Tag: vaccines

The Myth of an Autism Epidemic

We hear stories about the rise in autism and the autism epidemic all of the time.

Autism prevalence rates have been steady at 1 in 68 since 2010.
Autism prevalence rates have been steady at 1 in 68 since 2010.

Every few years, the CDC had been releasing a new report which showed a higher prevalence of autism in the United States, including:

  • 1 in 150 children in 2000
  • 1 in 150 children in 2002
  • 1 in 125 children in 2004
  • 1 in 110 children in 2006
  • 1 in 88 children in 2008
  • 1 in 68 children in 2010
  • 1 in 68 children in 2012

Looking at those numbers, it is easy to see most people think that the rate of autism is rising.

And if the rate of autism is rising, then there must be a cause.

Thinking about it like that, it becomes easy to see why vaccines became the scapegoat for causing autism, especially after Andrew Wakefield told everyone that it “is my feeling, that the, the risk of this particular syndrome developing is related to the combined vaccine, the MMR…”

The Myth of an Autism Epidemic

Many experts don’t think that there is an autism epidemic though.

“…the numbers of people born with autism aren’t necessarily increasing dramatically. It’s just that we’re getting better and better at counting them.”

Emily Willingham

There are several different explanations for the apparent rise in the number of children being diagnosed with autism, including:

  • better recognition among health care providers
  • better recognition among parents
  • diagnostic substitution – children were once diagnosed with other conditions, such as mental retardation and learning disabilities
  • broadening of the criteria used to diagnose autism, including changes in DSM criteria, which went from labeling children with autism as having childhood schizophrenia (1952) and including just three essential features of infantile autism (1980) to adding PDD-NOS (1987) and more subtypes and symptoms to the autism diagnosis category in DSM-IV (1994).
  • social influences, including that more parents may have wanted to seek help when more resources become available and because they may have become more accepting of the possibility that their child had autism, leading them to seek a diagnosis and services. For example, before 1975 and the Education for All Handicapped Children Act, children with disabilities were excluded from school. And then in 1990, the Individuals with Disabilities Education Act (IDEA) included autism as a separate disability, making it a little easier to get services.

All together, these explanations help explain what has been confirmed by numerous studies, that the true prevalence of autism hasn’t changed over time.

What To Know About The Autism Epidemic Myth

There is no autism epidemic.

  • There are adults and older people with autism. Did you know that the the first meeting of the National Society of Autistic Children was held in 1965?
  • The idea that the ‘autism epidemic’ is a myth is not new – experts have been talking about it for over 10 years, which makes you wonder why some people still push the idea. An idea that hurts autistic families.
  • A 2015 study concluded that “Changes in reporting practices can account for most (60%) of the increase in the observed prevalence of ASDs in children born from 1980 through 1991 in Denmark. Hence, the study supports the argument that the apparent increase in ASDs in recent years is in large part attributable to changes in reporting practices.”
  • Autism is thought to be genetically based.

Some folks, especially those in the anti-vaccine movement, don’t want to believe that there is no autism epidemic though.

“If there is no autism epidemic, if there is a “stable incidence” of autism over recent decades, then this alone is powerful evidence against the vaccine hypothesis – and in fact removes the primary piece of evidence for a vaccine-autism connection.”

Steven Novella on The Increase in Autism Diagnoses: Two Hypotheses

After all, if there is no autism epidemic, then they can’t blame vaccines for be causing an autism epidemic…

More About the Autism Epidemic Myth

 

That Black Box Warning on Vitamin K Shots

Vitamin K is not a vaccine, but some parents who plan on skipping or delaying their baby’s vaccines, also choose to skip this shot.

Vitamin K Shots

Given soon after a baby is born, a vitamin K shot is the most effective way to prevent both early onset and late onset vitamin K deficiency bleeding.

“The vitamin K injection is also a supposed safeguard in case your car is involved in a car wreck on the way home from the hospital or birthing center with newborn in tow.”

The Healthy Home Economist on why you should Skip that Newborn Vitamin K Shot

Although vitamin K deficiency bleeding has never been very common, it is often fatal, and it has been known for almost 125 years that it is caused by a temporary lack of vitamin K in newborns and younger infants.

Can’t you just give babies oral vitamin K to prevent this bleeding?

While oral vitamin K can prevent early onset vitamin K deficiency bleeding, which might start from birth to when a baby is about two weeks old, it won’t prevent late onset bleeding, even if you give the recommend three doses on schedule over two months (as they do in some countries). Babies with late onset vitamin K deficiency bleeding might not have symptoms until after they are two weeks old, or as late as 5 or 6 months old, and it can only be prevented with a vitamin K shot.

Can’t you just avoid dropping your baby or getting into a car wreck if you skip the vitamin K shot?

While you will hopefully do that anyway, the truth is that we don’t know why some infants with vitamin K deficiency bleeding develop bleeding in their brains, as it usually isn’t any kind of big trauma.

In 2013, seven babies over a period of eight months had early and late vitamin K deficiency bleeding at the Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Nashville.

Three of them required surgery to remove clots “out of their head” and may “have issues with seizure disorders and will have long-term neurological symptoms related to seizures and developmental delays.”

I don’t think any of them were dropped or were involved in car accidents on the way home from the hospital or birthing center.

All had refused to get their baby a vitamin K shot.

Why Do Parents Refuse Vitamin K???

So why do some parents choose to skip their baby’s vitamin K shot?

There are no toxic ingredients in your baby's vitamin K shot.
There are no toxic ingredients in your baby’s vitamin K shot.

Some parents simply think their baby doesn’t need it, especially if they have an uncomplicated, “gentle birth” at home. Of course that has nothing to do with whether or not your baby develops vitamin K deficiency bleeding days or weeks later. It also doesn’t matter whether or not you plan on getting your baby boy circumcised, although your pediatrician probably won’t do the circumcision if you skip the shot.

Other parents are worried about a possible link to leukemia and childhood cancer, an improbable link that was refuted way back in the 1990s.

And still others are worried about the mercury content of vitamin K shots. Or they are worried about other supposed “toxins” in the shot, that it is a synthetic version of vitamin K, or that the dose is too high.

“There is no evidence to suggest that the small amount of benzyl alcohol contained in Vitamin K1 Injection (Phytonadione Injectable Emulsion, USP), when used as recommended, is associated with toxicity.”

Vitamin K Package Insert

Why are they worried about these things?

Mostly because someone on the Internet told them to be worried about them, even though vitamin K shots are safe, are free of mercury and any other toxins you might really need to be concerned about, and the dose of synthetic vitamin K your baby gets in the shot will not cause an overdose.

Or they might be worried that their baby might get up to 100mcg/L of aluminum with each shot. Of course, since they are only getting 0.5ml with the shot, that only equals about 0.05mcg of aluminum! Although it is an extremely tiny amount, why is it even in there? It is not working as an adjuvant as some would propose (again, vitamin K is not a vaccine), but rather is likely just a byproduct of the manufacturing process. And you can be assured that your baby can quickly, and safely eliminate the small amount from their body.

“…several countries have reported a resurgence of late VKDB coincident with policies promoting the use of orally administered prophylaxis, even with multiple-dose regimens.”

AAP on Controversies Concerning Vitamin K and the Newborn

The shot (which works) is certainly safer than going to a compounding pharmacy for oral vitamin K (which won’t work to prevent all cases of late-onset vitamin K deficiency bleeding).

That’s right – oral vitamin K for babies isn’t even available in the United States.

That Black Box Warning on Vitamin K Shots

And then there is the black box warning in the package insert for vitamin K.

The package insert for vitamin K does include a black box warning, although these severe reactions are extremely rare in newborns who get a vitamin K shot to prevent vitamin K deficiency bleeding.
The package insert for vitamin K does include a black box warning, although these severe reactions are extremely rare in newborns who get a vitamin K shot to prevent vitamin K deficiency bleeding.

Why is it there?

It was found that people could have severe, life-threatening allergic reactions (anaphylaxis) if they got a large dose of vitamin K too rapidly through an IV. This type of dose would usually be given to patients with significant bleeding who were being treated with anticoagulants (anticoagulant reversal).

“Based on a review of the literature, use of parenteral vitamin K1 may result in severe hypotension, bradycardia or tachycardia, dyspnea, bronchospasm, cardiac arrest, and death. These reactions are most consistent with a nonimmune-mediated anaphylactoid mechanism. It appears that intravenous administration is more frequently associated with these reactions and occurs at an incidence of 3 per 10 000 doses of intravenous vitamin K1.”

Jamie N Brown on Characterizing the Severe Reactions of Parenteral Vitamin K1

This is not what happens when babies get their vitamin K shot though, although there is one non-fatal case report of anaphylaxis after a baby in Turkey got a vitamin K shot in 2014.

There are nearly 4 million births in the United States each year.

Almost all of them get a vitamin K shot very soon after they are born.

And yet there are no reports of anaphylaxis in the United States.

There are isolated case reports of anaphylaxis in newborns to other things, including antibiotics, hepatitis B immunoglobulin, total parenteral nutrition (TPN), and atracurium (used in anesthesia) – but not to vitamin K shots.

“Therefore the INTRAVENOUS and INTRAMUSCULAR routes should be restricted to those situations where the subcutaneous route is not feasible and the serious risk involved is considered justified.”

Vitamin K Black Box Warning

That’s why most parents don’t skip getting their baby a vitamin K shot. Or they come to regret the decision if they do.

“What it comes down to is that giving your child a shot of Vitamin K at birth is a small price to pay, especially when the cost of rejecting the shot can be severe brain injury and death. I can’t change what happened to Olive, but I can try to prevent it from happening to another baby.”

Olive’s Story

For most parents, avoiding the serious risk of vitamin K deficiency bleeding justifies their baby getting a vitamin K shot.

And that’s why vitamin K deficiency bleeding is so rare these days – at least among those babies whose parents didn’t choose to skip their vitamin K shot.

What To Know About That Black Box Warning on Vitamin K Shots

For most parents, avoiding the serious risk of vitamin K deficiency bleeding easily justifies their decision to get their baby a vitamin K shot, despite the presence of a black box warning.

More About That Black Box Warning on Vitamin K Shots

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Twenty One Things Every Parent Should Know

There is no need to use hydrogen peroxide on cuts and scrapes.
There is no need to use hydrogen peroxide on cuts and scrapes. Use soap and water instead.

You could just parent by instinct, but it is much better to supplement your instinct with a little helpful advice from some of the parents who have come before you.

While some of these things experts figured out through years and years of research, others are simply tips that folks figured out after making mistakes and understanding that there must be a better way to get things done.

  1. Vaccines are safe, necessary, and they work.
  2. Sleep is good. For everyone. Learn to help your baby sleep through the night by the time they are four to six months old.
  3. Three years is not a magic age at which every kid is potty trained. Some take a little longer. The main potty training mistake you can make is to push your kids when they aren’t ready.
  4. Some kids continue to wet the bed at night, even after they are potty trained.
  5. Don’t give aspirin to kids, even teens. It is a risk factor for getting Reye syndrome.
  6. If you still have them, safely dispose of mercury thermometers and syrup of ipecac.
  7. Experts don’t recommend that you use hydrogen peroxide to clean wounds any more. You can usually substitute soap and water instead.
  8. “Starve a fever; feed a cold” is an Old Wives’ Tale, like not drinking milk when your kids have a fever or diarrhea. It is not a real thing. If your child is sick and hungry, let them eat their regular diet. If they are sick and don’t want to eat, encourage them to at least drink a lot of fluids, and add bland foods, until they are ready to eat more.
  9. A green or yellow runny nose almost certainly means that your child has an infection, but unless it has been lingering for weeks or your child has a persistent high fever, then it is likely a viral infection that won’t respond to antibiotics.
  10. When your doctor prescribes antibiotics for your kids, think about whether the prescription is because your sick child needs it or because the doctor thinks you want it. Consider asking if your child might get better without antibiotics.
  11. Don’t force kids to “clean their plates” or eat foods that they really dislike. Picky eaters who are forced to eat are probably more likely to grow up to be picky adult eaters.
  12. Most kids, unless they are missing out on one or more food groups or have a chronic medical problem, probably don’t need a daily vitamin.
  13. Don’t just ask your kids if they are being bullied. Also ask if they ever bully  or see kids getting bullied. Someone is doing the bullying.
  14. All kids are different. Don’t compare them. Or at least don’t compare them too much. But talk to your pediatrician if your child’s growth and development really seems off-track compared to most other children.
  15. Some kids are harder to discipline than others. Try something else or get help if what you are doing isn’t working.
  16. Taking extra unnecessary risks, like hiding a loaded gun in the house, not having a fence around your backyard swimming pool, letting your kids ride a bike without a helmet, or letting them ride an ATV, etc., will increase the chances that your kids get hurt. Think about safety.
  17. Not every kid wants to play or is going to be good at team sports.
  18. Being on a “select” sports team probably doesn’t mean what you think it means. The selection process is just as likely to involve the fact that you can pay to be on the team and take extra lessons or classes, as it is to about your child’s skill level.
  19. For perspective, always remember that no matter how good or talented you think your child is, there is always another kid playing at a much higher level. That’s why so few end up playing in college or at higher levels.
  20. At some point, you child might say “I hate you!” Be ready, and understand that it almost certainly has nothing to do with you.
  21. The ‘free range kids’ movement is the opposite extreme to ‘helicopter parenting.’ Don’t fall for parenting fads.

And don’t believe everything you hear or read about parenting. Kids do come with instructions – good instructions, you just have to know when and where to get them. And who to trust.

Otherwise you could end up making all of the same mistakes that all of the rest of us have already made.

For More Information on Things Parents Should Know

Vaccine Preventable Diseases

There are over 25 vaccine-preventable diseases, including:

  • Anthrax – military use only
  • Adenovirus – military use only
  • Cervical Cancer (HPV)
  • Cholera
  • Diphtheria (DTaP)
  • Hepatitis A
  • Hepatitis B
  • Hepatitis E
  • Haemophilus influenzae type b (Hib)
  • Influenza (Seasonal Flu)
  • Japanese Encephalitis (JE) – travel
  • Measles (MMR)
  • Meningococcal disease (MCV4 and MenB)
  • Mumps (MMR)
  • Pertussis (DTaP)
  • Pneumococcal disease (Prevnar 13 and Pneumovax 23)
  • Poliomyelitis (IPV)
  • Rabies – after bites
  • Rotavirus
  • Rubella (MMR)
  • Shingles (Herpes Zoster) – for seniors only
  • Smallpox – eradicated
  • Tetanus (Tdap)
  • Tick-borne encephalitis
  • Tuberculosis (BCG)
  • Typhoid Fever – travel
  • Varicella (Chickenpox)
  • Yellow Fever – travel

Of course, kids don’t actually get vaccinated against all of these diseases.

They do routinely get 13 vaccines (bolded above) that protect them against 16 vaccine preventable diseases.

For more information:

Rotavirus Vaccines and Infections

Rotavirus is a now vaccine-preventable disease that can cause vomiting and diarrhea in young children.

While rotavirus isn’t the only cause of diarrhea in children, it was once the most common cause of severe diarrhea in young children.

Norovirus, several bacteria (Salmonella and Shigella), parasites, and other organisms still cause gastroenteritis (stomach flu) in children, but we don’t see rotavirus as much anymore. The National Respiratory and Enteric Virus Surveillance System (NREVSS) now reports low levels of rotavirus infection each year, with only about 5% of rotavirus tests now being positive during the peak of rotavirus season vs over 25% in the pre-vaccine era.

Rotavirus Infections

Children can develop symptoms of rotavirus symptoms about 1 to 3 days after being exposed to someone else who is sick with a rotavirus infections (the incubation period). These symptoms could include vomiting, watery diarrhea (without blood or mucus), fever, and abdominal pain. Although the fever and vomiting typically only last a few days, the diarrhea can often last at least 3 to 8 days or longer.

A rapid antigen stool test is available to test for rotavirus, but the diagnosis a typically made clinically, which means without testing and based on your child’s symptoms, especially if rotavirus infections are going around in your community.

Of course getting diagnosed with rotavirus is much less likely these days, now that we have a safe and effective vaccine.

While rotavirus was once the most common cause of severe diarrhea in children, leading to about 3 million cases of diarrhea, 55,000 hospitalizations, and 20 to 40 deaths in the United States each year, that has been greatly reduced in the post-vaccine era.

During the 2007-2008 rotavirus season, rotavirus activity decreased by more than 50% as compared to the 15 previous rotavirus seasons from 1991 to 2006. And during the 2010 to 2012 seasons, “the number of positive rotavirus tests declined 74%-90% compared with the pre-vaccine baseline and the total number of tests performed annually declined 28%-36%.”

Rotavirus Vaccines

The first rotavirus vaccine, Rotashield was quickly taken off the market in 1999 after it was found to be associated with an increased risk of intussusception, a type of bowel obstruction.

Newer rotavirus vaccines include:

  • RotaTeq – approved in 2006 and given to infants as a 3 dose vaccine series, it provides protection against five common strains of rotavirus, including serotypes G1, G2, G3, G4 and P1
  • Rotarix – approved in 2008 and given to infants as a 2 dose vaccine series, it provides protection against the most strain of rotavirus that most commonly gets kids sick

Both are live vaccines that are given orally and are thought to provide protection for at least two to three rotavirus seasons.

How good is that protection?

Completing either series of vaccines has been found to provide up to 98% protection against severe rotavirus gastroenteritis and up to 87% against any rotavirus gastroenteritis.

Infants should not get a rotavirus vaccine if they have had a severe allergic to a previous dose of the vaccine, to latex, if they have a history of intussusception, or if they have severe combined immunodeficiency (SCID).

They can usually get the rotavirus vaccine if they simply have some chronic stomach issues, like acid reflux or a milk intolerance, or if someone in the house has a problem with their immune system (just wash your hands after diaper changes). An immune system problem that is not SCID, an episode of acute, moderate or severe gastroenteritis, or other acute illness would be considered precautions to getting the rotavirus vaccine.

What To Know About Rotavirus

Rotavirus is a life-threatening disease that was once very common in childhood but can now be easily prevented with either the RotaTeq or Rotarix vaccines.

 

Sources:

American Academy of Pediatrics. Rotavirus infections. In:Pickering LK, Baker CJ, Long SS, eds. RedBook: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2015

Gershon: Krugman’s Infectious Diseases of Children, 11th ed.

Live attenuated human rotavirus vaccine, Rotarix. Bernstein DI – Semin Pediatr Infect Dis – 01-OCT-2006; 17(4): 188-94.

Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact, Environmental Contamination, and Unknown Modes of Transmission — United States, 2009–2013. MMWR. December 11, 2015 / 64(SS12);1-16

Tate JE et al. Trends in national rotavirus activity before and after introduction of rotavirus vaccine into the national immunization program in the United States, 2000 to 2012. Pediatr Infect Dis J. 2013;32(7):741-744.