Browsing Tag

Vaccines

The Consequences of Whooping Cough: How I Developed Cerebral Palsy

By March 16, 2015 No Comments
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I have cerebral palsy, and it’s something I’ve been hesitant to talk about my entire life. Cerebral palsy (CP) “is caused by injuries or abnormalities of the brain. Most of these problems occur as the baby grows in the womb. But they can happen at any time during the first 2 years of life.” As humbling as it is to accept, I have brain damage.

Except for the arrival of their favorite son, my parents have told me there was nothing remarkable about my birth in the mid-70s. Everything went according to plan, but when I was nearly three months old, too young for the vaccine, I contracted pertussis, more commonly known as whooping cough. This is likely how I came to develop CP.

Over the years my parents have told me how terrifying it was to hear me coughing and gasping for air. If they weren’t in the room with me and I got quiet they would have to check to see if I was sleeping or if I’d stopped breathing. Once I started walking my parents noticed my left foot was always on its toes and turned inwards. On the advice of a family friend, my parents took me to get evaluated, where I was eventually diagnosed with CP.

It wasn’t until my mid-20s that I truly understood what that experience must have been like for my parents. They had just witnessed their baby struggle through whooping cough and then learned their baby had cerebral palsy. I had just started walking, too young to talk, there was no telling the extent of my injury at that stage. Can you imagine their concern?

The years that followed involved frequent trips to the Children’s Hospital of Eastern Ontario (CHEO) for physiotherapy and testing, more than 10 years with a brace on my left leg, a decade of at-home exercises and casts on both legs for a period of time (which made for an awesome Hallowe’en costume that year – most candy EVER).

Having CP doesn’t mean you cannot succeed in life. My university Sociology professor informed the class that he had CP. He was the first person with CP I had come across that, like me, was only affected physically and not mentally. He suffered from slurred speech and tremors in his arms and hands, but obviously was able to flourish in academia.

I have had more than 35 years to come to terms with the long-term impacts of CP. IWorldCPDayCP-Infographic walk with a slight limp, my balance is a bit of an issue and my left calf is noticeably smaller than my right. I’m at a disadvantage in most sports (which is a shame since of the 3 children in family I was the only one that expressed any interest in sports). Despite my brothers’ claims, I haven’t suffered any mental impairment. I graduated with honors from high school and received a degree in Computer Science at the University of Waterloo.

I mentioned earlier that I’m hesitant to discuss my cerebral palsy, not because I am embarrassed by it, but due to the extent of my injury. I have the most minor case I have personally encountered. Every time I publicly mention that I have CP, I think of all the others with the same affliction. The trials in my life due to CP pale in comparison to theirs. I do not take for granted that I have been extremely lucky.

CP has a wide spectrum of injuries that can result in mental impairment, physical impairment, or both. Growing up, the son of the family that lived next door also had CP, his was the result of an avoidable birth injury. While Stephen was able-bodied, he was a man in his 30s with the intellect of a 6 year old and needed special care throughout his life. I cannot stress enough how lucky I am.

Just like my neighbor’s CP, mine was also avoidable. I was too young for the pertussis vaccine when I contracted the virus, however I caught it from someone. That person was likely either unvaccinated or were under-vaccinated. Recently there has been a movement against vaccinations in general and it frightens me that parents may not have their children vaccinated against pertussis and other illnesses. Measles, mumps, pertussis and others are seen as minor afflictions to some, but I see myself as an example of what can happen as a result of contracting one of these illnesses.

I’m sharing my story and the story of others in the hopes that it will sway at least one doubtful parent to vaccinate. While I’ve been extremely lucky, I was likely seconds away from being severely impaired. A parent should take advantage of any protection they can offer their child, and that includes vaccination.


 

References:
National Institutes of Health. Cerebral Palsy. Updated August 22, 2014. Retrieved March 15, 2015.

Centers for Disease Control and Prevention. Pertussis (Whooping Cough). Last updated December 1, 2014. Retrieved March 15, 2015.

Mayo Clinic. Whooping Cough. Last updated January 15, 2015. Retrieved March 15, 2015.

Children’s Hospital of Eastern Ontario (CHEO). Resources – Cerebral Palsy. Last updated May 2014. Retrieved March 15, 2015.

Mayo Clinic YouTube. Infant Girl with Whooping Cough. Published October 7, 2013. Retrieved March 15, 2015.

World Cerebral Palsy Day. What is Cerebral Palsy Infographic. September 2013. Retrieved March 15, 2015.

Booth, Michael. Nearly Half of All U.S. Children Undervaccinated, A New Study Shows. The Denver Post. January 21, 2013. Retrieved March 15, 2015.

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Categories: Accidents, Injuries, + Abuse, Chronic Illnesses + Conditions, Disability + Disability Advocacy, Infectious Disease + Vaccines

There’s Actually a Scientific Reason Behind Being #antivaxx

By February 24, 2015 No Comments
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In just under 10 minutes, Hank Green of YouTube’s famous SciShow gives the most scientific (while easily understandable) explanation of why people opt out of vaccines. His video follows the thinking of Nobel Prize winner Daniel Kahneman who claims that “[p]eople are much more afraid of their children dying from a vaccine than they are from a child dying of an illness that spreads naturally. If something would happen to their child after being vaccinated, their decision becomes a focus of enormous regret.”

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Categories: Infectious Disease + Vaccines, Science 101 + Mythbusting

What We Could Learn From Sweden

By February 19, 2015 No Comments
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I recently listened to a radio interview comparing Sweden to the US with regard to vaccination rates. I should emphasize the fact that the two countries share very little in common when it comes to healthcare, which naturally informs the average citizen about their medical choices BUT one detail stood out to me. Herd Immunity.

For years it was a term limited to my geeky global health cohort, but in Sweden, the ethos of herd immunity is on the minds of most average citizens.

A study by Björn Rönnerstrand published in The Scandinavian Journal of Public Health in 2013 investigated the connection between social capitol indicators and immunization during the 2009 H1N1 influenza season.

The takeaway?

Swedes who opted to vaccinate had higher levels of trust – trust in the healthcare system and in society. (Again, we share very little in common) What blew my mind was reading that the Swedish Institute for Communicable Disease Control created this slogan: “Be vaccinated to protect your fellow citizens.”  A slogan!  An others-focused slogan! Beyond promoting individual protection, this was about caring for others and ensuring communities felt secure.

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

How I Accidentally Started an Anti-Vaxx Myth in the Name of Science

By February 17, 2015 1 Comment
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I’m an infectious disease researcher and the mother of two children, so I’m usually the first person friends and family turn to whenever a disease is in the news. Since the Disneyland measles outbreak, I’ve responded to a lot of myths and misinformation from concerned parents.

As a mother I understand what it’s like to to want to arm yourself with as much information as possible to protect your children.  As an infectious disease researcher it’s frustrating to see people without knowledge of virology nor immunology misconstrue science, or simply ignore it, and spread dangerous misinformation.

A new anti-vaxx myth has surfaced which seems to have been developed as a result of my recent post “Disneyland Measles Outbreak is Due to Measles”, which discussed the measles genotype responsible for this outbreak. The post was a response to another circulating myth that the measles strain is unknown and could be the strain found in the vaccine. It seems my post was then misconstrued and has become the basis of yet another anti-vax myth.

The new myth goes like this: since the measles strain in the MMR vaccine is genotype A, the vaccine doesn’t protect against the strain of the measles responsible for the Disneyland outbreak, which is genotype B3. This is not true and I want you to know how and why it’s not true.  The MMR vaccine does provide cross-protective coverage for wild-type measles strains such as B3.

Before I get into the how and why, though, I want to define some terms:

  • RNA: Ribonucleic Acid are strings of nucleic acid, similar to DNA, that acts as a messenger of genetic information.
  • Genotype: The small differences within a specific region in the RNA or DNA of a species of microorganism.
  • Antigen: A protein on the surface of a virus or bacteria that provokes an immune system response.
  • Serotype: The same species of microorganism such as virus or bacteria that can be further divided into sub-groups based upon their surface antigens.
  • Epitope: The very specific part of the antigen which antibodies attach to.
  • Strain: A generic term to refer to subgroups of a virus or bacteria that include the above variables.

When a physician suspects a patient has the measles they take a sample from the patient through a throat or nasal swab and send it to be genetically sequenced.  Epidemiologists use two genes within the measles  virus to determine the virus’ genotype, specifically they look at regions of nucleotide sequences in the RNA called hemagglutinin (H) and nucleoprotein (N). This is where we get the labels genotype A and genotype B.

The measles virus has only one serotype which causes only one illness, unlike Human Papillomavirus which has dozens of serotypes and can cause different diseases.  This is why we see multiple serotypes included in the HPV vaccine and only one strain in each of the available measles vaccines which are all genotype A.  Additionally, Unlike other viruses, such as the flu, the genotypes within strains of the measles virus only vary ~12% at the nucleotide level.

For these reasons, studies including millions of individuals have shown that the genotype A strain in the measles vaccines available today produce the antibodies necessary to provide immunity to all strains of the measles.

Measles viruses recovered through testing are constantly monitored, analyzed and characterized to identify areas of the genome which may antigenically-drift.  The measles viruses currently circulating have also been tested against vaccine-derived antibodies to ensure vaccines will cross-protect against the numerous genotypes that have been detected in different parts of the world.

There are tests such as virus neutralisation assays that combine different measles viruses with serum samples (the antibody-rich fraction of blood) of people who have either been vaccinated or previously infected with wild-type measles to determine if antibody binding occurs to different measles genotypes.  A fluorescent tag is added in order to visualize a reaction and then the antibody-antigen complex is measured. Results of numerous studies demonstrate that vaccine-derived antibodies protect against many different measles genotypes:

One of the tools public health agencies such as the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) use to monitor and test the efficacy of the measles vaccines are antibodies called monoclonal antibodies (MAbs) and have found that between the vaccine strain (genotype A) and wild type measles viruses (genotypes B-D) the measles vaccines currently available offer protection against these strains.

Specifically, the CDC and the WHO have found that the current measles vaccines offer protection against measles genotype, B3 the strain responsible for the Disneyland outbreak.

It is frustrating to know that a post I intended to inform and educate parents has been used to fuel a myth that may put their children at risk.  If any further evidence was needed to support that the MMR vaccine is effective against the Disneyland measles outbreak, which has sickened 121 people to date (dozens more reported), only 7% of those infected had received two doses of the MMR vaccine.  If the MMR and MMRV vaccines were ineffective against genotype B3 we would see many more people with both doses of the vaccine test positive for the measles.

Measles is one of the most infectious diseases we know of and this interactive infographic demonstrates how measles can spread in variable susceptible populations.  If the vaccine did not proffer cross-protection, there would be tens of thousands of cases to date.  Help me save lives and It is a public health imperative that parents have accurate information in order to feel confident that the available measles vaccine do work and have an excellent safety profile.

 


Resources:
Science Mom. Disneyland Measles Outbreak is Due to The Measles.  JustTheVax.Blogspot.com. January 28, 2015. Retrieved February 16, 2015.

The RNA Society. What is RNA? Retrieved February 16, 2015.

Blamaire, J. Genotype and Phenotype Definitions. City University New York. 2000. Retrieved February 16, 2015.

National Institutes of Health. Antigen Definition. Medline Plus. August 11, 2013. Retrieved February 16, 2015.

Centers for Disease Control and Prevention. Serotypes and the Importance of Serotyping Salmonella. April 8, 2014. Retrieved February 16, 2015.

Medicinenet.com. Epitope Definition. June 16, 2012. Retrieved February 16, 2015.

Wikipedia. Strain (biology). Retrieved February 16, 2015.

Centers for Disease Control and Prevention. Specimens for Detection of Measles RNA by RT–PCR or Virus Isolation. November 3, 2014. Retrieved February 16, 2015.

Centers for Disease Control and Prevention. Genetic Analysis of Measles Viruses. November 3, 2014. Retrieved February 16, 2015.

“Wild-type measles viruses have been divided into distinct genetic groups, referred to as genotypes, based on the nucleotide sequences of their hemagglutinin (H) and nucleoprotein (N) genes, which are the most variable genes on the viral genome.

The 450 nucleotides encoding the carboxy-terminal 150 amino acids of the nucleoprotein has up to 12% nucleotide variation between genotypes. The 450 nucleotides that encode the carboxy-terminal region of the nucleoprotein (N–450) are required for determination of the genotype. The measles genotyping protocol is available from CDC.”

World Health Organization. Measles. March 11, 2013. Retrieved February 16, 2015.

“Many of the attenuated strains in use are derived from the Edmonston strain isolated in 1954, including the Schwartz, the Edmonston-Zagreb, and the Moraten strains. Other strains which are not derived from Edmonston strain include the CAM-70, TD 97, Leningrad-16, and Shanghai 191 (Ji-191) strains.”

Growdon, W. B., & Del Carmen, M. (2008). Human Papillomavirus-Related Gynecologic Neoplasms: Screening and Prevention. Reviews in Obstetrics and Gynecology, 1(4), 154–161.

Centers for Disease Control and Prevention. Serologic Testing for Measles in Low Prevalence Setting. November 3, 2014. Retrieved February 16, 2015.

Tamin, A., Rota, P., Wang, Z. et al., Antigenic Analysis Of Current Wild Type And Vaccine Strains Of Measles Virus. Journal of Infectious Diseases. (1994) 170 (4): 795-801.doi: 10.1093/infdis/170.4.795

“The serum samples from recently vaccinated persons neutralized both the Moraten and Chicago-I viruses equally well (table 1): There was a <2-fold difference in neutralization titers. In contrast, serum samples from persons with a recent wild type infection were able to detect antigenic differences between the viruses. Sera in this set had neutralization titers against Chicago-l that were 4-8 times higher (average, 5.1) than the titers against the vaccine strain.”

Bankamp, B., Takeda, M., Zhang, Y. Genetic Characterization of Measles Vaccine Strains. Journal of Infectious Diseases. (2011) 204 (suppl 1):S533-S548.doi: 10.1093/infdis/jir097

“On the basis of the sequences of their N and H genes, MeVs can be assigned to 1 of 23 genotypes and 1 provisional genotype [11, 12]. All vaccine strains and their wild-type progenitors are assigned to genotype A. Experiments with monoclonal antibodies have defined antigenic differences between the H proteins of genotype A vaccines and the H proteins of wild-type viruses grouped in other genotypes [62, 188, 189]. However, there is only 1 serotype for measles, and serum samples from vaccines neutralize viruses from a wide range of genotypes, albeit with different neutralization titers [188, 190] More importantly, despite the presence of different endemic genotypes, vaccination programs with standard measles vaccines have been successful in every country where they were performed adequately [191193]. Suboptimal seroconversion after vaccination is likely the result of inadequate coverage; improper administration, transport, or storage of vaccine; or age of the vaccine recipients [194196].”

Centers for Disease Control and Prevention. Measles Outbreak — California, December 201–February 2015. Early Release. Morbidity and Mortality Weekly Report. February 13, 2015. Retrieved February 16, 2015.

Centers for Disease Control and Prevention & World Health Organization. History and Epidemiology of Global Smallpox Eradication. Slides 16-1. Retrieved February 16, 2015.

Harris, R., Popovich, N., Powell, K. Watch how the measles outbreak spreads when kids get vaccinated – and when they don’t. The Guardian. February 5, 2015. Retrieved February 16, 2015.

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Categories: Infectious Disease + Vaccines, Science 101 + Mythbusting

What I Want You To Know: My Son’s Life Depends on Community Immunity

By February 11, 2015 1 Comment
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Most 15 year old girls are more interested in boys or music than how deep their science high school coursework is. And while I was also interested in boys and music, I remember asking my dad for a more challenging high school science course when I was 15. My dad, who has a degree in genetics, had given me a pretty decent science background up to that point, but he did as I asked and assigned the Human Genome Project for me to read, discuss, write papers on, and research. That started a lifelong love of medical research, and more broadly, medicine.

I have three children, and my youngest, Mac, was born with a rare form of spina bifida called myelomeningocele with shunted hydrocephalus. Amongst other things he is paraplegic, has a tracheostomy, and needs to use a ventilator to breathe at night.

Mac is my miracle child; my smart and vivacious little boy. He was not expected to see his first birthday, but like the courageous child he is, he has seen three. He’s the jokester of the family and he’s one of the most expressive nonverbal children you will ever meet.

We live about six hours away from the Disneyland theme park in Anaheim, California. When I first heard of the measles outbreak stemming from the park, I was on high alert. Because we live so close to the center of the outbreak, I knew it was only a matter of time before the outbreak spread to our community.  So when I got the news release from our local public health office on January 28th that there was a confirmed case in our county, our life was upended.

According to news reports, this is how the measles came to my community: An unvaccinated adult contracted the disease while in another part of California and then came to Fresno County and visited the area’s largest mall, including the Disney Store and Build-a-Bear, places I often visit with my kids.  The infected individual also visited the labor and delivery ward at one of our local hospitals.

Our pediatrician advised us to stay home from ALL unnecessary gatherings (necessary being only life/death situations) until the measles is cleared from our county. No church, birthday parties, playgrounds, malls, grocery store trips as a family, weddings, after school activities or fast food restaurants.  We’ve even had to keep Mac home from the preschool that he loves for the last two and a half months.

My older two children are fully vaccinated for their ages. However, because Mac was medically frail for so long, our pediatrician declined to vaccinate him at various times during his first year–including against MMR–until he was strong enough. As he’s become stronger we’ve been able to catch him up on a few shots but his immune system has difficulty building appropriate levels of the antibodies needed for immunity. As a result, he is much more susceptible to the disease even though he’s vaccinated.

The common cold or flu are major medical events in our home and the measles is life and death.  For those in my community and elsewhere that have refused vaccinations due to personal beliefs, and not because of sound medical advice, this is what I want you to know:

  1. Mac is a child and we chose life for him when we were told about the seriousness of his medical conditions before he was born.  I want to choose life for him now but that choice has been taken away from me.  For Mac, the measles are literally life and death.
  2. I understand you have concerns about vaccinating, but choosing fear instead of information has severe effects for kids like Mac and those that are fighting other serious illnesses such as cancer.
  3. Even if our family makes it through the outbreak unscathed, your choice not to vaccinate has isolated my family and taken activities away from my children that they enjoy.
  4. One of our family rules is to think of others first.  My two older children were vaccinated on schedule because I wanted to protect them, and others, from serious illness. My family is relying on you to do the same.
  5. I would not ask you to do anything for your children that I would not do myself.  Once the outbreak has subsided and he is strong enough, Mac will receive his MMR vaccination.  I only ask that if your child is old enough and strong enough that they also receive their shots on schedule.

All in all, the risk of measles for my family is literally the loss of my vibrant little boy. His medical conditions make him one of the few fragile children whose protection by herd immunity is of paramount importance. If herd immunity breaks down, he is in the topmost percentage of at-risk children for severe complications and death from even a minor case of the measles.  This is where my heart is: society needs to be aware of children like Mac, and just how much they depend on you.

 


Resources:
Spina Bifida Association. Hydrocephalus and Shunts in the Person with Spina Bifida. Retrieved February 10, 2015.

Centers for Disease Control and Prevention. Health Alert Network Advisory: U.S. Multi-state Measles Outbreak, December 2014-January 2015. January 23, 2015. Retrieved February 10, 2015. CDCHAN-00376.

County of Fresno Public Health Department. Measles Case Confirmed in Fresno County. Retrieved February 10, 2015.

Centers for Disease Control and Prevention. Vaccines and Immunizations: Possible Side Effects from Vaccines > MMR. Updated August 19, 2014. Retrieved February 10, 2015.

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Categories: Chronic Illnesses + Conditions, Disability + Disability Advocacy, Infectious Disease + Vaccines, Policy, Politics, + Pop Health

Does HPV Vaccine Gardasil Really Have A Dark Side?

By February 9, 2015 No Comments
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In their story on the purported devastating side-effects of the HPV vaccine, Gardasil, the Toronto Star’s David Bruser and Jesse McLean buried the lead. In both the print and video amplifier, the message “in the cases discussed in this story, it is the opinion of a doctor or patient that a particular drug has caused a side effect. There is no proof the vaccine caused a death, illness or hospitalization,” [emphasis mine] was buried either at or towards the end.

I’m usually a fan of the Star’s reporting, a good friend is a former reporter and editor with the paper, so I was shocked to see the specious connections made by the Star’s team about a life-saving vaccine. The Star’s story arrives in the midst of a national dialogue on the safety, efficacy and necessity of vaccines, which makes it all the more crucial to fact check the story’s claims.

If Gardasil carries with it a risk higher than reward I would be the first to say it needs to be pulled, but the data does not bear this out. But multiple studies (Chao, et al., 2012; Arnheim-Dahlström, et al., 2013; and CDC MMWR Weekly July 26, 2013 / 62(29);591-595) involving literally millions of subjects have shown no increased incidence of autoimmune disorders post vaccination with either variation of the HPV vaccine.

A crucial error in the story is Bruser and McLean’s misinterpretation (misrepresentation? misunderstanding?) of the Vaccine Adverse Event Reporting System (VAERS). In the simplest of terms VAERS is quantitative input, not qualitative output. Anyone can, and is encouraged to, report an injury to VAERS that they believe to be caused by a vaccine. Reporting a suspected injury to VAERS is not the same as a confirmed causal relationship.

The stories told by the girls and their mothers in the Star piece are heartbreaking, and I do not doubt these girls suffered debilitating illnesses. But what’s crucial to the story is whether or not those illnesses were caused by the Gardasil vaccine.

In one story, there may be a clear connection, however, the connection speaks not to the safety of the vaccine but rather to importance of vaccine safety communication. The article and video highlights the story of Kaitlyn, a teenage girl given the shot even though she told the nurses(s) she was allergic to a key component in the vaccine. If the nurse(s) did ignore Kaitlyn’s warnings and gave her the shot anyways, this does not imply an issue with the safety of the vaccine. It does imply that our health care professionals need to better educated about the components and contraindications for each vaccine.


Resources:
Chao, C., Klein, N. P., Velicer, C. M., Sy, L. S., Slezak, J. M., Takhar, H., Ackerson, B., Cheetham, T. C., Hansen, J., Deosaransingh, K., Emery, M., Liaw, K.-L. and Jacobsen, S. J. (2012), Surveillance of autoimmune conditions following routine use of quadrivalent human papillomavirus vaccine. Journal of Internal Medicine, 271: 193–203. doi: 10.1111/j.1365-2796.2011.02467.x

Arnheim-Dahlström, L., Pasternak, B.Svanström, H., Sparén, P., Hviid, AAutoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study

CDC Morbidity and Mortality Weekly Report (MMWR). Human Papillomavirus Vaccination Coverage Among Adolescent Girls, 2007–2012, and Postlicensure Vaccine Safety Monitoring, 2006–2013 — United States July 26, 2013 / 62(29);591-595

CDC Vaccine Adverse Event Reporting System (VAERS). Last updated July 24, 2013. Retrieved February 8, 2015.

U.S. Department of Health and Human Services Centers for Disease Control and Prevention Food and Drug Administration. Do Your Part for Vaccine Safety: Report to VAERS. Retrieved February 8, 2015.

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Categories: Ages + Stages, Infectious Disease + Vaccines, School-Aged Children, Science 101 + Mythbusting, Tweens + Teens