Last month The Hollywood Reporter published an illuminating investigation on immunization trends in Los Angeles County, which revealed that vaccination rates on the city’s wealthy west side, in neighborhoods like Beverly Hills and Santa Monica, had plummeted, as incidents of whooping cough surged. The piece had the virtue of offering New Yorkers yet another opportunity to feel smugly superior to their counterparts in L.A., because of course here on the East Coast we like our science to come from scientists, not from former Playboy models and people who feel entitled to pontificate about public health because they drink kefir.
In an interview with NPR last month about her new book, “On Immunity: An Inoculation,” the author Eula Biss presented the idea that vaccinating your children on schedule was now seen as “an extreme position.”
New York State and city have strict immunization requirements, which have been further strengthened over the past two years. It is not possible here, as it is in California, to obtain a philosophically based exemption from those rules for your child. In January, the city health department decreed that all enrolled children from 6 months old through age 5, whether attending public or private schools, had to receive a flu shot before Dec. 31. Parents, though, can recuse their children from vaccination protocols with religious exemptions, which are relatively uncomplicated to obtain.
And certainly some exploitation of that loophole is exercised. Amanda Uhry, who runs a consultancy called Manhattan Private School Advisors, which, as its name suggests, helps parents through the private-school application process, said she recently turned down a half-dozen clients when she discovered that they were opposed to vaccination. For a long while she had never inquired about the issue, but a few years ago, a child she was working with missed his kindergarten interview because of whooping cough, which left her stunned.
“I thought, Whooping cough? Who gets whooping cough anymore?” she said. The episode compelled her to start asking about vaccination early on. “No application to any school asks, ‘Are you an anti-vaxxer?’ but these schools want to keep the anti-vaxxers out.” So, she said, “I ask people and if they get into the whole anti-vaxxer deal, I say, ‘Fine, we can’t work with you.’ ” You’re not, as she put it, “going to Horace Mann like this.”
There is enough appeal in anti-vaccination thinking among members of the affluent class that certain pediatricians in the city, as they have elsewhere around the country, have made it a policy in recent years to refuse to see children whose parents won’t have them immunized. A few years ago Pediatric Associates of NYC, which has branches in Murray Hill in Manhattan and Prospect Heights in Brooklyn, chose this course, David Horwitz, a partner in the practice told me, in large part because it simply became untenable to have unvaccinated children sitting in waiting rooms.
Within the American Academy of Pediatrics there has been a rancorous debate about whether doctors should see un-immunized patients, and the academy’s position has leaned toward an inclusive approach. But, Dr. Horwitz said, “we were spending a lot of time talking to parents who weren’t immunizing and who were terribly ill informed. A lot of people would continue to come back and come back and come back and we were spending so much time talking about vaccinations that we weren’t dealing with other things,” he said.
“We ultimately felt ethically uncomfortable seeing people who don’t vaccinate. We are advocates for children, not their parents.”
Among mothers and fathers coming in for an infant’s two-week visit, about 10 percent express opposition to vaccination, Barney Softness, a prominent Upper West Side pediatrician, told me, speaking of his practice. Dr. Softness works with patients to persuade them to immunize. Often he is successful, he told me, but often, “they give me lip service and then delay.”
Because so many New Yorkers are committed more to ambivalence than absolutism, and ultimately to their own neuroses above all else, the current moment of viral fear — the rise of Ebola and national reports of the spread of enterovirus 68 — is actually a fortuitous one for the project of shifting the opinions of deniers, even though there are no vaccines for those illnesses. A hepatitis-A scare on the Upper West Side last year led to a rush of patients coming in for various vaccines, Dr. Softness told me. “Nothing makes people want to get vaccinated more than reports of two cases of something in a ZIP code.”
Laura Popper, who has had a pediatric practice on the Upper East Side since the late 1970s, has never accepted families who refuse to vaccinate their children as patients. As a resident at Columbia nearly 40 years ago, she witnessed as two little girls who were sisters died of diphtheria after a relative visiting from the Dominican Republic turned out to be a carrier. The girls weren’t immunized. “I said to myself then, this will never again happen under my watch,” Dr. Popper said.
“My feeling is that it will take something like that on a very large scale to get upper-middle-class people to realize that this is serious stuff,” she said, even more so than terrorism or other global concerns. “You look around and most of the deaths in the world are from contagious diseases. Not ISIS.”
Original article by Ginia Bellafante of The New York Times
What You Should Know for the 2014-2015 Influenza Season
What sort of flu season is expected this year?
It’s not possible to predict what this flu season will be like. Flu seasons are unpredictable in a number of ways. While flu spreads every year, the timing, severity, and length of the season varies from one year to another.
Will new flu viruses circulate this season?
Flu viruses are constantly changing so it's not unusual for new flu viruses to appear each year. For more information about how flu viruses change, visit How the Flu Virus Can Change.
When will flu activity begin and when will it peak?
The timing of flu is very unpredictable and can vary from season to season. Flu activity most commonly peaks in the U.S. in January or February. However, seasonal flu activity can begin as early as October and continue to occur as late as May.
What should I do to prepare for this flu season?
CDC recommends a yearly flu vaccine for everyone 6 months of age and older as the first and most important step in protecting against this serious disease. While there are many different flu viruses, the seasonal flu vaccine is designed to protect against the top three or four flu viruses that research indicates will cause the most illness during the flu season. People should begin getting vaccinated soon after flu vaccine becomes available, ideally by October, to ensure that as many people as possible are protected before flu season begins.
In addition to getting vaccinated, you can take everyday preventive steps like staying away from sick people and washing your hands to reduce the spread of germs. If you are sick with flu, stay home from work or school to prevent spreading flu to others.
What should I do to protect my loved ones from flu this season?
Encourage your loved ones to get vaccinated as soon as vaccine becomes available in their communities, preferably by October. Vaccination is especially important for people at high risk for serious flu complications, and their close contacts.
Children between 6 months and 8 years of age may need two doses of flu vaccine to be fully protected from flu.
Children younger than 6 months are at higher risk of serious flu complications, but are too young to get a flu vaccine. Because children younger than 6 months cannot get a vaccine, but are at high risk for serious flu-related complications, safeguarding them from flu is especially important. If you live with or care for an infant younger than 6 months of age, you should get a flu vaccine to help protect them from flu.
In addition to getting vaccinated, you and your loved ones can take everyday preventive steps like staying away from sick people and washing your hands to reduce the spread of germs. If you are sick with flu, stay home from work or school to prevent spreading influenza to others.
When should I get vaccinated?
CDC recommends that people get vaccinated against flu soon after vaccine becomes available, preferably by October.
It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against the flu.
We encourage vaccinating patients soon after vaccine becomes available, preferably by October so as not to miss out on opportunities to vaccinate. Those children aged 6 months through 8 years who need two doses of vaccine should receive the first dose as soon as possible to allow time to get the second dose before the start of flu season. The two doses should be given at least 4 weeks apart.
When will flu vaccine become available?
Shipments may begin as early as late August and continue throughout September and October until all of the vaccine is distributed.
Where can I get a flu vaccine?
Flu vaccines are offered at both our Uptown and Downtown office locations.
What kind of vaccines will be available in the United States for 2014-2015?
We use intramuscular (IM) and nasal spray vaccines. The vaccines we use are formulated to protect against four flu viruses (quadrivalent flu vaccines).
Are there new recommendations for the 2014-2015 influenza season?
One possible change to the current recommendations is regarding the preferential use of LAIV in healthy children 2-8 years.
What flu viruses does this season’s vaccine protect against?
Flu vaccines are designed to protect against flu viruses that experts predict will be the most common during the upcoming season. Three kinds of flu viruses commonly circulate among people today: Influenza A (H1N1) viruses, influenza A (H3N2) viruses, and influenza B viruses. Each year, one or two flu viruses of each kind are used to produce the seasonal influenza vaccine.
All of the 2014-2015 influenza vaccine is made to protect against the following three viruses:
- an A/California/7/2009 (H1N1)pdm09-like virus
- an A/Texas/50/2012 (H3N2)-like virus
- a B/Massachusetts/2/2012-like virus.
Some of the 2014-2015 flu vaccine also protects against an additional B virus (B/Brisbane/60/2008-like virus).
Vaccines that give protection against three viruses are called trivalent vaccines. Vaccines that give protection against four viruses are called quadrivalent vaccines.
How effective is the flu vaccine?
Inactivated influenza vaccine effectiveness (VE) can vary from year to year and among different age and risk groups.
How long does a flu vaccine protect me from getting the flu?
Multiple studies conducted over different seasons and across vaccine types and influenza virus subtypes have shown that the body’s immunity to influenza viruses (acquired either through natural infection or vaccination) declines over time. The decline in antibodies is influenced by several factors, including the antigen used in the vaccine, the age of the person being vaccinated, and the person's general health (for example, certain chronic health conditions may have an impact on immunity). When most healthy people with regular immune systems are vaccinated, their bodies produce antibodies and they are protected throughout the flu season, even as antibody levels decline over time. Older people and those with weakened immune systems may not generate the same amount of antibodies after vaccination; further, their antibody levels may drop more quickly when compared to healthy people.
For everyone, getting vaccinated each year provides the best protection against influenza throughout flu season. It’s important to get a flu vaccine every year, even if you got vaccinated the season before and the viruses in the vaccine have not changed for the current season.
Will this season's vaccine be a good match for circulating viruses?
It's not possible to predict with certainty if the vaccine will be a good match for circulating viruses. The vaccine is made to protect against the flu viruses that research indicates will likely be most common during the season. However, experts must pick which viruses to include in the vaccine many months in advance in order for vaccine to be produced and delivered on time. And flu viruses change constantly (called drift) – they can change from one season to the next or they can even change within the course of one flu season. Because of these factors, there is always the possibility of a less than optimal match between circulating viruses and the viruses in the vaccine.
Over the course of the flu season, CDC studies samples of circulating flu viruses to evaluate how close a match there is between viruses used to make the vaccine and circulating viruses.
One of the ways that helps CDC evaluate the match between vaccine viruses and circulating viruses is with a lab process called ‘antigenic characterization’. The match between the vaccine viruses and the circulating viruses is one factor that impacts how well the vaccine works.
Can the vaccine provide protection even if the vaccine is not a "good" match?
Yes, antibodies made in response to vaccination with one flu virus can sometimes provide protection against different but related viruses. A less than ideal match may result in reduced vaccine effectiveness against the virus that is different from what is in the vaccine, but it can still provide some protection against influenza illness.
In addition, it's important to remember that the flu vaccine contains three or four flu viruses (depending on the type of vaccine you receive) so that even when there is a less than ideal match or lower effectiveness against one virus, the vaccine may protect against the other viruses.
For these reasons, even during seasons when there is a less than ideal match, CDC continues to recommend flu vaccination for everyone six months and older. Vaccination is particularly important for people at high risk for serious flu complications, and their close contacts.
Can I get vaccinated and still get the flu?
Yes. It’s possible to get sick with the flu even if you have been vaccinated (although you won’t know for sure unless you get a flu test). This is possible for the following reasons:
- You may be exposed to a flu virus shortly before getting vaccinated or during the period that it takes the body to gain protection after getting vaccinated. This exposure may result in you becoming ill with flu before the vaccine begins to protect you. (About 2 weeks after vaccination, antibodies that provide protection develop in the body.)
- You may be exposed to a flu virus that is not included in the seasonal flu vaccine. There are many different flu viruses that circulate every year. The flu vaccine is made to protect against the three or four flu viruses that research suggests will be most common.
- Unfortunately, some people can become infected with a flu virus the flu vaccine is designed to protect against, despite getting vaccinated. Protection provided by flu vaccination can vary widely, based in part on health and age factors of the person getting vaccinated. In general, the flu vaccine works best among healthy younger adults and older children. Some older people and people with certain chronic illnesses may develop less immunity after vaccination. Flu vaccination is not a perfect tool, but it is the best way to protect against flu infection.
Is there treatment for the flu?
Yes. If you get sick, there are drugs that can treat flu illness. They are called antiviral drugs and they can make your illness milder and make you feel better faster. They also can prevent serious flu-related complications, like pneumonia.
Make sure you see your physician at the most convenient time for your schedule by making your “Back to School” physical appointment now.
Simply give us a call, reserve your appointment date and time, and then enjoy the summer knowing you won’t be scrambling before fall to get all your “Back to School” tasks done.
West End Pediatrics is ready to help you with:
Pre-School and Kindergarten physicals and required vaccinations: You’ll be ready to supply the school with the necessary forms when they’re requested!
Middle School and High School sports physicals: Your children will be ready for fall sports practice when it starts in late summer!
Annual wellness appointments: Medication reviews, upcoming school trips abroad, and influenza vaccinations can all be discussed with your physician at the time of your appointment.
College physicals: Many universities have students moving into dorms by mid-August. Be prepared now to send them off in excellent health!
Asthma, Allergy & Special School Action Plans: Meet with your physician to discuss your action plan for fall and have medications, the plan, and forms ready for the school nurse before school starts.
Call (212) 769-3070 for Uptown Appointments or (212) 353-0072 for Downtown Appointments.
Thanks for choosing West End Pediatrics.
One of my 11-year-old twin daughters recently came home from school distraught. When I asked why, she lifted her foot.
There was dog poop on her sneakers.
She watched as I flicked away the doggy detritus with a twig, then scrubbed the sole of her shoe with an old brush and hot water. “We don’t like to pick up Buddy’s poop, either,” I could hear her telling her sister, “but we do it because it’s gross to leave it on the sidewalk.”
When I handed her the shoe, cleaned and as good as new, she beamed. “Thanks, Mom,” she said, lacing up. But after a few test twirls in the yard, she stopped.
“Didn’t that dog’s owner know he would cause so much trouble for other people?” she asked, brow furrowing. “He might have even caused trouble for himself if he came back and stepped in it!”
At the tender age of 11, she had seen how one person’s bad decision could negatively affect others.
The same lesson is playing out for patients and doctors across the country, albeit under far graver circumstances.
This year, there has been a major resurgence of measles, a dangerous disease that for decades had been virtually unknown in the United States. And it’s become clear that measles has re-emerged as a public health issue in this country because large numbers of individuals remain unvaccinated.
Up until the late 1960s, measles was an unavoidable scourge, infecting millions of children each year. Highly contagious, it could lurk in the air for hours after an infected individual had passed by, resulting in more than 400 deaths and nearly 50,000 hospitalizations annually, as well as innumerable chronic disabilities when it spread to the lungs and brain.
Happily, in 1966 scientists developed a safe and effective vaccine. With this vaccine in hand, public health officials, pediatricians and infectious disease experts began a series of campaigns to eradicate the disease. Their principal strategy was to create “herd immunity,” or “community immunity.”
In any given population, there would always be individuals who would not develop immunity to measles, even after receiving the vaccine, or who could not receive the vaccine because they were too young (less than a year old) or had immune systems already weakened from diseases like cancer or AIDS. But health care experts discovered that if at least 95 percent of a community were immunized against measles, all the members of that group would be safe. Even if someone with the disease entered the community, the immunized majority would serve as a “buffer zone” preventing further spread to unimmunized individuals.
If, however, the rates of vaccination fell below 95 percent and community immunity dropped, that safety net would disappear.
In 2000, after three decades of intensive efforts, public health officials declared that endemic measles had been eradicated in the United States.
But just as the experts were claiming victory, Dr. Andrew Wakefield, a British gastroenterologist, published in The Lancet a study of 12 children that posited a causal link between the measles vaccine and an intestinal disorder and autism. Subsequently, dozens of peer-reviewed studies based on the experience of millions of children found nothing to support such speculation, and in 2010 The Lancet retracted the study, citing fraudulent data and ethics violations. The same year, the British Medical Council barred Dr. Wakefield from practicing medicine because of ethical lapses.
The retraction, the disciplinary actions and all the subsequent scientific findings that refuted Dr. Wakefield’s assertion did little to dampen the enthusiasm of his most fervent supporters. They continued to promote his work and the idea that the measles vaccine could cause autism. Believing that they were protecting the young against neurological harm, these parents refused to vaccinate their children and encouraged others in their communities to do the same.
Pediatricians and infectious disease experts warned that these parents were putting their unvaccinated children at increased risk. Measles remains the eighth leading cause of mortality worldwide and the greatest vaccine-preventable cause of death among children. Studies have shown that unvaccinated children are 35 times more likely to contract the disease than immunized children.
Furthermore, the health care experts cautioned, it wouldn’t be just their own family members that these parents were putting at risk.
This year the proverbial poop has hit the propeller. Over the last five months, there have been 16 outbreaks and almost 500 reported cases of measles. It’s the highest number of cases since 2000, and the number continues to rise. Almost all the outbreaks can be traced to an unvaccinated individual who contracted the disease while traveling abroad, and the majority of people who subsequently caught the disease were unvaccinated by choice.
Moreover, because as many as a quarter of all parents in certain communities chose not to vaccinate their children, pockets of the population have lost the protective effects of herd immunity. In these communities, measles has spread like wildfire, infecting not only those who were unvaccinated by choice but also infants too young to be immunized, and children and adults with immune systems already compromised.
And, it gets worse.
Given the earlier success of the measles eradication campaign, most patients and their doctors no longer know how to recognize the disease. Patients, unaware that they are ill with such a contagious disease, go to hospitals and clinics assuming that the providers there will know what to do to help them.
But most practicing doctors, myself included, have never cared for a patient with measles. Confronted with a patient suffering from a fever, red eyes, runny nose, cough and blotchy rash, we don’t even think of measles, let alone order the dramatic precautions necessary to prevent its spread, like mandating facial masks, isolating patients in rooms equipped with specialized ventilation systems and reporting to appropriate infection control experts.
And because measles was virtually nonexistent in the United States until this year, many clinicians still assume that patients are vaccinated against the disease and therefore not susceptible.
“We have a whole generation of physicians who have never seen measles,” said Dr. Julia Sammons, medical director of infection prevention and control at the Children’s Hospital of Philadelphia. Dr. Sammons has just published in The Annals of Internal Medicine a primer on the diagnosis, treatment, prevention and control of measles to help increase awareness among doctors. “You’re not going to make the diagnosis or make efforts to control spread if it’s not on your radar screen,” she said.
While there have been no deaths yet associated with the recent outbreaks, the lesson for patients and doctors is clear.
When it comes to public health, bad personal choices can have potentially devastating effects on others.
“It’s easy to believe that vaccines are harmful if you aren’t seeing the consequences for yourself and other people,” Dr. Sammons said. “But we need to remember that measles is a preventable disease.”
News: Measles Advisory
If you develop the symptoms described below...
Please call our office(s) immediately. You can reach us by the following contact points:
There are 16 confirmed cases of Measles in New York City. Health officials are advising the public of the potential risk of exposure.
- The number of confirmed measles cases has increased from 6 to 16 since February 5, 2014 with ongoing transmission.
- The majority of recent cases reside in Northern Manhattan.
- Two cases were in Bronx residents.
- Four cases have been hospitalized.
- Cases include 9 children and 7 adults.
- Among the children, 4 were aged <1 year and, therefore, too young to have been vaccinated; three were aged 13 months to 15 months and two were unvaccinated due to parental refusal.
- The 7 adults ranged in age from 22 years to 63 years. Among the adults, 5 thought that they had been vaccinated, but did not have their vaccination records for documentation, and 2 cases had previously received 2 doses of MMR vaccine.
Background on Measles
Measles is a highly infectious and potentially serious disease that is easily transmitted through the air. Symptoms include high fever, cough and runny nose, followed by a rash. The rash often starts on the face before spreading to the rest of the body.
If you develop the symptoms described above...
Please call our office(s) immediately. You can reach us by the following contact points:
For additional information regarding outbreak please click: Here
For additional information regarding Measle please click: Here
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