Vaccines and vaccinations


Vaccine basics

Vaccine basics (Vaccines.gov)
Recommended Immunization Schedules For Children, Teens, and Adults (CDC)
Vaccines and immunizations (Centers for Disease Control and Prevention Immunization schedules for children and adults)
Infographic shows which vaccinations to get at which ages (infancy through later adulthood) (Generations United)
Why immunize? (CDC)
Vaccines for travelers (CDC) Travelers may need these vaccines because there is a risk of certain diseases in countries they are visiting.
State vaccination requirements (CDC)
CDC vaccine price list (Vaccines for Children Program (VFC)
Glossary of Vaccines and Immunizations Terms (Vaccines.gov)
Guide to Federal Immunization Web Sites (Vaccines.gov) Agencies that regulate or administer vaccine/​immunization programs (CDC, FDA, NIH, Vaccine Injury Compensation Program, BARDA, NVPO, Department of Defense, Veterans' Affairs, HIV.gov, Healthfinder.gov, Healthcare.gov)
Valuing vaccinations across generations (Infographic, Generations United, 2-18-16). Three illnesses that can be passed between older and younger generations--flu, pneumonia, and whooping cough--are preventable with immunizations.
Advocacy for Immunization How to generate and maintain support for vaccination programs.
Lack of vaccinations leaves some older adults vulnerable (Bara Vaida, Covering Health, Association of Health Care Journalists, 5-3-18) "“The flu vaccine gets this bum rap,” he said. “We focus on the effectiveness of it and the incidence of preventing the flu, but what we aren’t talking about is the benefits of (the vaccine) if you happen to get the flu. The complications will be ameliorated (and you will be sick for fewer days). If you are 65 and you get the flu and have to be hospitalized, you will come out of the hospital in a walker because your muscles will have atrophied. So I ask my older adult patients, do you want to risk your independence by not getting vaccinated?”
For Immunization Managers (CDC, various resources, including vaccination coverage articles and reports)
Immunization Action Coalition (IAC). See Ask the Experts
GAVI, The Vaccine Alliance Created in 2000, Gavi is an international organisation - a global Vaccine Alliance, bringing together public and private sectors with the shared goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries.
California’s vaccination requirement is constitutional, says federal court (Eugene Volokh, WaPo, 8-29-16 ) California recently repealed its "personal belief exemption" to the requirement that public and private school students be immunized.
History of Vaccines. An educational resource by the College of Physicians of Philadelphia.
Antibodies: Friend & Foe (Thomas Packard, Healthcare in America,12-29-16)
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Measles and other disease- and age-specific vaccines


Available vaccines ***Children's vaccinations***Adult vaccinations***Ebola vaccine***Flu shots (influenza vaccine)***Hepatitis vaccine***Herpes vaccine***Human papillomavirus (HPV) vaccine***Malaria vaccine***Measles vaccine*** Meningitis vaccine***Mumps vaccine***Pneumococcal vaccine***Polio vaccine***Rabies vaccine***Shingles (herpes zoster) vaccine ***Typhoid vaccine***Yellow fever vaccine

Available vaccines


Index of available vaccines. Recommended U.S. immunizations and non-routine immunizations for people in certain jobs and travel situations, organized by disease : Chickenpox (Varicella), Diphtheria, Flu (Influenza), Hepatitis A, Hepatitis B, Hib (Haemophilus influenzae type b), HPV (Human Papillomavirus), Measles, Meningococcal, Mumps, Pneumococcal, Polio (Poliomyelitis), Rotavirus, Rubella (German Measles), Shingles (Herpes Zoster), Tetanus (Lockjaw), and Whooping Cough (Pertussis). (Centers for Disease Control and Prevention)
Recommended vaccines by age (CDC) These vaccines are recommended for infants, children, teenagers and adults of certain ages.
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Children's vaccinations


Straight Talk about Vaccination (Matthew F. Daley, Jason M. Glanz, Scientific American, 9-1-11) Parents need better information, ideally before a baby is born
Why it’s a bad idea to space out your child’s vaccination shots (Lena H. Sun, WaPo, 4-17-17) "The longer a child waits for a vaccination, the greater the risk that he or she will be exposed to these diseases while unprotected."
"Thirty years ago, children received vaccines that protected against eight diseases: measles, mumps, rubella, diphtheria, tetanus, pertussis, Haemophilus influenzae type b and polio. The total number of bacterial and viral proteins contained in earlier versions of these vaccines was a little more than 3,000.
"Today, young children receive vaccines that protect against 14 diseases: the eight earlier ones plus hepatitis A, hepatitis B, rotavirus, influenza, chickenpox and pneumococcal disease. But the total number of bacterial and viral components in these vaccines is only about 150.
"When the vaccine for pertussis, or whooping cough, was developed, for example, it had about 3,000 such components, Feemster said. Now the vaccine contains three to five proteins."
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Adult vaccinations


Vaccines are not just for kids (Anna Gorman, KHN, 7-13-16) Millions of people newly covered under the Affordable Care Act can get certain vaccinations — for the flu, tetanus, measles, hepatitis A and B, meningococcal disease and other illnesses — with no copay or other out-of-pocket cost. Why vaccines are important for adults and what is being done to increase their vaccination rates.
Adults Skipping Vaccines May Miss Out On Effective New Shingles Shot (Michelle Andrews, KHN, 3-20-18) Federal health officials recommend that adults get a number of vaccinations, including protections against shingles, the flu, pneumonia, tetanus, diphtheria and pertussis. But immunization rates are generally low.
Should you get vaccinated at the pharmacy? (Theresa Carr, Consumer Reports, 4-29-17) Yes. "CVS, Rite Aid, Walgreens, and other chains and some independent pharmacies offer more than the flu shot—they typically also administer other immunizations recommended by the Centers for Disease Control and Prevention (CDC), including vaccines against pneumonia, polio, shingles, Tdap (tetanus, diphtheria and pertussis), and varicella (chicken pox). In addition, many also offer travel immunizations for meningitis, typhoid, yellow fever, and other diseases." "Under the Affordable Care Act, private [insurance] plans are required to fully cover the cost of recommended vaccinations for adults and children as preventive medical care." (Medicare Part B covers only flu, pneumonia, and hepatitis B vaccines. Read article for further details on savings.
Seniors Need 2 Pneumonia Vaccines, CDC Panel Says (Steven Reinberg, HealthDay News, 2-3-15) Adults 65 and older need two vaccines to better protect them from bacterial infection in the blood (called sepsis), meningitis and pneumonia, according to a revised vaccination schedule from the 2015 Advisory Committee on Immunization Practices (ACIP). Vaccinations need to be given a year apart, expert recommends. According to the National Foundation of Infectious Diseases (NFID), about 1 million U.S. adults get pneumococcal pneumonia every year. As many as 7 percent die from these infections. Although fewer people get pneumococcal meningitis or sepsis, the death rate is higher -- 10 percent or more, according to the foundation.
Stop Treating 70- and 90-Year-Olds the Same (Louise Aronson, NY Times, 8-11-17) Just as we don’t confuse toddlers with teenagers, or young adults with their middle-age parents, so, too, are we able to distinguish 70-year-olds from the nonagenarians a generation ahead of them. Those two groups — the “young old” and the “old old” — don’t just differ in how they look and spend their days; they also differ biologically. As a result, it’s likely that we are incorrectly vaccinating a significant number of the 47 million Americans over 65. With advancing age, the immune system weakens so older adults are more susceptible to infections — more likely to get sick, more likely to require hospitalization and more likely to die. At the same time, immunizations provide less protection. Older people may need different dosing or even biologically different vaccines. And, given lengthening life spans, we may also be routinely undervaccinating older adults. There are simply different risk-benefit ratios for older adults; the frailest and oldest often incur all the immediate harms of treatments, from prevention to intensive care, without seeing the benefitscenter>[Back to Top]

Ebola vaccine


Everything You Need to Know about the Ebola Vaccine (Dina Fine Maron, Scientific American, 5-17-18) Public health workers are preparing to roll out inoculations even as the disease has spread to an urban location
‘You’re holding your breath’: Scientists who toiled for years on an Ebola vaccine see the first one put to the test (Helen Branswell, STAT, 5-22-18) "An Ebola outbreak has once again commanded global attention, eliciting feelings of dread, anxiety, and concern. But for a small community of researchers who have toiled for years to develop a vaccine against Ebola — one that is being used for the first time to try to contain an outbreak — it is also thrilling. These scientists take no joy in knowing as they do the devastation that the virus can wreak. But after years of frustration with the global response to Ebola outbreaks — and a sense of helplessness in the face of so much misery — they see what’s happening now in the Democratic Republic of the Congo as a possible watershed moment, one that could forever shape the way in which health officials respond to Ebola epidemics."
Ebola vaccine reaches Congo as death count grows (Reid Wilson, The Hill, 5-21-18) A massive vaccination campaign began in Congo on Monday in an effort to stem an outbreak of the Ebola virus that has spread for more than a month. The World Health Organization (WHO) and a nongovernmental organization that delivers vaccines, Gavi, said Monday that more than 7,500 doses of a new vaccine had been deployed to the Equator Province.
An Ebola Vaccine Gets Its First Real-World Test (Adam Rogers, Science, Wired, 5-21-18)
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Flu shots (the search for fully effective influenza vaccine)


• ****Despite push for a universal flu vaccine, the ‘holy grail’ stays out of reach (Helen Branswell, STAT, 3-5-18) There is some momentum, but we're not even close. "[I]t isn’t clear if antibodies are enough to protect against flu. It could be that other parts of the immune arsenal — T cells, for instance — have to be harnessed if a vaccine is to be more broadly effective. There are also many questions about the impact of 'imprinting' on our ability to respond effectively to flu vaccines. That term refers to the shaping of each individual’s immune profile, created by the flu viruses each of us encountered, both through infection and vaccination — and the order in which they happened. It’s thought, for instance, that we will always generate the best response to the type of flu virus that triggered our first infection.)" "Monto thinks moving away from the need to vaccinate annually could improve the impact of next-generation vaccines. There are many complexities, such as the repeat vaccination question, that stand between us and those better flu vaccines." I recommend you read the full article.
Big Pharma Has the Flu (Maryn McKenna, Wired, 1-18-09) Flu vaccines make pharma companies $3 billion a year and aren't very effective. Without a Manhattan Project-style initiative to modernize immunizations, things aren’t going to get any better. "The flu virus itself is to blame. The measles virus that threatens a child today is no different from the one that circulated 50 years ago, so across those 50 years, the same vaccine formula has worked just fine. But flu viruses—and there are always a few around at once—change constantly, and each year vaccine formulators must race to catch up....Now consider this: Right now, millions of people, roughly 100 million just in the United States, receive the flu vaccine every year. If those shots were converted to once or twice or four times in a lifetime, manufacturers would lose an enormous amount of sales and would need to price a new vaccine much higher per dose to recoup."
• ****We're underfunding research on vaccines that may be able to prevent another terrible flu season (Henry I. Miller, LA Times, 1-19-18) "Since the 2004-05 season, the flu vaccines' effectiveness has varied from 10% to 60%. This year, the vaccine is an especially poor match, in part because what's going around is predominantly a virulent strain called H3N2. Although that strain is targeted by this season's flu shot, most of the vaccine is prepared from fertilized chicken eggs, a method known to reduce its effectiveness against certain strains, particularly H3N2....Regulators could encourage manufacturers to stop using chicken eggs and instead prepare vaccines in "cultured cells" — cells that are removed from animals and grown in controlled conditions."...The federal budget for flu vaccine research is meager compared with $1 billion spend to develop HIV vaccines and the many billions spent on vaccins for the Zika and Ebola viruses. (A vaccine specialist explains what needs to happen.)
Covering U.S. efforts to create a universal flu vaccine (Bara Vaida, Covering Health, AHCJ, 3-12-18) As NASW puts it, "Why journalists should cover the Pandemic and All Hazards Preparedness and Response Act reauthorization."
Pregnant women need a flu shot (CDC)
Why do you need to get a flu shot every year? (Melvin Sanicas, TEDEd video, animation by Andrew Foerster) All year long, researchers at hospitals around the world collect samples from flu patients and send them to top virology experts with one goal: to design the vaccine for the next flu season. But why do we need a new one every year? Vaccines for diseases like mumps and polio offer a lifetime of protection with two shots early in life; what’s so special about the flu? Melvin Sanicas explains.
Time for My Annual Flu Shot: Does it Really Work? (Elise Welburn Martin, Healthcare in America, 10-6-16)
The Flu Shot Can't Give You The Flu (Thomas Packard, Healthcare in America, 10-14-16) Subunit and Inactivated Vaccines Explained With a Picture'
The flu: What you need to know (blog post, this site)
A Century After 1918, Flu Pandemic Preparedness Still Lacking (Jackie Powder interviews Anthony Fauci, Global Health Now, 11-15-1). “A hundred years after the lethal 1918 flu we are still vulnerable … public health infrastructure has improved greatly, but without a universal vaccine a single virus could result in a world catastrophe,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, speaking at the forum “The Next Pandemic: Are We Prepared?” Particularly concerning to Jaime Yassif, program officer for Biosecurity and Pandemic Preparedness with the Open Philanthropy Project, is the predictable cycle of “panic and neglect.” We are currently in a neglect phase. Said Yassif: “As soon as the acute phase of an emergency passes, attention diminishes. It’s really incumbent on us … to maintain sustained attention.” Major vulnerabilities include inadequate pandemic warning systems, delays in vaccine development and the movement of viruses between animals and humans, according to researchers, US public health officials and global health experts.
State's top court defends city's flu vaccine mandate for children (Jonathan LaMantia, Crain's New York Business, 6-28-18) New York's highest court said today that the city Board of Health and Health Department can mandate annual flu vaccines for children in city-regulated day care and preschool, reversing lower court rulings. The Health Department said it would begin enforcing the rule immediately.
Influenza Pandemics (College of Physicians of Philadelphia, The History of Vaccines)
The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry. (Hear him talk about 1918 on C-SPAN. Very interesting.)
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Hepatitis vaccine


Hepatitis A Is Surging and Cities Don’t Have the Resources to Stop It (Lauren Weber and Alissa Scheller, HuffPost, 11-4-17)
Vaccine Shortage Complicates Efforts To Quell Hepatitis A Outbreaks (Stephanie O'Neill, Kaiser Health News, 11-14-17)
Viral Hepatitis: New U.S. Screening Recommendations, Assessment Tools, and Treatments (Corinna Dan et al., American Journal of Nursing, July 2015) center>[Back to Top]

Herpes vaccine


Years Before Heading Offshore, Herpes Researcher Experimented On People In U.S. (Marisa Taylor, Kaiser Health News, 11-21-17) Three years before launching an offshore herpes vaccine trial, an American researcher vaccinated patients in U.S. hotel rooms in brazen violation of U.S. law, a Kaiser Health News investigation has found. Southern Illinois University associate professor William Halford administered the shots himself at a Holiday Inn Express and a Crowne Plaza Hotel that were a 15-minute drive from the researcher’s SIU lab. Halford injected at least eight herpes patients on four separate occasions in the summer and fall of 2013 with a virus that he created, according to emails from seven participants and interviews with one participant. Offshore Human Testing of Vaccine Ignites Debate in U.S. (Rebecca Gibian, Real Clear Life, 8-21-17) An American university and a group of wealthy libertarians, including tech billionaire and Trump adviser Peter Thiel, are backing the offshore testing of an experimental herpes vaccine. Their actions defy U.S. safety protections for human trials, reports Kaiser Health News. With the debate over vaccination safety raging in the US, American researchers are increasingly going offshore (and away from current FDA regulations) to conduct clinical trials. Meanwhile, researchers at several universities and private research centers have been working on two different herpes vaccines under FDA and IRB oversight, one which is expected to undergo final trials by 2018. It will then be submitted to the FDA for approval.
Offshore Human Testing of Herpes Vaccine Stokes Debate Over U.S. Safety Rules (Marissa Taylor, KHN, 8-28-17) Defying U.S. safety protections for human trials, an American university and a group of wealthy libertarians, including a prominent Donald Trump supporter, are backing the offshore testing of an experimental herpes vaccine. The American businessmen, including Trump adviser Peter Thiel, invested $7 million in the ongoing vaccine research, according to the U.S. company behind it. Southern Illinois University also trumpeted the research and the study’s lead researcher, even though he did not rely on traditional U.S. safety oversight in the first trial, held on the Caribbean island of St. Kitts....The push behind the vaccine is as much political as medical. President Trump has vowed to speed up the FDA’s approval of some medicines. FDA Commissioner Scott Gottlieb, who had deep financial ties to the pharmaceutical industry, slammed the FDA before his confirmation for over-prioritizing consumer protection to the detriment of medical innovations.
Participants In Rogue Herpes Vaccine Research Take Legal Action (Marisa Taylor, Kaiser Health Network, 3-13-18) Three people injected with an unauthorized herpes vaccine by a Southern Illinois University researcher have filed suit against his company, demanding compensation for alleged adverse side effects from the experiments. SIU professor William Halford, who died in June, had injected Americans with his experimental herpes vaccine in St. Kitts and Nevis in 2016 and in Illinois hotel rooms in 2013 without safety oversight that is routinely performed by the Food and Drug Administration or an institutional review board.

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Human papillomavirus (HPV) vaccines


What is HPV?
Cancer doctors leading campaign to boost use of HPV vaccine (Laurie McGinley, WashPost, 6-19-16) The 64,000-member American Academy of Pediatrics has urged members to use the HPV vaccine. But Cleveland pediatrician Margaret Stager, who works on adolescent health issues for the organization, said it remains “brand-new territory” for many doctors, especially older physicians. “They have seen whooping cough, meningitis, measles and mumps and have real-life evidence of the power of vaccines to save lives,” she said. “Now we have a whole new fundamental concept, because this vaccine is trying to prevent cancer several decades from now.” The nation’s leading cancer doctors are pushing pediatricians and other providers to help increase use of the HPV vaccine, which studies show could help avert tens of thousands of cancer cases during young Americans’ lives. Yet a decade after its controversial introduction, the vaccine remains stubbornly underused even as some of those diseases surge. The vaccine’s low uptake among preteens and adolescents belies its universally acknowledged effectiveness in preventing the most common sexually transmitted infections linked to the human papillomavirus. Those infections can cause a half-dozen cancers, including more than 90 percent of anal and cervical cancers; 70 percent of vaginal, vulvar and oropharyngeal, or middle throat, cancers; and 60 percent of penile cancers.
Cancer doctors leading campaign to boost use of HPV vaccine (Laurie McGinley, WaPo, 6-19-16) We have a vaccine for certain cancers. Why don't more people get it? The 64,000-member American Academy of Pediatrics has urged members to use the vaccine. But Cleveland pediatrician Margaret Stager, who works on adolescent health issues for the organization, said it remains “brand-new territory” for many doctors, especially older physicians. “They have seen whooping cough, meningitis, measles and mumps and have real-life evidence of the power of vaccines to save lives,” she said. “Now we have a whole new fundamental concept, because this vaccine is trying to prevent cancer several decades from now.”
New Vaccine Recommendation Cuts Number Of HPV Shots Children Need (Michelle Andrews, KHN, 3-28-17)
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Malaria vaccine


Covering Health:
"Malaria is a parasite transmitted to people through a mosquito bite. The pathogen develops in the liver and then destroys the body’s red blood cells. There is currently no vaccine available for humans.CIDR has developed a vaccine that is in phase I clinical trials, and will publish results “soon,” Aitchison says. The vaccine would prevent the malaria parasite from entering the liver and multiplying. In 2016, 216 million people developed malaria worldwide and 445,000 died, according to the World Health Organization. UNICEF estimates that about 3,000 children die daily from malaria. About 1,700 people in the U.S. are diagnosed with malaria annually, but almost all of the cases are in travelers returning from sub-Saharan Africa and south Asia..." Newly merged infectious disease organization offers journalists’ resources (Bara Vaida, Covering Health, AHCJ, 8-14-18) See: Scientists discover antibody that prevents malaria, opening door for new treatments and vaccines (Clare McGrane, GeekWire, 3-19-18)
Barriers to Developing a Malaria Vaccine (Centers for Disease Control) Although progress has been made in the last 10 years toward developing malaria vaccines, there is currently no effective malaria vaccine on the market. More than a dozen vaccine candidates are now in clinical development, and one, GlaxoSmithKline Biologicals’ RTS,S, is in Phase III clinical testing—the first malaria vaccine candidate to advance this far.
Frequently asked questions about malaria (CDC)
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Measles and measles vaccine


According to the CDC: ".....From January 1 to June 17, 2011, more measles cases were reported in the United States compared with the same period since 1996." As more parents opt not to vaccinate - we could lose herd immunity. We may see more vaccine preventable infectious diseases in our country imported by travelers. Indirect costs are astronomical."
Why one case of measles is a public health emergency (Erin Archer Kelser, Germ Nurse, 1-9-15) The short answer: Measles can cause significant illness and death, is highly contagious, and we don’t want it to gain a foothold again in the United States. Kelser also provides the longer answer.
Measles sweeps an immigrant community targeted by anti-vaccine activists (Helen Branwell, STAT, 5-8-17) For years, anti-vaccine activists have worked on the sizable Somali-American community in Minnesota, urging them to refuse to let their children receive the MMR vaccine. They’ve been successful: The vaccination rate has plunged. And now, the state is struggling to contain a large and growing measles outbreak that is spreading rapidly through the Somali community and threatens to move beyond it.
Quiz: Are You Prepared to Confront the Measles Outbreak? (Russel W. Steele, Medscape, 2-10-15) A good way to test your knowledge before you read these other articles, all interesting (in different ways) on an important topic.
The communications gap on vaccines (Sharron Kahn Luttrell, Harvard Gazette, 9-16-13). Panelists call for more outreach, research to counter misinformation. “Why would anybody hesitate to vaccinate their kids?” said Barry R. Bloom, Harvard University Distinguished Service Professor and Joan L. and Julius H. Jacobson Professor of Public Health at HSPH. “Where do they get their information? How good is the information? Is it social networks? Is it over the back fence? Is it from moms at school? It’s very hard to develop a strategy if in fact we don’t know the values people are bringing when they come to the pediatrician.” Critical to developing a comprehensive communications strategy is research into why parents are anxious and how they make decisions about whether to vaccinate their children on time, on a delayed schedule, or not at all, the panelists agreed.
Measles Outbreak, Measles Vaccine: Top Questions Answered (Tia Ghose, Rachael Rettner and Tanya Lewis, LiveScience, 2-5-15) "The U.S. measles outbreak now includes at least 102 infected people in 14 states. Most of the cases have been tied to Disneyland in Southern California. The outbreak has many people wondering why a disease that was eradicated from the United States in the year 2000 is now infecting so many people, and what role vaccination requirements may have had in the outbreak. We asked experts to explain how the vaccine works and why the outbreak is happening now.
How to Cause a Measles Epidemic in Five Easy Steps (Paul Marantz, The Doctor's Tablet blog, Einstein College of Medicine, 2-5-15)
Anti-Vaccine Movement Ushers Measles into the Limelight (AllGov California, with links to other articles)
Two Infants Too Young For Vaccinations Contract Measles From Unvaccinated People At Disneyland (Tara Culp-Ressler, ThinkProgress, 1-8-15)
Vaccine Critics Turn Defensive Over Measles (Jack Healy and Michael Paulson, Science, NY Times, 1-30-15) As officials in 14 states grapple with a measles outbreak, the parents at the heart of America's anti-vaccine movement are being blamed for incubating an otherwise preventable public-health crisis.
Measles Is A Killer: It Took 145,000 Lives Worldwide Last Year (Jason Beaubien, All Things Considered, 1-30-15) The uproar over the U.S. outbreak glosses over a bigger problem: Measles takes a tragic toll in poor countries. But a vaccine can effectively stop this deadly — and highly contagious — disease.
Measles Deaths Fall to a Record Low Worldwide (Donald G. McNeil Jr., Health, NY Times, 12-26-17) For the first time in history, annual deaths around the globe from measles have fallen below 100,000, the World Health Organization announced this year. As recently as the 1980s, measles killed 2.6 million people a year. The decline — a public health triumph, as measles has long been a leading killer of malnourished children — was accomplished by widespread donor-supported vaccination that began in the early 2000s....The disease kills up to 6 percent of malnourished children in poor countries, the W.H.O. estimates, and up to 30 percent in some outbreaks among refugees. Half of the world’s unvaccinated children live in six countries: Congo, Ethiopia, India, Indonesia, Nigeria and Pakistan."
I Read the Anti-Vaccine Doctor’s Manifesto so You Don’t Have to (Anna G. Mirer, Worse for the Fishes, 1-30-15)
Journalists around the country tracking vaccination rates (Pia Christensen, Covering Health, 2-5-15)
Goodnight Measles: Bedtime Stories for Your Unvaccinated Child (Hannah Levintova, Mother Jones, 2-13-15) The anti-vaccine movement has no problem innoculating kids with propaganda.
Addressing Vaccine Hesitancy (Barry R. Bloom, Edgar Marcuse, and Seth Mnookin, Science, 4-25-14) A recent report concluded that current public health communication about vaccines may actually increase misperceptions or reduce vaccination intention, and that attempts to increase concerns about communicable diseases or correct false claims about vaccines may be counterproductive. we need research that addresses how and when attitudes and beliefs about vaccines are formed, how people make decisions about immunization, how best to present information about vaccines to hesitant parents, and how to identify communities at risk of vaccine-preventable disease outbreaks.
Thanks to Norman Bauman for important links on this topic.
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Meningitis vaccine


Paralympic Champion Makes The Case For Meningitis Vaccine (Alison Bruzek, Shots, NPR, 1-4-15) Amy Purdy, who lost both lower legs because of bacterial meningitis, performed with Derek Hough on Dancing With The Stars (see photo). At age 19, she was diagnosed with bacterial meningitis. "It affects only about 4,000 people a year in the United States, according to the Centers for Disease Control and Prevention, but more than 10 percent of those people die. Others, like Purdy, suffer devastating consequences, including hearing loss, brain damage, or the loss of limbs from bloodstream infection" (sepsis). College students are especially vulnerable, because meningitis is spread by living in close quarters and sharing drinking and eating utensils, or kissing. That's why the CDC recommends meningitis vaccine for all teenagers, especially if they weren't vaccinated as preteens. Purdy wasn't living in a dorm and she was incredibly healthy when she contracted the infection. "For me, it was life-changing. I nearly died multiple times in the hospital. I lost my legs, I lost my spleen, I lost my kidney function. I lost the life that I knew."
Meningitis B Vaccine’s High Price Poses A Health Care Conundrum For College-Bound (Shefali Luthra, Kaiser Health News, 9-8-17)
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Mumps vaccine


Rise in mumps outbreaks prompts U.S. panel to endorse 3rd vaccine dose ( Lena H. Sun, WaPo, 10-25-17) A federal expert panel on Wednesday recommended a third dose of the mumps vaccine when an outbreak occurs. The move was in response to the rise in mumps outbreaks since 2006, especially among highly vaccinated college students. More than 6,000 cases of the contagious viral illness were reported last year in the United States, the most in a decade. Unlike outbreaks of measles, which have taken place in populations with significant numbers of unvaccinated people, the mumps outbreaks have occurred in communities with high rates of immunization and people who often have received both recommended doses of the vaccine. The committee did not recommend an extra shot for everyone. It voted unanimously to recommend a third dose of mumps-containing vaccine only for people who are determined by public health officials to be at increased risk for mumps because of an outbreak.
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Pneumococcal vaccine


Adults: Protect Yourself with Pneumococcal Vaccines (CDC) Many adults are at risk for pneumococcal disease. Two vaccines provide protection against this serious and sometimes deadly disease. Talk to your healthcare professional to make sure you are up to date on these and other recommended vaccines. PCV13 protects against 13 strains of pneumococcal bacteria and PPSV23 protects against 23 strains of pneumococcal bacteria. Both vaccines provide protection against illnesses like meningitis and bacteremia. PCV13 also provides protection against pneumonia. CDC says who should and shouldn't get the vaccine, and not to get them both at once.
Pneumococcal Disease (CDC primer) Streptococcus pneumoniae, or pneumococcus, is a type of bacterium that causes pneumococcal [noo-muh-KOK-uhl] disease. Pneumococcal infections can range from ear and sinus infections to pneumonia and bloodstream infections. Children younger than 2 years old and adults 65 years or older are among those most at risk for disease.
The Ratcheting Cost of the Pneumococcal Vaccine: What Gives? (Shefali Luthra, Kaiser Health News, 11-29-17) The notice that comes every November from the drug company Pfizer yane — or Coke in an airport. They charge what they want to.” The Advisory Committee on Immunization Practices (ACIP), a consultatory panel to the federal Centers for Disease Control and Prevention, recommends Prevnar 13 for all children younger than 2 — given at 2, 4, 6 and 15 months — as well as for adults 65 and older. A full pediatric course of the vaccine typically involves four shots. In 2010, a single shot cost about $109, according to pricing archives kept by the CDC. It currently costs about $170, according to those archives. Next year, Pfizer says, a shot will cost almost $180. Physicians have to stock it and although they will mostly be reimbursed through insurance, it can take months for that to come through, which is an especially tough proposition for small practices on tight budgets. “The cost of vaccines is definitely something in primary care we worry about, because we’re on thin margins. … You don’t want to provide a service you lose money on, even if it’s as important as immunization.”
There is no such thing as “free” vaccines: Why we rejected Pfizer’s donation offer of pneumonia vaccines. (Jason Cone, Executive Director of Doctors Without Borders in the United States, Medium.com, 10-10-16) Pneumonia claims the lives of nearly one million kids each year, making it the world’s deadliest disease among children. As the only producers of the pneumonia vaccine, Pfizer and GlaxoSmithKline (GSK) are able to keep the price of the vaccine artificially high; since 2009, the two companies have earned $36 billion on this vaccine alone. For years, we have been trying to negotiate with the companies to lower the price of the vaccine, but they offered us donations instead. By giving the pneumonia vaccine away for free, pharmaceutical corporations can use this as justification for why prices remain high for others, including other humanitarian organizations and developing countries that also can’t afford the vaccine. Critically, donation offers can disappear as quickly as they come. Donations can also undermine long-term efforts to increase access to affordable vaccines and medicines. They remove incentives for new manufacturers to enter a market when it’s absorbed through a donation arrangement. Pfizer should lower the price of its lifesaving pneumonia vaccine for humanitarian organizations and all developing countries to $5 per child. Only then, will we have a meaningful step towards saving children’s lives both today and in the future.
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Polio vaccine


Pronounced [PO-lee-oh]
Polio Vaccination (CDC) One of the recommended vaccines. Inactivated polio vaccine (IPV) is the only polio vaccine that has been given in the United States since 2000. It is given by shot in the arm or leg, depending on the person’s age. Oral polio vaccine (OPV) is used in other countries.
Critical Vaccine Shortage Threatens Polio Eradication Efforts (Maryn McKenna, Newsweek, 12-29-16) Polio remains endemic in Pakistan after the Taliban banned vaccinations, instigated attacks targeting medical staffers and spread suspicions about the inoculations.
Polio Vaccine (Children's Hospital of Philadelphia) Since travel makes the world a much smaller place, a recurrence of polio is merely a plane ride away.The inactivated polio vaccine (IPV) is given as a series of four shots at 2 months, 4 months, 6 to 18 months, and again at 4 to 6 years of age. Because IPV has no serious side effects, the benefits of the vaccine clearly outweigh its risks.
FDA Accelerates Development of Polio Virus Treatment for Brain Cancer (Silas Inman, Cure, 5-17-16) The FDA granted the recombinant oncolytic poliovirus PVS-RIPO a breakthrough therapy designation as a potential treatment for patients with recurrent glioblastoma multiforme (GBM), citing evidence from an ongoing phase 1 study that is exploring overall survival rate in patients with grade 4 malignant glioma, according to a statement by the developer of the immunotherapy, Duke Medicine.
ABOUT THE FASCINATING HISTORY OF POLIO VACCINATION:
A “Polio Warrior” Recounts Decades of Struggle Toward Eradication (Maryn McKenna, National Geographic, 4-12-15) Maryn interviews John Sever about his role and that of Rotary International in campaigns to vaccinate every child, in an attempt to eradicate polio around the world, about the relative roles of the Salk and Sabin vaccines, and about changes in thinking about the two.
The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis by Paul Offit (as reviewed by Michael Fitzpatrick (Journal of the Royal Society of Medicine, March 2006) "The Cutter incident had an ambivalent legacy. On the one hand, it led to the effective federal regulation of vaccines, which today enjoy a record of safety `unmatched by any other medical product'. On the other hand, the court ruling that Cutter was liable to pay compensation to those damaged by its polio vaccine—even though it was not found to be negligent in its production—opened the floodgates to a wave of litigation. As a result, `vaccines were among the first medical products almost eliminated by lawsuits'. Indeed, the National Vaccine Injury Compensation Program was introduced in 1986 to protect vaccine manufacturers from litigation on a scale that threatened the continuing production of vaccines. Still, many companies have opted out of this low-profit, high-risk field, leaving only a handful of firms to meet a growing demand (resulting in recent shortages of flu and other vaccines)."
Debunked: The Polio Vaccine and HIV Link (College of Physicians of Philadelphia, The History of Vaccines)
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Rabies vaccine


Rabies Vaccine: What You Need to Know (Centers for Disease Control)
Rabies Prevention (CDC, in animals and in humans)
Pre-Exposure Vaccinations (CDC)
Rabies (CDC, broader-based information, including global statistics and links to technical articles)
Administration of Rabies Vaccination State Laws (American Veterinary Medical Association, for animals)
Why a simple, lifesaving rabies shot can cost $10,000 in America ( Sarah Kliff, Vox, 2-7-18) Untreated rabies is always fatal — but key drugs leave families with thousands in medical debt.
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Shingles vaccine


No Excuses, People: Get the New Shingles Vaccine (Paula Span, New Old Age, NY Times, 11-10-17) Dr. William Schaffner, preventive disease specialist at the Vanderbilt University School of Medicine, said, “This vaccine has spectacular initial protection rates in every age group. The immune system of a 70- or 80-year-old responds as if the person were only 25 or 30.” Large international trials have shown that the vaccine, Shingrix, from the firm GlaxoSmithKline, prevents more than 90 percent of shingles cases, even at older ages. It is far more effective in the elderly than the old Shingles vaccine, Zostavax.
Adults Skipping Vaccines May Miss Out on Effective New Shingles Shot (Michelle Andrews, KHN, 3-20-18) Federal officials have recommended a new vaccine that is more effective than an earlier version at protecting older adults against the painful rash called shingles. But persuading many adults to get this and other recommended vaccines continues to be an uphill battle, physicians and vaccine experts say. “I’m healthy, I’ll get that when I’m older,” is what adult patients often tell Dr. Michael Munger when he brings up an annual flu shot or a tetanus-diphtheria booster or the new shingles vaccine. Sometimes they put him off by questioning a vaccine’s effectiveness
Should I Get the Shingles Vaccine? (Mark A. Kelley, Health Web Navigator, 1-11-17)
The New Shingles Vaccine: What You Should Know About Shingrix (Diane Umansky, Consumer Reports, 1-25-18) The CDC now recommends this vaccine for its strong, longer-lasting protection
Why Does My Shingles Vaccine Cost So Much? (Teresa Carr, Consumer Reports, 4-28-17) Medicare may not provide good coverage for this vital protection
CDC Panel Recommends a New Shingles Vaccine (Sheila Kaplan, NY Times, 10-25-17) CDC recommends a new vaccine to prevent shingles over an older one that was considered less effective. The new vaccine, called Shingrix and manufactured by GlaxoSmithKline, is recommended for adults ages 50 and older. The panel’s recommendation gives preference to the new vaccine over Merck’s Zostavax, which has been the only shingles vaccine on the market for over a decade and was recommended for people ages 60 and older. The disease, also known as herpes zoster, can range in severity from barely noticeable to debilitating. It is caused by the varicella-zoster virus, which also causes chickenpox. GlaxoSmithKline said its new vaccine would cost about $280 and would be available next month. Zostavax costs about $223.
Older Adults Are Still Skipping Vaccinations (Paula Span, NY Times, 12-2-16) By not being vaccinated, older adults are exposing themselves to higher risk from shingles; tetanus, diphtheria and whooping cough (Tdap vaccine); and flu, all of which can hit harder in old age. "Shingles results from the same virus that causes chickenpox, which nearly all older Americans have had. The virus typically remains dormant for decades, but the odds of its reactivation rise steeply after 50 as the immune system weakens. The lifetime risk of shingles is one in three, rising to one in two for those over 85." “Don’t delay, as the consequences of shingles can be devastating,” advises Consumer Reports’ medical director, Orly Avitzur, a neurologist who has seen firsthand the painful effects of lingering nerve damage. See Why Does My Shingles Vaccine Cost So Much? (typically about $200, Theresa Carr, Consumer Reports, 4-28-17) Carr suggests getting your shots at the pharmacy to save money.
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Typhoid vaccine


Inactivated typhoid vaccine (shot) One dose provides protection. It should be given at least 2 weeks before travel abroad to allow the vaccine time to work. A booster dose is needed every 2 years for people who remain at risk.
Typhoid vaccine information statement (CDC) Generally, people get typhoid from contaminated food or water. Typhoid is rare in the U.S., and most U.S. citizens who get the disease get it while traveling. Generally, people get typhoid from contaminated food or water. Typhoid strikes about 21 million people a year around the world and kills about 200,000. There are two vaccines to prevent typhoid. One is an inactivated (killed) vaccine given as a shot. The other is a live, attenuated (weakened) vaccine which is taken orally (by mouth).
We’re Out of Options’: Doctors Battle Drug-Resistant Typhoid Outbreak (Emily Baumgaertner, NY Times, 4-13-18) The first known epidemic of extensively drug-resistant typhoid is spreading through Pakistan, infecting at least 850 people in 14 districts since 2016, according to the National Institute of Health Islamabad. The typhoid strain, resistant to five types of antibiotics, is expected to disseminate globally, replacing weaker strains where they are endemic. Experts have identified only one remaining oral antibiotic — azithromycin — to combat it; one more genetic mutation could make typhoid untreatable in some areas
W.H.O. Approves a Safe, Inexpensive Typhoid Vaccine (Donald G. McNeil Jr., NY Times, 1-3-18) A new, highly effective typhoid vaccine — the only one safe for infants — has been approved for global use by the World Health Organization.
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Yellow fever vaccine


Yellow fever is a serious viral infection that still occurs in certain parts of Africa and Latin America. It is spread through the bite of an infected mosquito. Yellow fever vaccine is given only at designated vaccination centers. Most people begin to develop immunity within ten days and 99 percent are protected within a month of vaccination. "The yellow fever vaccine provides lifelong protection for most people. Booster doses and new vaccination certificates used to be recommended every 10 years for people who continued to be at risk of the infection, but this is no longer necessary in most cases." But check well in advance against the WHO country list, if you will be traveling in Africa or Latin America.
Planning A Trip To Brazil? Do Not Forget Your Yellow Fever Vaccine (Melvin Sanicas, Healthcare in America)
Yellow Fever Vaccination (CDC)
WHO Country list (countries that require proof of vaccination for yellow fever (and sometimes malaria), because travelers may be exposed to it within that country.
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Books about vaccines and immunization


I have not personally reviewed these books, but I have included only books that got good reviews.
Calling the Shots: Why Parents Reject Vaccines by Jennifer A. Reich. “Calling the Shots treads confidently into the explosive terrain of vaccine refusal. In this must-read exploration of the burdens of modern mothering, Reich takes seriously the desires of mothers to make their own decisions to protect their children from risks. But she also shows how anti-vaccine stances by the privileged few may undermine the social compact and threaten the public good. This is a well-written, important, and very timely book.”--Steven Epstein, author of Inclusion: The Politics of Difference in Medical Research
The Vaccine-Friendly Plan: Dr. Paul's Safe and Effective Approach to Immunity and Health-from Pregnancy Through Your Child's Teen Years by Paul Thomas and Jennifer Margulis. This story. It’s Time to Start a New Conversation About Vaccines explains where the authors stand on "to vaccinate or not to vaccinate": Yes, but know what you're doing, and where there may be dangers. For example, it explains why parents should never give their children Tylenol before or after vaccines. (Story linked to:
Acetaminophen as a cause of the autism pandemic? It makes absolutely no sense … at first.
(SafeMinds). “Children who used acetaminophen at age 12 to 18 months were more than eight times as likely to be in the autism group when all children were considered and more than 20 times as likely to be in the autism group when limiting cases to children with regression....There was no similar autism effect with ibuprofen. In fact, as Schultz explained to me recently by email, “I did not see a direct association with any of the vaccines themselves. It was only the combination of acetaminophen and the MMR vaccine which increased autism risk.”
The Vaccine Race: Science, Politics, and the Human Costs of Defeating Disease by Meredith Wadman. The story behind the book's genesis: How a debate over patient consent rules led to a book on vaccine history (Bara Vaida, Covering Health, AHCJ, 2-6-18), and see also Author reflects on writing a book about vaccines, medical research (Bara Vaida, AHCJ). The book "tells the story of how vaccines for diseases such as rubella and rabies were created and how the research led to an understanding of how and why humans age. The book also takes an unflinching look at the dark side of medical research, including the use of vulnerable populations for vaccine clinical trials, before the U.S. developed patient consent laws."
The Vaccine Book: Making the Right Decision for Your Child by Robert W. Sears (Sears Parenting Library)
Miller's Review of Critical Vaccine Studies: 400 Important Scientific Papers Summarized for Parents and Researchers by y Neil Z. Miller. Studies critical of vaccination.
Vaccines 2.0: The Careful Parent's Guide to Making Safe Vaccination Choices for Your Family by Mark Blaxill and Dan Olmsted.
The Panic Virus: The True Story Behind the Vaccine-Autism Controversy by Seth Mnookin.
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MMR vaccine, a fraudulent report on autism, and the anti-vaxxer movement


The problems with the anti-vaccine movement
A Brief History of Vaccine Conspiracy Theories (Kate Wheeling, Pacific Standard, 1-13-17) Vaccine skepticism is as old as the idea of inoculation itself, but the recent politicization of vaccination is putting us all at risk.
Journal Retracts 1998 Paper Linking Autism to Vaccines (Gardiner Harris, Research, NY Times, 2-2-10) The Lancet, a prominent British medical journal retracted a 1998 research paper that set off a sharp decline in vaccinations in Britain after the paper’s lead author suggested that vaccines could cause autism.
History of Anti-vaccination Movements (College of Physicians of Philadelphia, The History of Vaccines)
Denialism: what drives people to reject the truth (Keith Kahn-Harris, The Guardian, A Long Read, 3-8-18) From vaccines to climate change to genocide, a new age of denialism is upon us. Why have we failed to understand it?
How the case against the MMR vaccine was fixed (Brian Deer, British Medical Journal, 2011) A 1998 Lancet paper, chiefly by Andrew Wakefield, implied a link between the measles, mumps, and rubella (MMR) vaccine and a “new syndrome” of autism and bowel disease. Clear evidence of falsification of data in that article should now close the door on this damaging vaccine scare, write BMJ's top editors. In a seven-part series, journalist Brian Deer shows the extent of Wakefield's fraud and how it was perpetrated. Others have criticized this series for being overhyped.
The Wakefield MMR verdict (Ben Goldacre, Bad Science, 1-28-10) An excellent summary of what happened, with the media sharing blame with Wakefield.
20 years ago, research fraud catalyzed the anti-vaccination movement. Let’s not repeat history. Julia Belluz, Vox, 2-27-18) How Andrew Wakefield’s shoddy science fueled autism-vaccine fears, and the media helped his claim go viral.
California doctor, renowned vaccine skeptic, placed on probation for exempting child from all vaccinations (Deepa Bharath, Mercury-News, 6-30-18) Dr. Bob Sears, a renowned Dana Point pediatrician who has been sought out by parents who wish to opt out of the state’s mandatory vaccine requirements, has been placed on probation for 35 months by the Medical Board of California. The June 27 order, which will go into effect on July 27, allows Sears to continue his medical practice but requires him to go through 40 hours of educational courses for each year of probation and a professional ethics course.
Anti-vaccine activists spark a state’s worst measles outbreak in decades (Lena H. Sun. WaPo, 5-5-17) The young mother started getting advice early on from friends in the close-knit Somali immigrant community here. Don’t let your children get the vaccine for measles, mumps and rubella — it causes autism, they said. Suaado Salah listened. And this spring, her 3-year-old boy and 18-month-old girl contracted measles in Minnesota’s largest outbreak of the highly infectious and potentially deadly disease in nearly three decades.
Fake news and distrust of science could lead to global epidemics (Heidi Larson and Peter Piot, Wired UK, 1-9-18) "Vaccines are one of the most important scientific inventions of all time, preventing millions of cases of disease every year and helping to consign once-deadly outbreaks to history. Yet these vital public-health tools are under threat from growing public mistrust in immunization and the rise of so-called "fake news" drowning out expert voices. This "anti-vax" sentiment and pushback against scientific evidence threatens public health around the world, from measles outbreaks in the US and across Europe, prompting stricter vaccination laws, to persisting polio in Pakistan and Afghanistan. If this trend continues, 2018 could see a devastating resurgence of deadly diseases previously on the brink of eradication....These are disruptions that set back, rather than advance, scientific progress. Examples range from the 2017 WhatsApp and Facebook anti-vaccination campaigns in South India, which sparked fear and refusal of the measles rubella vaccine - some linked to now debunked autism anxieties around the MMR vaccine nearly 20 years ago in the UK - to similar social-media-propagated false rumours provoking vaccine refusals, measles outbreaks and diphtheria deaths in Malaysia. As a result of declining immunisation levels, between 2016-2017 Europe experienced 35 deaths due to measles, a disease that was nearly wiped out. All of those deaths were preventable."
The Vaccine War (Frontline, PBS, 4-27-10) Public health scientists and clinicians tout vaccines as one of the greatest achievements of modern medicine. But for many ordinary Americans vaccines have become controversial. Young parents are concerned at the sheer number of shots — some 26 inoculations for 14 different diseases by age 6 — and follow alternative vaccination schedules. Other parents go further. In communities like Ashland, Oregon, up to one-third of parents are choosing not to vaccinate their kids at all. This is the vaccine war: On one side sits scientific medicine and the public health establishment; on the other a populist coalition of parents, celebrities, politicians and activists.
The enduring appeal of conspiracy theories (Melissa Hogenboom, BBC, 1-24-18) In certain pockets of America, measles diagnoses have been spreading at previously unprecedented rates. Less than a decade earlier, measles had been largely eliminated in the US. The gradual resurgence can, researchers say, be directly attributed to people who were not vaccinated.
Misinformation lingers in memory: Failure of three pro-vaccination strategies ( Sara Pluviano, Caroline Watt, and Sergio Della Sala, PLOS One, 7-27-17) Strategies to correct vaccine misinformation are ineffective and often backfire, resulting in the unintended opposite effect, reinforcing ill-founded beliefs about vaccination and reducing intentions to vaccinate--according to an evaluation of three vaccine promotion strategies.
On Vaccines and Autism: An Open Letter to Larry Wilmore (David Kyle Johnson, Psychology Today, 1-29-15) The Nightly Show's Larry Wilmore knows vaccines are safe...If you have an anti-vaccination advocate (i.e., anti-vaxer) on your panel, include someone who has the skills or knowledge to debunk her claims.
Distributors of Anti-Vax Film Are Trying to Keep an Autistic Rights Advocate from Criticizing It (Anna Merlan, Jezebel, 7-27-16). "Vaxxed is the anti-vaccination film made by Andrew Wakefield" and is shown "to breathless audiences who see Wakefield as a personal savior and believe the government is engaged in a vast coverup of the fictional autism-MMR link." Fiona O’Leary, an Irish mother of five, a woman with Aspergers syndrome and the founder of an organization called Autistic Rights Together, says the film “is spreading misinformation and harm.” "She’s also promoting a longshot petition addressed to Texas Attorney General Ken Paxton. It reads, in part: VACCINES DO NOT CAUSE AUTISM! VACCINES SAVE LIVES!"
The problems with the BMJ’s Wakefield-fraud story by Seth Mnookin, author of The Panic Virus: The True Story Behind the Vaccine-Autism Controversy. Booklist review: "Over the last three decades, the incidence of autism spectrum disorder, better known simply as autism, has risen dramatically in the U.S., from approximately 1 in 1,000 children to 1 in 110, arousing widespread concern among parents and psychiatrists alike. A few of the many potential possible culprits scientists have targeted are faulty genes and thimerosal, a mercury-laced preservative in vaccines. Former Newsweek senior journalist Mnookin focuses his masterful investigative skills primarily on the latter, highly controversial possibility, illustrating how the current, misguided anti-vaccine movement can be blamed almost equally on panic-driven parents, sensation-hungry media, and PR-challenged health authorities. In making his case, Mnookin covers a wide swathe of medical history, from polio outbreaks to the scare tactics of fringe British researcher Andrew Wakefield, who first forged the dubious vaccine-autism link. While Mnookin dismantles this link convincingly, his argument that multivaccine cocktails have been proven safe is ultimately less persuasive. Still, he’s an able, engaging wordsmith, and this cautionary tale about misinformed medical alarmism is thoroughly compelling." --Carl Hays, Booklist. Author's summary here: The Panic Virus: Who decides which facts are true? One study after another failed to find any link between childhood vaccines and autism. Yet the myth that vaccines somehow cause developmental disorders lives on. Meanwhile millions of dollars have been diverted from potential breakthroughs in autism research, families have spent their savings on ineffective “miracle cures,” and declining vaccination rates have led to outbreaks of deadly illnesses like Hib, measles, and whooping cough. Most tragic of all is the increasing number of children dying from vaccine-preventable diseases. See also Talking to Vaccine Resisters (Seth Mnookin, New Yorker, 2-4-15) and The Panic Virus, Seth Mnookin's blog on PLOS (the Public Library of Science).
Islamic anti-vaxxers undermine efforts to prevent diphtheria outbreak in Indonesia (Adam Harvey, ABC News, 1-15-18) Now, a vaccination campaign against diphtheria in Indonesia is being undermined by alternative health practitioners and some hardline Muslim clerics who claim immunisations are un-Islamic. "The Prophet shows us that immunisation should come from the regular daily consumption of healthy substances : honey, herbs, olive oil; dates and goat's milk. If we don't follow that, we can be easily infected with diseases," she said.
Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies (LE Taylor, AL Swerdfeger, and GD Eslick, Vaccine, 6-17-14, on PubMed) Findings of this meta-analysis suggest that vaccinations are not associated with the development of autism or autism spectrum disorder. Furthermore, the components of the vaccines (thimerosal or mercury) or multiple vaccines (MMR) are not associated with the development of autism or autism spectrum disorder.
Anti-Vaxxers Are Using Twitter to Manipulate a Vaccine Bill (Renee DiResta, Wired, June 2015) One small, vocal group can have a disproportionate impact on public sentiment and legislation. Welcome to Anti-Vax Twitter.
Penn and Teller on Vaccines (video) Measles in Disneyland should be a wake-up call for the anti-vaccine movement. Will it? Magicians Penn and Teller do their part and show us why anti-vaccination is nonsense. (Warning: explicit language.)
Mercury, Vaccines, and Autism: One Controversy, Three Histories (Jeffrey P. Baker, Am J Public Health. 2008 February) The controversy regarding the once widely used mercury-containing preservative thimerosal in childhood vaccines has raised many historical questions that have not been adequately explored. Why was this preservative incorporated in the first place? Was there any real evidence that it caused harm? And how did thimerosal become linked in the public mind to the “autism epidemic”?
Seriously flawed’ study linking behavioral problems to Gardasil has been retracted (Rachel Feltman, WaPo,2-25-16) Retraction Watch reports that a paper published online in the journal Vaccine last month and temporarily removed weeks later has now officially been retracted.
Then again:
Values and vaccines ( Maggie Koerth-Baker, Aeon) Parents who reject vaccination are making a rational choice – they prefer to put their children above the public good Is vaccination a social obligation or a personal decision? Anti-vaccination may be rational but is it reasonable? Scientists personally think the trade-off between the small risks of side effects and the big benefit of herd immunity is a fair one, but it it’s easy to forget that our perspective on the trade-off is a belief, and not a provable fact. Scientists try to fight with facts, assuming the public just doesn’t know what’s going on, while the public gets angrier because it’s not being listened to. An interesting, thought-provoking essay.
Why Facts Don't Change Our Minds (Elizabeth Kolbert, New Yorker, 2-27-17)
How My Daughter Taught Me that Vaccines Do Not Cause Autism (Juniper Russo, Voices for Vaccines)
Article linking autism to vaccination was fraudulent. Fiona Godlee, editor in chief, Jane Smith, deputy editor, and Harvey Marcovitch, associate editor, British Medical Journal 5 Jan 2011. A 1998 Lancet paper, chiefly by Andrew Wakefield, implied a link between the measles, mumps, and rubella (MMR) vaccine and a “new syndrome” of autism and bowel disease. Clear evidence of falsification of data in that article should now close the door on this damaging vaccine scare, write BMJ's top editors. In a seven-part series, journalist Brian Deer shows the extent of Wakefield's fraud and how it was perpetrated: How the case against the MMR vaccine was fixed
Vaccines Don't Cause Autism (Sabin Vaccine Institute).
Vaccines and Autism: A Tale of Shifting Hypotheses (Jeffrey S. Gerber and Paul A. Offit, Clinical Infectious Diseases, 2-15-09, doi: 10.1086/​596476). Although child vaccination rates remain high, some parental concern persists that vaccines might cause autism. Three specific hypotheses have been proposed:
(1) the combination measles-mumps-rubella vaccine causes autism by damaging the intestinal lining, which allows the entrance of encephalopathic proteins;
(2) thimerosal, an ethylmercury-containing preservative in some vaccines, is toxic to the central nervous system; and
(3) the simultaneous administration of multiple vaccines overwhelms or weakens the immune system.
The authors discuss the genesis of each of these theories and review the relevant epidemiological evidence.
Unfounded Autism Fears Are Fueling Minnesota's Measles Outbreak (Mark Zdechlik, Shots, NPR, 5-3-17) In Minnesota, the vast majority of kids under two get vaccinated against measles. But state health officials say most Somali-American 2-year-olds have not had the vaccine — about six out of ten. "It is a highly concentrated number of unvaccinated people," he says. "It is a potential kind of gas-and-match situation...Somali-American leaders here are in firm agreement with the Minnesota health department in trying to knock down the pseudoscience behind the unfounded claims that getting vaccinated can lead to autism." Understanding The History Behind Communities' Vaccine Fears (Emily Sohn, NPR, 5-3-17) Fewer than half of Minnesota children of Somali descent have received the MMR shot that protects against measles, mumps and rubella, according to the Minnesota Department of Public Health. Multiple studies have shown spikes in vaccine-preventable diseases (including pertussis, polio, mumps and measles) in schools and regions around the world with low vaccination rates, such as affluent neighborhoods in Northern California and an Amish community in Ohio, it is extremely challenging to change people's opinions about vaccines, Dubé says. Attitudes are often deeply ingrained."
Dr. Peter Hotez, latest vaccine pitchman, clueless on vaccine-autism science (J.B. Handley, Jr., Healthcare in America, 2-2-17). A dissenting essay, from a man whose son is autistic, and who questions the arguments of Offit, a vaccine developer.
The forgotten history of autism (TED talk by Steve Silberman, March 2015. Available in 31 subtitle languages and an interactive transcript--click on transcript and it will appear on the screen). An Austrian doctor by the name of Hans Asperger published a pioneering paper in 1944. Because it was buried in time, autism has been shrouded in misunderstanding ever since--because of one dishonest scientist's interpretation of an apparent spike in autism cases. In 1975, 1 in 5,000 kids was estimated to have it. Today, 1 in 68 is on the autism spectrum. What caused this steep rise? Steve Silberman points to “a perfect storm of autism awareness” — a pair of psychologists with an accepting view, an unexpected pop culture moment (a movie called "Rainman"), and a new clinical test. An important overview that sheds important light on a controversy that is causing deaths all over the world and that provides hope, enabling autistic people and their families to finally get the support and services they deserved.
Study Addresses ‘Too Many Too Soon?’ Vaccine Concerns (Autism Speaks, 3-29-13)
On Vaccines and Autism: An Open Letter to Larry Wilmore (David Kyle Johnson, Psychology Today, 1-29-15) The Nightly Show's Larry Wilmore knows vaccines are safe...If you have an anti-vaccination advocate (i.e., anti-vaxer) on your panel, include someone who has the skills or knowledge to debunk her claims.
How My Daughter Taught Me that Vaccines Do Not Cause Autism (Juniper Russo, Voices for Vaccines)
Penn and Teller on Vaccines (video) Measles in Disneyland should be a wake-up call for the anti-vaccine movement. Will it? Magicians Penn and Teller do their part and show us why anti-vaccination is nonsense. (Warning: explicit language.)
Mercury, Vaccines, and Autism: One Controversy, Three Histories (Jeffrey P. Baker, Am J Public Health. 2008 February) The controversy regarding the once widely used mercury-containing preservative thimerosal in childhood vaccines has raised many historical questions that have not been adequately explored. Why was this preservative incorporated in the first place? Was there any real evidence that it caused harm? And how did thimerosal become linked in the public mind to the “autism epidemic”?
Vaccines for measles, mumps and rubella in children (Vittorio Demicheli et al., Cochrane Database of Systematic Reviews, 2-15-12)
Remember, vaccinations are about developing herd immunity to protect those who cannot be vaccinated. In many of these diseases, the patient is contagious before showing recognizable symptoms, so it isn't just a question of keeping at home the child who is sick. Vaccination isn't just about your child. It's about the kid with cancer down the street, the neighbor who had an organ transplant, and other kids who have a pregnant mom or newborn at home, and so on. (Hat tip to Erin Archer Kelser, Germ Nurse a writer who is a registered nurse, certified in infection control)
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The problems with the anti-vaccine movement

Article linking autism to vaccination was fraudulent. Fiona Godlee, editor in chief, Jane Smith, deputy editor, and Harvey Marcovitch, associate editor, British Medical Journal 5 Jan 2011. A 1998 Lancet paper, chiefly by Andrew Wakefield, implied a link between the measles, mumps, and rubella (MMR) vaccine and a “new syndrome” of autism and bowel disease. Clear evidence of falsification of data in that article should now close the door on this damaging vaccine scare, write BMJ's top editors. In a seven-part series, journalist Brian Deer shows the extent of Wakefield's fraud and how it was perpetrated. Others have criticized this series for being overhyped.
Fake news and distrust of science could lead to global epidemics (Heidi Larson and Peter Piot, Wired UK, 1-9-18) "Vaccines are one of the most important scientific inventions of all time, preventing millions of cases of disease every year and helping to consign once-deadly outbreaks to history. Yet these vital public-health tools are under threat from growing public mistrust in immunisation and the rise of so-called "fake news" drowning out expert voices. This "anti-vax" sentiment and pushback against scientific evidence threatens public health around the world, from measles outbreaks in the US and across Europe, prompting stricter vaccination laws, to persisting polio in Pakistan and Afghanistan. If this trend continues, 2018 could see a devastating resurgence of deadly diseases previously on the brink of eradication....These are disruptions that set back, rather than advance, scientific progress. Examples range from the 2017 WhatsApp and Facebook anti-vaccination campaigns in South India, which sparked fear and refusal of the measles rubella vaccine - some linked to now debunked autism anxieties around the MMR vaccine nearly 20 years ago in the UK - to similar social-media-propagated false rumours provoking vaccine refusals, measles outbreaks and diphtheria deaths in Malaysia. As a result of declining immunisation levels, between 2016-2017 Europe experienced 35 deaths due to measles, a disease that was nearly wiped out. All of those deaths were preventable."
The enduring appeal of conspiracy theories (Melissa Hogenboom, BBC, 1-24-18) In certain pockets of America, measles diagnoses have been spreading at previously unprecedented rates. Less than a decade earlier, measles had been largely eliminated in the US. The gradual resurgence can, researchers say, be directly attributed to people who were not vaccinated.
Anti-vaccine activists spark a state’s worst measles outbreak in decades (Lena H. Sun. WaPo, 5-5-17) The young mother started getting advice early on from friends in the close-knit Somali immigrant community here. Don’t let your children get the vaccine for measles, mumps and rubella — it causes autism, they said. Suaado Salah listened. And this spring, her 3-year-old boy and 18-month-old girl contracted measles in Minnesota’s largest outbreak of the highly infectious and potentially deadly disease in nearly three decades.
Misinformation lingers in memory: Failure of three pro-vaccination strategies ( Sara Pluviano, Caroline Watt, and Sergio Della Sala, PLOS One, 7-27-17) Beliefs in the autism/​vaccines link and in vaccines' side effects, along with intention to vaccinate a future child, were evaluated after three vaccine-promotion strategies were test, and the results reveal possible backfire effects. Existing strategies to correct vaccine misinformation are ineffective and often backfire, resulting in the unintended opposite effect, reinforcing ill-founded beliefs about vaccination and reducing intentions to vaccinate.
The Vaccine War (Frontline, PBS, 4-27-10) Public health scientists and clinicians tout vaccines as one of the greatest achievements of modern medicine. But for many ordinary Americans vaccines have become controversial. Young parents are concerned at the sheer number of shots — some 26 inoculations for 14 different diseases by age 6 — and follow alternative vaccination schedules. Other parents go further. In communities like Ashland, Oregon, up to one-third of parents are choosing not to vaccinate their kids at all. This is the vaccine war: On one side sits scientific medicine and the public health establishment; on the other a populist coalition of parents, celebrities, politicians and activists.
Distributors of Anti-Vax Film Are Trying to Keep an Autistic Rights Advocate From Criticizing It (Anna Merlan, Jezebel, 7-27-16). "Vaxxed is the anti-vaccination film made by Andrew Wakefield" and is shown "to breathless audiences who see Wakefield as a personal savior and believe the government is engaged in a vast coverup of the fictional autism-MMR link." Fiona O’Leary, an Irish mother of five, a woman with Aspergers syndrome and the founder of an organization called Autistic Rights Together, says the film “is spreading misinformation and harm.” "She’s also promoting a longshot petition addressed to Texas Attorney General Ken Paxton. It reads, in part: VACCINES DO NOT CAUSE AUTISM! VACCINES SAVE LIVES!"
How the case against the MMR vaccine was fixed (British Medical Journal)
The problems with the BMJ’s Wakefield-fraud story by Seth Mnookin
The Panic Virus: The True Story Behind the Vaccine-Autism Controversy by Seth Mnookin. Booklist review: "Over the last three decades, the incidence of autism spectrum disorder, better known simply as autism, has risen dramatically in the U.S., from approximately 1 in 1,000 children to 1 in 110, arousing widespread concern among parents and psychiatrists alike. A few of the many potential possible culprits scientists have targeted are faulty genes and thimerosal, a mercury-laced preservative in vaccines. Former Newsweek senior journalist Mnookin focuses his masterful investigative skills primarily on the latter, highly controversial possibility, illustrating how the current, misguided anti-vaccine movement can be blamed almost equally on panic-driven parents, sensation-hungry media, and PR-challenged health authorities. In making his case, Mnookin covers a wide swathe of medical history, from polio outbreaks to the scare tactics of fringe British researcher Andrew Wakefield, who first forged the dubious vaccine-autism link. While Mnookin dismantles this link convincingly, his argument that multivaccine cocktails have been proven safe is ultimately less persuasive. Still, he’s an able, engaging wordsmith, and this cautionary tale about misinformed medical alarmism is thoroughly compelling." --Carl Hays, Booklist.
Vaccines and autism (links to several articles)..

On Vaccines and Autism: An Open Letter to Larry Wilmore (David Kyle Johnson, Psychology Today, 1-29-15) The Nightly Show's Larry Wilmore knows vaccines are safe...If you have an anti-vaccination advocate (i.e., anti-vaxer) on your panel, include someone who has the skills or knowledge to debunk her claims.
How My Daughter Taught Me that Vaccines Do Not Cause Autism (Juniper Russo, Voices for Vaccines)
Anti-Vaxxers Are Using Twitter to Manipulate a Vaccine Bill (Renee DiResta, Wired, June 2015) One small, vocal group can have a disproportionate impact on public sentiment and legislation. Welcome to Anti-Vax Twitter.
Penn and Teller on Vaccines (video) Measles in Disneyland should be a wake-up call for the anti-vaccine movement. Will it? Magicians Penn and Teller do their part and show us why anti-vaccination is nonsense. (Warning: explicit language.)
Mercury, Vaccines, and Autism: One Controversy, Three Histories (Jeffrey P. Baker, Am J Public Health. 2008 February) The controversy regarding the once widely used mercury-containing preservative thimerosal in childhood vaccines has raised many historical questions that have not been adequately explored. Why was this preservative incorporated in the first place? Was there any real evidence that it caused harm? And how did thimerosal become linked in the public mind to the “autism epidemic”?
Seriously flawed’ study linking behavioral problems to Gardasil has been retracted (Rachel Feltman, WaPo,2-25-16) Retraction Watch reports that a paper published online in the journal Vaccine last month and temporarily removed weeks later has now officially been retracted.
Then again:
Values and vaccines ( Maggie Koerth-Baker, Aeon) Parents who reject vaccination are making a rational choice – they prefer to put their children above the public good Is vaccination a social obligation or a personal decision? Anti-vaccination may be rational but is it reasonable? Scientists personally think the trade-off between the small risks of side effects and the big benefit of herd immunity is a fair one, but it it’s easy to forget that our perspective on the trade-off is a belief, and not a provable fact. Scientists try to fight with facts, assuming the public just doesn’t know what’s going on, while the public gets angrier because it’s not being listened to. An interesting, thought-provoking essay.
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Other problems in the vaccine world


Freezing, shortages among global vaccine challenges (Center for Infectious Disease Research and Policy, CIDRAP, 3-30-17) A special supplement to the journal Vaccine published yesterday aims to measure the biggest challenges to global vaccine campaigns today, noting that vaccine stockouts—or complete unavailability of vaccines—occur at least monthly, while 19% to 38% of vaccines worldwide are subjected to improper refrigeration practices. Outmoded delivery systems could compromise the efficacy of vaccines, says Benjamin Schreiber, a senior health advisor with UNICEF. "Often a supply arrives in a capital city and has to travel hundreds of miles before it gets to the correct clinic or health center," Schreiber said in an interview. "We know a vaccine has to be kept stable at 2 to 8 degrees [Celsius, or 36°F to 46°F], but our data show that's not happening at least 20% of the time." Freezing is a problem that affects vaccines in both high- and low-income countries. Researchers also found that vaccine stockouts, or instances of running out of vaccine supplies, are a startlingly frequent occurrence in many parts of the world. One in every three WHO member-states experienced at least one stockout of at least one vaccine for at least 1 month each year. And 38% of nations in sub-Saharan Africa reported national-level stockouts annually.
Our Dogs Can Get Lyme Vaccines And We (Still) Can't. When Might We? (David Scales, WBUR, CommonHealth, 7-21-17) We "used to have a vaccine for Lyme, called LYMErix, but it was pulled from the market. Now, the only family member who can get a Lyme vaccine is your dog....Despite a good safety record in clinical trials, some people experienced what they thought were side effects and sued SmithKline Beecham, the manufacturer....While the official line is that poor sales led the vaccine's maker to pull it, most experts think the specter of lawsuits was a key factor. Though an FDA panel ultimately found no link between the vaccine and arthritis, SmithKline settled lawsuits making that claim. And by then, the vaccine was already dead....It will be years before a new Lyme vaccine could make it through FDA trials." See also The History of the Lyme Disease Vaccine on a website called The History of Vaccines (an educational resource of the College of Physicians of Philadelphia).
Years Before Heading Offshore, Herpes Researcher Experimented On People In U.S. (Marisa Taylor, Kaiser Health News, 11-21-17) Three years before launching an offshore herpes vaccine trial, an American researcher vaccinated patients in U.S. hotel rooms in brazen violation of U.S. law, a Kaiser Health News investigation has found. Southern Illinois University associate professor William Halford administered the shots himself at a Holiday Inn Express and a Crowne Plaza Hotel that were a 15-minute drive from the researcher’s SIU lab. Halford injected at least eight herpes patients on four separate occasions in the summer and fall of 2013 with a virus that he created, according to emails from seven participants and interviews with one participant. Offshore Human Testing of Vaccine Ignites Debate in U.S. (Rebecca Gibian, Real Clear Life, 8-21-17) An American university and a group of wealthy libertarians, including tech billionaire and Trump adviser Peter Thiel, are backing the offshore testing of an experimental herpes vaccine. Their actions defy U.S. safety protections for human trials, reports Kaiser Health News. With the debate over vaccination safety raging in the US, American researchers are increasingly going offshore (and away from current FDA regulations) to conduct clinical trials. Meanwhile, researchers at several universities and private research centers have been working on two different herpes vaccines under FDA and IRB oversight, one which is expected to undergo final trials by 2018. It will then be submitted to the FDA for approval.
Offshore Human Testing of Herpes Vaccine Stokes Debate Over U.S. Safety Rules (Marissa Taylor, KHN, 8-28-17) Defying U.S. safety protections for human trials, an American university and a group of wealthy libertarians, including a prominent Donald Trump supporter, are backing the offshore testing of an experimental herpes vaccine. The American businessmen, including Trump adviser Peter Thiel, invested $7 million in the ongoing vaccine research, according to the U.S. company behind it. Southern Illinois University also trumpeted the research and the study’s lead researcher, even though he did not rely on traditional U.S. safety oversight in the first trial, held on the Caribbean island of St. Kitts....The push behind the vaccine is as much political as medical. President Trump has vowed to speed up the FDA’s approval of some medicines. FDA Commissioner Scott Gottlieb, who had deep financial ties to the pharmaceutical industry, slammed the FDA before his confirmation for over-prioritizing consumer protection to the detriment of medical innovations.
Participants In Rogue Herpes Vaccine Research Take Legal Action (Marisa Taylor, Kaiser Health Network, 3-13-18) Three people injected with an unauthorized herpes vaccine by a Southern Illinois University researcher have filed suit against his company, demanding compensation for alleged adverse side effects from the experiments. SIU professor William Halford, who died in June, had injected Americans with his experimental herpes vaccine in St. Kitts and Nevis in 2016 and in Illinois hotel rooms in 2013 without safety oversight that is routinely performed by the Food and Drug Administration or an institutional review board.
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Vaccine information for medical professionals

The Vaccine Times
Vaccines News (Science Daily)
WHO says use of sole dengue vaccine should be curtailed (Helen Branswell, STAT, 12-22-17) The World Health Organization says use of the world’s only licensed dengue vaccine should be restricted because of concerns it increases the risk of severe disease in people who have never previously had dengue. See FAQs: Updated Questions and Answers related to the dengue vaccine Dengvaxia® and its use (World Health Organization, 12-22-17)
Concerns over one dengue vaccine raise alarms over others in development (Helen Branswell, STAT+, 2-2-18) Requires subscription to read.
Vaccine Shortage Complicates Efforts To Quell Hepatitis A Outbreaks (Stephanie O'Neill, Kaiser Health News, 11-14-17) San Diego County, battling a deadly outbreak of hepatitis A, is postponing an outreach campaign to provide the second of two inoculations against the contagious liver disease until a national shortage of the vaccine is resolved, the county’s chief public health officer said. “Our goal is to get that vaccine in as many arms as possible for that first dose...”
Another Way For Anti-Vaxxers To Skip Shots For Schoolkids: A Doctor’s Note (Ana B. Ibarra and Barbara Feder Ostrov, California Healthline, 9-5-17) Dr. Tara Zandvliet was inundated with calls and emails from parents last year, after California passed a law nixing personal beliefs as an exemption from school vaccinations. Suddenly, many parents sought exemptions for medical reasons. Someone even faked two medical exemption forms purportedly written by the San Diego pediatrician, copying a legitimate document she’d provided for a patient and writing in the names of students she’d never treated, she said. She learned of the forgeries only when the school called for verification. For families seeking exemptions without a health reason, perhaps because they’re misinformed or philosophically opposed to vaccines, Zandvliet takes the opportunity to educate them. Sometimes, she succeeds in getting reluctant parents to partially vaccinate their children, or to spread out vaccines over a longer period than the U.S. Centers for Disease Control and Prevention recommends. Not vaccinating all children could undercut the collective protection against contagious diseases that the state law seeks to bolster.
How Do You Change An Anti-Vaccine Parent's Mind? Scare The Crap Out Of Them (Tara Haelle, Forbes, 8-4-15) From that article: Zachary Horne, at the University of Illinois at Urbana-Champaign, and his colleagues proposed that “parents’ decisions to accept or refuse vaccinations for their children should depend on not only the risks associated with vaccinating, but also the risks of not vaccinating.” They point out that “it is often easier to replace an existing belief with an alternative belief rather than attempting to directly counter it.” In other words, don’t debunk. Tell another story.
In this study, "a random third of them were provided with three pieces of information, all from the CDC website: a mom’s description of her child contracting measles, three warnings about the dangers of not vaccinating and then three photos – a child with measles, a child with mumps and a baby with rubella. A second group received CDC website information summarizing the research showing that vaccines and autism are not linked. The third group, a control/​comparison group, simply read two paragraphs about the costs and benefits of feeding birds....in this new study, when the participants answered more questions about vaccines after reviewing the materials, those who read the mother’s account and saw the images did shift their attitudes. “Fear is an incredibly powerful motivator, and the anti-vaccine crowd has done a fabulous job of capitalizing on that knowledge,” Tannenbaum said. “We shouldn’t ignore that information when the fact of the matter is, there are already quite a few truly frightening motivators that fall on the side of encouraging vaccination. There’s nothing comforting and relaxing about real-life photographs of rubella.”
Mumps outbreaks are spiking — and raising questions about vaccine effectiveness (Helen Branswell, STAT, 3-29-17) Large and lengthy mumps outbreaks have been reported in multiple places across the US over the past couple of years and, worryingly, often among people who have been vaccinated against the disease. The reason for the resurgence is a mystery. The vaccine’s problems could be a double-edged sword — eroding the confidence of vaccine believers while shoring up the resolve of vaccine opponents.The most common symptoms are facial swelling, flu-like aches, and fever. The mumps virus is transmitted in saliva, and a number of factors affect how well it spreads. Living conditions where a lot of people share a space, drink from the same glass, share food, set people up for getting the mumps.
As more parents refuse vaccines, more doctors cut ties with families (Rebecca Plevin, Southern California Public Radio, 8-31-16) California is the third state in the nation – after Mississippi and West Virginia – to ban vaccine exemptions based on personal or religious beliefs. The most common concern of anti-vaccine parents in 2013 was that vaccines are unnecessary, according to a survey of pediatricians.. The authors of the report suggest this is because most parents of young children have little or no experience with vaccine-preventable diseases.
Countering antivaccination attitudes ( Zachary Hornea, Derek Powellb, John E. Hummela, and Keith J. Holyoakb, Proceedings of the National Academy of Sciences, 6-11-15) "Myths about the safety of vaccinations have led to a decline in vaccination rates and the reemergence of measles in the United States, calling for effective provaccine messages to curb this dangerous trend. Prior research on vaccine attitude change suggests that it is difficult to persuade vaccination skeptics and that direct attempts to do so can even backfire. Here, we successfully countered people’s antivaccination attitudes by making them appreciate the consequences of failing to vaccinate their children (using information provided by the Centers for Disease Control and Prevention). This intervention outperformed another that aimed to undermine widespread vaccination myths."

Physician Communication With Vaccine-Hesitant Parents: the Start, Not the End, of the Story (Julie Leask and Paul Kinnersley, Pediatrics, 5-26-15) Physicians should aim for both parental satisfaction and a positive decision to vaccinate.19 Researchers must continue to develop conceptually clear, evidence-informed, and practically implementable approaches to parental vaccine hesitancy, and agencies need to commit to supporting the evidence base. Billions of dollars fund the research and development of vaccines to ensure their efficacy and safety. There needs to be a proportional commitment to the “R&D” of vaccine acceptance because vaccines are only effective if people willingly take them up.

Working with vaccine-hesitant parents (Noni E MacDonald, Jane C Finlay, Canadian Paediatric Society, 5-3-13). How can health care providers more effectively engage vaccine-hesitant parents in a decision-making partnership? What follows are five important steps in this process.
1. Understand the specific vaccine concerns of the parent: Use motivational interviewing, ie, questions that are client-centred, semidirective and aimed at changing behavior.
2. Stay on message and use clear language to present evidence of vaccine benefits and risks fairly and accurately.
3. Inform parents about the rigour of the vaccine safety system.
4. Address the issues of pain with immunization.
5. Do not dismiss children from your practice because parents refuse to immunize.
In summary, dealing with vaccine-hesitant parents requires knowledge and skill. Health care professionals must understand parents’ specific concerns and take time to foster trust. This means presenting the evidence in a way that parents can understand it and showing compassion for the child. Taking the time to do these things well can mean the difference between a child being immunized or not.

Effective Messages in Vaccine Promotion: A Randomized Trial (Brendan Nyhan, Jason Reifler, Sean Richey, Gary L. Freed, Pediatrics, Feb. 2014) Refuting claims of an MMR/​autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/​autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects. (In short, as Felice Freyer puts it, information and images only caused parents who were doubtful to dig in their heels.)
Conclusions: Current public health communications about vaccines may not be effective. For some parents, they may actually increase misperceptions or reduce vaccination intention. Attempts to increase concerns about communicable diseases or correct false claims about vaccines may be especially likely to be counterproductive

There’s a surprisingly simple way to convince vaccine skeptics to reconsider (Carolyn Y. Johnson, Wonkblog, WaPo, 8-3-15) "Here is a depressing fact about facts: In the face of beliefs, they often have little power....A new study found that while it may be tempting to lecture someone that they're just wrong about vaccines and autism, it may be more powerful to simply tell and show them exactly what it's like when a child gets sick from a disease that could have been prevented....In a study published Monday in the Proceedings of the National Academy of Sciences, psychology researchers have found that a more effective way to persuade parents to change their attitudes about vaccinations is not to tell them they're wrong; It's to introduce new facts.[Parents were more likely to change their minds when given] "a parent's description of what it was like to have a child with measles, warnings about the importance of vaccination, and photos of a child covered with measles and rubella rashes, or a young boy's face horribly swollen by mumps. 'What’s going on with anti-vaccination parents, we think, is because they haven’t seen kids with measles and mumps, those consequences aren’t that real to them. And the other consequence, the purported link between vaccination and autism, is.'
How to address vaccine hesitancy: New AAP report says dismissal a last resort (Ruben J. Rucoba, American Academy of Pediatrics, 8-29-16). In a new clinical report co-authored by Dr. Jesse M. Hackell, the Academy has officially acknowledged for the first time that dismissal of a patient is an option in certain circumstances for patient families who categorically refuse vaccines. This story links to several related stories. Drs. Edwards and Hackell emphasize that dismissal should be undertaken only if these conditions are met:
The pediatrician has exhausted all means of education with the family.
The family has been made aware of the office policy concerning dismissal of non-vaccinators.
The geographic area is not in short supply of pediatric providers.
The practice continues to provide health care until the family finds another provider (usually 30 days).
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