The measles outbreak that began at Disneyland in December is officially over, the CDC reported last week. Between that announcement and this week’s European Immunization Week and National Infant Immunization Week in the U.S., it’s an opportune time to reflect on what the winter measles outbreak might mean in a broader social context in the U.S. As a high-income country with a comparatively well-developed health infrastructure and a Vaccines for Children program that ensures low-income children can get all their recommended vaccines, the biggest barriers to vaccination here are less often logistical or financial ones so much as they are psychological and ideological ones. Measles may be contagious, but, in a way, so is vaccine hesitancy. But just as containing a measles outbreak is exhausting, challenging, and complex, so is addressing the many concerns parents may have about vaccines.
The outbreak made a couple of things undeniably apparent: the small pockets of low immunization coverage that have begun to proliferate here and there throughout the U.S. – even if overall national immunization coverage rates have remained very high – really do pose a risk to the rest of the country. Although the majority of those who became sick with measles were unvaccinated, many of them had not received the vaccine because they were too young – babies who are more vulnerable to the serious complications measles can cause. Others had received the vaccine, but measles is so infectious that even a vaccine that works 95 to 98 percent of the time cannot protect everyone when an outbreak occurs.
Fortunately, no deaths occurred in the outbreak, which makes sense given the total number of cases and an estimated risk of death in 1 out of 1,000 to 2,000 measles cases (depending on how you calculate it and various factors influencing the rate). But media reports and social media postings of hospitalizations appeared sufficient to bring many parents into doctors’ offices to get their children the MMR (which was found once again this week not to increase the risk of autism spectrum disorders). It’s too soon for any studies to have scientifically assessed how the outbreak influenced parents’ attitudes or kids’ catch-up visits or families switching from not vaccinating to vaccinating, but anecdotal evidence from dozens of doctors I spoke to and in media reports implied that the outbreak hit home for a lot of parents who finally realized the threat measles can pose when immunization coverage drops in local communities.
On the other hand, the outbreak unleashed the fury of those parents who had previously comprised the silent majority: the ones who vaccinated their children according to the CDC schedule, who recognize the safety and effectiveness of vaccines, and who are fed up with the increasing risks posed by parents choosing not to vaccinate. It is reasonable for a person to have the right to choose what risks they want to take on for themselves and their families with medical interventions, but how do we balance that risk against the right of others not to get ill from a disease that can cause far more damage than the vaccine that can prevent it? That was the question that raged (and still does) in headlines, op-eds, blogs, comment threads, social media, and parenting groups. Read the rest of this entry »
Yesterday, April 12, marked the 60th anniversary of the announcement that Jonas Salk‘s inactivated polio vaccine was “safe, effective and potent.” It’s somewhat difficult to imagine today the kind of effect that news had. I’ve written about that day and the days leading up to it – and the tragic days that followed a few weeks later with the Cutter incident – over at Forbes, which I hope you’ll check out.
In the meantime, I’ve pulled together a couple images, all in the public domain, from that time that show just how monumental the moment was.
For more images, check out the photo gallery at the Academy of Achievement website
Welcome back, Brontosaurus! An opportunity to explain the scientific process to your dinosaur-loving kids!
Remember how heartbroken you were when you found out they demoted Pluto? Well, a new investigation of paleontological evidence might just make up for it… Brontosaurus is back! A massive 300-page study in the open-access journal PeerJ has made the case that Brontosaurus should once again become its own genus, distinct from the genus Apatosaurus. Rather than summarizing the tortured history of the massive sauropod, I’ve included an infographic below with the timeline of Brontosaurus’s discovery, re-extinction, and now its return.
The short version is that in the mad rush to discover new species of dinosaurs in the late 19th and early 20th century, there was sometimes confusion about whether a specimen was new or simply another individual of a species already discovered. The first Brontosaurus, or “Thunder Lizard,” was found and named in 1879, but just a few decades later in 1903, it was determined that the two species of Brontosaurus were not different enough from the species of Apatosaurus that had been discovered, so the former were folded into the genus Apatosaurus. The genus Brontosaurus then ceased to exist since Apatosaurus had been named first. (There is much more to the story, which is worth learning if you’re going to discuss this with your children. You can read a more detailed version of the story in the study’s press release, though be warned that the press release is a little over-the-top.)
Fast forward to today: Without getting into the weeds too much, three researchers – Emanuel Tschopp, Octávio Mateus, and Roger B.J. Benson – examined all the evidence available on the bones of dinosaurs in the family Diplodocidae to find commonalities and differences in the morphology (an organism’s structure) of different specimens. To say they were thorough would be an understatement. When I sent the paper to paleontologist Dana Ehret, Curator of Paleontology for the Alabama Museum of Natural History, to confirm that it was legit, his first line in his email back to me was “This paper is a monster!” That’s a good thing – it’s just under 300 pages long. And again and again in the evidence they reviewed, the Brontosaurus emerged as its own unique genus. So then they took the traits of the bones they identified as grouping together as Brontosaurii and determined what characteristics make up the now-resurrected genus Brontosaurus. Read the rest of this entry »
We’ve had a bad run of illness in the past several weeks, and that’s meant measuring out acetaminophen, ibuprofen, an antihistamine, an anti-nausea medication, an oral steroid, and a medication for reflux at different times for one kid or the other. In the midst of all this, a mistake was bound to happen, and it did. We’ve gotten pretty good at communicating between ourselves and others who watch our children regarding whether and when a dosage has been given, therefore avoiding a double (or triple!) dose. But the bottles look alike and the labels don’t always specify what symptoms the medication treats. So my youngest was given 5 mL of his reflux medicine — except he’s only supposed to get 1 mL of it; it was mistaken for the steroids he was prescribed (which he does get 5 mL of). So he ended up with five times the dosage he was supposed to get for the reflux meds. Fortunately, a call to the nurse line and then poison control let us know he would be fine and that we didn’t need to take him to urgent care to get his stomach pumped.
But other kids aren’t so lucky. I reported last fall on a study in Pediatrics which found that medication errors outside of a medical setting are incredibly common – on average, they occur every 8 minutes. While the vast majority are like ours, not requiring medical treatment, a small percentage do required critical care, and even more rarely, some result in death. Another study found that more than 70,000 children a year end up in the emergency room because of an accidental overdose, and two of the most common reasons are incorrect measurement and using the wrong measuring device. A new policy statement from the American Academy of Pediatrics aims to address at least part of that problem by encouraging all medication measurements to be prescribed in metric, specifically in milliliters, or mL.
I wrote about this policy statement at HealthDay already, so here I’ll just hit the highlights, and they’re really pretty straightforward: no more teaspoon of this or tablespoon of that. Now it’s all milliliters, preferably using a syringe (which usually comes with the medication), and only using one of those small measuring cups if a syringe isn’t available. Here are the key recommendations:
- Exclusively use milliliters and exclusively use “mL” as an abbreviation
- Don’t have any measurements except mL on a dosing device
- Round to the nearest 0.1, 0.5 or 1 mL
- Use a zero before the decimal (0.1 instead of .1) but no zeroes after the last digit after the decimal (0.5 instead of 0.50) to avoid giving ten times the dose
- Frequency of dosage should be clearly described on the label
Another of the recommendations actually would have prevented the error that occurred at our house if we had kept each syringe with its respective medication. The recommendation that pharmacies, hospitals and health centers should distribute appropriate-volume dosing devices also suggests, “When possible, dosing devices should not be significantly larger than the dose described in the labeled dosages to avoid twofold dosing errors.” The syringe that went with the reflux meds only went up to 2 mL. The larger syringe for the steroid medication went up to 5 mL. Of course, ours was a fivefold error rather than a twofold one, but had we kept the right syringe with the right medication, it would have been impossible to give him five times the dose.
These new recommendations are not all that new. Many practices, such as that of Dr. Roy Benaroch (whom I quoted in the article and who blogs at the highly recommended Pediatric Insider), have already been exclusively using metric. But by publishing this official statement, the AAP hopes to standardize this practice across the U.S. and banish the teaspoon (which was often just a kitchen spoon, varying in size and volume) as well as a large proportion of the medication dosing errors that occur each year. This practice won’t eliminate all those errors. But it has the potential to cut out a huge chunk of them if doctors fulfill their role in educating patients and parents, and parents are conscientious about measuring. At the very least, we’re one step closer to using the same measuring system that every other country on the planet uses.
As I wrote about at Forbes today, PBS Frontline aired an updated version of their 2010 documentary “The Vaccine War” last night, including information about the current measles outbreak that started at Disneyland and the legislative effort in California to roll back personal belief exemptions for vaccines that allow parents to opt out of getting recommended vaccines for school attendance. During the show, discussion on Twitter followed the hashtag #VaccineWar. Most of those participating had been invited to do so by the digital content manager at Frontline.
I had also been invited to participate, but I declined. For one thing, spending my time, unpaid, to provide free marketing to a documentary airing on a publicly funded medium is inappropriate in my opinion. But above and beyond that, the email invitation mentioned that PBS Frontline was seeking people “from all sides” of the issue. So I asked for clarification about what that meant. The first response was not specific enough, so I spelled out my question in my second email: “I’m sorry to belabor the point, but I’m still not clear on what kind of diversity you have invited. I suppose I should be more blunt. Have you invited people who explicitly believe that the risks of vaccines outweigh the benefits? Have you invited [list of four known anti-vaccine activists who propagate misinformation] or similar individuals?”
I received the following response: “I guess my email wasn’t to the point enough. Yes! We are looking to include more people who specifically believe that the risks of vaccines outweigh the benefits. We are still reaching out and adding to our list.”
Those who follow my work know my deep concerns with false balance in the media on scientific issues. Therefore, I wrote the following response back:
“Thank you for the clarification. I will have to decline participation in the event because it sounds as though it will be counterproductive and confusing to parents who see it, and I am not comfortable in participating in something that can cause damage to public health. You mentioned in your original email that you were seeking informed discussion on Twitter about the film, but specifically seeking individuals who hold a non-science-based belief that is counter to the evidence to participate would not lead to an informed discussion. It will only lead to the confusing back-and-forth “debate” that further confuses and isolates parents, and that is not something I can participate in in good conscience. I have spent a great deal of my writing discussing the perils of false balance — see the links below — and I will not participate in a program specifically designed to contain false balance. When you present “both sides” as equally valid despite a consensus of scientific evidence on one side and a combination of cherry-picked, misunderstood, non-representative papers or anecdotes on the other side, you do a disservice to parents and to public health. In fact, as Curtis Brainard excellently covered at the Columbia Journalism Review, the media has already played a pernicious role in the current levels of vaccine hesitancy: “Sticking with the truth: How ‘balanced’ coverage helped sustain the bogus claim that childhood vaccines can cause autism”: http://www.cjr.org/feature/
Peer reviewed research has further shown the damaging effects of inaccurate or misleading comments made online which reflect beliefs instead of facts, which is exactly what will be brought by those who believe incorrectly that vaccines’ risks outweigh their benefits: http://www.sciencedaily.com/
The tenor of comments can play a role as well, and when those who refuse to accept the scientific consensus on vaccines participate, the tenor often becomes unpleasant, which can also influence parents’ perception of vaccine science. See: http://www.nytimes.com/2013/
Why Is Katie Couric Promoting Vaccine Skeptics?: http://www.politico.com/
Discussions about vaccination have always been fraught, particularly over the past decade, but the tenor of the national discussion has intensified since the Disneyland outbreak this winter has jumpstarted the nation toward what’s likely going to be a record year of cases since measles was eliminated in 2000.
Yet measles cases aren’t going to stop occurring because we’re shouting at one another. Much of the anger and vitriol spewed in both directions is likely only to further polarize the discussion about vaccinations and leave sincerely concerned, confused, uncertain parents in the middle left without any sense of what they should do to protect their children’s health. In fact, many of the misconceptions that exist about parents who don’t vaccinate or delay vaccinations can do as much damage when it comes to “fence-sitting” parents as anti-vaccine misinformation that may lure those parents in when they feel alienated by the “pro-vaccine” groups.
I don’t consider myself pro-vaccine, and I never have. I consider myself pro-science, pro-evidence, and pro-science-based and evidence-based data and information. Now, in one of the most vitriolic settings for vaccine discussions, there is finally a place for parents to get accurate, science-based, evidence-based information about vaccines without risking mockery, snide comments, sarcastic jokes, judgmental advice or any of the other turn-offs that make it difficult for parents just to ask a question: The Vaccine Page.
As the page’s description states, “We have seen a need for a place to come with questions and concerns where parents can trust that they will not be mocked, bullied, criticized or intimidated.” As this attitude is something I’ve promoted for a long time, it won’t surprise any readers here to hear I’m involved with The Vaccine Page. The pretty bluntly named page came out of discussions with three other moms who find the bitterness of vaccine discussions as frustrating and damaging as I do, and we joined together to change that. We recruited one heck of a team, if I do say so myself, that runs the gamut of clinicians, moms, researchers and advocates. And we offer something unique that, to our knowledge, doesn’t exist anywhere else in social media: a page providing accurate information with all disclosures and qualifications, in plain language, without judgment — and we don’t allow others to pile on either. Read the rest of this entry »
At last, the book has been written (and the editing process has begun), so I will soon be able to return to regular posts. Today I’m sharing a great infographic about measles and the MMR vaccine, developed by Sylvia Wood. Her original graphic, where she also lists references, can be found here.
No naps. Period. No matter what. Not even for 15 minutes. That was the guideline we conveyed to my son’s childcare center starting sometime around his second birthday. It had nothing to do with any research we had read. In fact, we didn’t know much at all about children’s naps at all. All we knew that was that bedtime became even more, let’s say “challenging,” than usual (and it was already practically a 2-hour ordeal, despite following a set routine each evening) when our son napped during the day.
Each time he moved up to a new class at the childcare center, we would convey this information as firmly as we could during parent-teacher conferences. The teachers would remind me that they were required by company policy to have all children sitting on their cots during nap time, even if they didn’t nap. I said that was fine – as long as my son didn’t sleep. Could they give him some books? Let him play with some cars? Let him work on something the kids had done earlier before I’d dropped him off? And if he happened to fall asleep, could they please, please, please wake him up?
We knew every single time when they didn’t. I suppose they didn’t realize, despite our attempts, how important our request was, or else they just didn’t believe us. It would happen a couple times in each new classroom. I would come in the day after and casually ask, “So, do you remember if D happened to fall asleep during nap yesterday?” They would think back. “Um, yea, come to think of it, I think he did nap yesterday.” Or, “Um, yea, I think he fell asleep for just 15 minutes at the tail end of nap time, that’s all.” I would smile tightly. “That’s all.” Sigh. “Yes,” I would say. “I thought so. He went to bed at 1 a.m. last night.” Their face would contort into disbelief. ONE?! ONE A.M.?! Yup. 1 a.m. If our son fell asleep, even for 15 minutes, during the day, we knew we were in for it, and if he slept without our knowledge, we found out the hard way and lost four or five hours to the battle. (And this was even while using melatonin.) Sometimes we were lucky and it was midnight, but that was always the early side if he napped during the day. Even for 15 minutes.
And so, that’s my massively long anecdote to introduce the study out today that – Hallelujah! – actually provides some evidence for our experience! It was so lovely to discover it wasn’t just us – this is actually a “thing.” What makes this study all the more interesting is that it’s a systematic review, not a single study. The authors reviewed 26 studies about daytime naps in children up to 5 years old, looking at all kinds of outcomes: cortisol levels (stress hormone measurement), nighttime sleep, behavior, obesity, frequency of accidents, and cognitive skills. But only one finding consistently popped up across the studies: daytime naps were linked to falling asleep later, sleeping less time overall at night, and sleeping more poorly, particularly among children older than 2. Read the rest of this entry »
Hello readers! It probably seems odd for me to be so quiet in the midst of the current measles outbreak, but I’ve been immersed in book writing until the past few days. As I continue wrapping up loose ends after finishing up the writing of the book, I’m publishing a guest post by occupational medicine doctor Donald Bucklin. The post below represents only Dr. Bucklin’s perspective. I have not paid him to write the post, and he has not compensated me for publishing it. Enjoy!
I was listening to National Public Radio (NPR) one morning and they were giving an update on the Ebola epidemic in Guinea.
That epidemic has killed thousands of West Africans in the past year, and superstition and misinformation still rule the country. Many in Guinea still believe Ebola doesn’t exist, or the vaccine is part of some CIA plot that western countries are pushing.
Others believe the sick are carted away and quietly dispatched. People hide when they’re sick because of these beliefs. No one wants to expose their family and friends to the very real possibility of Ebola and death.
Living in the modern world, a wealth of scientific information is just one click away, and yet some people are effectively making choices based on superstition and mumbo-jumbo.
How could that be? Very easily is the answer. It’s happening right now in the U.S. where a measles outbreak, that started in Disneyland, has resulted in more than a 100 cases in at least seven states and stirred up the controversial issue of mandatory vaccinations.
Measles is nothing to take lightly. It’s a viral disease that is pretty bad, and is highly infectious. Approximately 90 percent of unvaccinated people living in a house with someone with measles becomes infected.
Neither Ebola, HIV nor TB have anywhere near that kind of infection rate. Measles is hard to avoid because an infected person spreads the virus for several days before they are even sick.
And sick you are – highlighted by a fever up to 104º F, cough and head congestion, and a rash all over your body that itches like crazy. Welcome to Dante’s 7th Circle of Hell!
Pneumonia and meningitis are common complications from measles, and otherwise healthy people sometimes die of it. In the past (pre-vaccine days) measles killed tens of thousands of people in the U.S.
Unlike smallpox, measles has not been eradicated from the planet; it is still around.
We have had a good and very effective measles vaccine for 40-plus years, thanks to a guy named Maurice Hilleman, who developed the vaccine. He saved more lives in the 20th century than any other scientist (including doctors).
That whole theory is based on a totally discredited British Lancet study released in 1998. It was simply bad science and has been proven wrong numerous times. Every scientific organization has renounced this supposed vaccine-autism link.
The MMR/autism link is simply the black glove in the OJ Simpson trial. It’s a distraction and not the truth.
They are now testing two vaccines against Ebola that look pretty promising. That leaves many of us optimistic that we can stop this deadly disease and halt its epidemic nature.
Fortunately, we’ve already found the right vaccine for smallpox, measles, mumps and many other once dangerous diseases. Let’s hope we can add Ebola to the list, but let’s also hope we can continue to keep vaccination rates high for those diseases we can already protect against.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.
I’ve been so immersed in finishing up the book that I’ve been unable to devote much time, attention or writing to the ongoing measles outbreak that stemmed from exposures at Disneyland. BELIEVE me I have a lot to say, and my mind has been swirling, but I’ve been forcing myself to remain focused on the book. That said, one of the pieces going around that is especially poignant is something I couldn’t pass up sharing. You’ve likely already seen it, but just in case you haven’t, you need to read the letter famed children’s author Roald Dahl wrote in 1980 as children were dying from measles – a disease for which a highly vaccine had been available for decades. In fact, the vaccine became available the year after Dahl’s oldest daughter died in 1962 from a complication of this illness. Dahl is author of Willy Wonka and the Chocolate Factory, James and the Giant Peach, and other favorites you’ve likely read.
“Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.
“Are you feeling all right?” I asked her.
“I feel all sleepy,” she said.
In an hour, she was unconscious. In twelve hours she was dead.
The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.
On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.
It is not yet generally accepted that measles can be a dangerous illness. Believe me, it is. In my opinion parents who now refuse to have their children immunised are putting the lives of those children at risk. In America, where measles immunisation is compulsory, measles like smallpox, has been virtually wiped out.
Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunised, we still have a hundred thousand cases of measles every year. Out of those, more than 10,000 will suffer side effects of one kind or another. At least 10,000 will develop ear or chest infections. About 20 will die.
LET THAT SINK IN.
Every year around 20 children will die in Britain from measles.
So what about the risks that your children will run from being immunised?
They are almost non-existent. Listen to this. In a district of around 300,000 people, there will be only one child every 250 years who will develop serious side effects from measles immunisation! That is about a million to one chance. I should think there would be more chance of your child choking to death on a chocolate bar than of becoming seriously ill from a measles immunisation.
So what on earth are you worrying about? It really is almost a crime to allow your child to go unimmunised.
The ideal time to have it done is at 13 months, but it is never too late. All school-children who have not yet had a measles immunisation should beg their parents to arrange for them to have one as soon as possible.
Incidentally, I dedicated two of my books to Olivia, the first was ‘James and the Giant Peach’. That was when she was still alive. The second was ‘The BFG’, dedicated to her memory after she had died from measles. You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children.”