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Alternative Vaccination Schedules

Evidently the 7 billionth human is going to be born on October 31. Happy birthday and welcome to the Earth.  If you were unfortunate enough to be born into a developing country or a affluent California family, you may not receive your vaccinations, and may join one the 57 million who die each year of vaccine preventable diseases (VPD).

I totally misread the table.  It’s about 4,320,000 who die of VPD. Well, I said I was no damn good at stats.

And if you are doubly unlucky, you may be exposed to illness from an unvaccinated friend, family or health care worker before you can get your vaccines, and join the ranks of the ‘only’s.’  The ‘only’s’ are those who die of vaccine preventable diseases and are mentioned in anti-vaccine literature in a sentence like ‘VPD X is a mild illness in most children and only kills Y% of cases ’.  As I have said before the anti-vaxers do not care for whom the bell tolls.

I am no good at statistics.  I signed up for, and dropped, statistics at least 4 times in college.  Once they got past the bell shaped curve, it was one incomprehensible huh?  Part of the problem with statistical concepts such as risks, both relative and absolute, is that it is often impossible to get a feel from what they represent. For me it is like metric measurements.  I know what a 8 mile hike represents, but not an 8 kilometer hike.  Same with centigrade and liters.  I have been unable to internalize what metric means in my daily life.

Some statistics I have to accept with no real feeling as to their magnitude.  That estimated 57 million deaths from vaccine preventable illness?  That’s a number I can’t wrap my head around.  It translates to about 148,000  11 000 day, or the population of my home town Portland, dying every two days month.  I (still) can’t imagine that volume of death.  In 30 years I have seen exactly one death from a VPD,  a pregnant female who developed chickenpox and its resultant pneumonia.   Chicken pox, hepatitis A and B, and pertussis are the only viral VPD’s of which I have seen more than one case.   The only vaccine preventable illness I see routinely, and I should put preventable in quotes because I am not so sure the disease is currently preventable in adults, is the Pneumococcus.  Certainly vaccination of kids with the conjugate vaccine has lead to a decrease in disease in adults, but that appears to be a temporary victory and the vaccine for adults, the Pneumovax, is of marginal efficacy.

I know intellectually that VPD’s are a major source of morbidity and mortality in the rest of the world, and that they, along with many other infections,  are an airplane flight away from starting an outbreak.  It has happened with mumps and measles, and it will happen again.  But VPD’s have virtually no impact on my day to day experience as an infectious disease doctor and as head of our Infection Control programs.  My time and energy are directed elsewhere.

What are parents to do?  When raising kids in the US there is no need to worry directly about VPD’s. It is more a theoretical worry,  because thanks in part to vaccines, the childhood plagues of the past are history, and who needs to fret about history when there are real risks to your children.   I wonder, given the hassle of getting the kids to the pediatricians, how compulsive I would have been about getting my kids vaccinated on schedule if it were not a requirement for school.  I  probably would have kept reasonably on track, like my dental cleaning, but would not have been the model of promptness, given the lack of VPD’s in the community.  It is nice to have the stick of the educational system keeping us honest, and the schools are wise to have immunization as a condition of enrollment.  Schools represent an excellent center for rapid infectious disease amplification and spread.

Laziness is evidently not the main reason that parents do not get their kids vaccinated according to the CDC guidelines.  Pediatrics this month has an article, Alternative Vaccination Schedule Preferences Among Parents of Young Children, that evaluated why parents are using alternative vaccine schedules. They polled the parents of kids between the ages of 6 months and six years of age about their utilization of the vaccine schedule, and I can’t decide if the results are good or bad, given the large number of irascible contrarians in the US population. Or perhaps I watch too much cable news. I am an optimist at heart so  I suppose the glass is half full, albeit with bile.

13% of parents interviewed were using an alternative vaccination schedule, but  only 2% refused all vaccinations.  Most, rather than no vaccination, refused some vaccinations or waited until the children were older before giving the vaccination.  So is 2% complete refusers, a low number or a high number?  Does 13% qualify for an only? Is 87% great?  Well, no.  For most diseases, the coverage rates you want to maximize herd immunity for those who cannot be immunized is in the 95% plus range.  I always emphasize for the housestaff that the first word in my medical subspeciality is infectious.  Not kind of infectious or sort of infectious.  These beasts have evolved to rapidly jump from person to person and it takes very little exposure for them to cut loose in populations.  In the old days my field was called contagious diseases, and I kind of prefer that title, even though most of the diseases in the hospital are no longer particularly contagious.

Good news: “Among the alternatively vaccinating parents, only 8% reported using a well-known alternative schedule, such as those promoted by Dr William Sears (6%) and Dr Donald Miller (2%).”  It would appear that the advice of Dr. Sears et. al. is being mostly ignored by the alternative vaccinators.

Bad news: However, with true American do-it-yourself Dunning Kruger gumption,

it was more common for alternative vaccinators to indicate that they themselves (41%) or a friend (15%) had developed the schedule. Among the 36% of respondents who endorsed the “other” response to this query, several indicated in the free-text section that they had “worked with their child’s physician” to develop the alternative schedule.

A do-it-yourself vaccination schedule.  It flabbers my gaster.  Having spent most of my adult life thinking about infections and their treatment and prevention, I find the field almost impossibly difficult.  The decisions that go into the CDC vaccination schedule represent the best opinion of some the brightest and most experienced minds in medicine who are not me.  Joke.  Really.  I would only question the CDC if I had spent three professional lifetimes in the field of vaccinations.  And yet time with the googles and talking with friends and family is evidently enough to come up with your own approach to the vaccination schedule.  I am glad these parents are not also responsible for deciding on doing an appendectomy or piloting my airplane.  I have asked this in the past, but what is it about medicine where people think they can know better with no experience and little education?  It is my field of expertise and I am more often in not uncertain if I know better.

It would appear that physicians may be a bigger problem.  Co-dependent is the term, I think.

While 8% had to change providers because they wanted to use an alternative schedule and

30% their child’s doctor “seemed hesitant to go along” with their vaccination preferences but still agreed to do so, 40% indicated that their child’s doctor “seemed supportive” of their vaccination preferences, and 22% indicated that their child’s doctor had been the one to suggest using an alternative vaccination schedule.

Of 2064 respondents, 59 (22% of 13%) found a physician who recommended an alternative schedule.  We do not know if that was a bias (parents knew about that providers dirty little secret when choosing a doctor for their child) or the number of docs promoting potentially dangerous vaccination schedules is much higher than I would have thought.   Still, that is almost 3% of doctors who are, well, wackaloons.  3% is not an only. 3% is appalling. Would you want 3% of your surgeons to have a severe shake or 3% of your pilots to have narcolepsy?

It is interesting to see what vaccines the parents elected not to give to their kids or delay in giving.

It reminds me of the Eisenberg article in the NEJM http://www.ncbi.nlm.nih.gov/pubmed/8418405 where it was purported that 35% of Americans use alternative medicine.  When you look at the data, it is only by  using an extremely broad definition of unconventional including relaxation techniques and commercial weight loss  programs could the 1 in three statistic be reached.  Real wackaloon therapies like homeopathy and energy healing were in the 1% range.  I found that table of unconventional medicine use in that continually favorably spun article reassuring, not worrisome.  Americans are not as gullible as the SCAM proponents would wish.  I try and keep that in mind when I watch Presidential debates.  Repeat after me.  Americans are not THAT gullible.

Even though AOA, Jenny McCarthy  and others have worked hard to spread fear about vaccinations and have gladly taken credit for that fear, it appears that the message is not as effective as they might wish.

The list is, very arguably, reassuring.  As far as the disease severity is concerned, the list is roughly in order of morbidity and mortality risks for kids. If I had to rank vaccines in the order I would give them up if forced, that is about the order I would do it.  I would give up flu vaccination first and polio and pertussis last, although it is akin to deciding in what order I would like organs removed.  I really would just as soon keep them all, thank you very much.

However, a glass 6 to 86% empty, it is still not full.   Herd immunity and the group benefits are, I know, a poor reason to recommend vaccination.  Presidential politics reminds me that there is always a strong ’screw you’  sentiment in the US. I only saw it on the Daily Show, but I think Ron Paul being asked if he would let an uninsured patient trauma just die the archetype of that attitude. Being your brothers keeper is low on the US to do list, and if my child’s lack of vaccination leads to someone else illness and death, so be it.  There was  a time when the concept of a rising tide lifting all boats was a public health concept embraced by most, when we worked together for the common good.  A life in medicine has definitely demonstrated that that idea, if indeed it was once alive, is dead and buried with a stake in the heart, beheaded and covered in garlic, not that health care and public health is a vampire.

The attitude of ‘me first’ is oddly seen in health care workers, as I subscribe to the idea that in medicine you have an obligation to always put your patients first. Despite hospitalized patients being particularly susceptible to acquiring influenza, that about 1 in 5 cases of flu are subclinical and if acquired in the hospital, the patient has a 27% chance  of dying of flu, 36% or more of HCW’s refuse the flu vaccine each year.  It is not as if they have some special knowledge that prevents them from receiving the flu.  They give the same old dumb ass reasons every year.

Still, even small decreases in vaccination rates have disproportionate adverse consequences, as “1% increase in the proportion of school-aged children who were underimmunized, the risk of pertussis infection among fully vaccinated children doubled.”  I would wager that there are similar ill effects from avoiding other vaccines; it would seem plausible.  But how does a parent understand the abstract concept and act accordingly when there is no disease in their immediate environment?  Only Sherlock Holmes was wise enough to understand the significance of the dog that did not bark.  I had a similar problem with hand hygiene for years, the lack to understanding that not washing hands today leads to an infection tomorrow. It took a decade of intensive work as well as a change in how hands are hygienated  (from soap and water to alcohol foam) to take rates from 20% to 95%, although I suspect the real driving force was the knowledge that infection rates were going to be published for all to see.  Impending public embarrassment is a powerful motivator.

The main reason (61%) of  parents altered the vaccination schedule is ‘it seemed safer’.  It is better to feel safe than to be safe; the spirit of Fernando lives on.  These parents were also more likely to see the risk of disease and transmission to be less, and have more non-mainstream vaccination beliefs; it seems that the  ‘too many, too soon mantra’, of the anti-vax proponents is resonating with alternative vaccinators.  If there is a fear of autism as a reason for changing the schedule, it is not addressed in the paper.  However by delaying the vaccinations past the age of onset of autism diagnosis, parents may feel safer in giving their children the vaccines.   It would have also have been interesting to know what particular fears and experiences lead to the use of an alternative vaccination schedules.

Rare adverse experiences, even if not casual, can have a disproportionate influence on future behavior.  I know clinically I remember bad outcomes with far more clarity than the successes.  Even when I know the complication were unrelated to my therapeutic intervention or a known, and rare, complication of care (like deafness from aminoglycosides from treatment of enterococcal endocarditis), where I can at least rationalize that it was the occasional misfortune that happens as part of even the best of care, on occasion I still have to fight the urge not to repeat the past intervention for fear of a repeat of the same complication.  It is hard not to give in to the fear, even when I know the fear is irrational.

It could be a lot worse.  The glass could have been even emptier.

…nearly 1 of 4 parents (22%) following the recommended schedule disagreed or strongly disagreed that the schedule “recommended by vaccination experts” was the best one to follow. Similarly, 1 of 5 parents who followed the recommended vaccination schedule thought that delaying vaccine doses was safer than providing them according to the recommended schedule.

I find that a curiosity,  that a significant number of patients were choosing to do something to their kids that they did not think was best for them.  There is no reason given for that choice, but there appears to be a sizable number of patients are at risk to opt out of the vaccination schedule if given the opportunity.  Equally curious is the 19% of alternative vaccinators who think delaying vaccination increases the risk of infection and spread of diseases, yet delay all the same.  Do they think that the risk of the vaccine is greater than the diseases?  They must, although the sign of an educated person is the ability to hold two contradictory thoughts in the head at the same time.

The preponderance of information in the medical literature on vaccinations is as clear as any topic in medicine.  Vaccines are effective and they are safe.  The best bet for keeping your child, and your community, healthy is to get vaccinated and to do it on schedule.  There are people who see the issue differently, and is often the case, the reasons are more subtle and complicated that one would except.  And there is still much to be understood as to why people do and do not participate in the vaccination schedule.

Posted in: Vaccines

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33 thoughts on “Alternative Vaccination Schedules

  1. WilliamLawrenceUtridge says:

    1.6 km to the mile. An 8 mile hike is close to 13 km, an 8 km hike is 5 miles.

    Someone from a country who uses pounds, gallons and two kinds of ounces should not lecture the rest of the world (particularly those on the far more sensible metric system) :)

    Interesting wrinkle regarding measles vaccination from Quebec:

    http://www.cbc.ca/news/health/story/2011/10/20/measles-quebec-vaccine-schedule.html

  2. DugganSC says:

    I was on a consistent vaccine schedule, and plan on doing the same with my children, and I heartily endorse others to do so (I think there was only one vaccine that my mother ever refused and it was one of the Hepatitis ones. I was getting one of them because I was traveling to Russia but she refused the sexually transmitted one because I wasn’t at risk with my behavior. Which, incidentally, she was completely right about). While I do endorse vaccination, I have occasionally idly wondered if the nearly universal fear of needles children grow up with, and which adults often carry with them, is the result of how many vaccinations are muscle shots (butt shots, as I remember hazily) done at an early age, often by pediatricians who’re a little shaky on their needle technique. I remember getting the MMR vaccination and being amazed that the needle didn’t hurt when being inserted because my experience had always been that injections involved someone stabbing something square into you.

    Actually, I also never got the vaccination for meningitis. My graduate school required it, but only for students staying on campus. It was not required when I went to college, and I’ll admit that I’ve never felt the need to “catch up” there. *wry grin* Like you said, the stick of school requirements is very effective…

  3. Off-topic, but in agreement: I must be from the same era, since I have no idea how far a kilogram is, and have a hard time figuring out whether I could lift a weight that is 100 millimeters.

    The worst: I can only comprehend hail if it is expressed in either the citrus-fruit scale (hail the size of a grapefruit, orange, etc.), or the athletic ball scale (hail the size of baseballs, ping-pong balls, etc.).

  4. But seriously: vaccaintion compliance is worse for low SES / underserved populations / low health literacy. Using administrative data as a source to measure this problem, and to evaluate the outcomes of interventions, is a great strategy.

    However, this anti-vaccer movement greatly complicates the use of vaccination admin data to detect and address inequities in a fundamental cornerstone of healthcare.

  5. Thought/composition typo:

    “Chicken pox, hepatitis A and B, and pertussis are the only viral VPD’s of which I have seen more than one case.”

    You probably shroud re-word that and either remove either the word pertussis or the word viral.

  6. AlexisT says:

    To be fair, the CDC schedule is the best schedule on a population wide basis, taking everything into account. It’s possible that the best schedule for an individual child might be different. Of course, that doesn’t mean you can decide it for yourself based on a book.

    Example, and I’m deliberately going to use one anti-vaxers will hate: France, Germany, and the UK give the DTaP at 2, 3, and 4 months. I am told this gives you better coverage for pertussis earlier in life, when it’s most dangerous. The CDC gives it at 2, 4, and 6. I am told that this was due to concerns about compliance–it’s better with 2 monthly intervals. That’s a perfectly valid reason for a large group recommendation, but it doesn’t mean an individual might not be better served by the British schedule. For that matter, different national organizations make different recommendations; it shows there isn’t one perfect schedule, but several good ones based on how you prioritize different factors. US gives varicella vaccine, UK rejected it as not cost effective for the NHS.

    As for pediatricians: I had my second child a few weeks ago. When we took him to the ped for his first visit, we got the new parent welcome pack. (My older child had started at this practice when she was nearly 3, so we’d never had it before.) It included a form letter about vaccination, which can be summarized as: “We’re happy to discuss vaccines with you. If you then decide not to vaccinate according to the CDC schedule, you’re fired.” I’m told several practices in my area have done this. I think peds are getting fed up with the DIY schedules, not least because they call for a lot more visits and make more work for the office.

    (For the record: Older child immunized according to NHS schedule up to 18 months, caught up to US schedule within a year after that.)

  7. windriven says:

    “the Pneumovax, is of marginal efficacy.”

    Now you tell me.

  8. WilliamLawrenceUtridge says:

    Seriously, anyone using imperial measurements doesn’t get to complain about the metric system. 1000 mL to a litre, 1000 g to the kilogram. How many feet in a mile? How many ounces in a pound? UK ounces, US ounces, or Troy ounces? How many ounces in a cup? Now we just have to get the French working on diong something about the number of degrees in a circle. 360? That’s just stupid.

    Duggan, somewhere on SBM is a post about the best practices for pain-free injection. It was maybe a year ago, and it was very, very interesting, particularly if you are a parent with a kid getting vaccinations.

    The argument about sexual activity and vaccination (i.e. “my child isn’t having sex therefore doesn’t need X vaccine” where X is an STD) always bothers me. Rebecca Watson has a video on YouTube about the HPV but in general getting vaccinated against something that happens to be an STD despite low risk due to age or personal habits always struck me as a good idea. Prevention is prevention, you never know when you might catch something from a toilet seat.

  9. LovleAnjel says:

    @WLU

    The “my baby doesn’t have sex!” reason is so wrong on many levels. Biggest reason: Maybe they won’t have sex, but will they kiss? HPV can be transmitted orally, and oral infection increases the risk for mouth & throat cancer. This is also why all children should be vaccinated, not just girls.

  10. ConspicuousCarl says:

    I thought people in Oregon didn’t even pump their own gas, but now they want to be their own doctors? Maybe it’s some kind of displaced self-control issue.

  11. I suspect that vaccine refusal in affluent parents has a great deal to do with jockeying for social status among alpha moms.

    Also, my anecdotal experience makes me suspect that when these parents claim to have worked out alternative schedules with their “physicians,” they do not mean what you think they mean. A lot of altie moms use this and similarly misleading descriptors as code for “herbalist,” or what-have-you.

    Anecdotally again, I hear through the grapevine that pertussis is emerging in the unvaccinated community in Laramie, WY. When my son attended a crunchy preschool there a few years ago, I estimate that the rate of complete compliance with the CDC schedule was around 60% of kids in his school. It’s just way too easy to get a philosophical vaccine exemption for school in some states.

  12. ConspicuousCarl says:

    Anthropologist Underground on 21 Oct 2011 at 3:00 pm

    I suspect that vaccine refusal in affluent parents has a great deal to do with jockeying for social status among alpha moms.

    Also, my anecdotal experience makes me suspect that when these parents claim to have worked out alternative schedules with their “physicians,” they do not mean what you think they mean. A lot of altie moms use this and similarly misleading descriptors as code for “herbalist,” or what-have-you.

    I was thinking that the “worked with” phrase could also be the curve ball. They might have a real doctor, but the alternative schedule is what the doctor finally agreed to after they got tired of the parent’s nonsense.

    “The vaccine manufacturer is a friend of yours?”

    “The vaccine manufacturer is a friend of yours?”

    “The vaccine manufacturer is a friend of yours?”

    ….FINE, we’ll wait another 9 months.

  13. hepbmom says:

    @Duggan — I’m assuming you are referring to Hep B as the “sexually transmitted” hepatitis. Like HIV/AIDS, there are several ways to transmit the Hep B virus. Yes, it can be transmitted sexually, but it is also transmitted through blood exposure and most frequently virtically from the mother during birth.

    Many, many parents I know put off the Hep B vaccine because their children aren’t sexually active. They don’t think about the fact that their children could be exposed to it every day at daycare, school, or at my house from my child.

    Just two weeks ago, my son, who has chronic Hep B and who already has scarring on his liver at age 3, fell and banged his lip. I didn’t notice it was bleeding until he drank from his water bottle and saw blood on the nozzle. I wiped it with a tissue and thought I hid the bottle well away. As we were leaving the playgroup, I saw a two-year old girl drinking from the water bottle. I got the great pleasure of driving to their house after playgroup and informing them that their child had a possible blood exposure to Hep B. They told me she had never been vaccinated for anything. I strongly encouraged them to contact their doctor right away. They did, and they started the vax series.

    Luckily they have been very discrete (I think!) and promised to keep my disclosure confidential. We live in a very small town, and I’d prefer to keep my son’s medical information confidential until he is old enough to do with it as he wishes.

    I would love to scream from the rooftops that Hep B is not purely a sexually transmitted disease and that it is around and in your community. But I keep quiet for my son’s sake.

    Maybe you all can scream or me??

  14. Chris says:

    WLU:

    Seriously, anyone using imperial measurements doesn’t get to complain about the metric system. 1000 mL to a litre, 1000 g to the kilogram. How many feet in a mile? How many ounces in a pound? UK ounces, US ounces, or Troy ounces? How many ounces in a cup? Now we just have to get the French working on diong something about the number of degrees in a circle. 360? That’s just stupid.

    Since I spent a good chunk of my youth not in the USA, I grew up quite comfortable with metric units. I can switch back and forth quite easily. This is an advantage for any American engineer.

    I learned this when the company I worked for decided they needed help with an international construction contract, a UK oil well in the North Sea. So they lent a lead engineer who grew up in Germany and a newby engineer flunky (me) to do some structural dynamic calculations. Even with the very slow phone modem connection on a teletype terminal in the newly vacated office building we were sent there, we did quite well. Though we both laughed at the use of the term “kilogram-force” by the British company instead of Newtons.

    (we worked in a group that used slinches for mass, it is like “slugs”, only it is the force divided by gravity as about 386 inches/second-squared)

    I should note that as a person who has lived outside of the USA in my youth I was vaccinated for typhoid, typhus and yellow fever. I actually had dengue fever. And yet I know better than to use the idiotic crutch called a “gravity constant” because I to like keep all of my units consistent!

  15. William M. London says:

    57 million represents estimated total deaths from all causes worldwide in a year, not estimated total deaths worldwide from vaccine-preventable diseases.

  16. Jurjen S. says:

    In Dr. Crislip’s defense, he didn’t criticize the metric system; he said he cannot internalize what the measurements convey, and that’s largely a matter of cultural acclimatization. Speaking as a Dutch immigrant to the US, I’ve managed to adapt to measurements of distance and mass, but I simply cannot wrap my head around Fahrenheit, in the sense of “should I wear a coat? or can I get away with just a sweater, provided I’m not outside for too long?” By the same token, because I left the Netherlands in 2002, I never fully adapted to the euro, and I still tend to convert prices to guilders in order to gauge whether they’re high or low. And that creates a disconnect, because I’m not adjusting for the last nine years’ worth of inflation.

    The best way to adapt, to my mind, is not to try mental conversions of one system to the other; to get a feel for what the numbers mean, you have to refer to a physical experience. Don’t think “8 kilometers is ~5 miles,” think “8 kilometers is about an hour and a half’s walk on flat terrain.” Better yet, have a friend plot an 8-km walk and walk it together, letting the other person navigate; by the end of the walk, your body will know what walking 8 km feels like. For measurements of mass, 2-liter soda bottles can be found in every grocery store, and much like a U.S. pint is one avoirdupois pound of water (in which the U.S. pint and gallon differ from the Imperial), one liter of water weighs one kilogram; thus, a 2-liter bottle of soda is a close to a 2-kilo weight as makes no odds. So when you read a measurement of mass in metric, try mentally converting to soda bottles. Don’t think of 90 kilos as “just under 200 pounds”; think of it as 45 bottles of soda.

  17. lilady says:

    @ hepbmom: When I worked as a public health nurse, I was assigned to coordinate the Perinatal Hepatitis B Prevention Program, which was started in 1990. I retired 6 years ago and up to the time I retired there were more than 900 cases of children who were exposed at birth to hepatitis B due to their mother’s chronic hepatitis B carrier status.

    The program is very intensive with case management begun during the pregnant woman’s first trimester, home visits and telephone calls to the mother to provide education to her, to provide her partner and household members testing and referrals to a public health clinic for free hepatitis B immunizations for those who are uninfected. We coordinated with the delivery hospital and nursery staff faxed records of the infants’ immunization with the vaccine and HBIG within 12 hours of birth. Reminder notices were sent to the child’s parent and pediatrician to get these infants completely immunized at 6 months of age and to be tested for immunity against the virus.

    There were 3 cases (.003 %) of infants who became infected and more than 900 who were successfully immunized. These are the children who benefited by public health programs to prevent lifelong infections with this potentially deadly virus. If an infant does not receive prophylaxis at birth with vaccine and HBIG and complete the 3-dose series in a timely fashion the infection rate is up to 90% and 90% of infants infected at birth will not be able to clear the virus and will be chronic lifelong carriers of the virus.

    Children born in areas of the world with high endemicity and who are adopted may not have received proper prophylaxis at birth and do have a risk of chronic carrier status. Pediatricians who provide care for such children test them for the the presence of hepatitis b surface antigen and those children found to be chronically infected will have their liver function monitored and will be referred to a specialist for anti-viral treatment where warranted.

    Brava hepbmom, for educating your close circle of friends and “I am screaming” for you.

  18. DugganSC says:

    Honestly, her decision might have been as much financial as anything else. Our family was never terribly well off, and as I remember it, that vaccine would have cost few hundred dollars or so (there was a schedule of injections I’d have to take). Since I was at low risk for getting infected, it didn’t make sense. And, admittedly, I’m pretty sure the doctor was framing it in terms of sexual activity, so I don’t know that I can blame my mother for not realizing that there were other vectors than as a sexually transmitted disease. And is transmission by other means common enough to be a concern for anyone other than nurses and other people who frequently work around blood and needles?

    As regards the meningitis vaccine, I’ll admit that that is largely complacency on my side. Haven’t got it yet and there’s no requirement for me to get vaccinated, so I haven’t. And, as mentioned before, it’s of questionable efficacy on adults, at least from what I remember reading on this blog.

  19. simoncerrado says:

    Bit of a glaring error at the start there, since 57 million is the TOTAL amount of deaths every year, from every cause, and not the number of deaths from vaccine-preventable diseases.

    CIA Factbook:8.12 deaths/1,000 population

    Do the math.

    https://www.cia.gov/library/publications/the-world-factbook/geos/xx.html

    Go to “WORLD” and to “PEOPLE AND SOCIETY”, scroll down to “DEATH RATE”

    Just so’s you know. Get your shots anyway.

  20. Calli Arcale says:

    DugganSC — I can understand your mother’s reasoning. It does make sense, if one is unaware of the other avenues of Hep B infection.

    Is transmission by other means common enough to be a concern for anyone besides health workers? Depends on your personal acceptance of risk. I think it is, personally, but I tend to be risk-averse. If one is traveling to a country with less-than-stellar medical care, I’d be concerned about it. First, because the number of chronic carriers in the general community is much larger, increasing your odds of exposure. Secondly, because these countries may not have as good controls on their supply of blood and blood products for hospital use, and, if things are particularly bad, may even be reusing needles. Which means that in addition to avoiding sexual encounters, you should also avoid accidents that could result in major trauma. Obviously you’ll want to avoid accidents anyway, but if all accidents were avoidable, we wouldn’t need so many emergency rooms.

  21. wales says:

    “That estimated 57 million deaths from vaccine preventable illness? That’s a number I can’t wrap my head around.”

    There’s good reason for that, it’s wrong. the VPD portion is approximately 4 million, or around 7% of the total annual deaths from all causes of 57 million (clearly stated in the table in your link).

    Might want to correct the error so that those who don’t read the comments are not misled.

  22. Mark Crislip says:

    Not so clearly, I misread that table several times, even when I went back after the comments said I got it wrong. I read the all causes as a summation of the table, all causes equal to all vaccine causes.

    But I fixed it in the main body.
    Thanks

  23. lilady says:

    @ Duncan – The one hepatitis vaccine you didn’t get is hepatitis B which is a blood-borne virus. The other hepatitis vaccine you did get is hepatitis A which is a different virus spread via the fecal-oral route and causes food-borne illness in this country and in foreign countries as well.

    I believe you are mistaken when you said you received vaccines “in the butt”. None of the Recommended Childhood Vaccines are injected into “the butt”…they are injected subcutaneously (SQ) or intramuscular (IM), depending on which vaccine is being injected. Infants younger than 1 year receive SQ vaccines in the thigh and older children and adults receive SQ vaccines in the upper outer triceps area. Infants younger than 1 year receive IM vaccines in the anterolateral thigh muscle and older children and adults receive IM vaccines in the deltoid muscle. Many of the vaccines would have decreased efficacy if given “In the butt” and the risk to damaging the sciatic nerve, when drugs such as antibiotics are given in the buttock, are serious.

    SQ injections for infants and adults are given with a thin (23-25 gauge) 5/8 inch needle. IM injections are given with a larger needle usually 1 inch (22-25 gauge). Neonates and pre-term infants will only require a 5/8 inch needle for IM vaccines. The vaccine administrator evaluates the patient’s body mass for the length of the IM needle to make certain the vaccine is deposited into the muscle mass and only obese people would require a longer (1-1/2 inch needle).

    Vaccines given the IM route can be uncomfortable…the worst for me was the 3-dose series of the hepatitis B vaccine in my non-dominant left deltoid, which left me with a dull ache for several weeks following each shot.

    BTW, many health insurance plans do not provide coverage for medical bills incurred for services outside of the United States. Recently I had (ahem), reasons to check into Medicare Coverage for foreign travel and there is absolutely no coverage for any medical care outside of the United States. My “medicare gap” medical plan does provide coverage and all the costs of medical care outside of the USA when refused by Medicare, would be covered by that private medical insurance plan

  24. DugganSC And is transmission by other means common enough to be a concern for anyone other than nurses and other people who frequently work around blood and needles?

    Not sure how long ago you went to Russia, but our travel doctors recommended it when we went to China four years ago. like Calli Arcale said, rates are high in some countries and if you were in an accident or got ill and required medical care, then you might possibly be exposed. It was also recommended that we bring needles and require their use in the event we needed any injections.

    This is not to fault your mom, sounds like the doctor may not have covered these concerns.

    Our Hep B vaccines were covered by insurance, not sure if that’s also recent or just good insurance.

  25. LMAO says:

    micheleinmichiganon 25 Oct 2011 at 6:50 am
    [blockquote]Our Hep B vaccines were covered by insurance, not sure if that’s also recent or just good insurance.[/blockquote]

    The reality is, even those with good health coverage will typically pay out of pocket for immunizations, either due to deductibles or being a non-covered service in adults.

    So, for those who don’t have a third party to pay for their immunizations, you might want to seek out a county health department. My checking found the prices to be at least 50% less than the local pharmacy charges, and some were as much as 80% cheaper.

    My local health department charges only $33 per injection for hep B. Meningitis vaccination (i.e., Menactra) is more definitely costly at $107, but this is still very cheap compared to the cost of the illness. It’s also a [b]very[/b] low “premium” for high-quality, life-long “insurance” ;)

    I would add that hepatitis A vaccinations are deemed optional for the majority of USA populations. This is really unfortunate, however, as most of us do eat at restaurants where food preparation/handling “might” be (almost certainly IS) by persons who come from at-risk regions (e.g., Mexico). Also, if you or your child(ren) do/might travel to such high-risk regions (and if you plan to eat anything other than packaged food while you’re there), I would strongly encourage you to get this series. It’s a truly miserable illness and so worth a few extra bucks to avoid ever dealing with it (only $25 per injection at my local health dept). I don’t know the actual stats, but the majority of the cases I’ve encountered were found to have been contracted right here in the good ol’ US of A.

  26. lilady says:

    There are other ways of acquiring Hepatitis B…through tattooing and through body piercing, if sterilization technique are not followed. In my county, the local health department requires that tattoo artists undergo training in sterile techniques. When my daughter made me keep my promise to have her earlobes pierced at age 12, it was done by her pediatrician. The pediatrician also pierced my ears, when I turned 40 and when I made up my mind that I “deserved” some gold earrings that were not clip-ons.

    Michelleinmichigan…I am wondering if in fact the adults in your family who received hepatitis b vaccine were covered by your health insurance carrier? Most carriers only cover children for the Recommended Childhood Vaccines; hepatitis B vaccine is on that list. Insofar as coverage for adults for Hepatitis B vaccine, many private insurance companies will reimburse for that particular vaccine for specific “high risk” conditions such as adults who are on hemodialysis. Hepatitis A vaccine is only recommended for a limited group of kids such as Alaskan Indian and Native American children…hence the lack of reimbursement for that vaccine.

    LMAO-You provided some great information about the availability of very low cost vaccines for children and adolescents at public health clinics. Public health clinics are all VFC (Vaccines for Children) Providers. Some private pediatricians and Family Practice docs are also VFC providers…you can probably locate the VFC providers in your area by checking out the CDC VFC website…or by contacting your county health department.

    VFC provides all the Recommended Childhood Vaccines free of charge to all VFC providers (paid for by Federal tax dollars). Clinicians who are “plugged into” the VFC program are permitted to charge a nominal fee (set by regulations) for the cost of administering each vaccine.

    VFC is a terrific program and all kids birth to 19 years of age who are on Medicaid or whose parents don’t have health insurance for their children or whose private health insurance does not cover vaccines are eligible for these low cost vaccines.

    The CHIP Program (Childrens Health Insurance Plan) also funded with Federal tax dollars offers low cost health insurance for youngsters whose parents don’t meet income eligibility under Medicaid and provides great coverage at reasonable premium costs.

    It has been 6 years since I retired as public health nurse, but I know when I worked there, most cases and outbreaks of hepatitis A were acquired here in the USA. Our sanititarian/food inspectors did frequent scheduled intensive restaurant inspections and “surprise” inspections whenever we received certain complaints (2 or more people dining together who were later diagnosed with the virus). Each owner/manager of eating establishments underwent training provided by the health department before a license to operate was issued.

    Recently, we have seen a large influx of fresh fruit and veggies imported from foreign countries which have been implicated in food-borne illnesses. I always wash the rinds of melons with soap and water, before I cut into them, stay away from “buffet-type” restaurants to increase my chances of not acquiring a food-borne illness.

    You may think I am overly cautious…it comes with the territory when you have worked in public health.

  27. liladt “I am wondering if in fact the adults in your family who received hepatitis b vaccine were covered by your health insurance carrier? Most carriers only cover children for the Recommended Childhood Vaccines; hepatitis B vaccine is on that list.”

    Hmm, I thought is was paid for…but I am not 100% sure. We had a lot of expenses happening, I may be mis-remembering. My apologies

  28. oops, sorry that was a quote from LMAO, not lilady.

  29. lilady says:

    @ Michelleinmichigan: Hi, I think we both questioned you about the insurance coverage…no need to apologize.
    We should both stop posting during the wee hours of the morning…have a great day.

  30. I’m not sure if I’m any better mid-day then in the middle of the night. :)

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