Vaccine Safety Curriculum for Medical Residents - American Academy of Pediatrics - Page 9

[Rrrrrachel]

Not yet, but I will when I get a chance. It was my impression when I posted that and chose to use the word suspicion.

[Rrrrrachel]

Ok, so after reading them I'm still comfortable saying suspicion. One link didn't work, several were all about the same outbreak in the Netherlands, and one was an article that didn't even talk about mutation, but definitely implied something was up.

I'm not dismissing the idea at all, I think it probably has, but there's not a ton of science on it yet, so it's still a hypothesis (or suspicion).

[Turquesa]

But....these mutations have been confirmed.  Need more links?

http://www.dailytelegraph.com.au/news/whooping-cough-strain-now-immune-to-vaccine/story-e6freuy9-1225828959714

http://www.dailytelegraph.com.au/news/national/vaccine-resistant-whooping-cough-babies-at-risk/story-e6freuzr-1226322564866

http://www.newscientist.com/blogs/shortsharpscience/2010/02/whooping-cough-evolves-to-esca.html

http://jb.asm.org/content/180/9/2484.full

I'd say "suspicions" is a little bit of an understatement, wouldn't you?  Come to think of it, do you have any supporting evidence for this statement from your post?

Herd immunity for pertussis still works in most areas.

I didn't know that there was any research quantifying all of the pertussis outbreaks and the amount of vaccinated v. unvaccinated people catching the illness.  If you could provide such research, I'd like to see it.  I do know that cases in California, Long Island, Wisconsin, Pennsylvania, the UK, Nebraska, Kentucky, and Australia (see above)---to name a few--provide reasonable grounds for critics to stop finger-wagging at non-vaxxing parents for causing these outbreaks. 

[Rrrrrachel]

I don't really want to argue with you about my word choice.

[purslaine]

I thought was an interesting read on how health care providers could communicate with vaccine-concerned parents.    I did not go over it with a fine tooth comb, but what I saw looked reasonably respectful.  

http://pediatrics.aappublications.org/content/127/Supplement_1/S127.full

[Turquesa]

Originally Posted by Rrrrrachel 

I don't really want to argue with you about my word choice.

The issue is about science and data, not semantics.  You've asserted here and elsewhere that unvaccinated children are to blame for pertussis outbreaks, and that "herd immunity for pertussis still works in most areas."  And I'm saying that the science and data so far don't agree.  But no worries.  We don't have to pursue this one.

I thought was an interesting read on how health care providers could communicate with vaccine-concerned parents.    I did not go over it with a fine tooth comb, but what I saw looked reasonably respectful.  

http://pediatrics.aappublications.org/content/127/Supplement_1/S127.full

This is definitely a step in the right direction.  With this strategy, we're hearing more dialogue and less of that ego-driven desire to "win a debate" with patients.  But because it's uncited, I do wonder where the authors are getting this bit of info:

HCPs have the greatest influence on a parent's decision to vaccinate his or her child.

[Rrrrrachel]

I don't think it put it quite that way, but when vaccination rates fall outbreaks go up, sooo . . .

[purslaine]

Turquesa…I took a look at the article and found a few footnotes for where they were getting the idea that HCP's were a great influence on whether people vaccinate.  Here is one:

http://pediatrics.aappublications.org/content/118/5/e1287.full

The article did classify parents into 5 categories - and did say that one or two of the categories would be hard to reach.  I expect most non-vaxxer would fall into a "hard to reach" category.

I can see HCP having an influence on people who are wishy/washy on the idea of vaccinating.  I think they will have less influence on those who have done a lot of research and contemplation.  

I don't think most people are wishy/washy though - most parents go in wanting to vaccinate, and of the small percentage that question the idea, some will be intractable, and some might be open to influence.  

[Rrrrrachel]

I totally disagree, I think most parents are very washy washy and either err on the "safe side" because they've "heard so much" or just vaccinate because their doctor says they should. I think it's a small minority that goes in educated either way.

I'm sorry I made that last comment, I let myself get goaded. It is obviously not fair to blame outbreaks on unvaccinated children, it's a silly endeavor to try to lay blame on anyone for something like that. It bothers me, though, when people try to act like their decision not to vaccinate is consequence free. You ARE putting your child at greater risk of vpd and you ARE making them more likely to pass the disease along to others and you ARE compromising herd immunity. You obviously think the risk of vpd is less than the risk of side effects, and I don't expect anyone to vaccinate just for the "greater good" of herd immunity (I certainly wouldn't) but that decision comes with consequences just like my decision to vaccinate does.

[thegoodearth]

Originally Posted by Rrrrrachel 

I totally disagree, I think most parents are very washy washy and either err on the "safe side" because they've "heard so much" or just vaccinate because their doctor says they should. I think it's a small minority that goes in educated either way.
I'm sorry I made that last comment, I let myself get goaded. It is obviously not fair to blame outbreaks on unvaccinated children, it's a silly endeavor to try to lay blame on anyone for something like that. It bothers me, though, when people try to act like their decision not to vaccinate is consequence free. You ARE putting your child at greater risk of vpd and you ARE making them more likely to pass the disease along to others and you ARE compromising herd immunity. You obviously think the risk of vpd is less than the risk of side effects, and I don't expect anyone to vaccinate just for the "greater good" of herd immunity (I certainly wouldn't) but that decision comes with consequences just like my decision to vaccinate does.

There is another side to the bolded statement as well. Some might say: "You ARE putting your child at risk for vax side effects and you ARE not making them less likely to pass the disease along to others." And as far as herd immunity goes --- well some people who don't vax believe "herd immunity" to be a myth.  There are consequences for every choice period. Vax, not vaxxing, home birth vs hospital birth, driving vs walking - that's life. I think that where the disagreement probably comes in is exactly WHAT those consequences are... so it becomes more of a value judgment. So I guess one just has to accept that not everyone is going to to see it the same way. 

[phathui5]

Originally Posted by stik 

They also remember pre-vax outbreaks.  

Probably not, since most medical residents are under thirty.

[slmommy]

Originally Posted by stik 

They also remember pre-vax outbreaks.  

Originally Posted by phathui5 

Probably not, since most medical residents are under thirty.

Stik was addressing this question I had asked in the post above that statement originally:

"On a side note, I wonder if pedis from older generation are more likely to be ok with sel/del/non vaxing. They remember prior schedules, have probably seen some reactions, aren't fresh out of med school, and have probably eaten humble pie a few times. "

[member234098]

Edited by member234098 - 5/25/12 at 4:52pm

[an_domhan]

You ARE putting your child at greater risk of vpd and you ARE making them more likely to pass the disease along to others and you ARE compromising herd immunity.

Sorry, I'm late to this very long threat and this comment is quite early on, and was likely responded to... but I must also respond.  Everyone is at risk of vaccine available disease and Everyone is capable of spreading disease - regardless of vaccination status.  Vaccinated persons that do not present clinically even more so, since they mingle in the herd and no one bothers to think they're "spreading disease" since they were vaccinated donchakno? 

[an_domhan]

but when vaccination rates fall outbreaks go up, sooo . . .

You do realize that when vax rates fall, that alerts are sent across the globe to every clinical institution to be on the lookout for [disease for which said vax rate has fallen] - do you think this might raise awareness?  Or does that argument only work for Autism?

[Rrrrrachel]

So when vaccine rates fall in hole in the wall Idaho alerts go out all over the globe? No, I didn't know that.

[Rrrrrachel]

And that doesn't explain the county by county correlation between low vacc. rates and higher infection rates. I would think that would cause the rate to go up everywhere.

[an_domhan]

Ok.. I exaggerated and alerts are not tied to vax rates (this is an indirect assertion on my part because because they are tied to "VPD"s).  Subscribe and see for yourself... you can become one of the 1.35 million subscribers :)  @cdcemergency -

When you raise awareness about something... you find it.  When you don't look for it, you don't find it.  If I tell you not to think of Christianity, what will you do?  Think of Christianity. 

And that doesn't explain the county by county correlation between low vacc. rates and higher infection rates. I would think that would cause the rate to go up everywhere.

You know what they say about correlation and causation right?  This is good example of looking and finding, with bias.  If you walk into a community knowing that vax rates are lower than "standard", are you really telling me that you're not looking for reasons to "prove" why this is a bad idea?  And do you really believe that vaccinated persons are handled in the same fashion as those classified as "unvaccinated"?  When my 10 year old was diagnosed with pertussis @ age 4 (fully and totally over-vaccinated) - they did not even test her for it!  It was only at my insistence that they swab and do labs, and guess what?  We would have left there with "Oh, it's just viral.. it'll run its course."  No worries about the infants she was co-mingling with whatsover, because she was vaccinated... and somehow viewed to be in superior health, absolved from any notion that she might be spreading disease just like every other person on the planet when they are susceptible.

[Rrrrrachel]

I don't buy that for counties that are right next door to each other, but I can see why you would.

[nukuspot]

You know what they say about correlation and causation right?  This is good example of looking and finding, with bias.  If you walk into a community knowing that vax rates are lower than "standard", are you really telling me that you're not looking for reasons to "prove" why this is a bad idea?  And do you really believe that vaccinated persons are handled in the same fashion as those classified as "unvaccinated"?  When my 10 year old was diagnosed with pertussis @ age 4 (fully and totally over-vaccinated) - they did not even test her for it!  It was only at my insistence that they swab and do labs, and guess what?  We would have left there with "Oh, it's just viral.. it'll run its course."  No worries about the infants she was co-mingling with whatsover, because she was vaccinated... and somehow viewed to be in superior health, absolved from any notion that she might be spreading disease just like every other person on the planet when they are susceptible.

This is exactly a huge problem that I am trying to figure out how to deal with.  My DD (unvaxxed) has many totally vaxxed friends.  We have a pertussis outbreak going on in my state currently.  I am meticulous when my DD has even a cold not to bring her out near other kids because it *might* be pertussis.  However her totally vaxxed friends are forever going to parties, playgroups, etc with snotty noses and terrible coughs.  We were at a birthday party today.  One of her toddler friends has a terrible cough.  I know he is totally vaxxed because I've talked to his mom about his recent flu vaccine...She's a 100% pro-vax parent.  I have no problem with that choice she made for her child BUT he is at a birthday party with tiny infants coughing all over the place.  Just because he had 4 DTaPs does NOT mean he isn't carrying around a subclinical or mild case of pertussis and transmitting it, especially with the current outbreak, it's much more logical to assume yes than no.  I found that really hard to deal with.  Doctors NEED to tell parents their fully vaxxed kids can still be carriers, period.