Health and Science News for Parents
Mar
18

Measles, Schools and Selective Exemptions: Competing Approaches to Preventing Outbreaks

written by Tara Haelle

Today’s post is a guest post by Dorit Rubinstein Reiss, a professor of law at the University of California Hastings College of Law. She discusses two editorials published in Pediatrics today that address concerns about school exemption policies and preventing vaccine-preventable disease outbreaks. This post does not necessarily reflect the views of this blog or me, Tara Haelle. I have invited Dr. Reiss to offer her commentary because this is her area of expertise, and she does an effective job of explaining and exploring the concepts discussed in the editorials. This article will also be co-posted at Skeptical Raptor later today.

The best way to increase immunization rates and protect a community from outbreak is anything but settled. Serious, thoughtful, pro-vaccine policy scholars and policy makers disagree on whether it’s better to remove all non-medical exemptions, tighten exemptions, and so forth. A new proposal takes the discussion in a different direction.

smiling infant wearing a yellow shirt with a kiss graphic that says "You can kiss me. I'm vaccinated."

Public health officials agree on the need to ensure as many children as possible are vaccinated. But the question of how to get there is a different story.

In a recent article in Pediatrics, Childhood Vaccine Exemption Policy: The Case for a Less Restrictive Alternative, Douglas J. Opel et al. made a case for limiting non-medical exemptions for the measles vaccines only. The authors explained that “Our goal is simple: to see as many children immunized as possible.” However, they don’t think removal of nonmedical exemptions is the way to get there. While acknowledging alternatives – making non-medical exemptions harder to get, or enforcing current laws better – their contribution is to offer a new alternative: allowing non-medical exemptions to all vaccines except measles vaccines, and removing non-medical exemptions for those.

This post examines their arguments. For each argument it explains the authors’ claims, the response editorial’s rebuttal, and adds some thoughts. In short, while the proposal is interesting and enriches the debate, its drawbacks, in my view, far outweigh its benefits.

Why do Opel et al think removing non-medical exemptions from measles vaccines only is a good idea, superior to removing all non-medical exemptions?

Measles is an unusual case

The authors argue that there is scientific justification to treat measles differently than other diseases because measles is unusually contagious, requiring high rates of herd immunity. In addition, measles is severe enough and outbreaks common enough that measles is a significant threat to the public health. The measles vaccines is also both safe and effective at preventing outbreaks. Other vaccines are also generally safe, but for example, the pertussis component of DTaP isn’t as effective at preventing outbreaks.

In their response, Childhood Vaccine Exemptions: A Broader Perspective is Required, Byington et al disagree. They point out that diseases with low RO – less infectious than measles – can cause extensive harm and be harmful, even deadly. Such diseases did, in fact, causes thousands of deaths (and led to hundreds of thousands of cases). While the required rates to prevent measles are high, herd immunity thresholds for other diseases are hardly low, ranging in the area of about 85-94%. Since school immunization requirements are extremely effective at preventing disease, the authors imply we should use them to the extent possible – without non-medical exemptions – to prevent these other dangerous diseases. The authors don’t say it in those words, but I think it’s a fair reading of their argument, and I agree with them.

On the other hand, there is a potential argument that the proposal does not immediately mean return of preventable diseases. Most people vaccinate even in states that have easy to get exemptions, though the rate of exemption is higher in those states than in those with hard to get exemptions. The need to get at least one vaccine would remove exemptions of convenience, keeping rates high.

I think this argument is a little tricky, since the rates of people who vaccinate selectively or on a delayed schedule are higher than of those who are completely non-vaccinated. Limiting removal of non-medical exemptions to measles vaccines would not necessarily assure rates of other vaccines remain high. The concern that this will lead to a drop in immunization rates for other diseases – a concern the authors themselves acknowledge – is very real.

While it’s hard to disagree that measles is unusually contagious, I do not think the natural conclusion is that it is more important to prevent it than other preventable diseases, to the tune of removing non-medical exemptions for measles vaccines only. As Opel et al themselves highlight, some of the other diseases are more deadly or harmful than measles. The combination of measles’ contagiousness and the effectiveness of the vaccine not only creates a strong argument for maximizing rates to prevent it – and I agree with the authors on that – but make it a good canary in the coal mine. Return of measles can be a warning sign – rates are dropping to a degree where the population starts to be vulnerable to outbreaks. This allows action before other diseases with higher rates of fatalities and harms (and as the authors mentioned, measles is bad enough) return. Read the rest of this entry »

Mar
11

Preparing for the Worst Day of the Year: Daylight Saving Spring Forward

written by Tara Haelle

The worst day of the year is upon us: this weekend, we “spring forward” for Daylight Saving Time this Sunday, March 13. It’s a double whammy because we lose an hour of sleep AND still must deal with the havoc that one hour of sleep shift creates for our kids. (I regard autumn’s “fall back” as the second worst day of the year, ameliorated only by the extra hour of sleep we get.) I write quite a bit about sleep and have read hundreds of research studies about sleep, but I have yet to come across the secret sauce that makes DST time-shifting more painless for parents.

This year, I interviewed Andy Rink, MD, a pediatric sleep expert and creator of the Lully Sleep Guardian*. I tend to be a fan of Q&As because they often make for easier reading and skimming, so here’s my Q&A with Dr. Rink on what to do about Daylight Saving Time. In addition, families who travel across time zones will find some tips on dealing with the threat of jet lag as well.

The spring forward DST time change is often a headache for parents trying to keep their children on a consistent sleep schedule. Photo by Anissa Thompson

The spring forward DST time change is often a headache for parents trying to keep their children on a consistent sleep schedule. Photo by Anissa Thompson

Many parents dread the arrival of DST time changes. Is it really that bad, or are we making it worse on ourselves?

For many of us, the loss of one hour’s sleep can sometimes feel like a household crisis because of the havoc it wreaks on your family’s schedule. Kids who have been sleeping on firm schedules for years can suddenly start waking up at odd hours of the night, tearful and confused. Parents who really need that extra hour of sleep can feel sluggish and groggy all day at work. As a physician and pediatric sleep expert with a background in childhood sleep disorders, I’ve seen countless families suffer from the cumulative effects of having too little sleep.

In what ways can the time change to DST in spring affect the sleep and sleep schedules of infants, young children and families in general?

Whether it’s jet lag from traveling across time zones or a one-hour change due to Daylight Saving Time, the abrupt loss of an hour’s sleep affects the internal body clock. Infants and children will be fighting to stay on their schedule according to their internal clocks, so naturally ALL of their daily activities (not just sleep) will tend to be pushed back one hour. If you do nothing to adjust the schedule around DST (which is actually a good option for early risers), your child will wake up an hour later, nap an hour later, may eat an hour later, etc. This can be similar in adults, although typically you can expect your reaction to DST to be similar to taking flight and having a one-hour time change.

What, if anything, can parents do leading up to the time changes (in the days or weeks before) that can mitigate this effect, particularly for toddlers and preschoolers?

You can adjust them gradually, by tapering daily schedules (including naps, meals and bedtimes) in 10-minute increments the entire week leading up to the Daylight Saving Time “spring forward” on Sunday, March 13. Or you can get around Mother Nature by installing room-darkening or black-out shades in the child’s nursery or bedroom. Make sure the entire family is well-rested leading up to the time change, so that everybody is up to dealing patiently with earlier than usual risers, and grumpier than usual little ones. The best thing that all families should do is make sure their children are getting good naps and are well rested going into the weekend.

For parents who have a child that is an early riser, spring DST can be a great time to do nothing and allow your child to naturally start sleeping in an hour later. For these families, they can follow the above nap tips, but they should refrain from adjusting bed or nap times. After Sunday, they should then move all daily activities (nap times, meal times, bath times, etc.) forward an hour to keep the child on the later schedule. They can slowly start moving daily activities around, but to keep their child sleeping later, they should try to maintain the later nap, bed, and wake times.

The other method is to slowly adjust the child’s schedule if you want to keep them on the same sleep/wake schedule they are currently on. Parents can start about a week before DST with moving the bedtime (and all of the child’s activities as much as possible) up 15 to 20 minutes. Then every couple of days, move things back another 15 to 20 mins. Around the switch to DST, or at least within the week after, they child should be back on their normal schedule. Trying to switch all their schedule a full hour on Sunday can be tough for kids.

If parents do not do anything to prepare for the time change to DST, how long does it typically take for young children to adjust to a slightly new schedule?

It generally takes a few days to a week to naturally adjust to the one-hour time difference.

To what extent can the tips you’re providing here help parents deal with jet lag when they’re traveling across time zones with young children?

Whether it’s jet lag from traveling across time zones or a one-hour change due to DST, the same principles can apply. However, if it just a short trip (a week or less), then it may be easier to just “do nothing” and move the child’s schedule forward or back an hour while on the vacation.

How much sleep should toddlers, preschoolers, and elementary-age children each be getting each night, and what are the consequences if they get too little sleep?

Here are the latest sleep recommendations from the National Sleep Foundation Interestingly, the results of their comprehensive 2014 poll showed that parents on average report their children are sleeping on average one hour less than they should be getting. The best word of advice is consistency. Try to keep as close to the same bedtime routine as possible each day, on weekdays and weekends, at home and on vacation.

Is it possible for children to get “too much” sleep? If so, what would that look like, and what would the consequences of it be?

It’s not possible for a newborn to get too much sleep. If a young child is sleeping too much during the day, a consequence might be not sleeping through the night. If a teenager is sleeping too much, it could be due to a growth spurt, too much late night activity, or a sign of depression.

What if my child suffers from nightmares or sleep terrors or other sleep disorders? First of all, you’re not alone. It’s estimated that sleep disorders like sleepwalking and night terrors affect nearly 25% of American children. The problem is, when one family member suffers from a sleep disorder, studies show the entire family tends to suffer from increased stress and lack of sleep. Luckily there are some new technologies designed to help re-adjust children’s sleep patterns so they can avoid the problem all together. If it occurs during DST, the best thing to do is let the episode run its course and try to get to bed earlier the following night.

My family and I have a hard enough time falling asleep. What are some ways to get the family to settle in more easily?

Start the process of winding down an hour or two before the family goes to bed. Give children a relaxing bath. Dim their bedroom lights. Read a calming story. For adults, this means easing up on the alcohol or caffeine during the two hours prior to your bedtime. Be sure to limit your water intake in the evening to avoid bathroom breaks in the middle of the night.

I’ve used videos on my smartphone or an iPad to help my son settle down at bedtime occasionally in the past. How might the light from those devices affect him or me?

A 2014 study from the National Academy of Sciences found that the use of electronic devices such as e-readers and tablets right before bed can prolong the time it takes to fall asleep, suppress the natural levels of melatonin present in the body, delay the circadian clock, and reduce alertness in the morning. All of this will decrease chances of having a good night’s sleep during Daylight Saving Time, when it’s needed most.

 

*I have not used, tested, or researched the Lully Sleep Guardian, its mention is not an endorsement of this blog, and I do not receive any payment or in-kind compensation for mentioning the product. I link to it only as a courtesy to Dr. Rink for answering my questions.

Jan
29

Small Pediatricians Group Promotes Ideology, Not Evidence

written by Tara Haelle

A small group of pediatricians called the American College of Pediatricians periodically releases policy statements about various child and teen health issues. It’s obviously always important to understand who or what the source of information is, even when (perhaps especially when, George Orwell would say) the name itself sounds reliable.

So, who are these ACP* folks? First, they’re not in any way associated with the American Academy of Pediatrics, the national organization representing more than 60,000 pediatricians across the U.S. who make recommendations based on the most current research. The AAP are recognized as a credible, evidence-based professional organization whose positions carry great influence in child and maternal health. Certainly several medical specialties have more than one professional organization, but that doesn’t mean they are all equivalent in terms of their reliability.

Determining what is best for children's well-being should rely on what evidence shows us, not what non-evidence-based ideology promotes. Photo by Joplin Hendrix Da Silva Cruz

Determining what is best for children’s well-being should rely on what evidence shows us, not what non-evidence-based ideology promotes. Photo by Joplin Hendrix Da Silva Cruz

While the AAP relies on the evidence base to issue their policy statements, American College of Pediatricians relies on a politically-motivated social conservative agenda in drafting their policy statements. I don’t discuss politics or political ideology on this blog, and that’s not going to change today. Social conservatism and social liberalism or progressivism both have a place in our political landscape. But when political ideology replaces evidence in promoting a particular policy about children’s health, an organization oversteps its bounds in prioritzing children’s best interests. Belief systems should not dictate health or medical recommendations when they contradict facts from research.

The AAP has issued a tremendous number of evidence-based policy statements over the years. From foster and adopted children to children and disasters to mental health to adolescent health to sports and fitness to vaccines to community health to… there’s just about no topic related to children’s lives that the AAP hasn’t considered in light of the most current scientific research. By contrast, the American College of Pediatricians has issued exactly 34 position statements, and even a brief perusal of their titles will make it clear that they are ideologically focused not because they cover topics that the AAP does not but because the list is proportionally dominated with controversial topics about which social conservatives have strong political agendas. Read the rest of this entry »

Jan
28

Mixing and Matching Rotavirus Vaccines Is No Problem

written by Tara Haelle

Two different rotavirus vaccines have been licensed by the FDA: RotaTeq and Rotarix. Both of these came after Rotashield, an earlier vaccine that lasted barely over a year on the market before it was pulled because it led to a bowel obstruction disorder called intussusception in about 1-2 out of 10,000 infants. (RotaTeq and Rotarix also increase the risk of intussusception, which I explain in detail here, but the risk is lower.)

It’s not unusual for different companies to make vaccines for the same disease, but RotaTeq and Rotarix have slightly different schedules too: RotaTeq is given in three doses, and Rotarix is given in two doses. But if a doctor runs out of the brand your child got last time when you come in for the next well visit, is it safe to mix and match the two? That’s what a new study investigated.

A boy receives a dose of the rotavirus vaccine, an oral vaccine. Photo by Amber Cox

A boy receives a dose of the rotavirus vaccine, an oral vaccine. Photo by Amber Cox

With the exception of influenza vaccines, which have a lot of different options, most parents probably don’t spend a lot of time researching individual types of the same vaccine, such as Daptacel, the DTaP vaccine manufactured by Sanofi, versus Infanrix, the DTaP vaccine manufactured by GlaxoSmithKline. (If you’re interested, you can find a full list of all the different vaccine brand names and what they contain at this CDC page.)

For the most part, your child receives whatever your doctor stocks. And, for the most part, there aren’t many significant differences between brands in terms of the way the vaccine is made. Some brands may contain slightly different components than another — which might be relevant if your child has a very specific known allergy to a particular brand’s ingredient — but the vaccines are generally pretty similar.

RotaTeq and Rotarix have pretty different manufacturing processes, however. Both are live oral vaccines, but they use different components of the actual virus to induce immunity. RotaTeq, licensed in 2006 to Merck, is pentavalent, which means it uses five reassorted human and cow rotaviruses mixed together. Children receive the first dose between 6-15 weeks old and should get the two additional doses by 8 months old. Rotarix, licensed in 2008 to GlaxoSmithKline, is monovalent, made from a single human strain of rotavirus. Its first dose is also recommended between 6-15 weeks with the second dose given by 8 months old. It’s worth noting that the introduction of these vaccines has gone far in reducing rotavirus infections and has boosted herd immunity against the disease. Read the rest of this entry »

Jan
11

How the U.S. Vaccine Schedule Compares to Other Countries’ Schedules

written by Tara Haelle

A common question I’m asked and that I see in forums discussing vaccines relates to how the U.S. recommended childhood immunization schedule compares to other nations, particularly those with similar economics and populations to those of the U.S. Now a new interactive tool at BMJ can help you explore exactly that question.

Screenshot 2016-01-09 17.42.07

The multimedia graphic “Calling the Shots” allows you to select individual vaccines or specific countries and lets you explore individual doses, total doses, and the time scale for recommendations for G8 countries. How a country makes decisions about vaccination recommendation is no simple formula. They consider the burden of the disease, both in terms of mortality and in terms of overall suffering and disability, and the cost of that burden compared to the cost of the vaccine. They also consider the effectiveness of the vaccine and its safety profile, including possible side effects. They may also take into account what they expect the uptake of a vaccine to be — a vaccine that’s recommended but which few people actually get may end up being less cost-effective as a result.

Cost is a particularly tricky issue because health care systems differ across different countries. For example, the UK does not routinely recommend the chickenpox (varicella) vaccine as the U.S. does. The reasons for this stem primarily from how the healthcare systems between the two countries differ. Chickenpox can be fatal, but it still kills rarely — about 100 cases a year in the U.S. before the vaccine. That’s no small number for the 100 families who lost someone to the disease, but it is relatively small compared to the scale of the U.S., whose population is considerably larger than that of the UK. In the U.S., where both private insurance companies and federal Medicaid funds pay for the vaccine, the cost-effectiveness calculation and the risk-benefit calculation in terms of illness and side effects both work out in favor of recommending the vaccine. In the UK, the risk-benefit calculation also works out, but the cost-effectiveness one does not. To put it bluntly, simply not enough kids would die from chickenpox every year for the UK government to justify paying for the shot for all its youth.

The above example is one example, but similar calculations must occur for every vaccine considered for a particular country’s schedule. The meningitis B vaccine, for example, is not recommended in the U.S. in part because it’s still a relatively rare disease, but it’s much more common in several countries overseas. The difference in the disease’s incidence will therefore play a role in how the national health agency of that country determines whether the vaccine should be recommended and for whom. Below is an embedded window showing you the page where the tool is hosted (scroll down a little to see the interactive part), but it’s easier to use on the BMJ site.

Jan
9

Happy New Year! Resolutions for 2016

written by Tara Haelle

Good riddance to 2015! It was a difficult year for this home, and it was incredibly rough in terms of world events. (I felt as though I could have rewritten this post — discussing ways to talk to children about traumatic events in the wake of the Newtown massacre — at least five times in 2015.) Last year also involved a lot of work for me, in good ways and challenging ways, and a lot of travel. That meant that this blog suffered much more than it typically does, which has become an unfortunate refrain. Therefore, I’m making three resolutions specific to this blog.

First, expect to see at least one original blog post each week from here on out. And if you don’t, feel free to hassle me. I really want to continue providing content here for regular readers in addition to the all the writing I’m doing at Forbes and various other outlets. One of the things that has held me up in the past is that I felt as though I *had* to publish a post about a new study or topic as soon as it was released. That’s how I used to do things at this blog, but that was before I had an extensive schedule of stories for other outlets and at Forbes. So, the posts you’ll read here may be a few days or even a few weeks behind in covering a study you might have seen in the news, but hopefully the difference is that you get something out of the analysis here that you didn’t in the mainstream news stories.

Second, expect to see a round-up of stories worth checking out every Friday or Saturday. At the end of each week, I’ll gather up various pieces from the week’s news, including items I’ve written as well as items in the news in general. I may also add a new section that links to press releases (clearly labeled!) and their original studies for the items that I wish I had been able to write about but couldn’t. The challenge I face every week is that so much fascinating research comes out, and it’s simply not possible to read it all, much less cover it all.

Third, I’m going to more actively seek some guest posts. This could be a double-edged sword. I’m frequently contacted via email by individuals looking to write for this blog, but few of them appear to have examined the style of the blog well enough to realize how crucial it is to examine peer-reviewed evidence in posts. There are certainly times I post “fluffier” items, and I’m going to open it up more to women sharing their personal stories because I think anecdotes *do* have a place in understanding our world and the human experience — as long as we’re not relying on them as evidence to make health decisions. In general, however, I welcome any contributions that look specifically at the evidence base in connection with a particular issue. Unfortunately I cannot pay for these — the advertising revenue on this blog does not even cover operating costs in terms of the domain and server so maintenance is a continual loss — but I hope some individuals may be interested in sharing nonetheless.

Our book will be officially released the first week of April!

Our book will be officially released the first week of April!

Aside from these resolutions, I’ll provide an update of a few activities and events this year that readers may be interested in. First, of course, is that the evidence-based parenting book I co-authored with Emily Willingham, a fellow blogger at Forbes I recommend following, will be out in April. We’re in the midst of booking radio and other interviews now, so hopefully you might catch us on the airwaves in addition to seeing some excerpts online and our book on shelves at your local bookstore. For those interested in pre-ordering the book, you can do so at Amazon and elsewhere. This Amazon link to The Informed Parent is an affiliate link, which I’ve just begun using. This means I will receive a commission if you purchase the book using that link, but your price will not be any different.

Next, I am working on several children’s book projects, and I’m looking forward to sharing those when they’re available. They are all science-related, with release dates ranging from this upcoming spring to two years from now.

Next, I have set up a TinyLetter newsletter for those who may be interested in receiving *all* of the articles I write, regardless of publication or topic, as well as other articles I’ve found worthwhile. I send it out approximately twice a month. You can see previous newsletters in the archive to get a sense of what will arrive in your email box.

Finally, I will potentially be doing some additional public speaking events this upcoming year that I’ll announce in the newsletter above. I will continue to write at Forbes, and my work will continue to appear in NPR, HealthDay, Everyday Health, Pediatric News, Medscape, and various other outlets.

Nov
24

It’s That Time Again: Separating Fact from Fiction about the Flu Vaccine

written by Tara Haelle

This post is co-published with NPR’s health blog Shots. Check out the story for updated information about this year’s flu shot from a CDC medical officer.

Once again, flu season is upon us — and so are all the misconceptions, excuses and worries that have kept so many people away from getting their flu vaccines. Plenty of people are fully informed about the flu vaccine’s safety and effectiveness and simply choose not to get the vaccine, as is their right (as long as they don’t work in healthcare settings where it’s required). But many others may have skipped the shot because they’ve bought into one of the many myths about the vaccine that always circulate with the influenza virus itself. Or perhaps they’ve read something unsettling about the vaccine that has a kernel of truth in it, but which has been blown out of proportion or misrepresented.

Of all the vaccines out there, the flu vaccine is unique in several ways: it’s the only one the CDC recommends for the entire (eligible) population every year, it has the most variability (and nearly always the lowest percentages) in effectiveness, and it has more tall tales told about it than Paul Bunyan. Much of the debunking and explaining you’ll find here is essentially the same as in past years’ posts, but a couple misconceptions have been rearranged, and I spent a bit more time discussing the evidence about potentially lower effectiveness of the flu vaccine in people who had gotten it the previous year.

Don't let bad information get in the way of making an important health decision.

Don’t let bad information get in the way of making an important health decision.

Another change you’ll find is that the “myths” are now concerns, phrased as questions. What’s up with that? I made that change for a couple reasons. One relates to the research findings that straight up stating myths and then debunking them can backfire, though this new approach doesn’t necessarily eliminate that risk. Another reason is that stating misconceptions declaratively implies an adversarial approach by the reader when, in reality, I hope and expect the majority of people reading this post genuinely have questions about the vaccine. So writing each one as a question better represents that spirit of inquiry.

Finally, I called these items “concerns” instead of “myths” because several of the issues discussed here are not outright “myths.” That is, some of these concerns originated from factual situations, but the details got gnarled and twisted along the way, or else the fact itself doesn’t have the implications people may expect it does. “Concerns” therefore better captures that each of these items is a legitimate concern for many people but is something that simply requires explanation, whether that’s an outright debunking or simply context and clarification.

One thing that needs a bit of clarification is last year’s vaccine’s effectiveness, as I discuss in the NPR Shots blog post that accompanies this one. The overall flu vaccine effectiveness last year was an uninspiring 23%, low enough to legitimately make you wonder why you bothered if you got the vaccine. But as I explain at NPR based on an interview with CDC influenza medical officer Lisa Grohskopf, the overall effectiveness doesn’t capture the effectiveness of each strain within the vaccine.

A poor match with the H3N2 strain — which caused the most illness and the most serious cases — was responsible for the lion’s share of that low number. Meanwhile, the match between the vaccine strains and the virus strains for B viruses, which circulated the most toward the end of the season, was good enough that the vaccine was closer to 60% effectiveness for those strains. This year, changes to the H3N2 strain for the vaccine should boost the effectiveness and offer a better showing than last year’s lousy run, according to Grohskopf.

With that info out of the way, let’s get to the flu vaccine concerns, with two important notes. First, for those who prefer to do their own research, I’ve provided all my sources in the hyperlinks. More than half of these go directly to peer-reviewed research articles, 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 misconceptions and clarify common concerns about the flu vaccine. This post does not constitute a recommendation from me personally to each reader to get a flu vaccine. You should always consult a reliable, trusted medical professional with questions that pertain specifically to you. For the CDC recommendations on the 2015-2016 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 concerns at the top followed by the factual information below it. They hyperlinked facts will jump to that explanation. I use “flu shot” and “flu vaccine” interchangeably to refer to any type of flu vaccine, including the nasal vaccine.

Concern #1: Can getting the flu vaccine give you the flu or may you sick?
Fact: The flu shot can’t give you the flu.

Concern #2: Do I really need to get the flu vaccine this year if I got it last year?
Fact: For now, a new flu shot each year is still recommended.

Concern #3: Could getting the flu vaccine make it easier for me to catch viruses, pneumonia or other infectious diseases?
Fact: Flu vaccines reduce the risk of pneumonia and other illnesses.

Concern #4: Isn’t the flu shot just a “one size fits all” approach that doesn’t make sense for everyone?
Fact: You have many flu vaccine options, including egg-free, virus-free, preservative-free, low-dose, high-dose and no-needle choices.

Concern #5: Can the flu shot cause death?
Fact: There have been no confirmed deaths from the flu shot.

Concern #6: Aren’t deaths from the flu exaggerated?
Fact: Deaths from influenza range from the lower thousands to tens of thousands each U.S. flu season.

Concern #7: Aren’t the side effects of the flu shot worse than the flu?
Fact: Influenza is nearly always far worse than flu vaccine side effects.

Concern #8: Don’t flu vaccines contain dangerous ingredients such as mercury, formaldehyde and antifreeze?
Fact: Flu shot ingredients do not pose a risk to most people.

Concern #9: Shouldn’t pregnant women avoid the flu shot or only get the preservative-free shot? Could the flu vaccine cause miscarriages?
Fact: Pregnant women are a high risk group particularly recommended to get the flu shot. Fact: The flu shot reduces miscarriage risk. Fact: Pregnant women can get any inactivated flu vaccine.

Concern #10: Can flu vaccines cause Alzheimer’s disease?
Fact: There is no link between Alzheimer’s disease and the flu vaccine; flu vaccines protect older adults.

Concern #11: Don’t pharmaceutical companies make a massive profit off flu vaccines?
Fact: Vaccines comprise a tiny proportion of pharma profits. That makes it possible for them to continue making them in the event of a pandemic.

Concern #12: Flu vaccines don’t really work, do they?
Fact: Flu vaccines reduce the risk of flu.

Concern #13: But flu shots don’t work in children, do they?
Fact: Flu vaccines reduce children’s risk of flu.

Concern #14: Can flu vaccines cause vascular or cardiovascular disorders?
Fact: Flu shots reduce the risk of heart attacks and stroke.

Concern #15: Can vaccines can break through the blood-brain barrier of young children and hinder their development?
Fact: Flu vaccines have been found safe for children 6 months and older.

Concern #16: Will the flu vaccine cause narcolepsy?
Fact: The US seasonal flu vaccine does not cause narcolepsy.

Concern #17: Can the flu vaccine weaken your body’s immune response?
Fact: The flu vaccine prepares your immune system to fight influenza.

Concern #18: Can’t the flu vaccine cause nerve disorders such as Guillain-Barré syndrome?
Fact: Influenza is more likely than the flu shot to cause Guillain-Barré syndrome.

Concern #19: Can the flu vaccine make you walk backwards or cause other neurological disorders like Bell’s palsy?
Fact: Neurological side effects linked to flu vaccination are extremely rare (see Concern #18), but influenza can cause neurological complications. Fact: The flu shot has not been shown to cause Bell’s palsy.

Concern #20: Don’t people recover quickly from flu since it’s not really that bad?
Fact: Influenza knocks most people down *hard*.

Concern #21: Can people die from the flu even if they don’t have another underlying condition?
Fact: Otherwise healthy people DO die from the flu.

Concern #22: Can people with egg allergies get the flu shot?
Fact: People with egg allergies can get a flu shot.

Concern #23: Can’t I just take antibiotics if I get the flu?
Fact: Antibiotics can’t treat a viral infection.

Concern #24: Since I got the flu last time I got a flu shot, that means it doesn’t really work for me personally, right?
Fact: The flu shot cannot guarantee you won’t get the flu, but it reduces everyone’s risk.

Concern #25: But I don’t need the shot since I never get the flu, right?
Fact: You can’t predict whether you’ll get the flu.

Concern #26: Can’t I protect myself from the flu by simply eating right and washing my hands regularly?
Fact: A good diet and good hygiene alone cannot prevent the flu.

Concern #27: Won’t getting the flu simply make my immune system stronger?
Fact: The flu weakens your immune system while your body is fighting it and puts others at risk.

Concern #28: If I get the flu, why won’t just staying home prevent me from infecting others?
Fact: You can transmit the flu without showing symptoms.

Concern #29: Can having a new vaccine each year make influenza strains stronger?
Fact: There’s no evidence flu vaccines have a major effect on virus mutations.

Concern #30: Isn’t the “stomach flu” the same thing as the flu?
Fact: The “stomach flu” is a generic term for gastrointestinal illnesses unrelated to influenza.

Concern #31: Is there any point in getting a flu shot if I haven’t gotten one by now?
Fact: Getting the flu shot at any time during flu season will reduce your risk of getting the flu. Read the rest of this entry »

Nov
3

Help “Shatter the Myths” about postpartum depression

written by Tara Haelle

When I had my first son, I and my husband were on the lookout for symptoms of postpartum depression. I have a history of depression and am therefore already at higher risk for postpartum depression than the average person. As I have already written, I did not experience the overwhelming love that so many new moms describe, and that did worry me. But I also felt fortunate that I never fell into the depths of postpartum depression. Perhaps it was my vigilance, perhaps it was the support I had, or perhaps I was just really damn lucky.finalMTTDgraphic1-1

I was not so lucky with my second child. I had my second son while working on our book (thank goodness it’s done!). I struggled a great deal with breastfeeding and was not able to exclusively breastfeed him as I had done with my first son and as I had planned. (That is a whole other post I will write another day.) I was fine for the first several months, but eventually I did experience postpartum depression. It was not so surprising considering I had experienced prenatal depression as well, the cousin that no one remembers to talk about.

Fortunately, however, I knew the signs, and I had received enough support in treatment in the past that I knew to seek help quickly. I contacted my OB/GYN’s office and began seeing a therapist in addition to adjustments to my medication. Early, prompt treatment is essential to recovery. Postpartum depression is an illness like any other, and it requires treatment.

Other women, however, are not so fortunate to have the support, knowledge, and understanding of postpartum depression as I did. They suffer in silence, believing they are worthless, inadequate, horrible mothers. They may worry about hurting themselves or their child sometimes. They alternate between thinking the way they feel is normal and thinking they are completely abnormal. They don’t know that they need to get help, or perhaps worse, they are scared to ask for it. Read the rest of this entry »

Nov
2

What happens when you mix cuddles with philanthropy? An opportunity for a conversation

written by Tara Haelle

The insanity of my schedule of late has meant that I’ve not kept up with blogging here as much as I’ve wanted to. I have a few pieces in the works to rectify that. But I needed to publish this post today because it involves an opportunity that ends this evening — a “discount” on sending 10 meals to children in need.

Everest the Penguin is one of the cuddle+kind dolls whose purchase donates 10 meals to families in need.

Everest the Penguin is one of the cuddle+kind dolls whose purchase donates 10 meals to families in need.

Of course, I’ll need to back up a bit first to explain. I rarely write about items I’m offered or mailed sent to review because more than enough “mommy bloggers” fill that role already and my focus is on evidence-based parenting topics. But today I’m breaking that rule of thumb — I think for the first time? — because it somewhat fits my desire to expand the blog’s focus a little bit into areas of social justice, albeit remaining grounded in evidence.

One area I’d like to explore is evidence-based ways we can teach our children empathy and encourage them to think more broadly about the world outside their community. Although I have not had a chance to delve into this research yet, I suspect simply starting conversations about the needs of children overseas — kids relate to other kids — may be a start for the youngest children. That’s precisely the kind of opportunity that a new non-profit called cuddle+kind offers.

Created by Jennifer and Derek Woodgate of Milton, Ontario, cuddle+kind sells handmade dolls, each of whose purchase donates 10 meals to children by way of their partners, World Food Program USA and Children’s Hunger Fund. (Both these charities rank high on the Charity Navigator.) You can read the specifics about the dolls on their website, but I agreed to check out one of the dolls they sent for a couple reasons. One was that they selected such high-quality charities to partner with. Another was that the dolls are manufactured by Peruvian women, providing them with fair trade income. That’s an issue dear to my heart both as someone who advocates for gender equality and fair trade and as someone who has visited Peru multiple times. Read the rest of this entry »

Sep
24

A Q&A with me about vaccines, health communication & immunization legislation

written by Tara Haelle

As you’ve probably noticed by the recent erratic posting on this blog, I’ve been crazy busy. Some has been good — lots of new assignments and new opportunities — and some has been challenging — family health issues — but it’s all made it difficult to blog as regularly as I want to, and I have a long list of posts half-written in my head and waiting to be finished and posted. fbtimeline_BirthTo6

Although I missed the opportunity to post much during National Immunization Awareness Month in August, I did answer questions for a Q&A with Sophia Bernazzani, community manager of [email protected], the official blog for the online master of health administration from the Milken Institute School of Public Health at the George Washington University. They published the Q&A last week, and I’m reproducing it with permission here because I answer several questions that my blog readers may have as well. Enjoy!

Since last winter, there have been outbreaks of measles in the U.S., a disease that was declared eliminated in 2000. Recent incidences have been frightening because they’re manageable in a world where nearly everyone gets vaccinated, but some people use personal reasons to avoid them. What needs to change in the conversation to prevent future diseases and superbugs from becoming a full-fledged outbreak?

There needs to be a big overhaul in the way we talk about immunization to remove shame and finger-pointing from the conversation. I’ve found that some of the people who promote immunizations cite biological research but don’t also refer to social science research. However, there’s a lot of research on what convinces people to get vaccinated. What doesn’t work is shaming people and finger-pointing … and that’s what’s going on in conversations today. There also needs to be a change in how doctors talk to patients about immunizations. Patients have real concerns, and given rampant misinformation online and in the media, their concerns aren’t unreasonable. People can’t get all of the information they need about immunizations on Google.

But some doctors ask, “Why don’t you trust me?” when patients ask questions. That’s the wrong attitude. Skepticism is healthy, and many doctors aren’t well-equipped to handle all the concerns about immunizations that vaccine-hesitant parents may have during a 15-minute checkup. The problem is insurance companies don’t reimburse doctors for the extra time, so most can’t afford to spend more time with patients going over these concerns. I would love to see a complete overhaul of the health care system in which insurance companies could empower doctors to spend time with their patients to build trust and show them evidence to improve immunization rates.

Doctors need to be empathetic and compassionate, and not dismissive. I understand the perspective of a doctor who spends years in training and residency and is the subject matter expert. I can understand how doctors would feel insulted when patients say they don’t trust them. But it’s not about doctors, it’s about the big picture. It’s about patients versus vast amounts of misinformation, not patients versus doctors. There will be some people you can’t reach, but a lot more vaccine-hesitant people can be reached with empathy and compassion.

What are your thoughts on laws like S.B. 277, a law passed this summer in California, that eliminate personal and religious exemption from vaccines for school-aged children? Why aren’t other states passing similar laws?

Read the rest of this entry »



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