Why I care about neglected tropical diseases in Texas – and so should you.

CDC Global

CDC Global

By Jennifer R. Herricks, Ph.D.

Did you know that a group of infections known as neglected tropical diseases, or NTDs, afflict the people of Texas, even in big cities like Houston? Neither did I, until I began my postdoctoral work studying disease and poverty. I learned that these diseases affect people’s ability to work, learn and be productive, and that this burden falls disproportionately on the poorest Texans who have the least resources to deal with the repercussions.

This motivates me to do what I can to help our neighbors that suffer from these significant, yet understudied, conditions. One way we can all help is by talking with policymakers because they have the ability to make potentially lasting change. This April I had the perfect opportunity to share what I know about NTDs with Texas lawmakers. I describe that experience below, and I hope it inspires others to get involved with the political process when important issues are at stake.

During Texas’ current legislative session, Rep. Sarah Davis introduced House Bill 2055 regarding the establishment of a sentinel surveillance program for emerging and neglected tropical disease.  On April 21 the Texas House Committee on Public Health contemplated the bill, and I was there with Anna Dragsbaek, president and CEO of The Immunization Partnership, to provide testimony. Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, provided written testimony.

Like most people, when the committee heard the term “neglected tropical diseases,” they thought about rare diseases that exist only in exotic locations. However, these diseases are not rare — affecting 1.4 billion people globally — and despite the word “tropical,” they can occur anywhere — especially in areas of extreme poverty — including the United States. And while diseases like chikungunya, dengue fever, Chagas disease and cysticercosis may sound exotic, they are very close to home. The combination of a mild climate, the presence of insect vectors and animal reservoirs, and high rates of poverty make Texas and the surrounding states a “hot zone” for NTDs.

In 2011 the National School of Tropical Medicine at Baylor College of Medicine established a Tropical Medicine Clinic at Ben Taub Hospital in the Texas Medical Center. Each week physicians at this Houston clinic see patients with one or more NTDs.

The question naturally arises, as it did in the public health hearing: How many Texans suffer from NTDs? The most recent estimate is that 12 million Americans live with at least one NTD. But, as we testified, a precise burden of NTDs in the U.S., and in the state of Texas it is difficult to attain for several reasons. Perhaps the most important is a lack of awareness about NTDs, even among the medical community. Due to this lack of awareness, many patients are undiagnosed or misdiagnosed and cases often go unreported.

Many of these diseases are chronic and debilitating. Neurocysticercosis can cause epilepsy; toxoplasmosis and toxocariasis can cause blindness and developmental defects in children; Chagas disease can cause fatal cardiomyopathy; trichomoniasis is associated with infertility and poor birth outcomes. Recent work has also linked NTDs to other conditions, such as asthma, mental illness and an increased susceptibility to HIV infection.

In addition, there are financial costs associated with NTDs. The economic burden of Chagas disease in the U.S. is projected to be almost $1 billion, and neurocysticercosis is estimated to cost $17 million in the state of California alone.

The good news is that these terrible consequences can be avoided if the right public health interventions are put in place. To do this efficiently and effectively, we need to have more accurate data about the true burden of these diseases in our communities. HB 2055 would enable the state of Texas to determine better disease estimates to meet this goal. Implementation would be simple, as this program can be rolled into existing disease surveillance mechanisms without additional costs.

These arguments were laid out before the Texas House Public Health Committee without opposition, and the bill recently passed the House, but there is still a long way to go. It must pass in the Senate before it can be sent to the governor. All of this must happen before the end of the Texas legislative session on June 1, or we have to start our efforts again during the next session in 2017. Knowing that the legislature is very busy, it is important to keep them engaged on this issue so that it is not simply put to the side.

Hearing from constituents can motivate elected officials to take action. For my part I am doing everything I can to let the Texas legislature know that HB 2055 is important to me and why it should be important to them and to all Texans. While it may not always be possible for me to go to Austin to tell them in person, I know I can reach them by phone, mail, e-mail, even twitter! I hope other Texans will also see the imperative need for HB 2055 and take action by talking to their elected officials. Together we can create the political will to tackle NTDs and other important issues in our towns, our state and our country.


Jennifer R. Herricks, Ph.D., is a postdoctoral fellow in disease and poverty at the National School of Tropical Medicine at Baylor College of Medicine and Rice University’s Baker Institute for Public Policy.

MMR, the CDC and Brian Hooker: A Guide for Parents and the Media

This post originally appeared on Harpocrates Speaks on September 8, 2014 and has been reposted here with permission from the author.  

MMR, the CDC and Brian Hooker: A Guide for Parents and the Media

The anti-vaccine community has been in a tizzy lately over a supposed “CDC whistleblower”, Dr. William W. Thompson, who, according to them, revealed fraud at the United States Centers for Disease Control and Prevention (CDC). To bolster their claim, they point to a new study from one of their own, Brian S. Hooker, that purports to show evidence of an increased risk of autism among African American boys who receive their first MMR vaccine late. However, the claims appear to be hollow and unfounded, and so they have chosen to rely on emotional arguments that may sound convincing to those who are not familiar with the issues and people involved. In a truly egregious fashion, they have erroneously and cynically compared this whole thing to the Tuskegee syphilis study, and equated the CDC with Adolf Hitler, Josef Stalin and Pol Pot, combined.

With that in mind, here is a brief FAQ for parents, news media and others to help them understand what the claims are and what the evidence actually says. The questions below have been raised or implied by anti-vaccine activists. Hopefully, this will prevent inaccurate reporting and help parents feel reassured about the MMR vaccine.

Did the CDC commit fraud?

A small group of vocal activists claim that the CDC committed fraud by intentionally covering up data. This group, which blames vaccines for a wide range of problems, offers no evidence in support of this claim. The closest they come is pointing to a statement released by a CDC researcher, William W. Thompson, in which he mentions a scientific disagreement over what data to publish in a 2004 paper on which he was an author (“Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan Atlanta“). The study examined the age of first MMR vaccination and autism but found no association. While one could read into Thompson’s statement an implication of wrongdoing, he does not allege any fraud either on his part nor on the part of the rest of the team associated with the 2004 paper. Even though his statement makes no mention of fraud, some people who wish to scare people about vaccines and make others distrust the CDC point to his statement as evidence of fraud.

Did the CDC hide data from the public?

No. The data set used by the CDC in the 2004 paper has always been available to qualified researchers.Instructions on how to access these data are available on the CDC web site.

Did the CDC cover up a finding that the MMR vaccine is linked to autism?

From the facts that are known at this time, the CDC does not appear to have covered up anything. In 2004, the CDC conducted a study examined children with autism (cases) and those who don’t have autism (controls), then looked at the age of MMR vaccination to see if cases were more likely to have been immunized at a certain age than controls. While no clear association was discovered, they did notice that there was an odd finding that more cases than controls were vaccinated later than 24 months of age but before 36 months of age. To see if this apparent association was real, they gathered more information from state birth certificate records for all study subjects that had a Georgia birth certificate. This additional information allowed them to see if there might have been some other factor (e.g., birth weight, parents’ age, mother’s education level, etc.) that might have been responsible for the strange finding. Once the researchers controlled for these additional factors, the anomaly disappeared, meaning that there was no connection between MMR vaccination and autism. The published paper included the results of the birth certificate analysis by race and age at first MMR vaccination, but did not include a racial comparison from the larger group for age at first vaccination, because racial information was not available for all subjects, and that strange finding from the larger group was not reliable. Furthermore, as the subgroup analysis showed, that initial finding was wrong. In response to the noise from the anti-vaccine movement, the CDC released a statement in support of their original study.

Did CDC lie when they said they got more information from birth certificate records?

No. Many anti-vaccine activists, including Brian Hooker, have stated that the birth certificates do not contain the information the CDC researchers stated they obtained from them (birth weight, mother’s education, etc.). While the birth certificates that parents receive have limited information, a more complete worksheet (PDF) is completed by the hospital staff and kept on file with the state. The information on the Georgia state birth worksheet is similar to the U.S. Standard Certificate of Live Birth (PDF). These complete birth records have information on birth weight, whether the birth was premature or at term, if the baby was a twin/triplet/etc., the mother’s education level, and so on. [Edited to add (9/16/14): Parents’ education, for example, has been on the standard birth certificate since 1969 and still on it for the 1989 revised version.] The CDC researchers used these complete birth certificate records in their 2004 study. More information on the standard birth worksheet, including revisions, can be found on the CDC’sNational Vital Statistics System web site.

Did CDC use the birth certificate requirement to exclude African Americans from the study?

No. An early claim among anti-vaccine activists was that the CDC researchers only required birth certificates for African American children in their study so they could exclude them from the birth certificate subgroup analysis. This, so the claim goes, was so they could hide an association between MMR vaccine and autism among African American boys. But the researchers used birth certificates for all of the children in their study. This is illustrated in Table 2 from the 2004 study (reproduced here for commentary):

Click to enlarge.
From: DeStefano, et al. (2004). “Age at First Measles-Mumps-Rubella
Vaccination in Children With Autism and School-Matched
Control Subjects: A Population-Based Study in Metropolitan Atlanta”

The birth certificate requirement was not used to suppress data on African Americans. This anti-vaccine claim appears to have been made specifically to exploit race and stir up fear and anger in the African American population.

Was the decision to use birth certificates arbitrary and irrelevant?

No. As the authors of the 2004 study note (emphasis added):

Among case and control children whose records we were able to match with Georgia birth certificate files, we performed a subanalysis to evaluate possible confounding by differences in birth and maternal characteristics.

The full study population data showed a possible association between age of first MMR and autism, but the data did not contain information that may have pointed to other causes of that association. The birth records did have that information, and allowed the researchers to discover that the MMR was notassociated with autism.


Did a new study find that there is an increased risk of autism in African American boys?

A study (“Measles-mumps-rubella vaccination timing and autism among young african american boys: a reanalysis of CDC data“) published in August 2014 in the journal Translational Neurodegeneration by Brian S. Hooker did conclude that there was an increased risk of autism in African American boys who were given their first MMR vaccine between 24 and 31 months of age (Hooker cut off at 31 months, rather than 36 months as in the CDC study, because, after excluding low birth weight infants, there were “insufficient cases” at 36 months; the subgroup he analyzed is different than in the CDC’s study). His study also found that there was no association between MMR and autism at other ages, nor was there any association for African American girls nor for children of any other racial category. However, his results regarding African American boys are almost certainly wrong.

The original 2004 study by the CDC was what is called a case-control study. (A case-control study takes two matched groups, one with a condition and one without, and looks to see how likely or frequently they were exposed to a potential risk factor. It can suggest associations, but usually doesn’t prove causation.) The data for that study were collected with the case-control design in mind. Hooker’s study appears to be a cohort study, which is a completely different type of study design, yet he used the same CDC data set that was designed for a case-control study. (A cohort study starts with people who do not have the disease of interest, then follows them to see if different levels of exposure to a suspected risk factor increases the risk of the disease or condition of interest.) Using data designed for use in one type of study design in a study with a completely different design can introduce errors into the analysis. Hooker then used an inappropriate statistical analysis (either Pearson’s chi-squared test, as mentioned in the Methods, orFisher’s exact test, as noted in the tables) to analyze the data. This type of test ignores variables that can skew results, as well as making a small signal seem very large. Hooker admitted in a presentation at an anti-vaccine conference (around the 17:00 mark) on August 29, 2014 that he used a very simple technique, that “simplicity is elegance”, and that he prefers to do simple things rather than intellectually challenging things. However, elegant does not mean correct; his “simple” analysis ignored confounding variables. Another shortcoming of the study is that Hooker does not report the number of individuals included in his subgroup analyses. The size of the groups matters. The smaller the group, the more likely a finding is due to chance. Since publication, the journal has withdrawn Hooker’s study due to concerns about the validity of its conclusions as well as possible conflicts of interest that were not disclosed by Hooker or the peer reviewers who reviewed the study. [UPDATE (10/4/14): The journal has fully retracted Brian Hooker’s paper due to undeclared conflicts of interest and invalid statistics and methods.]

Who is Brian Hooker?
 
Brian S. Hooker is the father of an autistic child. He has a degree in biochemistry, but has no formal training in statistics or epidemiology, nor is he trained in any field pertinent to the study of vaccines or autism (e.g., immunology, vaccinology, childhood development, developmental psychology, etc.). Hooker has an open case claiming vaccine injury for his son before the Vaccine Court. He is also a board memberof an anti-vaccine organization called Focus Autism. Focus Autism is the organization that funded Hooker’s study. Hooker is also ideologically opposed to vaccines and the CDC, as evidenced by an email he sent to former director of the CDC, Julie Gerberding, in which he wrote, “I would personally urge you to review the Book of Matthew 18:6 and consider your own responsibility to all children of the U.S. including my own son.” The referenced Bible passage reads (King James Version):

But whoso shall offend one of these little ones which believe in me, it were better for him that a millstone were hanged about his neck, and that he were drowned in the depth of the sea.

What do you mean by undisclosed “conflicts of interest”?

Authors of scientific articles are supposed to provide a clear statement of any conflicts of interest that might bias their results. The purpose is to make the reader aware of what might influence the author’s conclusions regarding the data and findings they are reporting. In his study, Brian Hooker only disclosed that he “has been involved in vaccine/biologic litigation”. The statement implies that he is not currently involved in litigation related to vaccines. In reality, Hooker has an active case before the Vaccine Court in which he is suing the government for what he claims is his son’s vaccine-induced autism. He stands to benefit from studies that find a connection between vaccines and autism. He also fails to disclose that he is a board member of the anti-vaccine organization Focus Autism, which funded the study.

The journal in which Hooker published his study, Translational Neurodegeneration, allows authors to submit suggestions for possible reviewers. These reviewers ought to be experts in the relevant fields and should not have strong personal or business ties to the study authors. The journal may choose to use the reviewers suggested by the authors, or they might pick researchers who have published papers previously in the same journal on the same or related subject. We do not know who the reviewers were, but there are some likely candidates, none of whom are qualified to act as peer reviewers and have numerous conflicts of interest, including working relationships with Hooker.

Did Hooker’s study prove Andrew Wakefield right?

No, it did not. Andrew Wakefield has long advocated the belief that the MMR vaccine causes autism. If we ignore all of the flaws in Hooker’s 2014 study and assume that his findings are accurate, Hooker’s study shows that the MMR is not associated with autism. In other words, Hooker’s study, if it is accurate, proves Andrew Wakefield (and much of the anti-vaccine movement) wrong. The only group in which Hooker found an association (and even that association is not proof of causation) was among African American boys who got the MMR vaccine late (between 24 and 31 months). But, as noted above, Hooker’s study was quite flawed and so his findings are very likely incorrect.

Was Hooker’s study retracted?

Yes. On October 3, 2014, the journal Translational Neurodegeneration fully retracted Brian Hooker’s study, issuing this accompanying statement:

The Editor and Publisher regretfully retract the article [1] as there were undeclared competing interests on the part of the author which compromised the peer review process. Furthermore, post-publication peer review raised concerns about the validity of the methods and statistical analysis, therefore the Editors no longer have confidence in the soundness of the findings. We apologise to all affected parties for the inconvenience caused.

PubMed has also updated their listing for the study, with large red box warnings that the study has been retracted and “RETRACTED” stamped in block print across the face of the study text:

Click to enlarge.

The Bottom Line

Despite much noise being made by the small, yet incredibly vocal, anti-vaccine community, there is no evidence of fraud on the part of the CDC, nor is there convincing evidence of any cover-up. Brian S. Hooker’s study contains a number of flaws leading to a spurious, and biologically implausible, conclusion. In fact, the quality of the study is such that the journal that published it withdrew it pending further investigation, citing serious concerns about the validity and potential conflicts of interest. This entire issue is, in reality, much ado about nothing. It is just another example of anti-vaccine activists doing bad science to put your children at greater risk of harm, all because they cannot accept their own children as they are.
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Further Reading:

Posts discussing Hooker’s allegations, excluding anti-vaccine sources

Timeline

Posts discussing Hooker’s allegations from anti-vaccine sources

Timeline

Other links

2 bills that could save lives

This post originally appeared in TribTalk, a publication of The Texas Tribune, on May 1, 2015. 

immunize

By , and

As families who have dealt with meningitis, we understand all too well the pain wrought by this terrible disease.

Greg is the parent of a college student who died from meningitis. Patsy is the mother of Jamie, a student who survived the disease but lost both legs and several fingers.

All Texas families can learn the critical and fundamental importance of vaccinations from our experiences, and we take seriously our responsibility to promote vaccines.

Meningitis is a fast-killing disease that can be fatal to an average healthy individual within 24 hours. While the disease is rare, surviving it is even rarer, and many survivors are permanently scarred or disfigured. Jamie not only survived meningitis but also recently graduated from the University of Texas at Austin, and she is traveling the world to encourage other young people to protect themselves against preventable diseases.

The Texas Legislature is again debating immunization policies, and a small but loud group of anti-immunization activists has again appeared at the Capitol. While all Texans are entitled to their own opinion, protecting the health and safety of all children should take precedence over any personal agendas. For families affected by these terrible and preventable diseases, vaccines aren’t a fad — they’re the foundation of basic, cost-effective health care.

All Texans should have the ability to protect their children from disease and to help those children become protected adults. That’s why we ask the Texas Legislature to listen to science and prioritize Senate Bill 298 by state Sen. Kirk Watson, D-Austin, and House Bill 2171 by state Rep. J.D. Sheffield, R-Gatesville. This legislation would make it easier for us to protect our children by easing college admission and making sure that all children have access to their shot records as they transition to adulthood.

Meningitis doesn’t wait for college. A student at Kingwood High School near Houston recently died from the disease. Watson’s bill would implement guidelines from the Centers for Disease Control and Prevention to add a meningitis booster in high school, helping to prevent more needless deaths among young students.

The bill would also ensure that students have the meningitis shot required for college admission. Texas was the first state in the country to require meningitis vaccination for college students and is already seeing a surge in immunization rates thanks to highly successful meningitis laws. And under Watson’s bill, because the cost of the immunization can be high, the federal government’s Vaccines for Children program — not students or the state — would pick up the tab.

Sheffield’s bill would help young adults maintain access to their immunization records. Currently, the state’s immunization registry only gives young adults one year to ask the state to not delete their shot history. With Sheffield’s bill, Texans would have until their 26th birthday to opt to keep their immunization records on file for later use for employment and college admission. In an ideal world, 18-year-olds would care about their shot records. Sheffield’s bill would simply give young adults more time to opt in to the registry as adults.

As the 2015 Texas legislative session begins to wind down, it’s critical that lawmakers prioritize these bills. It is not an exaggeration to say that they would save lives. Hundreds of thousands of Texans would immediately get the protection we know they need.

Our families were touched by a preventable disease. Help us make sure fewer families share our experience.

How Stories Changed My Life

This post originally appeared on the Texas Children’s Blog on April 20, 2015 in honor of the National Infant Immunization Week. It has been reposted here with permission from the author. 
NIIW (1)

By 

National Infant Immunization Week (NIIW) is a week dedicated to highlighting the importance of infant immunizations. In honor of NIIW, I thought I’d share why infant immunizations are important to me as a parent and as a public health professional.

While it’s obvious that I am passionate about immunizations, most people don’t know that I had a unique experience a few years ago that stirred my passion and shaped my beliefs about immunization. It all started when I wrote a book.

The book is titled “Vaccine-Preventable Disease: The Forgotten Story” and is a collection of stories and photos of individual and families affected by a vaccine-preventable disease.

While writing this book, I met many individuals and families and learned how vaccine-preventable diseases changed their lives.

The first family I met was the Throgmortons, a family who lost their 6 week-old baby to pertussis. A few months later I met the Lastinger and Palmer families, both of whom lost their young daughters to the flu. Emily Lastinger was just 3 years old and Breanne Palmer was just 15 months old when they died. Over the next few years I continued to meet families whose lives were devastated by vaccine-preventable diseases. The Metcalfs nearly lost their daughter, Julieanna, to Hib meningitis. Jenny Wise lost her brother, Andrew, to hepatitis B. Abby Wold and Jamie Schanbaum lost their legs, several fingers, and barely came out alive after contracting meningococcal meningitis. A few years ago I met the Williams who lost their son, Nicolas, to meningococcal meningitis. I’ve also gotten to know the Cary family over the last several years. Billy Cary was 13 when he contracted influenza and nearly died. He spent almost 2 months in the hospital and even today, at age 18, he has lingering effects from his illness. Most recently, I met Micah Kramer and Mayra Camaano who nearly lost their 9-year-old daughter, Chloe, to influenza. There are many more families included in the book that I haven’t mentioned and many more stories yet untold. To read stories from “Vaccine-Preventable Disease: The Forgotten Story” please visit here. To watch a video and learn more about Billy Cary and Chloe Kramer’s story, please visit here.

All of these individuals and families were brave enough to allow me to sit in their living room and listen while they shared some of their most intimate memories. As hard I tried to maintain a professional composure during these interviews, I never left with a dry eye.  Instead, I left feeling as though I had shared in their loss.

So why am I passionate about the importance of infant immunizations? Simply put, meeting these families and hearing their stories irrevocably changed my life. Listening to these families’ experiences and living vicariously through them allowed me to fully understand the importance of vaccines. The memory of these experiences has never left me and undoubtedly, it has shaped me as a mother.

Pictured below are my two daughters. They are 2 and 4 years old. Like all parents, I want to protect them whenever I can. So I strap them securely in their car seats every day. I IMG_5472make sure they wear helmets whenever they ride their bikes. I lather them with sunscreen and bug spray when we’re outside. And of course, I immunize them – on time, every time. Like any parent, it is difficult for me to watch either of them endure pain, even if it is the relatively quick and minor pain of a needle in the arm or leg. But whenever I take my children for their shots, I remind myself of these stories and know that this one moment of pain will prevent much more serious pain, sorrow and loss like these families experienced. It quickly mitigates any anxiety, stress or fear. Whenever the slightest doubt about vaccines creeps in or you start to feel anxiety about vaccinating your baby, rest assured that vaccines are safe, effective and the best tool we have to prevent our children from devastating infectious diseases.

In the end, we are fortunate if we don’t have to learn this lesson the hard way.


Be sure also to check out the great videos also produced by Texas Children’s: Facing Influenza and Facing Meningitis

What do we learn when #SVUGoesViral? Quite a lot.

SVU

By Robyn Correll Carlyle, MPH

Full disclosure: I am not typically an SVU fan. But when I heard that the NBC drama was tackling measles, well, the vaccinerd in me just couldn’t resist.

So last Wednesday night I tuned in to watch, and I have to say, I was pleasantly surprised.

The plot started in standard SVU form. A group of prep school students partake in some scandalous activities, which results in inappropriate photos of underage teens being posted online. When detectives go to interview the kids, however, some of them are out sick with (you guessed it) measles.

While the detectives are attempting to trace the “viral” photos, they get wrapped up in investigating a parallel measles outbreak that spreads to dozens of people – including Sergeant Olivia Benson’s (Mariska Hargitay) immune-compromised foster son, who had only just received the MMR vaccine and didn’t have time to develop sufficient protection.

But how is that possible? These kids had to have been vaccinated?  asked Sgt. Benson incredulous.

It turns out, they hadn’t been vaccinated, despite medical records saying they had.

I won’t spoil it for you (if you missed the episode, you can watch it here on NBC’s website), but let’s just say a vaccine opponent nicknamed “Typhoid Trudy” has her day in court.

In the public health community, we grow to expect science portrayed in popular media to be sacrificed for the sake of plot. Statistics are exaggerated. Disease symptoms hyperbolized. But SVU touched on a wide range of topics throughout the course of the episode – signs and symptoms of measles, possible complications, the true risks and benefits of vaccination, who we vaccinate and when, etc. All of which was presented using scientifically accurate information. Because as it turns out, measles is dramatic enough. There’s no need to embellish.

There were a few mic drop moments – like when “Trudy,” whose son has been identified as the source of the measles outbreak, insists that as a mother, vaccination should be an individual decision. She exclaims passionately, “My child. My right. My decision.” The prosecutor then responds, “But you didn’t just make a decision for yourself, did you? You made a decision that endangered everyone else. What gives you the right to take away their choice?”

But what really impressed me were the more subtle moments. Like when Sgt. Benson finds out her son was exposed to measles, she makes a point of asking her colleague whether his kids were up-to-date. That little gesture, that simple act of just checking in with the people around her to make sure they are protected, is something that we don’t always see – in Hollywood or in real life. Yes, vaccination is something you do as an individual. But it’s an action that can protect not just yourself but your entire community.

When the measles outbreak made headlines in January, did you check in with your friends and family to make sure they were protected? Take a lesson from Sgt. Benson. It doesn’t have to be a big conversation. But it can make all the difference.

Click here for ideas on how you can talk about vaccines in every day conversations. 


Robyn is a project manager for educational programming at The Immunization Partnership

WHO: 10 Facts on Polio Eradication

In honor of the polio vaccine’s 60th anniversary this weekend, we wanted to share the World Health Organization’s 10 Facts on Polio Eradication. Thanks to the power of vaccination, we can #endpolio!

polio_11. Polio continues to paralyse children

While polio is a distant memory in most of the world, the disease still exists in some places and mainly affects children under 5. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.

polio_22. We are 99% of the way to eradicating polio globally

In 1988, when the Global Polio Eradication Initiative was formed, polio paralysed more than 350 000 people a year. Since that time, polio case numbers have decreased by more than 99% (with only 416 polio cases reported in 2013).

polio_33. There are just 3 countries which have never stopped transmission of polio

The 3 countries are Afghanistan, Nigeria and Pakistan. They face a range of challenges such as insecurity, weak health systems and poor sanitation. Polio can spread from these ‘endemic’ countries to infect children in other countries with less-than-adequate vaccination.

polio_44. Unlike most diseases, polio can be completely eradicated

There are 3 strains of wild poliovirus, none of which can survive for long periods outside of the human body. If the virus cannot find an unvaccinated person to infect, it will die out. Type 2 wild poliovirus was eradicated in 1999 and case numbers of type 3 wild poliovirus are down to the lowest-ever levels.

polio_55. Cheap and effective vaccines are available to prevent polio

There are 2 forms of vaccine available to ward off polio – oral polio vaccine (OPV) and inactivated polio vaccine (IPV). Because OPV is an oral vaccine, it can be administered by anyone, even volunteers. One dose of OPV can cost as little as 11 US cents.

polio_66. The global effort to eradicate polio is the largest public-private partnership for public health

In fact, it is the largest-ever internationally-coordinated public health effort in history. It is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, and is supported by key partners including the Bill and Melinda Gates Foundation. Underpinning the effort is a global network of more than 20 million volunteers worldwide who have collectively immunized nearly 3 billion children over the past 20 years.

polio_77. Large-scale vaccination rounds help rapidly boost immunity

The Global Polio Eradication Initiative assists countries in carrying out surveillance for polio and large-scale vaccination rounds. When India was still polio-endemic, there were 640 000 vaccination booths, 2.3 million vaccinators, 200 million doses of vaccine, 6.3 million ice packs, 191 million homes visited and 172 million children immunized: all this in just one round of the national immunization days.

polio_88. Every child must be vaccinated to eradicate polio

This includes those living in the most remote and underserved places on the planet. To get each vaccine safely to children everywhere, all manner of transport is used – from donkeys to motorbikes to helicopters – to reach those living in remote areas, in conflict zones or difficult terrain.

polio_99. Polio-funded staff, strategies and resources are also used to advance other health initiatives

Strategies to find and map every child can be applied to other public health initiatives. While a vaccination team is in a remote village, they can, for little additional cost, provide other health interventions while they are there. For example, vitamin A has been given alongside polio campaigns. Since vitamin A gives a general boost to immunity, it allows children to fend off a range of infections, this has averted more than 1.5 million deaths.

polio-1010. We can eradicate polio

In 2011, this little girl, Rukhsar Khatoon, was the last child to be paralysed by polio in India. The WHO South East Asia Region was declared polio-free in 2014, marking a significant leap forward in global eradication, with 80% of the world’s population now living in certified polio-free regions. The world can be freed of the threat of polio – with everyone’s commitment, from parent to government worker and political leader to the international community.

5 Ways you can support science-based immunization policy

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Every legislative session, there’s a flurry of activity. Hearings are held. Debates are had. And decisions set in motion changes that can have a profound impact on our communities, our families and even our own health. When it comes to immunization policy, it’s critical that those decisions be based on sound science and research.

Most Americans agree. The majority of us support vaccination requirements and understand the very real consequences of letting vaccination rates slip. Even still, policies regarding vaccination are rarely passed without heated discussions or commotion.

But amid the headlines and talking heads, there’s a voice missing in the conversation: yours.

We know you’re busy. You have a job, a family, a social life, hobbies – myriad competing priorities. But supporting science-based legislation doesn’t have to be hard or take up a ton of time. Here are 5 ways you can help support science-based immunization policy in your state:

  1. Be informed. There’s a lot of misinformation out there about what pending legislation will or won’t do. Be sure you understand what legislation is being proposed and what it will mean for you and your loved ones. If you aren’t sure where to start, try contacting your local immunization coalition. They will likely have their finger on what immunization-related legislation is being proposed and how it will impact the prevention of vaccine-preventable diseases in your state.
  2. Tweet at your legislators, or post on their Facebook page. It might not be as personal as a phone call or a letter, but communicating with your legislators on social media has the added benefit of being, well, social. Other people might see your messages and chime in. It’s a small action that can help gather more support for what you’re trying to accomplish and engage those who might otherwise have stayed on the sidelines.
  3. Write an e-mail or mail a letter to your legislators letting them know where you stand on certain immunization-related bills. If you live in Texas, you can find out who represents you by going to The Immunization Partnership’s website (there’s even a ready-made e-mail you can send in support of science-based legislation), or for those outside of Texas (but inside the U.S.), you can find out who represents you by going here. In your e-mail, be sure to share your story about how the proposed legislation will impact you and your community. You don’t have to write a lot – a few paragraphs are enough – but sending them a note is a good way to let your voice be counted.
  4. Make a phone call. The simple act of picking up the phone can go a long way. Often all it takes is 2-3 minutes to let your legislators and/or their staff know why it’s important for them to support science-based legislation when it comes to vaccination policy.
  5. Schedule a visit. It might not always be possible to visit with your legislators in person, but if you can, it can really make an impact. As former British Prime Minister Benjamin Disraeli said, “History is made by those who show up.” A face-to-face conversation with legislators demonstrates that you cared enough to take time out of your busy schedule to talk about these issues, and that carries a lot of weight.

If you support science-based immunization policy, please don’t stand on the side lines. Your voice matters.  Make it heard.

Have anything to add to the list above? Let us know in the comments below!

Children who can’t be vaccinated have rights, too

This post originally appeared in The Texas Tribune’s Trib Talk on March 23, 2015. 

Photo by Pan American Health Organization

Photo by Pan American Health Organization

By Heather Cummings

In 2013 my daughter, Kiera, was diagnosed with cystic fibrosis.

Despite her illness, Kiera, who is 5 years old, is a normal kid who wants to do normal kid things. In fact, children with cystic fibrosis are in many ways healthy and normal. They play sports, ride their bikes, have sleepovers and go to school.

But unlike most other children, their health is fragile, and illnesses, particularly serious infections, pose a substantially greater risk to their health.

Like all parents, my husband and I would do anything to protect our child from danger or harm. And while we may want to shelter Kiera from the dangers of the world, we know we can’t protect her from every potential risk.

But I take my responsibility to protect my daughter and her health very seriously. Unlike some other medically fragile children, my daughter can be and has been immunized. But even with these vaccines, she is still much more likely to become infected, with potentially fatal consequences.

If friends or family members are sick, we ask that they not come to our home. Our family is careful to limit our daughter’s exposure to situations and places where she might become exposed to infectious diseases. We ask for no special accommodations, merely respect for the realities of our daughter’s medical condition. And my daughter is not alone. Thousands of children throughout Texas cannot be immunized or are still at risk for disease even with immunizations.

In recent years, a quiet threat to our daughter’s health — and potentially to her life — has emerged. As more parents choose not to vaccinate their children because of fear, misunderstanding or willful ignorance, the threats to my daughter grow. The decision of other parents not to vaccinate their children threatens the lives of children who cannot be vaccinated and who are medically compromised, like my daughter.

Texans who choose not to vaccinate their children tend to live near one another in neighborhoods and communities. This clustering also concentrates unvaccinated children in specific and fixed locations, like public schools. In Texas and across the country, outbreaks of infectious disease center on these pockets of under-immunization.

Under Texas law, parents who choose not to vaccinate their children are required to report that choice to their public school. However, school districts are not required to report detailed information about campus-level immunization rates. The best available information parents like me have concerns district-level, not campus-level, immunization rates. This does me no good as I seek the best and safest school for my daughter.

This legislative session has included much talk of “school choice.” As the parent of a child with cystic fibrosis, I want school choice, too. I want the ability to choose which school has the highest immunization rates. I want to choose the school where my daughter is least likely to contract an infectious disease that could hurt or even kill her.

State lawmakers are currently considering legislation by Rep. J.D. Sheffield, R-Gatesville, that would make campus-level immunization information available to Texas parents. No privacy will be violated, and other parents and I will never know who in our children’s schools has or has not been vaccinated. Parents of medically fragile children thank Sheffield for understanding our concerns and for fighting for our children’s health and lives.

I respect the rights of parents who choose not to vaccinate. In return, I simply ask for their respect for my right to know the school where my child will be safest. This request is not only reasonable but also literally the least that our vaccine-hesitant neighbors can do to protect others from their choice not to vaccinate their children.

“Doing your research” on vaccines: a how-to guide for finding science-based info online

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Recent outbreaks of measles, mumps and whooping cough have been linked to inadequate immunization rates throughout the United States and abroad. While vaccination rates as a whole remain high across the U.S., there are small pockets of individuals who choose to delay or refuse vaccines altogether, leaving these communities vulnerable to disease.

Why do they choose to opt-out of some or all vaccines? The reasons vary, but a common theme among those who choose to stray from the ACIP recommended immunization schedule goes a little something like this:

“I’ve done my research.”

Unfortunately, this “research” is often done using sources that are not rooted in science. With all the misinformation and half-truths online regarding vaccination, how can parents genuinely interested in finding out more about the true risks and benefits of vaccines wade through the sea of information?

Thankfully, About Health writer and physician Dr. Vincent Iannello recently put together a guide to help direct you to the most science-based information.

Check it out:

Yes you can do Research about Vaccines on the Internet

Folks who are vaccine-hesitant, pro-vaccine choice, anti-vaccine, or whatever they like to call themselves often say that they have done their research. More often than not though, they have done it all on anti-vaccine websites.

If you really want to do your research and make the best decision for your family, in addition to spending that time on anti-vax sites, you should also talk to your pediatrician and:

To learn more about vaccines, I also highly recommend that you:

1. Read the book Deadly Choices: How The Anti-Vaccine Movement Threatens Us All by Paul Offit, MD

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