Vaccines and vaccinations


Vaccine basics

Vaccines basics (Vaccines.gov)
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.
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.
Why immunize? (CDC)
Pregnant women need a flu shot (CDC)
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 benefits.
Vaccines and immunizations (Centers for Disease Control and Prevention Immunization schedules for children and adults
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) See Carr's suggestion for possible ways to save money.
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."
State vaccination requirements (CDC)
History of Vaccines. An educational resource by the College of Physicians of Philadelphia]
New Vaccine Recommendation Cuts Number Of HPV Shots Children Need (Michelle Andrews, KHN, 3-28-17)
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.
Antibodies: Friend & Foe (Thomas Packard, Healthcare in America,12-29-16)
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
CDC Vaccine Price List (Vaccines for Children Program (VFC)
Viral Hepatitis: New U.S. Screening Recommendations, Assessment Tools, and Treatments (Corinna Dan et al., American Journal of Nursing, July 2015)
Is less effective pertussis vaccine the “new normal”? (Erin Archer Kelser, Germ Nurse, 7-20-15) Because the current vaccine may not be fully protective, providers and the public need to be aware of early symptoms, how to prevent disease spread, early treatment options, and the need for post-exposure prophylaxis if exposed.
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.

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.”
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Conditions for which immunization should be broadened

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.
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."
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.
For Immunization Managers (CDC, various resources, including vaccination coverage articles and reports)
Immunization Action Coalition (IAC). See Ask the Experts
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.”
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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 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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Measles and measles vaccines


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."
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.

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.

Talking to Vaccine Resisters (Seth Mnookin, New Yorker, 2-4-15) Mnookin is author of the book The Panic Virus: The True Story Behind the Vaccine-Autism Controversy

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.

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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Autism and vaccines

Vaccines Don't Cause Autism (Sabin Vaccine Institute).
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.
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 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.
Why Facts Don't Change Our Minds (Elizabeth Kolbert, New Yorker, 2-27-17)
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)
The Panic Virus, Seth Mnookin's blog on PLOS (the Public Library of Science). Mnookin's book: The Panic Virus: The True Story Behind the Vaccine-Autism Controversy. 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.
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.
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.
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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Vaccine information for medical professionals

The Vaccine Times
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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