Mumps in the Era of Vaccination

In case you missed it, there’s a mumps outbreak in the NHL that’s causing quite the stir.

HealthMap’s Disease Daily explains how these kinds of outbreaks can happen — even if most people are vaccinated.


This post originally appeared on HealthMap’s Disease Daily on May 8, 2014. It has been reposted here with permission from the authors.

Eastern Chipmunk with cheeks filled of food supply, Cap Tourmente National Wildlife Area, Quebec, Canada by Cephas

Eastern Chipmunk with cheeks filled of food supply, Cap Tourmente National Wildlife Area, Quebec, Canada by Cephas

By Jane Huston and Robyn Correll Carlyle

When we hear the word mumps, we picture a young boy wearing wool trousers and suspenders with comically swollen cheeks, left behind while his family takes the brand new Model T to town to see the latest Charlie Chaplin flick. Maybe we’re too imaginative but nonetheless, it sounds like a disease from the past.

So, imagine our surprise when we started hearing reports of a mumps outbreak at Ohio State University (OSU) in early January. What started as a few cases has now spread to more than 300 people throughout the state. And news of other mumps outbreaks have cropped up at Fordham University in New York and the University of Illinois.

The kicker? Most of those affected have been vaccinated.

How is this possible? If these people were vaccinated, how did they still get mumps? Wasn’t the vaccine effective?

The answer is complicated, and there are a few things you need to consider:

1. The majority of people getting sick with the mumps are vaccinated — but that’s because almost everyone is. The percent of small children in the United States with at least one dose of the MMR vaccine has been at or above 90 percent for nearly two decades now.

2. No vaccine is 100 percent effective. But then again, no surgical procedure or medication is either. Even Google goes down occasionally.

The mumps component of the MMR (measles, mumps, rubella) vaccine is between 75- 91 percent effective, and effectiveness is higher with two doses. As a result, up to 10-15 percent of those who get a mumps vaccine won’t actually develop sufficient antibodies to provide immunity, especially during an outbreak.

This can be for a few different reasons: First, the MMR is a live vaccine, which means that it needs to be kept alive to work. If a vaccine is not stored or handled properly, that vaccine can lose its potency and become less effective at helping your body produce antibodies. This is a particularly large challenge in developing countries, where the electricity and infrastructure needed to keep the vaccine at optimal temperatures is sometimes infrequently available. But power outages can happen in the United States, too, and if vaccines aren’t handled properly en route from the manufacturer to the provider’s office or pharmacy, there’s a chance they won’t be as effective.

Second, as much as we want to believe there can be a one-size-fits-all approach in medicine, human bodies aren’t all the same, and not all immune systems will react in the exact same way to vaccines. As a result, there are individuals who, for one reason or another, do not develop an immune response after vaccination, or who do develop some protection against a disease, but that protection is incomplete or temporary.

Fortunately, even if a vaccine fails in an individual, that person has something to fall back on: herd immunity. We’ve written about herd immunity before, and explained its role in protecting those who can’t get vaccinated for age or medical reasons. But herd immunity also protects those who are vaccinated and (unknowingly) do not generate the appropriate immune response.

3. Protection from a disease is not an all-or-nothing thing. Here’s an example: Say you are someone who got one dose of the vaccine and developed a weak, but present, immune response. Those antibodies will probably protect you if you come into contact with one infected individual in passing, but multiple infected individuals in close quarters? Probably not. Your immune system can handle a small amount of exposure to mumps, but not a full-on assault, which is what happens when you get those infected with the mumps in close proximity with a lot of other people — in a college dormitory, for example, or a crowded lecture hall.

4. Even with “breakthrough” cases, vaccination is still our best defense against the mumps. Before vaccination campaigns began in 1967, there were about 186,000 cases every year. In 2013, there were 438. Vaccination has resulted in a roughly 99 percent decrease in the number of mumps cases. So think of how much worse these outbreaks would be if vaccination rates weren’t already high.

Even if you do get the disease after getting vaccinated, chances are it will be a much milder illness. And while mumps might look like nothing more than a case of chipmunk cheeks, it can cause some pretty severe complications like pancreatitis or deafness. Prior to routine vaccination against mumps, 15 percent of cases suffered meningitis, two to five percent pancreatitis, and on rare occasions (about 1 in 20,000), patients could go deaf as a result of mumps infection.

Of the 309 cases of mumps in Ohio so far, there have been only three hospitalizations. If we applied pre-vaccination era hospitalization rates to the same number of cases, that number would be roughly five times higher.

So if anything, these mumps outbreaks demonstrate why vaccines are so important, and why everyone who can be immunized should be.

Unless, of course, you’re into chipmunk cheeks.


Jane manages the Vaccine Finder project at Health Map, the host site of the Disease Daily. Robyn is a contributing writer for the Disease Daily and works as a project manager for a non-profit focused on vaccine education. Both are fully up-to-date on their immunizations.

What We Didn’t Miss, Thanks to the Flu Vaccine

This post originally appeared on Voices for Vaccines. It has been re-posted here with permission from the author. 


In recognition of National Influenza Vaccination Week (NIVW) Voices for Vaccines is participating in a blog relay as part of a countdown to the first day of NIVW. Each day, a different Flu Vaccination Digital Ambassador will post about the importance of flu vaccination as it relates to their readers. You can follow the NIVW conversation on Twitter using hashtag #NIVW2014 and stay tuned as each Digital Ambassador shares who will be posting next. 

Countdown to NIVW blog relay schedule:

What We Didn’t Miss

Last season, influenza took the lives of 109 children. And 90% of those children had not received their flu vaccine.

Despite these statistics, many parents will not get their children vaccinated against the flu. In 2013-2014, less than 60% of children received their flu vaccines, an uptake rate only marginally better than the 42% of adults getting their vaccines.

I get it. Finding a flu vaccine can be a hassle, and if you have kids of different ages, you might have to schlep different kids to different places for different flu vaccines. And you have to go back every year to get them at a time of year when the school year is beginning and soccer practices, lawn work, and after school activities are all competing for your time and attention.

But I also get how terrible the flu is. It’s not just about the deaths. Influenza results in up to 200,000 people being hospitalized and can cost the US economy $87 billion each year. Even if your child is healthy and emerges at the other end of influenza infection unscathed, the flu is an awful illness.

Many people excuse themselves from their flu vaccines, claiming that they make them sick or that they don’t work. Of course, most people know that the mild malaise caused by a vaccine is nothing compared to full-blown illness and that the vaccines affords a 60% effectiveness against preventing influenza. When the vaccine does not prevent influenza, it helps reduce its severity.

45498_10151243273500698_922301626_nMy family’s experience with influenza in 2013 serves as a perfect object lesson for the importance of getting a flu vaccine. We are so grateful we all got our flu vaccines that year.

In January 2013, my husband, my 9 year old, my 4 year old, and I traveled to San Diego to attend a graduation ceremony for my stepson. The day after we arrived, we went to SeaWorld only to have our visit cut short when my 4 year old became warm and too tired to walk and announced that it hurt to breathe.

We rushed to urgent care, and my pre-schooler’s temperature continued to rise. He fell asleep in the waiting room and was coughing intermittently. He must have been achey and uncomfortable because he was moaning and restless. The urgent care doctor was alarmed when he saw him, and I guessed it was the flu because so many of his classmates had caught it in the weeks before we left for California. A lab test confirmed my hunch, and I felt grateful that SeaWorld had been almost empty and hoped that we hadn’t exposed anyone there.

We holed up in our hotel room, and by the next morning my husband had fallen ill as well. Every time my youngest child crawled into my arms only to sneeze on my face, I felt doomed. I figured it was only a matter of time before we were all sick, stuck in the hotel room, and unable to function.

But that never happened. My older child and I never got sick, and the illness was short-lived for both my husband and my pre-schooler. For half of us, the vaccine completely prevented influenza–even though we had very close, prolonged contact with the virus. For the other half of us, the vaccine seemed to mitigate the severity of the illness during a year when influenza seemed particularly virulent and claimed the lives of 171 children. By the time the graduation ceremony took place at the end of the week, we were all fever-free and well enough to attend.

Some would point to our story as a failure–we got our vaccines, and some of us still got sick! I think this interpretation is cynical. We gained so much by being vaccinated. We were spared the worst of what can be an intensely severe disease, we recovered quickly, and we were able to celebrate my stepson’s wonderful accomplishment with him.

So each year, we get our flu vaccines. We get them because influenza is a terrible illness, and any way of preventing it completely or making it less severe is worth the moment of pain (or unhappiness of sniffing) that we have to endure.

You will hear the statistics about children who lost their lives to influenza, but you won’t hear about children who are hospitalized because of the flu. You won’t hear about how miserable they are or how frightening it is to watch them battle the severest illness. You won’t hear about children like Colton, who admitted to the hospital at 15 weeks old with influenza. You won’t hear about the misery of illness or the fear of seeing your child very ill or the stress of being in the hospital, but this story is repeated far too many times every year. And you can help prevent it in your children.

I’m writing today because I don’t want your child to be a statistic or a story. I know you are busy and overwhelmed by parenting and pulled in a million different directions, but it is worth your time and energy to vaccinate your whole family against the flu.

Remember: CDC says an annual flu vaccination is the best protection against flu. Get your flu vaccine and encourage others to do the same by sharing your flu vaccine selfies on social media using the #VaxWithMe tag! Be sure to stop by the other NIVW relay participants’ blogs to learn about flu vaccination for everyone – tomorrow’s post will be hosted by Shot of Prevention.


Karen Ernst is the Parent-Leader of Voices for Vaccines. Neither she nor Voices for Vaccines received any compensation from any governmental agency for publishing this blog post or for participating in the Digital Ambassador program.

Voices for Vaccines is a parent-led nonprofit organization that helps parents advocate for on-time immunization in their communities. Join VFV at www.voicesforvaccines.org/join-us.

10 Reasons Why #GivingTuesday is the Best Day Ever

This post originally appeared on Salsa Labs’ Salsa Blog on November 25, 2014


Which day is better – #GivingTuesday or Black Friday? Well, here are 10 reasons why #GivingTuesday is so much better than Black Friday…

1. #GivingTuesday is much safer than Black Friday. You can avoid a trip to the hospital after getting trampled by people just trying to get into a store.

2. You don’t have to wake up at the crack of dawn. You can donate at any point during the day, whenever is most convenient for you.

3. You can participate from the comfort of your couch, in your PJs.

4. You can eat ice cream and watch Netflix while donating. That’s always a bonus.

5. You don’t have to break the bank to make a donation.

6. You can feel good about the money you gave, rather than regret the money you spent shopping.

… continue reading the full post here


Please support The Immunization Partnership this #GivingTuesday by going to our website: http://www.immunizeUSA.org or by clicking here.

The Best Advantage for a Healthy Life

Earlier this week, we posted this video from VaxNorthwest on our Facebook page. Not only is this family of five adorable, but they are offering a gift to the world by sharing their positive story of prevention. Most young mothers have never seen anyone affected by the diseases that vaccines protect our children against. We don’t see these diseases as often anymore because we vaccinate. What we do see is what happens when we don’t.  And that’s precisely why Brian, the father of the three kiddos in this video, is proud to vaccinate his kids. He wants to give his children every advantage that he can.

Stories are powerful, and peer-to-peer information sharing guides many of the decisions that parents make. We could share hard data with you for weeks straight about the benefit and safety of vaccines, but for many, stories matter just as much, if not more. Share your stories, and share them often. Proudly post a #flushotselfie on social media or mention to your friends that your teenager has finished all three doses of the HPV vaccine.  Tell your mom’s group how great it feels to have your baby on the recommended vaccine schedule. Be proud that you vaccinate, because you’re giving your baby the best advantage for a healthy life.  

Have you heard these “toxic” vaccine myths?

This post originally appeared on HealthMap’s Disease Daily on August 4, 2014. It has been reposted here with permission from the authors.


Douglas Muth

Image by Douglas Muth

By Robyn Correll Carlyle and Jane Huston 

Do you know you what makes a toxin a toxin? It’s not scary sounding names, news headlines, or anecdotes.

What makes a toxin a toxin is good old-fashioned biochemistry. The human body can be disrupted — or bolstered — by the same compound at different doses. Quantity and context count.

Even so, complicated chemical names have become synonymous with all things artificial, unnatural or unhealthy. But dihydrogen monoxide, after all, is just water (H2O).

When people claim that vaccines contain “toxins,” they are often referring to these three vaccine ingredients: mercury-containing thimerosal, aluminum and formaldehyde. But these ingredients are not as toxic as you might think. Here’s why.

Yes, there’s mercury in vaccines, but not the kind you’re thinking of.

Fun fact: there are actually multiple types of mercury compounds. One (methylmercury) is the kind found in tuna and has been shown to have devastating effects on the brain after it accumulates in the human body. A second (ethylmercury) is found in a preservative known as thimerosal, which has been used to protect vaccines from getting contaminated. The latter is processed more quickly by the body and requires much larger doses to cause harm.

The difference between methylmercury and ethylmercury is a lot like the difference between a shot of alcohol and a shot of antifreeze — one can make you blind drunk, the other will make you blind. Chemistry matters. To the human body, “methyl” and “ethyl” are very, very different.

Ethylmercury-containing thimerosal has a very long track record of safely and effectively preventing fungal or bacterial contamination of vaccines. The ingredient was removed preemptively from all routinely used childhood vaccines in 2001, but it needn’t have been. Studies have shown that thimerosal-containing vaccines are safe, with no ill effect beyond the standard pain or redness at the injection site.

There’s 10 times more aluminum in baby formula than in vaccines.

What’s ironic about occasional opposition to aluminum from the “green our vaccines” movement is that aluminium is the third most abundant element on the planet. It’s in food, water, air, herbs, pancake mixes, baby formula — even breast milk. It’s hard to imagine a more natural substance.

Exclusively breast-fed babies ingest over twice as much aluminum in the first six months of life as the sum of all routinely recommended vaccines combined. The science is conclusive: vaccines do not have any measurable effect on the amount of aluminum in the bloodstream of babies.

Aluminum salts have been used in vaccines since the late 1930s — that’s more than 70 years of accumulated safety data. We have a longer history of safety data on aluminum salts than we do on Tylenol™.

We use aluminum salts in vaccines because they help stimulate the immune system. They make vaccines more effective so that we can reduce not only the number of antigens, but also the number of doses you need to be protected. That means fewer shots.

Our bodies naturally produce formaldehyde.

You might think of formaldehyde as that smelly chemical that preserved the frog in your 10th grade biology class. But your body actually makes it.

Don’t believe me? Ask the U.S. Department of Health and Human Services’ Agency for Toxic Substances and Disease Registry: “Formaldehyde is naturally produced in very small amounts in our bodies as a part of our normal, everyday metabolism and causes us no harm.”

It’s an essential component in the synthesis of DNA and creation of proteins. In fact, a healthy baby already has 10 times more natural formaldehyde in their system than any one vaccine dose contains. Your body is making it right now.

It can be introduced into the body through the air we breathe or the food we eat. The reason we use formaldehyde in the vaccine development process is to deactivate or kill pathogens (the agents that cause disease). While extremely large quantities of formaldehyde can be hazardous, most of the formaldehyde used in the vaccine development process is removed well before the patient gets the vaccine. The trace amounts of formaldehyde that remain are quickly broken down by the body’s defenses.

The bottom line is that vaccines and all their ingredients have been well-tested and established to be very safe. Don’t let the myths around toxins or vaccine ingredients scare you.


Jane manages the Vaccine Finder project at Health Map, the host site of the Disease Daily. Robyn is a contributing writer for the Disease Daily and works as a project manager for a non-profit focused on vaccine education. Both are fully up-to-date on their immunizations.

The Best Awful Thing I’ve Ever Done for My Baby

Hannah and Mia

Hannah and Mia

By Hannah Richards

This happens to almost every new parent. I know it does. Because the nice nurse at the front desk of Intermed Pediatrics told me so when I came running out of the exam room with tears and mascara all over my face and breastmilk squirting through the front of my shirt.

Your child goes to the doctor’s office for their first set of vaccines, and the smiling nurse assistant comes waltzing in with fun BandAids and a teddy bear toy, and they stick 3 or 4 needles into your baby’s itty bitty thighs and….nothing happens.

It’s kind of like time stops….and the room becomes completely silent.

And then…it happens.

Screaming unlike any screaming you’ve ever heard. A scream that could not possibly be coming from lungs that small. And the nurses start blowing gently in your baby’s face to remind them to breathe in. And you realize that this could quite possibly be the first time your little bundle of joy has ever felt pain. And by the time you can curb all of your sobbing and pull the daggers of guilt out of your heart – you realize that your adorable baby is sleeping peacefully in your arms.

Getting vaccines is not fun. For anyone. Mostly for mom. But I’ll tell you what is much, much worse.

Measles.

And Hepatitis – and Meningitis and Polio and Pertussis and a bunch of other diseases that most babies in the United States will never have to experience thanks to vaccines. As long as we keep up with them, that is.

Now this is coming from someone who won’t even take Asprin for a headache because I am generally distrustful of drugs. I grew up on homeopathic remedies and breastmilk. BUT, I always had all of my vaccines. And my daughter will too. Because kids still die from diseases that have no business even existing anymore. And like most parents, I would literally give my life to protect her. Vaccines just happen to be way easier.

Since I’m not a doctor, scientist or immunologist, I’m not going to elaborate any further about the safety of vaccines or how incredibly important they are. But if you’re interested, there is some excellent research here and here.

Instead I will offer all of the new moms (and dads) out there some tips we’ve picked up along the way for making those ouchy little life-saving shots more tolerable for everyone. Here we go:

1. If you are breastfeeding, ask the nurse if you can breastfeed your child while they give them their shots. Breastfeeding is seriously a miracle cure for all things (skin rashes, eye infections, chapped nipples, etc.) – and shots are no exception. As soon as I learned this little tip, Mia’s crying time during shots went from 3-5 minutes to nothing at all.

2. If you are not breastfeeding, ask to hold your baby in your lap during the shots, and offer a bottle or pacifier. Again, I am not a doctor, but my personal experience would indicate that the sucking motion is an extremely soothing exercise for babies – and when they are sucking, they are not screaming.

3. Ask Dad to come with you. I don’t know why this is true, but when my daughter Mia was an infant her daddy always had the magic touch for calming her down. I think it was because he was able to keep his cool, whereas I was bubbling over with anxiety and fear – and Mia could feel it. Also, since I was breastfeeding, anytime she was in my arms, but not currently nursing, she got very, very angry.

4. Go easy the rest of the day. Mia was always a little bit sleepy (hallelujah!) on the days she got her vaccines. So I let her spend a

Mia

Mia

little bit more time in her swing or in my arms, just rocking or nursing. The nap schedule and feeding schedule went out the window on vaccine days, and I limited visitors. I chose not to give her Tylenol (even when she had a slight fever) because our doctor told us the fever was a good sign of her body developing antibodies, and that we should let it do its thing. However, if your baby is really uncomfortable you should do what feels right, or as your doctor advises.

5. Know your baby. All babies are different, and they all react slightly differently to vaccines. Some barely notice or care, others get uncomfortable, or sore – or a fever. Don’t try to compare your baby’s reaction to someone else’s – or worse – Dr. Google. Instead, trust your instinct and your knowledge of your own baby, and keep in touch with your baby’s doctor if you have questions.

The bottom line is that vaccines are hard. They can be painful for baby, and even more so for parents – and they can make the already difficult job of caring for a newborn even more tenuous. But they are the best awful thing you will ever have to do for your baby – and for everyone else’s babies. Especially those too small, or too weak or too immunocompromised to receive vaccines themselves.

I am incredibly fortunate to have the opportunity to receive such advanced and lifesaving healthcare for myself and my baby. I do not, and will not ever take that for granted.

For more great posts by Hannah, check out her blog Oh Baby Richards.

 

You might owe your life to Maurice Hilleman. So why don’t you know who he is?

by Eric Ward, October 2007

by Eric Ward, October 2007

This article originally appeared on HealthMap’s Disease Daily on June 10, 2014. It has been reposted here with permission by the authors. 

By Robyn Correll Carlyle and Jane Huston

 

“If I had to name a person who has done more for the benefit of human health, with less recognition than anyone else, it would be Maurice Hilleman. Maurice should be recognized as the most successful vaccinologist in history.”- Robert Gallo, co-discoverer of HIV

When you think of famous names in immunization (assuming you’re a vaccinerd, and prone to thinking of such things), you probably think first of Edward Jenner, creator of the smallpox vaccine. The next name might be Jonas Salk, the celebrated scientist who developed the first polio vaccine. You might have to think for quite a while before Maurice Hilleman comes to mind… or you might be thinking Maurice Hille-who?

Yet Hilleman is a veritable superstar in the world of vaccines, with more vaccines to his name than Beyoncé has #1 hits. While Hilleman never won a Nobel Prize or had his name in lights, he was revered by his peers in the scientific community and is credited for saving tens of millions of lives — maybe even yours.

And it all started on a farm in Montana.

Hilleman was born in 1919. Having lost his mother days after his birth, he was raised by his uncle and worked on the farm. He took an early interest in science and graduated first in his class at Montana State University with a degree in chemistry and microbiology. Later, he earned his doctoral degree in microbiology from the University of Chicago, where (fun fact) his graduate work led him to determine the true cause of chlamydia and laid the groundwork for discovering its treatment.

He helped develop his first human vaccine in 1944 to protect American soldiers overseas from Japanese encephalitis. The vaccine would eventually be replaced by others, but Hilleman was just getting started with what would be a long career in vaccinology.

We won’t tell you his full story — you can get the cliff notes here or a more detailed account in his biography. But trust us, it’s impressive.

He developed eight of the 14 currently routinely recommended vaccines and is the reason we are protected from measles, mumps, hepatitis A, hepatitis B, chickenpox, meningococcal disease, pneumococcal disease, and Haemophilus influenzae type B (Hib). Thanks to him, diseases that once claimed children’s lives or left them with severe disabilities are now largely a distant memory. During his career, Hilleman developed a total of 36 vaccines, making him perhaps the most successful vaccinologist in history.

So why haven’t you heard of him?

Hilleman was not one to brag. He didn’t name any of his discoveries after himself. He never sought recognition. He accepted praise humbly and quietly.

But perhaps the greatest reason why his name is largely unknown is because the successes that he achieved were silent. When public health practitioners do their job, the results look like… nothing. No one gets sick. Diseases don’t spread. Children don’t die. Life pretty much goes on as normal. But behind the scenes, there’s actually lot of work that goes into preventing kids from getting measles, or containing an outbreak of hepatitis A, or delivering clean drinking water to your home. All of those things are public health, and all of them are easy to take for granted.

And we have taken them for granted.

Right now, we’re in the midst of a cascade of vaccine-preventable disease outbreaks. Measles, a disease once declared officially eliminated from the United States, is popping up left and right. According to the CDC, there have been over 334 cases this year in the United States alone, the most in a single year since the disease was declared eliminated in 2000 — and we’re not even half way through the year yet. Ninety percent of those cases occurred in unvaccinated people or people with unknown vaccination status. Measles may not be circulating in the United States the same way it was pre-2000, but we’re still vulnerable to travelers importing the virus from other countries, as what’s happened so far in 2014 clearly shows.

That vulnerability is why it’s so important to keep our vaccination rates high, and to bring up coverage in any corners of this country where rates are low. Encourage your friends and family to check to see if they’re up-to-date on their vaccinations. If some of them have concerns, guide them to trusted, science-based resources like the CDC, World Health Organization or the American Academy of Pediatrics, and encourage them to speak with their primary care provider.

Every time you think, speak or advocate for measles immunization, you’re shining a little light on Maurice Hilleman and his amazing career. And while he may not have received as much recognition as he deserved while he was alive, we can still honor him and his accomplishments by protecting the hard-fought progress made in the fight against preventable disease.


Jane manages the Vaccine Finder project at Health Map, the host site of the Disease Daily. Robyn is a contributing writer for the Disease Daily and works as a project manager for The Immunization Partnership. Both are fully up-to-date on their immunizations.

What public health threats are scarier than ebola?

You might have heard a lot on the news lately about the ebola outbreak in West Africa. There have been roughly 7,500 cases and 3,500 deaths so far this year, with no sign of slow down. And now with a case in Texas, many people are concerned about this potential public health threat.

But not to worry. Dr. Thomas Frieden of the Centers for Disease Control and Prevention (CDC) told “This Week” anchor George Stephanopoulos he was confident that the single case in North Texas would not ignite an outbreak like that raging in West Africa.

“Here in the U.S., I remain quite confident we will not have a widespread outbreak,” he said. “We will stop it in its tracks, because we’ve got infection control in hospitals and public health that tracks and isolates people if they get symptoms.”

We can all breathe a little easier knowing that.

So if we don’t need to worry about ebola, what should we be worrying about?

The Immunization Partnership‘s President and CEO Anna C. Dragsbaek outlined 5 public health threats in Texas that are scarier than ebola in an op ed published in Texas Tribune’s Trib Talk on October 1, 2014:

5 public health threats in Texas scarier than Ebola

By , Oct. 1, 2014

hospitalroombeds

There’s no doubt about it: Ebola is scary.

The disease has a high mortality rate and no known cure. No vaccine is available to halt its spread. And now it has arrived in Dallas — the first confirmed case in the U.S.

A media firestorm is brewing, and the public is understandably concerned. But the threat of Ebola spreading in the U.S. is nominal. Highly advanced disease surveillance systems, well-developed quarantine and isolation laws, adequate hygiene and sanitation, and top-notch medical services will keep the U.S. from facing a crisis similar to the one sweeping through West Africa.

But that doesn’t mean we shouldn’t be worried about infectious diseases. In fact, there are at least five other preventable threats right now that are far more menacing — and Texans would be wise to pay close attention to them.

1. Influenza: Last year, widespread influenza in Texas led to the deaths of 20 children, most of whom were unvaccinated. The flu vaccine is widely available through clinics, workplaces, churches, commercial pharmacies and schools, but influenza vaccination rates among adults in Texas remain low. In Texas, only one in three young adults (who are most likely to have small children in the home and to transmit the virus to them) were immunized against influenza last season. Children died not from a rare infectious disease but from a vaccine-preventable disease that we didn’t protect them from.

2. Pertussis: In 2013, Texas reported 3,985 cases of pertussis, or whooping cough — more than any other state in the U.S. This disease is particularly dangerous for infants, which is why the vaccine is recommended for pregnant women and caregivers. Yet only about one in four adults who live with infants have been immunized against it.

3. Neglected tropical diseases: Chagas, Chikungunya, dengue and other so-called neglected tropical diseases, or NTDs, are all circulating in Texas. Several of these diseases cause long-term disabilities and even heart defects. Yet despite the potentially devastating impact of NTDs, doctors don’t always diagnose them properly, and many cases go unreported due to inadequate surveillance and a lack of funding for vaccine development. To determine the true burden of disease, the Texas Legislature should appropriate funds to expand the capacities of existing clinics to detect a host of NTD threats.

4. Measles: So far this year, 595 cases of measles have been reported nationally — as many as the previous five years combined and the highest number in 20 years. Texas has seen its share of cases, with outbreaks in Tarrant County and a few cases in Houston. Unlike Ebola, measles is an airborne disease and is highly contagious. Simply being in the same room with someone who has measles can — and almost always does — cause an unvaccinated person to be infected. A highly effective vaccine nearly eradicated the disease, but it has recently made a comeback due to the surge in children who are not fully immunized, which leads me to the fifth threat:

5. Vaccine refusal: Texas allows parents to opt out of vaccines for their children based on personal beliefs. This means that your child could be in a school with unvaccinated children, who would present a significant risk of spreading diseases like measles, chicken pox, meningitis or some other vaccine-preventable disease if there were an outbreak. In 2011-12, nearly 30,000 children in Texas schools were unvaccinated, most of them for non-medical reasons likely due to fears about vaccine safety that have been thoroughly refuted by the medical community. But due to regulations about how data are collected and stored, Texas parents don’t have access to any information about the immunization rates in their children’s schools. The parents of a child with an immune-suppressing illness have rights, too. The virus of vaccine refusal is based on pseudoscience, but it’s spreading every day in Texas, and we’re poised for a preventable tragedy.

Having spent six years living and working in Sierra Leone in a rural missionary hospital and later as a relief worker during the civil war, I’ve been watching the spread of Ebola in my former home with a heavy heart and a deep understanding of the overwhelming challenges facing the country. Given Sierra Leone’s brutally hot climate and lack of resources and public health infrastructure, it’s no surprise that the epidemic has quickly escalated to a public health emergency and humanitarian crisis.

But we can and will avert widespread outbreak in the U.S. The real threat is complacency and a disregard for the scientific evidence of vaccine safety. Texas must increase funding to fight vaccine-preventable disease, reform our laws to prioritize public health and respond to constant threats that jeopardize the health of our community.

Is everyone skipping vaccines?

We're immunized! Are you? by Pixabay

We’re immunized! Are you? by Pixabay

This post originally appeared on the Disease Daily on Aug 25, 2014. It has been republished here with permission from the authors. 

By Jane Huston and Robyn Correll Carlyle

August is National Immunization Awareness Month. To celebrate, we are going to tackle a myth about vaccination every Monday throughout the month. View previous posts here, here, and here.

In our last myth-busting post of the month, we’re taking on the impression you might get from reading blogs or news online about vaccines: that droves of parents are deciding not to vaccinate their kids anymore. We know that with all the anti-vaccine chatter on social media or in the news, it often feels like everyone and their next-door neighbor is delaying, cherry-picking, or downright refusing vaccines.

But vaccination is very much still the social norm. In 2012, among US children ages 19-35 months, 92.8 percent were fully vaccinated against poliovirus. Ninety-four percent were vaccinated against diphtheria, tetanus, and pertussis (three diseases prevented with the DTaP shot). Overall, 80 percent completed three important childhood series: DTaP, polio, and MMR.

If the majority of kids ARE getting vaccinated, why do we seem to only hear about those who aren’t? It’s a case of a silent majority versus a very vocal minority.

The fact is that nationally, vaccination coverage is relatively high — but not high enough. We need exceptionally high immunization coverage against exceptionally infectious diseases, like measles. And worst of all, national averages can hide some local variances that create dangerous powder kegs for infectious disease outbreaks.

For example, in California in the 2007-2008 school year, 92.1% of kindergarteners were fully immunized — not bad, right? Well, unfortunately it’s not that simple. Someplace like Glenn County reported 98.5% immunization rates — you go, Glenn Co! But… on the other hand, Nevada County reported that just 75.5% of its kindergarteners were fully immunized. That’s not high enough to ensure herd immunity against many diseases, like measles or whooping cough. One infectious traveler entering that under-protected community could be the spark to start an outbreak.

One potentially overlooked factor is why those kids are not fully immunized. And here the story gets a little more nuanced. There’s a big difference in being unvaccinated and undervaccinated. Unvaccinated children haven’t received a single vaccine; undervaccinated children have received one, some or even most of the vaccine schedule but are still missing some important shots. And it turns out these two groups are pretty different.

Researchers looked at a random sample of over 20,000 children, from 1995-2001 to learn a little more about those two groups of children. What they found was that only 0.3 percent were completely unvaccinated (here’s that vocal minority– these parents were more likely to report concerns around vaccine safety). It’s actually an incredibly small amount of people who are refusing all vaccines (good news!).

But… over 35 percent of children were undervaccinated to some degree. These children were statistically more likely to be racial or ethnic minorities, have a mother with low educational attainment, and live in poverty. These likely aren’t kids whose parents are refusing to let them get vaccinated, but they might be having trouble seeing a provider regularly or paying for vaccines. They’re falling through the cracks of the health system. This group is arguably the most important group for public health officials to focus on for outreach and more services.

Those who choose to delay or skip vaccines by choice — because of safety concerns or worries about the schedule — are still only a tiny portion of our population.

Almost everyone IS vaccinating. But to keep it that way, the silent majority needs to get louder about their support for vaccination.


Jane manages the Vaccine Finder project at Health Map, the host site of the Disease Daily. Robyn is a contributing writer for the Disease Daily and works as a project manager for a non-profit focused on vaccine education. Both are fully up-to-date on their immunizations.

Flu shots are for everyone – not just you.

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by Daniel X. O’Neil

This article originally appeared on the Disease Daily on December 2, 2013. 

By Jane Huston and Robyn Correll Carlyle

Two out of five.

When public health officials make their rounds to encourage everyone six months of age and older to get the flu vaccine this year, two out of every five of you won’t.

Maybe you’re too busy. Maybe you don’t think it’s that important. Maybe you think that the flu vaccine would give you the flu (which it can’t).

“I’m young and healthy,” you might say. “I never get sick. And even if I do, it won’t be that big of a deal.”

But here’s the thing: It’s not just about you.

If you have influenza, you can pass the virus on to other people, sometimes without even realizing you’re sick. The communicable period (the time during which an infectious agent may be transferred from an infected person to a susceptible person) for influenza is between five and seven days, but can start one full day before you feel any symptoms. Some people infected with the virus never develop any symptoms, but are still contagious. That means you are able to infect others with influenza without feeling sick yourself. It seems incredibly unfair, but hey, all’s fair in love, war… and infectious disease.

It can be normal, everyday interactions that you wouldn’t think twice about. You touch doorknobs after discreetly wiping your nose. You squeeze onto mass transit and give out a little cough. You stand next to people in line at the grocery store and chat with them in close proximity. All of which are prime opportunities for influenza to jump from one person to another.

When you leave yourself open to the flu, you also leave yourself open to spread that flu to other people. And what might not be “that big of a deal” to you, can be a very big deal to someone you care about.

Every year between five and 20 percent of Americans will be affected by influenza, and at least 200,000 people are hospitalized annually because of it.

“Hang on now,” you might say. “Can’t we just vaccinate the people most likely to die or be hospitalized from the flu?”

Here’s the thing. Not everyone can be immunized against the flu. Babies under the age of 6 months and those who are seriously ill, for example, are not able to get the vaccine. And even older adults (the population most likely to die or be hospitalized due to flu) might not develop a strong enough immune response even after they’ve been vaccinated.

That’s where you come in. Something as simple as getting your flu vaccine helps to avert an average of 2 million cases of the flu and 18,000 flu-related hospitalizations every year. Because you can’t spread the flu if you never get infected.

But if we can’t appeal to your sense of civic duty, how about your pocketbook? Every year, the flu results in an estimated 31.4 million doctors visits and direct medical costs averaging $10.4 billion annually. Because people are too sick to go to work — or in some cases lose their life to the flu — we forfeit an average of $16.3 billion every year in projected lost earnings.

If you get infected with the flu and pass the virus onto another unsuspecting soul, that could mean days of lost pay — or longer if they have a family that becomes infected as well. After all, each infected person is likely to infect an average of 1.3 more people.

So for two out of five of you, this is our plea. Please don’t be that guy. Don’t be the one who could have received the flu vaccine but didn’t and now everyone in your office/kid’s school or daycare/grandmother’s assisted living facility has come down with it, too. You’re better than that. Besides, no one likes the sick guy.

Get your flu vaccine.


Jane manages the Vaccine Finder project at Health Map, the host site of the Disease Daily. Robyn is contributing writer for the Disease Daily and works as a health educator for a non-profit focused on vaccine education. Both are fully up-to-date on their immunizations.