Pediatric Controversies: Immunizations 2/3

How many of you have heard the name Dr. Andrew Wakefield? His uber-small, sample study that linked childhood vaccines to autism was retracted by the British Medical Journal. Why is this important? This study fueled the fire for many people choosing not to immunize. But really, what harm is it not to immunize your child against common childhood diseases? You can read about this retraction and the impact it has by following this link: http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html

I want to introduce a concept to you. It's called herd immunity. I can already see index fingers flying up, scratching a few temples. Cows? She's talking about cows? This girl has lost her mind-- been working too many 12 hour shifts.




Malibu56/Photobucket

Let me explain. Herd immunity is the number of immunized individuals in a group (be it people or cows). It affords certain protection if the "herd" is largely immunized. Let me paint a scenario for you. Take a population of 100 people. Now, 99 of them are immunized against measles. There is a measles outbreak in the next town five miles over. Measles is highly contagious. What's the chance of measles taking hold in this community where 99% of individuals are immunized? What if the herd immunity in that town was 80%. What are the chances then?

In this scenario, the likelihood of measles taking hold in the community where 99% of people are immunized is low. Dr. Paul Offitt, in his book, Deadly Choices, states that likely 95% herd immunity will protect a community against measles. In 2008, the following states all had immunization rates <70%: Washington, Vermont, Idaho, Montana and Nevada. The likelihood of a measles outbreak taking hold in those state is high.
In the article above concerning Dr. Wakefield, it lists some of the ramifications of people choosing not to immunize.

"The now-discredited paper panicked many parents and led to a sharp drop in the number of children getting the vaccine that prevents measles, mumps and rubella. Vaccination rates dropped sharply in Britain after its publication, falling as low as 80% by 2004. Measles cases have gone up sharply in the ensuing years."

The 95% herd immunity for measles seems to hold true.

"In the United States, more cases of measles were reported in 2008 than in any other year since 1997, according to the Centers for Disease Control and Prevention. More than 90% of those infected had not been vaccinated or their vaccination status was unknown, the CDC reported."

But really, what's the problem with a case of measles? Why did they invent that vaccine anyway? You can read more about measles infection on the following links but one possible complication of measles infection is encephalitis (1:1000 measles cases). I was a little shocked by that number. Encephalitis is an infection in the brain.

1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002536
2. http://kidshealth.org/parent/infections/lung/measles.html

The main concern with measles is that it is highly contagious. There is no "cure" once a case is contracted, merely symptomatic support. Measles is very concerning if a pregnant woman contracts it. Read the following:

"If you're not immune to rubella and you come down with this illness during early pregnancy, it could be devastating for your baby. You could have a miscarriage or your baby could end up with multiple birth defects and developmental problems. Congenital rubella syndrome, or CRS, is the name given to the pattern of problems caused when a baby is born with the virus."

I think the following paragraph lends support to the point of having high herd immunity when it come to measles.

"Rubella has become quite rare in the United States, thanks to a very successful vaccination program. Before the rubella vaccine was developed in 1969, a rubella epidemic in 1964 and 1965 caused 12.5 million cases of the disease and 20,000 cases of CRS in the United States. In contrast, between 2001 and 2005, there were a total of 68 reported cases of rubella and five reported cases of CRS. And in 2006, there were just 11 reported cases of rubella and only one case of CRS."

Here is the link for these quotes: http://www.babycenter.com/0_rubella-german-measles-during-pregnancy_9527.bc.

How often do you hear this side when it comes to the immunization debate? What good is this for fiction? I talked to a pediatrician in our area and asked him what his current rates of immunization were. He stated he was lucky to have 50% of his kids immunized. Some of those children are now women of childbearing age. I think it would be easy to add as a pregnancy complication for any story. What about a measles outbreak?

What do you think?

Pediatric Controversies: Immunizations 1/3

I'm going to focus on aspects of the pediatric immunization controversy that could easily be a whole novel in itself (and has been), but can add layers to novels that have a pediatric character or perhaps you want to add conflict to an issue that involves a child.

Issue based novels that are preachy typically perform poorly. It has to be about characters first. A novelist who does this well is Jodi Picoult. There is generally a central issue in her novel but the characters are likely why you keep reading.

One of the largest areas in pediatrics that is a main source of controversy and angst amongs parents is whether or not to immunize their child. Much of this stems from the fear that there is a link between autism and vaccines, particularly the MMR vaccine. Thus far, no credible scientific study has proven a link between autism and any vaccine.



67cupchamps

Let's start by talking about thimerosal. Thimerosal is a preservative that contained mercury that was added to vaccines. This additive has largely been removed from immunizations since 2001. It can still be found in some influenza vaccines so if you're concerned, ask your healthcare provider about it.

However, did you know that since thimerosal has been removed from vaccines, rates of autism have continued to rise? I'm going to list some articles that talk about this revelation. Is it known among parents that this is the case? I'm not convinced.

Check out these resources:

1.http://journals.lww.com/neurotodayonline/Fulltext/2008/02070/Removing_Thimerosal_from_Vaccines_Did_Not_Reduce.6.aspx

2.http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/UCM070430

3.http://leftbrainrightbrain.co.uk/2010/09/thimerosal-in-vaccines-did-not-cause-an-autism-epidemic/

Unfortunately, the power of celebrity is over-riding sound medical study and research in some cases. Millions in research dollars have gone to disproving and have disproved many of these vaccination myths. The question to ask now is whether or not we should continue to investigate these myths or put these limited dollars into research that actually supports the autism community in finding a cure.

Not immunizing your children has risks as well. We'll be talking about this next post.

How can this add conflict to your novel? What if a child died from a disease that he could have been protected against but the parents chose not to immunize? Would that parent have guilt? Would the medical team caring for the child place blame on the parent? What are your thoughts?

I am very interested in comments, however, I know there is a lot of passion on both sides of this debate. So, keep it respectful and curse word free and it will stay posted-- even if you disagree.

Dislocations and Immunizations: HUH?!?

Normally, I post the upcoming week on Saturday but I had a wee issue with a shoulder dislocation yesterday and was in a slight drug haze after the fine ER doctor put said shoulder into place.

I don't know... I think since there's a lot of writers that follow this blog, I should do a book/gift card give-away for whoever leaves the best reason for the cause of the shoulder dislocation. Best comment wins and I'll decide next Saturday. Who's in to win!!

Plus, I'm loving Tim Tebow's winning streak and this is another cause to celebrate.

This week, since I'm already injured, I thought I'd tip my toes into a hot lava on controversy. The myths that surround immunizations. I know this is dangerous territory as both sides of the issue have passionate people that think they have the right opinion. I'm giving the medical perspective which I feel gets muted in the news by other activists.

I'm interested in comments... just keep it clean and respectful and it will stay up. Looking forward to hearing your thoughts and concerns.

Have a great week!!

Forensic Issues: Bruising

On every crime show where a murder has occurred, there's usually a big scene with the medical examiner asserting time of death or determining the time of an injury. In pediatrics, this becomes important when we look at timing a child abuse injury so we can place who was with the child during the suspected event.

The question is, can bruising give an exact time for the injury?




http://orthopedics.ygoy.com/

 Bruising happens when an object comes into contact with the skin, and the small capillaries underneath break open and cause bleeding. Generally, patterned shaped bruises are more suspicious for intentional injury. For something to make a pattern on the skin, it generally needs speed or velocity to imprint the pattern onto the skin. For instance, it is far different if I tap you with a belt versus swinging and slapping it down.

Point blank, bruising is not a good way to determine time of injury. Bruising is influenced a lot by the individual person. Are they on blood thinners? Do they normally heal quickly? Age factors influence speed of healing as well. Bruising can give a time frame but color of bruising is also open to interpretation. Here's one set of guidelines.

Color of Bruise
Red-- swollen/tender: 0-2 days
Blue/Purple: 2-5 days
Green: 5-7 days
Yellow 7-10 days
Brown 10-14 days

As you can see, 48 hours is a large time frame. In the case of pediatrics, imagine the potential of how many people could have come into contact with an infant.

Interesting bruising fact: Bruises generally heal from the inside out. If you watch a bruise you have, you'll notice they become lighter at the center as healing progresses.

Did you think bruises could give an accurate time frame for injury?