Health and Science News for Parents

Safety of the Tdap in pregnancy and exploring the evidence for pertussis cocooning

written by Tara Haelle

I began writing this post almost two months ago when a study I had been waiting for almost a year came out – one looking for clinical, epidemiological (“real world”) evidence for “cocooning,” which I’ll explain in a moment. But now I’m kind of glad I didn’t finish it then because it’s perfect to combine with the study that just came out looking at the safety of the Tdap vaccine during pregnancy.

The Tdap is the adult booster for the tetanus-diphtheria-acellular pertussis vaccine. While the tetanus booster is important for everyone, it’s the pertussis, or whooping cough, protection that is a bigger issue at the moment because rates have been climbing in a big way over the past decade. I’ve written before about the reasons for that: primarily the waning effectiveness of the vaccine with some contribution from geographical clusters of low vaccination rates. I’ve also written about the insights we’ve gleaned from the “baboon study” which call into question how effective cocooning might be in preventing the littlest babies from catching the illness. And that’s all the more reason why both these studies are so important.

You ARE making sure I'm as protected from pertussis as I can be, right?

You ARE making sure I’m as protected from pertussis as I can be, right?

The most recent one, published in JAMA Nov. 12., looked at pregnancy and birth outcomes in women who received the Tdap during pregnancy. It offers reassuring conclusions: no increased risk of preterm birth or underweight babies occurred among mothers getting the prenatal Tdap, and no increased risk of high blood pressure in pregnancy among those getting the Tdap before 20 weeks of pregnancy. A moderately increased risk of the bacterial infection chorioamnionitis showed up in those getting the Tdap, which I’ll address in a bit, but with more than 120,000 participants in the study, it’s a large enough study to find these results reliable.

As I wrote over on Forbes today, the Tdap has been recommended by the CDC during between 27 and 36 weeks of every pregnancy – yes, *every* pregnancy, even back-to-back ones – since October 2012. The hope is that, since infants don’t receive their first DTaP vaccine to protect against pertussis until 2 months old, they will receive sufficient antibodies through the placenta during pregnancy to offer some protection in those first few months, especially since infants under 3 months old are at the highest risk for death from whooping cough. And indeed, as I noted on the Forbes piece, a small JAMA study earlier this year showed a much higher pertussis antibody concentration – an average five times higher – in babies whose mothers got the shot.

This recommendation replaced the one for postpartum Tdap vaccination, part of a “cocooning” strategy in which all the individuals who will be around an infant too young to be vaccinated – such as household members, caregivers and grandparents – get the Tdap booster. The concept is basically a micro version of herd immunity: reduce the risk that those around a baby will get sick and thereby reduce the risk that the baby will get sick.

The problem is that nearly all the studies looking at the effectiveness of cocooning has been based on mathematical models, not on real-life (epidemiological) evidence. The difference is that mathematical model evidence calculates how many cases *should* be prevented based on certain assumptions, including the assumption that a person who isn’t coughing doesn’t have pertussis and can’t transmit it to others. And the baboon study showed us that those assumptions cannot necessarily be made. (Caveat: the study was in baboons — we don’t *know* that that asymptomatic transmission occurs in humans too, but it’s something we have to consider as a possibility.)

For example, a study I wrote about a few years ago found mothers were almost four times more likely than other household members to transmit pertussis to their infants. The authors calculated a substantial theoretical drop in infant infections – cutting infant cases in half – if mothers were vaccinated. But this conclusion was based, again, on math models and assumptions.

Meanwhile, epidemiological evidence would show an actual reduction in disease cases from cocooning, something that’s been shown with other vaccines but not yet with pertussis. The only studies that came close were one finding that postpartum Tdap immunization didn’t reduce cases in infants (ie, the cocooning wasn’t working if just mothers were vaccinated) and one last year that found indirect evidence that adolescent boosters moderately reduced infant pertussis hospitalization, though these findings speak more to herd immunity than to cocooning.

So, the big question – especially after the baboon study – is whether cocooning is effective in protecting infants from pertussis. And the study in Pediatrics in September began to give us the first glimmer of an answer: cocooning is not futile, but its effectiveness appears much more limited than hoped. Read the rest of this entry »


Two sisters’ Kilimanjaro climb raises awareness for at-risk newborns

written by Tara Haelle

As I write this, two businesswomen are somewhere along the long trek up Mount Kilimanjaro, the tallest mountain in Africa. Although I don’t typically write about awareness campaigns, I wanted to give a shout out on this one because Kilimanjaro has a special place in my heart, and the women’s cause does as well. Sisters Natalia Luis and Cidalia Luis-Akbar are making the climb to raise awareness about the importance of earlier and more accurate screening and diagnosis during high-risk pregnancies, thereby hopefully improving survival and quality of life for newborns at risk for premature birth or other complications.

Natalia Luis and Cidalia Luis-Akbar are climbing Mt. Kilimanjaro to raise awareness about the need for improved diagnostics in high-risk pregnancies.

Natalia Luis and Cidalia Luis-Akbar are climbing Mt. Kilimanjaro to raise awareness about the need for improved diagnostics in high-risk pregnancies.

The women were sponsored by Children’s National Hospital in Washington D.C., whose public relations folks reached out to me with this story. Although the hospital has already raised more than $200,000, their goal is more than double that, at half a million dollars. According to the press materials for the climb (available here), “Children’s National will use funds raised through Natalia and Cidalia’s 2014 Trek to engage bioengineers and bio-computational specialists to develop a holistic ‘fetal monitoring system,’ building off existing work spearheaded by Adré Jacques du Plessis, Children’s National’s Chief of Fetal and Transitional Medicine.”

In short, the hospital is raising funds to complete their design of software capable of analyzing data from ultrasound, fetal brain MRI results, placenta research and other diagnostics, and their hopes are admittedly lofty: “The resulting technology and protocols will allow our team, and ultimately other healthcare providers across the nation and around the world, to identify distress signals in utero, halt the development of cerebral palsy, spina bifida, and other diseases before they start, and ensure a safe transition for every baby.”

That’s clearly a bit overblown with the PR language — I don’t think climbing Kilimanjaro to raise a half million dollars will stop cerebral palsy and spina bifida (which, by the way, is best prevented with adequate folic acid intake) — but I am curious about what the software might be able to provide in terms of long-term research since Children’s National does conduct ongoing research that may lead to improved outcomes. Sometimes more information is beneficial, and sometimes it is harmful (especially if it leads to unnecessary interventions and causes undue stress and anxiety), so my hope is that the data gleaned from the software can lead to evidence-based interventions or preventive strategies, not just more information and more interventions. Read the rest of this entry »


Pretty poison pods pose pediatric problems

written by Tara Haelle

Okay, so I admit I had a little fun with the headline, but that’s about all the fun I can have with this issue since the study I’m writing about is far from amusing. Research in Pediatrics last week investigated poisonings involving laundry detergent pods, and the numbers are a bit staggering, even to me. I’m not saying that to be alarmist – prevention in the home is mostly pretty straightforward – but when I did the math, a child under 6 is exposed to a laundry detergent pod once every hour, and about three out of every four calls involves the child ingesting the detergent. (You can read the full study for free.)

Photo courtesy the U.S. Consumer Product Safety Commission.

Photo courtesy the U.S. Consumer Product Safety Commission.

I didn’t coin the term “pretty poisons,” which is described in poison prevention tip sheets as poisons that look like tasty products to eat or drink, such as candy or juice, but it seems apt for the colorful detergent pods that make doing laundry a little more convenient. Consider the bright Jolly Rancher green of the ones from the Consumer Product Safety Commission pictured here – to an infant or toddler, who accounted for two thirds of the poisonings in the study – it could look like a sweet.

Researchers with Nationwide Children’s Hospital in Ohio analyzed data on all laundry detergent pod exposures in 2012 and 2013 in the National Poison Data System (pulled from all the poison control centers throughout the U.S.) for kids under 6 years old. The total? 17,230 exposures. (I use exposures as they do in the study since it’s technically possible, though unlikely, that the same kid had more than one exposure during that time.)

Not surprisingly, 74 percent of those cases involved children under 3 years old. The authors pointed out that 1- and 2-year-olds are developmentally primed to put darn near anything into their mouths. With their “newfound mobility, exploration, curiosity and teething,” they said, it’s the prime age for getting into stuff they shouldn’t. Among the 900 or so poison reports that included details on the scenario, just over 40 percent of the cases involved pods left out or in the child’s sight.

Most of the overall exposures – 80 percent of them – were kids eating or swallowing the detergent pods, so it was unsurprising that the most common problems were vomiting (about half of all kids) and coughing or choking (13%). Other problems kids suffered included eye irritation or pain, drowsiness and red eyes. Only one death, a 7-month-old boy, was definitively connected to a laundry pod poisoning, but more than 700 children (4.4% of the total) were hospitalized, and several dozen experienced some pretty serious effects: Read the rest of this entry »


Re-Entry: My confusing and overwhelming homecoming from Mozambique

written by Tara Haelle

I’ve been back in the U.S. just over a week, and I’m only just starting to get on top of my schedule (as much as that is ever possible, that is). The re-entry has been… I’m not sure how to describe it. In some ways it’s been rough, in others calming, in others disorienting. My head and heart have been swirling since I returned. The four long flights back — totaling more than 24 hours in the air — were relatively uneventful but exhausting nonetheless. Going from warmth and sunlight to cold and early darkness after the time change has been rough (more the light change than the temperature change). The jet lag has surprisingly been helpful, aiding me in a normalized sleep schedule for the first time in more than two years. (I’ve been aiming to be in bed by 1 a.m. — rather than my usual 3 or 4 a.m. — and out of bed by 9 a.m. While I haven’t met those goals daily, I’ve come closer than ever before for the past week, and I’m hopeful I can keep it up.)

feet on beach looking at crashing waves

Taking a break on the beach in Xai Xai, Mozambique — though it was a lot of work getting there and leaving in sand that sunk so deep with each step!

I was thrilled to see my husband and my children, of course, but it feels incredibly odd to simply drop back down in the comforts of my life in the U.S., into my mundane (if impossibly busy) family life in a small town in the Midwest after spending two weeks intimately observing some of the worst healthcare facilities in the world and some of the most extreme poverty in the world. Last Thursday, my son had a routine dental check-up, and it was impossible not to compare the clean, spacious, heated office, with a corner for toys and an elevator whose glass back overlooks an indoor fountain, with the facilities I observed: cervical cancer screenings in a cell-like, hot, poorly lit room with mosquitoes buzzing about and the cacophony of mothers and children waiting for care just outside the door. A labor and delivery room where the toilet I used, just 15 feet from a laboring woman, had no seat, no toilet paper, no trash can and no soap that I could find — though it had more than two dozen mosquitoes buzzing about. And so on.

At the same time, I’ve been struggling just to get back into the swing of work. Although these two weeks in Africa were intense and full of work themselves, my stateside work was obviously put on hold, and I had stories to write and deadlines to meet starting from the weekend I returned. And then there were all the studies and other stories that have came out in the past week or two that I wanted to write about even while recognizing that I can’t freeze time and write about them all. (Expect to see some of them here and some on my new Forbes blog as I’m able to slowly catch up.)

I also lamented that I had so much to say in this blog, so many impressions from our visits that I had wanted to write about while there and after returning, from my additional pumping adventures (wait ’til you hear some of those!) to my personal experience as a mom and journalist working for two weeks far from my kids to visiting a mobile circumcision unit, observing a cervical cancer screening, talking with multiple HIV-positive wives of the same man, conversing with mothers and grandmothers at the market and all the many other experiences that have informed my understanding of Mozambican life. Yet it’s been all I can do to meet my minimum obligations here in Peoria, spend time with my family and get sleep. Read the rest of this entry »


Halloween: The Scary Thing You Actually Need to Worry About

written by Tara Haelle

Today’s guest post for Halloween is from Rachel Drake, a community manager at Obrello, an insurance company. The inclusion of this guest post does not mean that I endorse the services of Obrello. I think the information is important, and it is evidence-based, so I am hosting the guest post.

Sure, Halloween is frightfully full of ghosts and goblins, or maybe Iron Men and Elsas, but most children and parents recognize that it’s an evening of fun. That does not, however, mean that there are no safety concerns to look out for.

With little people dressed up in costumes that may partially obscure their vision, running around in the dusk and dark along the street, getting hit by a car is a real concern. According to research compiled by the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System (FARS) from 1990-2010, more children die from being hit by a car on Halloween than on any other night of the year.

Child Pedestrian Fatality RatesImage from

And during what time frame do the most pedestrian accidents occur that night? Unsurprisingly, peak trick-or-treating times are the most dangerous for children, particularly from 5pm-8pm.
Image from

Some parents may worry about urban legends focusing on razor blades in candy or about their children running and tripping as they traipse from one house to the next. But car collisions are the perhaps the biggest risk.

Even though child pedestrian fatalities are trending down every year, the data is still harrowing. Parents can take two approaches to reduce the risk of children’s deaths on Halloween. During trick or treating, be smart about where you go and don’t let children under the age of 12 trick-or-treat alone. Then, when you are driving, take extra precautions and keep an extra careful eye out for trick-or-treaters who may not be watching for you.


Mozambican art exhibit offers stark visual of pediatrician shortages

written by Tara Haelle

I mentioned in my post yesterday that I would share the other exhibit at the National Museum of Art in Maputo that I most compelling. I originally included it with that post, but these images deserved their own. The second floor art installation, by artist Naguib Abdula, starkly reveals children’s limited access to quality health care in this country.

Eleven doctor coats, one for each province of Mozambique plus the capital city, had been stiffened and painted. On the base of each one is the population of that province. Inside the coat is the number of pediatricians in that province. For example, the province Niassa has one pediatrician. For 1.2 million inhabitants. There are five pediatricians in the province Nampula. Where 4.1 million Mozambicans live. See all of them below. Unsettling and effective.

Edited to add: My colleague here in Mozambique, Chrysula Winegar, has also written about the pediatrician coats exhibit with additional context, much of which we learned this morning at a UNICEF meeting. Please check out her short, informative piece!

IMG_0428 Read the rest of this entry »


Pumping adventures on the way to Mozambique

written by Tara Haelle

Remember the International Reporting Project (IRP) fellowship I said I had received to travel to Mozambique and report on child health and immunizations? Well, I’ve been here just under two days and have had the pleasure of meeting all the other awesome colleagues I’ll be working alongside. Tomorrow will be our first official set of program events, and I’m already excited to learn more about the country and the stories I can tell. Expect to see a number of updates about the trip from me here over the next two weeks, starting with today!

This incredible sculpture is outside an art museum in Maputo, the capital city of Mozambique.

This incredible sculpture is outside an art museum in Maputo, the capital city of Mozambique.

The trip over here was relatively uneventful, but catching four flights over two days was grueling: Peoria to Chicago to DC to Addis Ababa to Maputo. The trickiest part for me, though, was pumping. My husband, mother-in-law and mother are taking care of my 4-year-old and 7-month-old while I’m here, but I want to be able to continue nursing when I return, so I’m traveling with — ready for this? — four breast pumps. Yes, four. I have one fantastic hospital-grade Medela Lactina Electric Plus, for which I had to buy a converter since it’s 120V input only. But boy can that sucker pump well! I’m incredibly grateful to my lactation consultant, Kathy Ireland at OSF Breastfeeding Resource Center, for setting me up with it.

Then I brought two Ameda Purely Yours pumps because one is several years old and was much used, but the brand new one was acting up. I brought both because there may be times I’m without access to electricity (or when we’re out in the field for many hours), and both can operate on AA batteries. Of course, neither pumps very well, and I didn’t trust either one — hence bringing both. And then I brought a Medela hand pump. Just in case. Yea, I suppose I’m taking this preserve-my-milk-supply thing pretty seriously, but it’s important to me to be able to continue nursing my youngest through 1 year, and this trip is personally and professionally important to me, so this is as close as it gets to working moms’ “having it all,” I suppose.

However, I’m going to be tweaking my pumping schedule on an ongoing, as-needed basis, which started right away. I flew to DC via Chicago on Thursday afternoon and pumped that evening, but I didn’t get up early enough to pump before leaving for the airport the following morning. I left at 7am for an 11:15am flight, and Dulles was an hour from where I was staying. Seems reasonable, right? Well, the drive took over an hour, then check-in took WELL over an hour (long enough for me to write a whole story on my iPhone), then there was security, then there was catching the train to my gate, and then I finally arrived at the gate… a few minutes before boarding began. No time to pump.

So, I boarded and asked the flight attendants for help in finding an outlet. None in the bathroom. None in the seat (even though this was a Dreamliner). The only place there were outlets was beside an emergency exit door in the aisle. So with the help of the flight attendant, I sat in the jump seat, plugged in the pump and got set up. And then I proceeded to pump in the aisle of the plane while boarding continued. Good times. The woman in the row across from the jump seat was a nurse and was very sweet and helpful. When she pointed out that my container was overflowing, I realized I only had one choice if I wanted to continue pumping (and I had to given how long the flight would be and how long I’d already gone), so I disposed of the milk in the only reasonable way I could right there, and then I continued.

So, that was a couple of firsts wrapped into one. However, I have to say I was incredibly impressed with how understanding, helpful and accommodating the Ethiopian flight attendant women were. Three of them helped at various times, and several checked on me throughout the flight. I wonder if American airline flight attendants would have been as accommodating. For the rest of the 12-hour flight, I pumped just two more times because the battery operated Amedas (the outlets didn’t work in flight) were lousy, and it was super cramped to be standing in the plane bathroom for 20-25 minutes. Then I briefly pumped with the Ameda in the Addis Ababa airport “bathroom,” which I put in quotes because it was a plywood makeshift area encircling one stall and two portable sinks. I stood there as a long line of women used the restroom, some asking me about my baby and where he was, some looking surprised, some confused, some shaking their head (I’m not sure why, but I think it was in sympathy). Needless to say, I was grateful for that 5-hour flight to end and finally arrive at the hotel.

Since arriving, things have gone a bit more smoothly. We had a luncheon today with all the fellows, and it’s quite an incredible bunch we have here, each with diverse backgrounds, experiences and reporting interests. (Seriously, check out everyone’s bio! And follow us on Twitter with the hashtag #IRPfellows!) I’m already getting excited about reporting by talking to them, and I was relieved to hear some of them express some of the same anxiety I had about really making this trip count by finding and reporting on some good stories. (However, I already have some ideas I’m looking forward to pursuing.) I’ve also been especially thrilled to meet fellow Chrysula Winegar, also a mom and a blogger, who works with the UN on issues related to health and motherhood. She and I hit it off right away, and it’s nice to have another mom on the trip who “gets” what it’s like to be pumping and leaving the kids behind.

And, speaking of mothers, that’s a perfect transition to the piece of art that captured my heart today, the one in the photo above of a big, strong mother wearing her baby and carrying a book. This sculpture sits outside an art museum in Maputo, the country’s capital, through which we took a walking tour today. Seriously, what could be more perfect than that? Strength, pride, defiance, love, motherhood, education, learning… It’s such a lovely sculpture, and the kind I’d love to see outside an art museum in the U.S. The other piece of art I appreciated so much will be in my next post.



It’s Baaaaack! 33 Flu Vaccine Myths You Don’t Need to Fear

written by Tara Haelle

Brace yourselves: Flu season is coming! And with the coughing, fevers and aches come all the alarmist articles and blog posts on unreliable, misinformative websites questioning the flu vaccine’s safety and effectiveness. There are already some good posts out there that address some of these misconceptions about the vaccine so many love to hate (including the CDC’s own one), but none quite get around to addressing every last claim I’ve heard, and most don’t provide the citations right then and there to back up the accurate information provided.

And so I began this list last year, attempting to address every last myth about the flu vaccine I had come across and provide all the links needed to see where my information had come from. Admittedly, some of the “myths” aren’t exactly myths – they contain a morsel of truth in them – but they are misconceptions in that the morsel of truth has become twisted, misrepresented or misunderstood, and therefore important to address.fluvaxpic33

The post last year went unexpectedly, uh, viral, revealing just how much people are craving accurate information about the flu vaccine. Hopefully it convinced at least some people to get the vaccine since last season’s H1N1 strain hit young adults particularly hard. Either way, I’ve decided to update the posts for the 2014-2015 flu season. So far this year, of course, Ebola has upstaged the flu and stolen most of the headlines about a killer virus. But flu season has not really quite begun just yet, so it remains to be seen which one will dominate the media throughout the winter. What’s ironic is that the flu kills more people in one year – in the U.S. alone – than Ebola has killed ever in history worldwide.

But I’m already getting ahead of myself – I’ve bumped Ebola to #1 on this year’s list – so let’s get to it with two quick, important notes: First, for those who prefer to do their own research, I’ve provided all my sources in hyperlinks. More than half of these go directly to peer-reviewed medical research, and a fair number go to the Centers for Disease Control and Prevention or the World Health Organization.

Second, but very important: I am a science journalist but not a medical doctor or other health care professional. I’ve compiled research here to debunk common myths about the flu vaccine. You should always consult a reliable, trusted medical professional with questions that pertain specifically to you. For the CDC recommendations on the 2014-2015 flu vaccines (including information on which vaccines pregnant women, the elderly and children under 2 should *not* get), please consult the CDC flu vaccine recommendations directly. There are indeed people who should *not* get the flu vaccine.

To make it easier to navigate, I’ve listed all 31 myths at the top followed by the factual information in parentheses, which is also a link to jump to that explanation. I use “flu shot” and “flu vaccine” interchangeably to refer to any type of flu vaccine, including the nasal vaccine.

Myth #1: You should fear Ebola more than the flu.
Fact: The flu poses greater risk to you than Ebola.
Myth #2: You don’t need the flu vaccine this year if you got it last year.
Fact: You need a new flu shot each year.
Myth #3: The flu shot is a “one size fits all” approach that doesn’t make sense for everyone.
Fact: You have many flu vaccine options.
Myth #4: People die from the flu shot.
Fact: There have been no confirmed deaths from the flu shot.
Myth #5: Deaths from the flu are exaggerated.
Fact: Thousands of people die from flu in a typical year.
Myth #6: The flu vaccine gives you the flu or makes you sick.
Fact: The flu shot can’t give you the flu.
Myth #7: Flu vaccines contains dangerous ingredients, such as mercury, formaldehyde and antifreeze.
Fact: Flu shot ingredients are safe.
Myth #8:  Pregnant women should not get the flu shot. The flu shot can cause miscarriages. Pregnant should only get the preservative-free flu shot.
Fact: Pregnant women should get the flu shot. Fact: The flu shot reduces miscarriage risk. Fact: Pregnant women can get any inactivated flu vaccine.
Myth #9: Flu vaccines can cause Alzheimer’s disease.
Fact: There is no link between Alzheimer’s disease and the flu vaccine; flu vaccines protect older adults.
Myth #10: Pharmaceutical companies make a massive profit off flu vaccines.
Fact: They’re a tiny source of pharma profit.
Myth #11: Flu vaccines don’t work.
Fact: Flu vaccines reduce the risk of flu.
Myth #12: Flu vaccines don’t work for children.
Fact: Flu vaccines reduce children’s risk of flu.
Myth #13: Flu vaccines make it easier for people to catch pneumonia or other infectious diseases.
Fact: Flu vaccines reduce the risk of pneumonia and other illnesses.
Myth #14: Flu vaccines cause vascular or cardiovascular disorders.
Fact: Flu shots reduce the risk of heart attacks and stroke.
Myth #15: Flu vaccines can break the “blood brain barrier” of young children, hindering their development.
Fact: Flu vaccines have been found safe for children 6 months and older.
Myth #16: Flu vaccines cause narcolepsy.
Fact: The U.S. seasonal flu vaccine does not cause narcolepsy.
Myth #17: The flu vaccine weakens your body’s immune response.
Fact: The flu vaccine prepares your immune system to fight influenza.
Myth #18: The flu vaccine causes nerve disorders such as Guillain Barre syndrome.
Fact: Influenza is more likely than the flu shot to cause Guillain-Barré syndrome.
Myth #19: The flu vaccine can make you walk backwards or cause other neurological disorders.
Fact: Neurological side effects linked to flu vaccination are extremely rare (see Myth #18), but influenza can cause neurological complications.
Myth #20: Influenza isn’t that bad. Or, people recover quickly from it.
Fact: Influenza knocks most people down *hard*.
Myth #21: People don’t die from the flu unless they have another underlying condition already.
Fact: Otherwise healthy people DO die from the flu.
Myth #22: People with egg allergies cannot get the flu shot.
Fact: People with egg allergies can get a flu shot.
Myth #23: If I get the flu, antibiotics will take care of me.
Fact: Antibiotics can’t treat a viral infection.
Myth #24: The flu shot doesn’t work for me, personally, because last time I got it, I got the flu anyway.
Fact: The flu shot cannot guarantee you won’t get the flu, but it reduces your risk.
Myth #25: I never get the flu, so I don’t need the shot.
Fact: You can’t predict whether you’ll get the flu.
Myth #26: I can protect myself from the flu by eating right and washing my hands regularly.
Fact: A good diet and good hygiene alone cannot prevent the flu.
Myth #27: It’s okay if I get the flu because it will make my immune system stronger.
Fact: The flu weakens your immune system while your body is fighting it and puts others at risk.
Myth #28: If I do get the flu, I’ll just stay home so I’m not infecting others.
Fact: You can transmit the flu without showing symptoms.
Myth #29: Making a new vaccine each year only makes influenza strains stronger.
Fact: There’s no evidence flu vaccines have a major effect on virus mutations.
Myth #30: The side effects of the flu shot are worse than the flu.
Fact: The flu is worse than flu shot side effects.
Myth #31: The “stomach flu” is the flu.
Fact: The “stomach flu” is a generic term for gastrointestinal illnesses unrelated to influenza.
Myth #32: If you haven’t gotten a flu shot by November, there’s no point in getting one.
Fact: Getting the flu shot at any time during flu season will reduce your risk of getting the flu.
Myth #33: The flu vaccine causes Bell’s palsy.
Fact: The flu shot does not cause Bell’s palsy. Read the rest of this entry »


Ebola is in the U.S. Are we all going to die?

written by Tara Haelle

Yes, we are all going to die.

But not from Ebola.Screen shot 2014-10-01 at 2.10.40 AM

The media and social networks are understandably abuzz with the news that an individual in Dallas has become the first U.S.-diagnosed case of the Ebola virus. Ebola has no vaccine or cure and is an exotic, foreign disease. Pop culture descriptions of its symptoms have been, at times, over the top (to put it mildly, ahem Richard Preston). And then there are the frightening double digits of mortality rates, the “50% to 90%” I keep seeing cited on Twitter and Facebook.

(ETA) First, however, Ebola is not nearly as contagious as some people may fear it is. Measles and flu are much more contagious, and more dangerous. Read this *excellent* explainer at NPR’s Shots to understand how contagious Ebola is.

Yes, those who become ill with Ebola have a high mortality rate… IN AFRICA. Many diseases have far higher mortality rates in different African countries than in developed countries because the medical care, facilities, resources and availability of trained healthcare workers tends to be far greater in places such as North American and Europe when compared to most countries in Africa.

Here, in the U.S., safety protocols, equipment, resources and overall medical care are far superior. As Tara C. Smith writes in her fantastic piece at The Guardian, we got this. In fact, everything you need to know to maintain a measure of calm about Ebola in the U.S. is perfectly encapsulated in Dr. Smith’s article, so please, stop reading this, click this link, and read her article. She’s an infectious disease specialist. She knows her stuff. (She wrote a great piece debunking myths about Ebola in August.) She’s not worried. Neither should you be.

When you’ve finished that piece and taken a deep breath, read the excellent Q&A about what we do and don’t know concerning the Ebola patient in Dallas and this other Q&A about the outbreak in general. To further ease your mind, read about the disease on the CDC website, including transmission, risk of exposure and a general Q&A. I also published a previous Ebola reading list here. If you’re still worried, go back to Dr. Smith’s article and pay special attention to that part where she says your risk of dying in a roller coaster is greater than your risk of Ebola. (Risks of fatal bee stings, food poisoning and horse kickings are all greater than the risk of Ebola. And so is the flu, even though many people skip their opportunity to protect themselves against that pathogen.)

I understand the first instinct to panic. Again, Ebola is exotic and frightening. It is reasonable to be concerned about other people becoming infected with any disease. However, the level of fear and attention we devote to that concern should be in proportion to the risk. Right now, that risk with Ebola is minuscule, and therefore our concern should be minuscule. It’s not irrational to feel the fear when it’s a new, exotic disease. It is irrational to give into that fear and call for drastic measures that the facts and the risk do not justify.

My parents and my sister’s family live in the Dallas area. I mostly grew up in the Dallas metropolitan area and taught there. The vast majority of my friends live there. If there were a real threat, I would have good reasons to be concerned. But there is not a real threat, and I am not concerned. Again, neither should you be.

And with that, I’ll leave you with this ever-so-succinct infographic from Vox.


It’s flu shot season! And there are more options than ever before

written by Tara Haelle

It’s that time of the year again! I will be working on updating my massive post on myths about the flu vaccine over the next week, but in the meantime, I’ve gone and gotten my own flu vaccine. This year, I got the FluMist, the nasal vaccine, at Walgreens, which is running a pretty awesome promotion through October 13 called “Get a Shot. Give a Shot.” Partnering with the United Nations Foundation’s Shot@Life program, Walgreens will donate one vaccine to children in developing countries for every vaccine administered at one of their U.S. pharmacies. You can watch a video about the program below.

I got the nasal flu vaccine this year. Photo taken by an unnamed helpful pharmacy staff member.

I got the nasal flu vaccine this year. Photo taken by an unnamed helpful pharmacy staff member.

I expected the process to quite smooth, and it mostly was, except the delay when I realized my insurance plan frustratingly doesn’t consider Walgreens in-network. I can get a 50% reimbursement for the vaccine that I submit info for, but the only way for me to get a flu shot fully covered by my insurance was to go to my doctor’s office or find an in-network pharmacy (of which there is one, which I’ve never heard of, in Peoria). I could have headed to my doctor’s office, but I went ahead and paid out of pocket at Walgreen’s for a couple reasons. First, my boys were with me, and I wanted my older son to see me getting the vaccine that he’ll be getting on Thursday. The FluMist is quadrivalent, which means it contains all four strains recommended by the World Health Organization, and it’s more effective for children aged 2 to 8 than the injection is. (Note that children under 2, adults over 49, pregnant women and individuals with certain conditions should not get the FluMist because it’s a live vaccine.)

I also went with Walgreens because I really support their Get a Shot Give a Shot program. As I head off to Mozambique in a few weeks, I’ll be reminded of how many children in the developing world still desperately need vaccines and all the different agencies working together to make that happen. I am willing to pay a little out of pocket to support a business who is working with those agencies. Finally, the pharmacy staff at my local Walgreens is simply outstanding. They have always been very friendly and helpful, and they go out of their way to be accommodating whenever they can. It may not be a “local” business as part of large national corporation, but I am still happy to patronize any place where I am treated well.

As I mentioned, I got the FluMist because I wanted the protection of four strains. There is never a guarantee of which strains will be circulating, so every extra bit of protection is helpful, especially when the flu vaccine’s effectiveness varies considerably from year to year. The only injection the pharmacy had available was trivalent Fluvirin (covering three strains), and since I’m not pregnant this year, I’m able to get the live vaccine, thereby stimulating my immune system to develop antibodies against the following four influenza strains:

  • an A/California/7/2009 (H1N1)pdm09-like virus
  • an A/Texas/50/2012 (H3N2)-like virus
  • a B/Massachusetts/2/2012-like virus
  • B/Brisbane/60/2008-like virus

Unusually, these are the same strains as in last year’s flu shot, but I got the shot again because flu vaccines are not designed to provide immunity beyond a single season. Typically, this is because it’s expected that different recommended strains each year will require new formulations. In fact, the WHO has already announced new strains – different from this year’s – to be included in next year’s vaccine, including those to be used for the Southern Hemisphere (currently heading into summer) during the next flu season. However, even when the strains are identical from last year’s shot to this year’s, there is some evidence that immunity from the seasonal flu shot wanes over the year. While it’s certainly possible I still have antibodies for the three strains from last year’s shot, I would rather ensure that my immunity is as strong as it can be each season.

The FluMist is a quadrivalent live vaccine which is contraindicated for some conditions. Photo by Tara Haelle

The FluMist is a quadrivalent live vaccine which is contraindicated for some conditions. Photo by Tara Haelle

So, what flu vaccine should you get this year? The flu vaccine is still unfortunately not among our most effective vaccines, due largely to how many strains of flu exist and how the strains change over the year. However, it still reduces the risk of the flu anywhere from approximately 40% to 70% (ish) each year. Whether you are immunocompromised, allergic to eggs, afraid of needles or have some other limitation, there is likely a flu vaccine option for you. I recommend checking out this *excellent* Washington Post piece that runs through all the options: the basic (trivalent) flu shot, the quadrivalent shot, the nasal spray (quadrivalent), the high-dose vaccine (for older adults), the recombinant vaccine (egg-free!), the PharmaJet-delivered vaccine (trivalent, no needle!), and the intradermal shot.

As always, neither this blog nor the Washington Post article nor any other news article is doling out medical advice. Always consult your doctor regarding which flu vaccine is right for you and your family members.

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