Vaccine Safety Curriculum for Medical Residents - American Academy of Pediatrics - Page 10

[Rrrrrachel]

I think most parents know that, but they probably also know a lot more about their child's condition than you do.

[nukuspot]

Firstly that is so unbelievably not true.  I have a huge circle of parent-friends.  Most vax their kids either on the traditional or the Sears schedule.  I posted on facebook a month ago about how vaxxed kids can still get pertussis (because of the recent press about how 80-90% of the cases here in WA are in fully vaxxed individuals) and I can't even tell you how many responses I got back from disbelief to amazement,  Not ONE of the parents knew that except two who had relatives with vaxxed kids all come down with pertussis.  They all thought that since their child was up to date on DTaP they were immune. Since then I have had many conversations with my friends about that fact, including with the mom I am referring to recently.  As a matter of fact, she came up to me and asked me today after noticing I had looked at her child who was coughing at that moment if I thought it sounded like whooping cough.  I told her I didn't know the answer to that because it can look more mild in a vaccinated child.  

Secondly your comment was amazingly rude.  I am sick of this hostility on this vaccination forum.  I have been coming on here periodically for awhile and I have noticed just in the last month that the tone has gotten completely horrible between certain members who are very pro-vax and others who are anti-vax.  I am neither, myself, actually.  I choose not to vaccinate my child at the moment but I am not against vaccines in general.  I come to this forum to share ideas and information, stories and questions.  NOT to be demeaned and put down.  Frankly, it makes me sick how rude certain members are to each other, and now to me.

[AbbyGrant]

Originally Posted by nukuspot 

Firstly that is so unbelievably not true.  I have a huge circle of parent-friends.  Most vax their kids either on the traditional or the Sears schedule.  I posted on facebook a month ago about how vaxxed kids can still get pertussis (because of the recent press about how 80-90% of the cases here in WA are in fully vaxxed individuals) and I can't even tell you how many responses I got back from disbelief to amazement,  Not ONE of the parents knew that except two who had relatives with vaxxed kids all come down with pertussis.  They all thought that since their child was up to date on DTaP they were immune. Since then I have had many conversations with my friends about that fact, including with the mom I am referring to recently.  As a matter of fact, she came up to me and asked me today after noticing I had looked at her child who was coughing at that moment if I thought it sounded like whooping cough.  I told her I didn't know the answer to that because it can look more mild in a vaccinated child.  

Secondly your comment was amazingly rude.  I am sick of this hostility on this vaccination forum.  I have been coming on here periodically for awhile and I have noticed just in the last month that the tone has gotten completely horrible between certain members who are very pro-vax and others who are anti-vax.  I am neither, myself, actually.  I choose not to vaccinate my child at the moment but I am not against vaccines in general.  I come to this forum to share ideas and information, stories and questions.  NOT to be demeaned and put down.  Frankly, it makes me sick how rude certain members are to each other, and now to me.

I'm sorry if you felt Rrrrachel was being rude, but without the context of this post, your first post did make it sound like you were making some assumptions.

[nukuspot]

You don't need to apologize for her.  It's not her in general, there has been a generally nasty tone on the whole vaccinations board lately.  So maybe she is just is in confrontation mode.  But there is no need.  And I still stand by my point, that doctors need to tell parents the effectiveness rates of vaccines.  Some would be great and positive (98% for tetanus!  Yay!)  But they also need to know that their fully vaxxed kid is only 56-80% covered for pertussis, so they should not assume they don't have it or could spread it if it is going around.  Which it is.  And parents are not being told, and they do not know it unless they do their own vaccine research which many do not do, and really shouldn't have to if they aren't research minded, their doctors who are giving the vaccines should be giving them full informed consent.  I really believe in this.

[thegoodearth]

Originally Posted by Rrrrrachel 

I think most parents know that, but they probably also know a lot more about their child's condition than you do.

I agree with nuk - why the nasty tone? 

[AbbyGrant]

     Quote:

Originally Posted by nukuspot 

And I still stand by my point, that doctors need to tell parents the effectiveness rates of vaccines.  Some would be great and positive (98% for tetanus!  Yay!)  But they also need to know that their fully vaxxed kid is only 56-80% covered for pertussis, so they should not assume they don't have it or could spread it if it is going around.  Which it is.  And parents are not being told, and they do not know it unless they do their own vaccine research which many do not do, and really shouldn't have to if they aren't research minded, their doctors who are giving the vaccines should be giving them full informed consent.  I really believe in this.

I completely agree doctors should tell parents about the effectiveness of vaccines including pertussis. I also wish there was a way to educate adults that they could be carriers with a mild case. I think a lot of people tend to associate it with babies or little kids and don't realize they could be spreading it around.

[Rrrrrachel]

I think you are reading a tone into that post that was not intended.

[slmommy]

Originally Posted by nukuspot 

Firstly that is so unbelievably not true.  I have a huge circle of parent-friends.  Most vax their kids either on the traditional or the Sears schedule.  I posted on facebook a month ago about how vaxxed kids can still get pertussis (because of the recent press about how 80-90% of the cases here in WA are in fully vaxxed individuals) and I can't even tell you how many responses I got back from disbelief to amazement,  Not ONE of the parents knew that except two who had relatives with vaxxed kids all come down with pertussis.  They all thought that since their child was up to date on DTaP they were immune. Since then I have had many conversations with my friends about that fact, including with the mom I am referring to recently.  As a matter of fact, she came up to me and asked me today after noticing I had looked at her child who was coughing at that moment if I thought it sounded like whooping cough.  I told her I didn't know the answer to that because it can look more mild in a vaccinated child.  

I agree with this. Most people I know think immunization = immune. I used to. I also think most people have no idea about the fact that some vaccines shed.

[Rrrrrachel]

The risk of shedding is greatly exaggerated. I can count on one hand the cases of disease that are from shedding.

I agree it's important people understand the limitations of vaccination.

[slmommy]

I'll agree maybe we do exaggerate it around here, but really, I'm in a country with OPV use (and no polio case in a couple decades), and the shedding action is counted on by health authorities to "immunize" more of the population...

I've heard anecdotes about oncologists asking recently immunized children not be in contact with cancer patient. MMR product insert shows babies can be exposed to rubella through shedding in breastmilk when mom receives pp MMR, although they don't provide #s about the clinical infection they allude to...

Most of the shedding vaxes have notes in inserts to take into consideration if child is living in household with immunodeficient person.

Anecdotes around here also point to varivax causing cp infection which can be and is transmitted to others.

I think it is just something to keep in mind around newborns and the immunosuppressed. Most people have never heard or considered it a possibility. 

[Rrrrrachel]

Opv aside (I wasn't taking that into account with my comment, I am often guilty of being to us centric) the risk of shedding is theoretical. We know it could happen because we've measured virus cells or whatever in poo of recently vaccinated people (and occasional in nasal secretions) in very low levels, but it's actually happened under a dozen times for all diseases. The amount of shedding a person who is actually sick does is several hundreds if not thousands times more than the shedding a vaccinated person does as a result of a vaccine, and that shedding is often of an attenuated version.

Especially when I hear people talking about it for things that aren't even whole cell or live virus vaccines. You can't catch a virus from a vaccine if the virus isn't there in the first place.

[slmommy]

Lots of vaccines do shed, and that is not "theoretical." Just like reactions we can question/diagree about how often it actually infects someone else, but my original point was that most people do NOT even realize it is a possibility.

Quote:

Rotavirus shedding in stool occurs after vaccination with peak excretion occurring around day 7 after dose 1. Live rotavirus shedding was evaluated in 2 studies among a subset of infants at day 7 after dose 1. In these studies, the estimated percentages of recipients of ROTARIX who shed live rotavirus were 25.6% (95% Confidence Interval [CI]: 10.2, 41.1) and 26.5% (95% CI: 15.5, 37.5), respectively. Transmission of virus was not evaluated. There is a possibility that the live vaccine virus can be transmitted to non-vaccinated contacts.

http://us.gsk.com/products/assets/us_rotarix.pdf

Quote:

Excretion of small amounts of the live attenuated rubella virus from the nose or throat has occurred in the majority of susceptible individuals 7 to 28 days after vaccination.

...

It is not known whether measles or mumps vaccine virus is secreted in human milk. Recent studies have shown that lactating postpartum women immunized with live attenuated rubella vaccine may secrete the virus in breast milk and transmit it to breast-fed infants.49

 In the infants with serological evidence of rubella infection, none exhibited severe disease; however, one exhibited mild clinical illness typical of acquired rubella.50,51

 Caution should be exercised when M-M-R II is administered to a nursing woman

http://www.merck.com/product/usa/pi_circulars/m/mmr_ii/mmr_ii_pi.pdf

Quote:

Post-marketing experience suggests that transmission of vaccine virus may occur rarely between healthy vaccinees who develop a varicella-like rash  and healthy susceptible contacts. Transmission of vaccine virus from a mother who did not develop a varicella-like rash to her newborn infant has also been reported. 

Therefore, vaccine recipients should attempt to avoid, whenever possible, close association with susceptible high-risk individuals for up to six weeks. In circumstances where contact with high-risk individuals is unavoidable, the potential risk of transmission of vaccine virus should be weighed against the risk of acquiring and transmitting natural varicella virus. Susceptible high-risk individuals include: 

• immunocompromised individuals 

• pregnant women without documented history of chickenpox or  laboratory evidence of prior 

infection 

• newborn infants of mothers without documented history of chickenpox or laboratory evidence of 

prior infection and all newborn infants born at <28 weeks gestation regardless of maternal varicella 

immunity.

http://www.merck.com/product/usa/pi_circulars/v/varivax/varivax_pi.pdf

[Rrrrrachel]

Like I said, we know they shed, but infection from shedding is rare or unheard of. It's a theoretical risk, not something that happens. The number of cases for all vaccines is somewhere less than ten.

[slmommy]

Originally Posted by Rrrrrachel 

Like I said, we know they shed, but infection from shedding is rare or unheard of. It's a theoretical risk, not something that happens. The number of cases for all vaccines is somewhere less than ten.

Do you have a link or study proving that number? How can you say it does not happen? The product inserts clearly said it does and has and has potential to happen.

How would we even know if a rotavirus infection in someone originated from natural or vax shed? Seems that there is plenty of acknowledgement that cp vax can cause infection in vaxed person and spread to others, I've seen plenty of discussion/anecdotes about that happening as well. Just because it is not studied doesn't mean it is not happening.

[Taximom5]

Originally Posted by Rrrrrachel 

Like I said, we know they shed, but infection from shedding is rare or unheard of. It's a theoretical risk, not something that happens. The number of cases for all vaccines is somewhere less than ten.

The number of cases has never been tracked, nor is it possible to track.

If someone takes their recently-vaxed and shedding toddler to the grocery store, where he sneezes and drools all over the cart handle, and the next person who uses the cart is someone on prednisone or chemo, and they take one of the nice free cracker/cheese samples, you're going to see a case of infection from shedding that couldn't possibly be tracked.

[Rrrrrachel]

It is tracked. It is possible to track because you can test the virus strain and see if it's the wild virus or the vaccine virus.

[slmommy]

but if someone has chickenpox or rotavirus or flu, unless it is a rare terrible case, why would they even go to the dr? or be tested for what strand? they would stay home and treat disease as if it were wild. My DD had cp or diarrhea I wouldn't go to hospital to test what strand of what virus... maybe that would be done if she had incredibly severe infection.

...right now they aren't even testing what is and what is not really pertussis in WA... you think every kid with cp gets tested for what strand they have??

[AbbyGrant]

     Quote:

Originally Posted by slmommy 

but if someone has chickenpox or rotavirus, unless it is a rare terrible case, why would they even go to the dr? or be tested for what strand? they would stay home and treat disease as if it were wild. My DD had cp or diarrhea I wouldn't go to hospital to test what strand of what virus... maybe that would be done if she had incredibly severe infection.

...right now they aren't even testing what is and what is not really pertussis in WA... you think every kid with cp gets tested for what strand they have??

I thought she was referring to the theoretical chemo patient who ate the crackers after touching the slobbery cart handle.  I'm guessing if a chemo patient got CP, they would end up in the hospital.

Edited by AbbyGrant - 5/21/12 at 8:12am

[slmommy]

Originally Posted by AbbyGrant 

     Quote:

I thought she was referring to the theoretical chemo patient who ate the crackers after touching the slobbery cart handle.  I'm guessing if a chemo patient got CP, they would end up in the hospital.

she is said the number of cases for all vaccines is less than 10.

Well here are 7 in pubmed I found quickly just for varicella, 1 newborn and 6 adults, and I don't think the majority of cases would be reported/tracked/ever found out because they would be in un or under vaxed kids, who would be assumed to have gotten wild infection, and they would not be tested for what strand.

Neonatal Vaccine-Strain Varicella Zoster Virus Infection 22 Days after Maternal Post-Partum Vaccination.

http://www.ncbi.nlm.nih.gov/pubmed/22572750

Transmission of varicella vaccine virus to a non-family member in China.

http://www.ncbi.nlm.nih.gov/pubmed/21134454

(ok, only acknowledges 6 cases of adult cp from vaxed kids worldwide, but most adults are immune, or would still not be tested for which strand) 

Whatever, this is just like reactions. 1 in a billion or more common? no way of knowing, its not tracked, reported, admitted, investigated or found out. Like I said, my original point was that it does and can happen. 

Looks like 20-25% of kids receiving rota shed it. Maybe this is still much less "bad" than natural infection going around... but it DOES shed, and most people are not aware of that fact at all.

[Rrrrrachel]

I can't prove it to you, no. Sorry. It is, however, reality. The inserts mention it because there is a theoretical risk and, believe it or not, vaccine safety is taken seriously and they want you to be aware of all possible risks, no matter how remote.