DC Child Accident & Safety Blog

The FDA has approved two vaccines to ward off infection by some strains of the human papillomavirus (HPV), which can cause cancer. But until recently, the shot was promoted only for girls. (The vaccine is useless unless given before the onset of sexual activity.)

But the federal Advisory Committee on Immunization and Practices (ACIP) recently issued a recommendation that boys and young men also receive the vaccination to protect against genital warts and anal cancer. Males are at a lower risk of developing cancer from HPV, but they can transmit HPV to their partners.

We recently wrote about the lag in HPV vaccination for young people, but that was before the ACIP issued its recent report. The more often parents are made aware of the solid science, the more likely they are to protect their children’s future health.

According to a Kaiser Family Foundation fact sheet, HPV infection in the U.S. is widespread, with more than 6 million new infections annually. Approximately half of all sexually active men and women will get HPV at some point in their lives.

Currently, the vaccines are administered in three doses over 6 months, but research is underway to determine whether two might be sufficient to provide protection.

A study published by the Centers for Disease Control and Prevention focusing on vaccination coverage of teenagers from 13 to 17 presents a good-news/bad-news scenario.

Good news: Adolescent vaccination rates for meningococcus (MenACWY, which protects against meningococcal meningitis), tetanus/diptheria/acellular pertussis (Tdap) and human papillomavirus (HPV), all increased from 2009 and 2010. Bad news: HPV vaccination rates lagged the other two, and less than one-third of the subjects completed the three-shot series.

Vaccinating against HPV protects girls from developing cervical cancer later in life and can protect boys from genital warts and anal cancer. But the shot has to be given before sexual activity begins.

The CDC survey has collected provider-verified vaccination data since 2006 in a random telephone survey of parents or caregivers, verified by records from health-care providers. The latest survey found that almost two-thirds of respondents had received MenACWY, slightly more than two-thirds had received the Tdap and nearly half of respondents received one the recommended three doses for HPV vaccine.

From 2009 to 2010, among girls who received the three HPV doses, coverage increased by 5 in 100, which was considerably less than those observed for the Tdap (13 in 100) and meningitis (9 in 100) vaccines.

There were notable geographic differences in who got the vaccines, with states in the southeast lagging other regions.

Melinda Wharton, M.D., M.P.H. and deputy director of the CDC's National Center for Immunization and Respiratory Diseases said, "Far too few U.S. girls are getting the HPV vaccine. We can do better at this — we've got in our possession a very powerful tool: a vaccine that prevents cancer," she said. "If we all take actions to protect girls starting today, we'll have generations of women who will never be diagnosed with cervical cancer."

One manufacturer’s HPV vaccine also is recommended for adolescent males to prevent four common HPV strains that cause genital warts and anal cancer.

Wharton told Medscape that several factors might explain the disparity in rates between HPV vaccination and the other two. Adherence is a lot easier for a single-dose vaccine than for one that requires three shots. And many parents believe that girls are too young at the recommended age (11 or 12) to receive the vaccine.

There isn’t really an answer to the first impediment, and the CDC recommends a two-dose series for MenACWY. As for the second impediment, as Wharton points out, the vaccine doesn’t work “unless it is given prior to the onset of sexual activity, and that's why we recommend it so young."

"Even if we know our children very well, we don't know when they are going to be first sexually active," Wharton said. "It's also possible that most parents are not going to be as concerned about [the young age at first dose] as providers think they might," she said. "If a provider makes a strong recommendation for this vaccine ... it may be that parents won't have many questions about it."

Your pediatrician doesn’t schedule vaccinations according to personal habits or family dynamics. It’s about preventing disease the most effective way possible. Science doesn’t judge; it analyzes.

The Supreme Court says parents whose children allegedly are injured by vaccine shots cannot sue the manufacturer in court even if the special federal panel set up to compensate vaccine injury victims rejects their claim.

Robalee and Russell Bruesewitz of Pittsburgh, filed a lawsuit for their daughter, Hannah, after their claim in the federal vaccine court was rejected. They say she was a healthy infant until she received the diphtheria, tetanus and pertussis (DTP) vaccine in April 1992. The vaccine was made by Wyeth, now owned by Pfizer, Inc. Within hours of getting the DPT shot, the third in a series of five, the baby suffered a series of debilitating seizures. Hannah continues to suffer from residual seizure disorder and has developmental problems and cannot care for herself.

Congress set up a special federal "no fault" compensation system in 1986, putting a small tax on each unit of vaccine sold. The system has paid $1.9 billion to families since then, but the vaccine court ruled that the Bruesewitz family didn't have enough evidence that their daughter's seizures were caused by the vaccine.

That form of the DTP vaccine was later taken off the market.

Justice Antonin Scalia, writing for six justices, said Congress intended to bar all suits against manufacturers other than the non-fault cases in the federal vaccine court. Two other justices, Ruth Bader Ginsburg and Sonia Sotomayor, disagreed. Nothing in the 1986 law "remotely suggests that Congress intended such a result," Sotomayor wrote.

David Frederick, who represented the Bruesewitz family at the Supreme Court, said, "I'm disappointed for the families of victims of defectively designed vaccines, who now have no remedy at law for their injuries."

Here are the latest recommendations from the U.S. Centers for Disease Control and Prevention on childhood vaccinations. Immunization shots took a bad, and unjustified, rap for their never proven connection to autism. These vaccines are necessary to prevent some very serious and even fatal infectious diseases.

The official chart of vaccines for kids under age 6 is here:

And this is the chart for children from age 7 to 18:

You can read all the explanations and footnotes at the CDC website here.

Two U.S. government agencies - the Centers for Disease Control and Prevention (CDC) and the the U.S. Agency for International Development (USAID) - joined the World Health Organization WHO) and the Russian Ministry of Health and Social Development to sign the global protocol of intent to eradicate polio wherever it occurs. The agreement also has the support of international charity organizations, such as Rotary International, and will reach out to communities throughout the world.

Polio has long been eradicated in North America due to successful vaccination programs, but outbreaks of this highly infectious crippling disease continue to occur in some central Asian and African countries. And because polio is extremely contagious, there is always a risk of it being transmitted to countries where it no longer exists or was thought to be eradicated, including the U.S. Since this poses a risk to unvaccinated children, the goal of the agreement is to eradicate all strains of polio.

Since 2006, only four countries - Afghanistan, India, Nigeria and Pakistan - remain polio-endemic with indigenous poliovirus circulation. Additionally, in four African countries wild poliovirus was either known (Angola, Chad) or suspected (Democratic Republic of the Congo, southern Sudan) to have persisted for for more than 12 months as of mid-2009, leading to their designation as having “re-established” transmission.

Unfortunately, the list does not end there, as the following countries have had imported polio cases or cases related to an imported poliovirus within the past 24 months: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d'Ivoire, the Democratic Republic of the Congo (DRC), Ghana, Guinea, Kazakhstan, Kenya, Liberia, Mali, Mauritania, Nepal, Niger, Russia, Senegal, Sierra Leone, Sudan, Tajikistan, Togo, Turkmenistan and Uganda.

Source: USAID

The conclusions of a 1998 study that appeared to link the measles-mumps-rubella (MMR) vaccine to autism were not only false but fraudulent, according to an article published in the British Medical Journal (BMJ).

The original study, written by Dr. Andrew Wakefield, reported on a dozen children, eight of whom were said to have developed gastrointestinal trouble and autism after receiving the MMR vaccine. The paper was published by the prestigious medical journal The Lancet and helped fuel an anti-vaccine movement that persuaded a significant number of parents in the U.S and Europe to shun childhood vaccinations, which in turn has led to an increasing number of outbreaks of mumps and measles.

Wakefield’s study was later renounced by 10 of its 13 authors. In February 2010, the Lancet retracted the 1998 article, and 3 months later, Wakefield and another physician author were stripped of their right to practice medicine in Britain. To date, no credible scientific evidence has clearly connected vaccines with autism or other developmental disorders

But vaccine critics remain skeptical, citing anecdotal evidence of a pattern of bad reactions in vaccinated children, including identical symptoms appearing in the same period. They contend that toxins used as additives and preservatives, and the number and timing of immunizations can cause developmental disabilities and other chronic health conditions in children with sensitive immune systems or genetic disorders.

The new examination of Wakefield's research alleges the British doctor and his colleagues falsified facts about the children. The allegations were made after comparing the reported diagnosis in the original paper with hospital records.

Among the more glaring new findings in the article, the first in a series on the Wakefield case by a British investigative reporter, is that hospital records show five of the 12 children studied had previously documented developmental problems, before they were vaccinated, though the original study reported all the children had developed normally until after they were vaccinated. In addition, behavioral problems that the original paper said appeared days after vaccination did not in fact appear for months in some of the children.

Source: CNN.com

You can view the article in the British Medical Journal here.

The Centers for Disease Control and Prevention (CDC) has issued a statement out of its Immunization Safety Office saying that Gardasil, the vaccine designed to prevent human papillomavirus (HPV) which can cause cervical cancer, is safe and should be given to girls starting at age 11 or 12.

The article notes that some political groups are frightened that the vaccine will encourage girls and young women to engage in sexual activities that the groups do not approve of, and apparently do not feel that saving these women's lives outweighs this risk. These political groups have been trying to claim that Gardasil is not safe or effective. But the CDC statement points out that a study of 370,000 vaccinations showed no evidence of a link to increased blood clots or other serious health problems, meaning that claims of Gardasil's dangers are counterfactual. From the article:

"The results are really reassuring," said Dr. Paul Offit, chief of the infectious diseases division at Children's Hospital of Philadelphia. "There's a public perception that the vaccine is not safe. This is important for countering negative information."

The article points out that there are almost 4,000 deaths from cervical cancer each year. Doctors hope that this vaccine will reduce the number of these deaths.

Until recently, public health officials only recommended flu vaccinations for children two years old or older.

But now, as flu season approaches, the Centers for Disease Control and Prevention (CDC) have recommended that babies as young as six months get the vaccine.

From the article:

The flu vaccine is recommended for people 50 years and over, people with certain chronic medical conditions, people in nursing homes, pregnant women, and children 6 months to 18 years old unless they have a serious egg allergy. The vaccine is also recommended for health workers, and anyone in close contact with infants or others at-risk.

For further information, go to www.cdc.gov and check out the links about the flu.

A small but growing number of parents across the U.S. refuse to vaccinate their kids, doubting the efficacy and safety of the vaccines.

The article suggests an intriguing reason for these refusals:

It is the absence, or close to it, of some illnesses in the United States that keep some parents from opting for the shots. Worldwide, 242,000 children a year die from measles, but it used to be near one million. The deaths have dropped because of vaccination, a 68 percent decrease from 2000 to 2006.

“The very success of immunizations has turned out to be an Achilles’ heel,” said Dr. Mark Sawyer, a pediatrician and infectious disease specialist at Rady Children’s Hospital in San Diego. “Most of these parents have never seen measles, and don’t realize it could be a bad disease so they turn their concerns to unfounded risks. They do not perceive risk of the disease but perceive risk of the vaccine.”

Most of these concerns, however, are unfounded: the safety risk of most vaccines are negligible. And failing to vaccinate not only puts the non-vaccinated child at risk, but also his or her playmates. Even effective vaccines do not work 100% of the time, so a vaccinated child is not necessarily protected from his or her non-vaccinated friends.

For more information, see the Centers for Disease Control (CDC) fact sheet on common vaccinations.

Babies under the age of one are especially susceptible to meningitis. They have the highest rates of infection, but the currently-existing vaccine cannot be used on them. It is restricted to children over two.

However, an experimental vaccine called Menveo may be effective in these infants. Here is what experts have to say about it:

The vaccine was about 94% effective when given in four doses, one at 2 months, 3 months, 4 months and 12 months — a dosing schedule that fits into standard vaccination programs in the U.K., says study author Matthew Snape, a pediatrician at the University of Oxford.

When given in three doses, one each at 2 months, 4 months and 12 months — the standard pattern for shots in the USA — the vaccine was 86% to 100% effective, providing more protection against some strains of the bacteria than others, Snape says.

If approved, a meningococcal vaccine could prevent half of the roughly 300 cases of meningococcal meningitis in babies under 2, says Amanda Cohn, a pediatrician at the Centers for Disease Control and Prevention.

Thirteen childhood diseases for which we have vaccines are causing fewer deaths than ever, according to a new study done by the Centers for Disease Control and Prevention (CDC).

Deaths and hospitalizations from smallpox, diphtheria and polio have gone down one hundred percent since vaccines against them were approved. Deaths and hospitalizations from nine of the diseases have gone down ninety percent, and only in only four diseases (all of which have vaccines that were approved only recently and thus have had less time to take effect in the population) did they go down less than ninety percent. Those four diseases were hepatitis A and B, varicella and invasive pneumococcal diseases.

This is a striking demonstration of the value of vaccinating children--a practice that is sometimes controversial, as many parents oppose it either for religious reasons or because of skepticism about its efficacy. Hopefully studies like these will address some of that skepticism and promote the use of vaccines in preventing deadly diseases.