study provided data showing that measles prevention through vaccination lowered childhood deaths from the pathogens that cause conditions such as pneumonia, sepsis, bronchitis, bronchiolitis and diarrheal diseases.

The study comes as many parents opt out of the measles, mumps and rubella (MMR) vaccine for their children based on discredited claims about the vaccine's safety or for religious and other reasons.

The MMR vaccine has been thoroughly studied by scientists around the world and has been found safe for children. This new study shows that its benefits may last much longer than previously thought.

Source: Will Dunham, http://www.reuters.com/article/2015/05/07/us-health-measles-idUSKBN0NS23N20150507

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