Parents are navigating conflicting opinions, social media discussions and misinformation. In the latest episode of For Kids' Sake, Alice Phillips, M.D., pediatrician and medical director for Ambulatory Quality at Cook Children's, discusses how families can find trustworthy information, understand immunization recommendations and feel confident asking questions and learn about the Cook Children’s Comfort Menu, a program designed to reduce fear and discomfort during vaccines and medical procedures.

Here's an edited Q&A version of the conversation.

Q: How should parents navigate all the information they're seeing about immunizations?

Dr. Phillips: First, please take a deep breath and pause and think, “who are my trusted sources?” and identify those. If something you read online sounds questionable, trust your instincts and bring those questions to your pediatrician. Parents don't have to sort through everything alone. We’ve been with you through sleepless newborn nights, potty training and maybe even scares at the hospital.

We’re here to help guide you through all of this information overload that we’re experiencing right now.

Q: Has anything changed about childhood immunization access?

Dr. Phillips: No. Families still have access to the same vaccines and should continue routine well-child visits. If your child is preparing for daycare, preschool or kindergarten, it's important to stay on track with those appointments and immunizations.

Q: What about delaying or spreading out immunizations?

Dr. Phillips: Parents have always had that option, but research has not shown delayed schedules to be safer. Delaying immunizations can create additional visits, increased costs and more stress for both children and families. If we did every shot separately, that is getting close to 30 or more visits for that child. That equals more time off work for families, trying to manage busy schedules, and a

Possibility that your child becomes scared of going to the doctor because they associate every visit with a shot.

Q: What is the Comfort Menu, and how can it help children who may struggle with shots or medical procedures?

Dr. Phillips: The Comfort Menu is a program developed by Cook Children's that helps children experience as little physical and emotional discomfort as possible during procedures like immunizations. We know shots can be scary, and we want to make the experience easier for both children and parents.

The Comfort Menu includes distraction techniques, toys, comfort positioning, parent involvement and tools that can help reduce discomfort. Sometimes parents naturally do some of these things themselves, like playing a child's favorite video during a shot. We also have other resources available, including numbing sprays and specialized comfort tools.

The program isn't limited to immunizations. It can also be used for IV starts, procedures and other situations where a child may feel anxious or afraid. For children who need additional support, we may involve Child Life specialists and other team members to help create a more positive experience.

The goal is simple: helping children feel as comfortable, supported and safe as possible during medical care.

Q: How are vaccines tested before they're approved?

Dr. Phillips: Vaccines go through extensive testing, including animal studies and three phases of human trials that evaluate safety and effectiveness. After FDA review, Cook Children's takes one step further and also conducts its own internal review process before adopting new vaccines. It's not a rubber stamp, we analyze all the evidence and research and a vaccine goes through these multiple steps before it’s ever introduced.

Q: You've shared that immunization is personal for you. Why?

Dr. Phillips: I’m very passionate about the pneumococcal vaccine because I’ve had two patients pass away from pneumococcal disease. Once it happens, it happens fast and it’s a hard bug to stop and it’s very powerful.

When the pneumococcal vaccine was first introduced, my own daughter was nine months old and received the very first dose given in my clinic. That's how strongly I believed then, and continue to believe today, in the protection vaccines provide.

I was willing to give my baby the first dose because it is an amazing thing, that we have these to save our kids. We aren’t just doctors, nurses or staff. We are moms too and in the end, we all want our kids to grow up happy and healthy and we have to focus on that.

*Additional information about the pneumococcal vaccine:
It protects against bacteria that can cause ear infections, pneumonia and other serious illnesses. The vaccine helps your immune system recognize and fight these germs before they can make you sick.

Q: Is it okay for parents to have questions?

Dr. Phillips: Absolutely! 100%. You ask questions about diapers, why wouldn’t you ask questions about vaccines?

Immunization science is complicated. Parents should feel comfortable asking questions and discussing concerns with their pediatrician. Don’t be afraid to ask questions.

Q: Is delaying immunization safer?

Dr. Phillips: No. Some diseases pose their highest risk during the first 12 months of life. Delaying immunization may leave children unprotected during their most vulnerable period.

Q: What's one of the biggest immunization myths?

Dr. Phillips: That vaccines are more dangerous than the diseases they prevent. Many vaccine-preventable illnesses can cause serious complications, and some can become life-threatening very quickly.

Q: Where should parents go for trustworthy information?

Dr. Phillips: Start with your pediatrician and evidence-based resources. If you see something online and aren't sure about it, bring it to your doctor and discuss it together.

Q: What would you say to a nervous parent?

Dr. Phillips: Every time I hear or read something new, I think, “Man. Parents must not just be nervous, they must be scared too.”

You're doing good work. You want what's best for your child. Keep asking questions and when you’re hearing something strange, lean on trusted medical professionals who can help you navigate those decisions.

Q: What is one thing parents should never feel embarrassed to ask?

Dr. Phillips: Anything. There are no bad questions.

And also flipping that on its head, parents should not be afraid to hear questions from us. When a family comes to me and they are worried about vaccines and don’t know what to do, I try to ask lots of questions about their worries and fears.

That is how we solve these problems and get to a solution that we’re all happy with.

Final Thoughts

Dr. Phillips: These are difficult times for many families. We understand that. Pediatricians and parents share the same goal: helping children grow up healthy and protected. We want families to know we're here to help.

Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health service clinic for information on clinics.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the required school shots, the Hepatitis B vaccine often raises the most questions, especially when it comes to why infants and young kids need protection so early.

Hospitalist Laura Romano, D.O., explains the key facts about hepatitis B and the vaccine that prevents it.

What is Hepatitis B?

Hepatitis B is a serious liver disease that is caused by the hepatitis B virus (HBV).

In adults, hepatitis B is usually spread through blood or intimate contact. In young children, however, the virus usually spreads through contact with infected bodily fluids. Transmission most commonly occurs during labor and delivery, but it can also happen through everyday activities, such as sharing a toothbrush or being bitten by a person who has the virus.

People infected with hepatitis B can spread the virus even if they show no symptoms. In fact, children often remain asymptomatic for years while still being contagious. This is especially concerning because infants and young children are more likely than adults to develop chronic, lifelong liver conditions, including permanent liver damage, cirrhosis (severe scarring), and liver cancer.

Treatment options for chronic hepatitis B are limited and focus primarily on halting the progression of liver damage rather than curing the virus itself. For severe cases where the liver has sustained significant damage, a liver transplant may ultimately be necessary.

How can the disease be prevented?

The most effective way to prevent hepatitis B is through vaccination. The vaccine is highly protective, offering about 95% effectiveness in preventing both acute and chronic infections. Since its routine inclusion in infant immunization schedules, rates of hepatitis B cases and associated liver cancer have steadily declined.

What would you like families to know about the hepatitis B vaccine and HBV?

• Hepatitis B is often misunderstood as a disease that only affects people engaging in high-risk or illegal behaviors. Anyone can contract the virus through everyday actions such as sharing a razor or toothbrush with someone who has the infection, even if that person shows no symptoms.
• Prenatal screening and maternal immunity testing alone are not enough to protect all children from hepatitis B. History has shown that targeting only 'high-risk' infants leaves gaps, leading to ongoing infections in both mothers and children that universal vaccination prevents.
• While some countries delay hepatitis B vaccination until children are older, their social and health care infrastructure differs significantly. Longer parental leave in those countries means children spend less time in daycare, where early exposure can occur. Also, universal health care access allows these countries to detect acute infections quickly and manage chronic cases more effectively.

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Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health Service Clinic.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Just weeks before students return to the classroom, the Texas Department of State Health Services (DSHS) issued a health alert following four reported cases of measles in July. According to DSHS, all four cases occurred within a single family after a family member traveled out of state.

With back-to-school season underway, pediatricians at Cook Children’s Health Care System are sharing key information about how measles moves through communities and how families can protect their children.

Measles is highly contagious. One infected person can potentially infect 12 to 18 unvaccinated individuals. The virus spreads through infectious respiratory droplets and airborne transmission (from coughing or sneezing), where tiny droplets can remain suspended in the air.

Cook Children’s experts say the best way to prevent getting and spreading the virus is to get the measles, mumps and rubella (MMR) vaccine.

The MMR vaccine is required by most school districts and Cook Children’s understands that navigating conflicting information about vaccines can feel overwhelming. Mary Suzanne Whitworth, M.D., medical director of Cook Children’s Infectious Diseases, explains the key facts about the measles and the MMR vaccine.

What is measles

Measles is a viral infection caused by the rubeola virus, which is not the same as rubella. The virus is very small, which makes it more contagious. It can remain in the air of a room for up to two hours after an infected patient leaves. Measles symptoms typically appear seven to 14 days after infection.

Symptoms include:

• Rash
• Fever, sometimes over 104º Fahrenheit or 40 º Celsius
• Runny nose
• Cough
• Red, watery eyes
• Sore throat
• Tiredness

Complications can include ear infections, diarrhea, pneumonia and, in rare cases, brain damage or death.

How can measles be prevented?

Vaccination is the most effective way to prevent measles. The first dose of the MMR vaccine is typically given to children on their first birthday (12 months old), followed by a booster at age 4. Talk to your pediatrician about questions and concerns. Children traveling outside the United States may be able eligible to receive the vaccine before their first birthday.

Because measles remains airborne for up to two hours, if 10 unvaccinated children are in a room with one infected child, nine of them will likely contract the virus.

In addition to getting vaccinated, the spread of measles can be mitigated by proper hygiene. This includes:

• Handwashing
• Covering your mouth and nose when you cough or sneeze
• Avoid sharing drinks or eating utensils
• Disinfect frequently touched surfaces

What would you like families to know about measles and the MMR vaccine?

Measles was declared eliminated from the United States in 2000. However, measles immunization rates have declined in recent years due to missed checkups during the pandemic, parental concerns and vaccine misinformation.

Measles also remains common in many parts of the world. Most recent U.S. cases stemmed from unvaccinated travelers returning from abroad. This drop in vaccination coverage makes communities vulnerable to disease resurgence.

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Collin County Health Care Services has issued a health alert due to an increase in chickenpox (varicella) across the county. Chickenpox is an infection caused by varicella-zoster virus, leading to a fever and an itchy rash with spots all over the body.

Because it is highly contagious, chickenpox is a reportable condition in Texas and must be disclosed to the local health department. According to health officials, schools and childcare settings are high-risk environments for outbreaks. Prompt identification and exclusion of cases are critical to limiting transmission.

While chickenpox used to be a common illness in the United States, it has become much rarer due to the chickenpox vaccine which helps prevent the infection.

Cook Children’s Health Care System doctors know parents and caregivers may have questions about this, Laura Romano, D.O., a hospitalist at Cook Children’s and mom herself, addresses some concerns.

• I got chickenpox as a kid. Should I be concerned if my little one gets it?
  • One infection with chicken pox should give you lifelong immunity.
• How effective is the varicella vaccine?
  • Two doses give up to 98% protection and have decreased hospitalizations and death by over 97% since 1995!
• What if my little one only had one dose. What does that mean for them?
  • If your child has already had one dose of the chicken pox vaccine, they will most likely not need another one if they get an actual infection. Please talk with your pediatrician about this.
• What happens if someone is immunocompromised and is around someone who has varicella?
  • The most common complication is a skin infection caused by scratching at the lesions, which may require antibiotics to help treat. Other more serious complications include pneumonia, ataxia (difficulty walking), dehydration, or encephalitis (swelling of the brain). People who also have chicken pox are at risk for shingles later in life. Vaccination against chicken pox helps prevent against all these complications including the furture risk of shingles.
• What complications can arise from chickenpox?
  • The most common chickenpox complications are bacterial infections of the skin and soft tissues in children and pneumonia in adults.
• How do you treat chickenpox?
  • While there is not a single treatment for chicken pox, doctors focus on symptom relief. Doctors recommend Tylenol for fever, calamine lotion or oatmeal baths for itchiness. Lesions should go away in the 10-14 days. 

Symptoms of Chickenpox:

A mild fever may occur 1 to 2 days before rash onset, particularly in adults. In children, the rash is often the first sign of disease.

Seek immediate medical attention when your child:

• has trouble breathing
• has a severe headache
• is very drowsy or has trouble waking up
• has trouble looking at bright lights
• has trouble walking
• seems confused
• seems very ill
• has a stiff neck
• has a fever that lasts for more than 4 days
• has a bad cough
• has an area of rash that leaks pus (thick, yellowish fluid) or becomes red, warm, swollen, or sore
• is vomiting

You've got questions? We've got answers covering everything about immunizations and vaccines. They each have a different role, but they both have the same goal. Learn more here: Immunizations and Vaccines Resources

Raising a child can come with a lot of questions, especially when it comes to their health and well-being. Vaccines, in particular, often spark a lot of conversation and curiosity among parents. It’s our priority to provide parents and caregivers with clear, reliable guidance. That’s why we asked Laura Romano, D.O., a hospitalist at Cook Children’s, to share the top 10 questions she receives from families.

1. Should my child receive the flu and RSV vaccines now? There seems to be so much confusion in the news, plus I’m not sure my insurance is going to cover all of this anymore.
Yes they should. Please get your seasonal vaccines as soon as possible!

Infants under 8 months whose mother did not receive an RSV vaccine while pregnant should receive their RSV immunization in October. If you did receive an RSV vaccination while pregnant, your child might still need their immunization. Please talk to your pediatrician to see if your child is eligible. RSV immunizations protect up to 90% of severe RSV infections.

Everyone in your house 6 months and older should also receive their seasonal flu vaccine. Ask your pediatrician whether your child should receive the COVID vaccine. These vaccines are recommended by the AAP among other organizations. Unfortunately, healthy children and adults can still have serious complications from the flu and COVID. 

I encourage you to have a conversation with your doctor and the financial representative in your primary care office. We all want to help your family and do what is best for your child.

2. Are vaccines safe and effective? 
Yes. Each vaccine is rigorously studied prior to its approval and is monitored even after it's approved to make sure it’s safe. 

Vaccines have saved nearly 200 million lives in a century, many of those lives were young children and babies. 

3. Do vaccines cause autism?
No. Decades of research have shown over and over again that there is not any link between vaccines and autism. The overwhelming majority of articles that have tried to show any association have been widely discredited by the medical community at large.

4. I heard vaccines contain things like aluminum and formaldehyde. Is that safe to put in my child's body?
Yes! Many of the ingredients found in vaccines are necessary to help the body produce an immune response, like aluminum, and can be found in nature. Aluminum is actually found in fruits and vegetables. It is also found in meat, dairy and produce in small amounts.

And yes, by itself, formaldehyde is dangerous and you wouldn’t want to ingest in any way. However, the amount contained in vaccines is so minimal, so it is very safe. The formaldehyde prevents bacteria from getting into the vaccine vial. 

These ingredients are necessary to make sure the vaccine is safe to give and that the body produces the best immune response. Think of these ingredients like baking cookies. You have to put baking powder and baking soda into the cookies for them to turn out delicious. 

5. Why are there so many shots these days? 
It is a good thing! Science and technology have allowed us to study more diseases and develop more vaccines to prevent children from getting sick! 

Also, many vaccines are now given in combination so there are less injections. 

6. Why don't you recommend a delayed vaccination schedule? 
We know based on years of study how the newborn’s immune system works and when the maternal antibodies begin to fade so vaccines are recommended at specific intervals to provide the most protection to the baby.

7. Will vaccines weaken my child's natural immune system?
Absolutely not! Multiple studies have shown that children who are fully vaccinated are not more at risk for other illnesses. 

On the other hand, certain vaccine-preventable illnesses like measles can cause complications like “immune amnesia” that damages their immune system and makes them more susceptible to other illnesses. 

8. Why does my healthy child need vaccines? Won't their immune system naturally protect them? 
Some vaccine-preventable diseases can cause serious complications including meningitis, seizures, blindness, hearing loss, loss of a limb, permanent brain damage, developmental delays, and pneumonias. Some diseases can be fatal. 

These are complications that we need to protect your child against. While their immune system might be able to fight off the disease, the complications would be devastating and life-changing. It is not worth the risk. 

9. Isn't Hepatitis B an STD? Why should my child get that vaccine? 
Yes, one of the ways that Hepatitis B is spread is through intimate contact but it can also pass from the mother to the baby and cause serious liver damage. Some mothers are not able to receive prenatal care and wouldn’t be tested for Hepatitis B prior to delivery so we vaccinate all babies to protect against liver damage. 

Hepatitis B can also be spread through blood transfusions, bites, lesions, certain sanitary habits, or contact with an infected person’s secretions. 

Vaccinating your child early against a potentially chronic disease is always a good idea! 

10. Are your kids vaccinated? 
Yes! I have two kids (a 7-year-old daughter and a 4-year-old son). Both of my kids are fully vaccinated for all the reasons listed above. 

Vaccines protect my children, my patients, my husband, and our community. Children who are fully vaccinated are less likely to spread disease to at-risk individuals, like my dad with diabetes, my daughter’s best friend who has a new baby sister at home, our friend who had a kidney transplant a few years ago, our neighbor who is undergoing chemotherapy, a co-worker whose daughter has congenital heart disease. 

Vaccines protect my kids and our friends and family. We vaccinate because it is the right thing to do and it is the safe thing to do.

Our goal at Cook Children’s is for our community, our patients and our patient families to stay as healthy as possible. If you have any questions, please contact your pediatrician. We’re here to help!

August is a chaotic month for any busy parent. Between back-to-school preparations and the last days of summer, it's easy to get overwhelmed. On top of that, August is also National Immunization Awareness Month—a perfect time to make sure your children are up-to-date on their vaccinations.

When people learn that I’m a pediatrician they often ask if my own two children are vaccinated and I always reply with a resounding yes. My children are vaccinated for several reasons: 

Vaccines are safe! 

• Every vaccine that is currently in use has gone through a rigorous testing phase to make sure that the vaccine is safe. Side effects and potential reactions are closely reviewed by multiple agencies at the federal level. Even after the vaccine has been approved, the Vaccine Adverse Effect Reporting System (VAERS) continues to monitor for additional side effects. 
• Millions upon millions of vaccines will be administered this year with minimal side effects. The most common side effects are low-grade fever, redness around the injection site or maybe some mild muscle aches. 

Vaccines are effective! 

• Vaccines have led to the eradication of previously fatal diseases like Smallpox. 

Vaccines save lives!

• Vaccines have saved the lives of nearly 200 million people in the past century. Many of those lives saved are of young children and babies. 
• Vaccines prevent diseases and illnesses that have serious consequences, even in healthy children. 
• Vaccines prevent diseases that can lead to hospitalizations, pneumonia, potential hearing loss, potential loss of an arm or a leg, brain damage, and even death. 

Vaccines do not cause autism. 

• Decades of research has shown again and again and again that there is no link between vaccines and autism. 

The ingredients in vaccines are safe. 

• Just as the individual vaccine is studied, the ingredients in vaccines are also rigorously studied. 
• Some vaccines contain ingredients like aluminum, which can be found in fruits and vegetables. Aluminum helps the body produce an immune response and is perfectly safe. 
• Vaccines can be preserved with very small amounts of formaldehyde, so small that it is not harmful at all. 
• These ingredients are like baking powder when you’re making cookies. By itself, baking powder does not taste good but in small amounts, it’s needed for your cookies to come out looking and tasting great! 

Vaccines are recommended by my children’s doctors.

• My kids’ pediatrician - along with the American Academy of Pediatrics, the American Academy of Family Physicians, the Infectious Disease Society of America, the American College of Physicians, the American Medical Association, and the American Nurses Association - all support routine childhood immunizations. 

Vaccines help keep my community safe. 

• My children are vaccinated because doing so protects them and our community. 
• Vaccines can help prevent your child from spreading illnesses to at-risk individuals such as your parents who have diabetes, your child’s classmate who has a newborn at home, your neighbor who is undergoing chemotherapy for cancer, your co-worker who just received a kidney transplant, or the cashier in the grocery store who has an autoimmune condition. 
• We rely on everyone to get their vaccines to keep the community safe. 

And the most important reason to me is that I want to protect my dad. My dad has type 1 diabetes and is immunocompromised. My kids will always get their flu vaccines every year so we can give him the BIGGEST hug without worrying about making him sick. 

So, this month, in between back-to-school shopping, meet the teacher nights and the ever-exciting first day of school, please call your child’s pediatrician and make sure that they are up-to-date on their vaccines. We would love to talk to you more and answer all of your questions and concerns! 

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Marc Mazade, M.D., Cook Children’s medical director of Infection Prevention and Control, encourages anyone who has not received the vaccine to do so. Vaccinations not only protect you, but also help limit the spread to others.

As of March 14, the Texas Department of State Health Services reported 259 cases of measles in Texas.

“I'm worried. It's a real dangerous situation right now,” Dr. Mazade said.  “There are lots of people who are eligible to receive the vaccine and haven't. There are areas where vaccine uptake has been really poor and it is likely to rip through these communities like wildfire, like it did in West Texas.”

The best way to prevent getting and spreading the virus is to get the measles, mumps and rubella (MMR) vaccine. We talked with Dr. Mazade about what makes this vaccine effective, who can get it and why vaccination is important.

Measles is one of the most contagious diseases humans have faced. Descriptions of the disease date back to at least the 9th century, according to the World Health Organization (WHO), and became more widespread in the 16th century. Prior to the vaccine, the Centers for Disease Control and Prevention (CDC) estimates three to four million people became infected per year, and 400 to 500 died.

Before the measles vaccine, which became available in its current form in 1968, most everyone got measles, Dr. Mazade said. While measles can be mild, it is “pretty miserable.” The virus can cause a fever from 104 to 106 degrees, congestion, cough and a red rash that spreads across the body. Complications from the measles are not uncommon, including ear infections and pneumonia. As of March 14, one child has died from the current measles outbreak.

“People don’t understand how dangerous it is and how dangerous vaccine preventable diseases are,” Dr. Mazade said. “It can be really serious for people who are pregnant, people with immunodeficiencies and people who are on immunosuppressants that would make them more susceptible.”

Herd Immunity

The current measles outbreak shows just how contagious it is.

In general, measles has not been transmitted within the U.S. for years due to herd immunity.

Herd immunity is the idea that when enough people are vaccinated against a disease, it is much harder for the disease to spread. Herd immunity for measles is reached when 90% of a population is vaccinated, Dr. Mazade said.

Imagine a group of 100 people spread out across a room. Ninety of them have been vaccinated and cannot get or give anyone else measles. One person in the room brings in the virus.

Perhaps the people nearby are all vaccinated; the virus will likely not spread or will only spread to a few people.  But if only half of the people are vaccinated, the infected person is likely standing near at least one other unvaccinated person. The disease can spread through the community, and can do so at an increasing rate.

With measles, face-to-face contact is not required to contract the disease, Dr. Mazade said. The infectious aerosol that is created when someone with measles coughs or sneezes fills the entire air space and even lingers in the air for up to two hours after a person with measles leaves the area. To go off of the room metaphor, measles can spread throughout a space quickly and endanger more people.

For years, the U.S. was like the first room. Sometimes, an unvaccinated person would travel abroad and bring back measles, but it was not able to spread due to herd immunity. In 2000, the U.S. documented zero cases of measles, and the virus was declared eliminated from the United States.

About 92 to 94% of a population needs to be vaccinated in order to achieve herd immunity for measles, according to the American Academy of Pediatrics. The current outbreak is due to that vaccination percentage dropping, Dr. Mazade said. Over the past few years, fewer and fewer people received the MMR vaccine.

Misinformation about vaccines has contributed to that decrease. Mazade encouraged people to seek direct sources for accurate vaccine information. The CDC, WHO and Cook Children’s vaccine resource page are good places to find accurate information.

Asking your doctor directly may be the best way to get information on your vaccine questions.

 “Trust your doctor,” Dr. Mazade said. “He or she is the best source of information about vaccines and vaccine safety.”

Getting Vaccinated

Fortunately, future measles outbreaks are preventable.

The MMR vaccine is safe and available for unvaccinated adults to receive -- and it is extremely effective. The first dose grants about 93% immunity and the second, and final, dose grants 97% immunity. This means that 97 out of 100 vaccinated people exposed to measles will not become sick.

The measles vaccine can be administered to children who are 12 months old and is part of the recommended vaccine schedule that the CDC recommends. If you did not get the vaccine as a child -- or are not sure if you did -- talk to your doctor.

Some people may want their children to get the vaccine early due to the outbreak. As of now, this is not recommended by our local health department. Babies who are younger than six months will likely not respond to the vaccine and not achieve immunity, Dr. Mazade said. Even if the baby has been exposed to measles, the vaccine is not recommended at this age. Dr. Mazade recommends talking to your doctor if you have concerns about measles exposure.

Even if this outbreak slows down, it is still important to get vaccinated.

“If people who are fully eligible are not fully vaccinated, we will be in the spot time and time again,” Dr. Mazade said. “Until we have a huge outbreak with lots of sick people."

Vaccinations and immunizations

Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

 Julee Morrow, M.D., a pediatrician at Cook Children’s Harris Parkway, is one of the few current doctors at Cook Children’s who treated patients during that time.

“A majority of the kids that I took care of had to get admitted to the hospital,” Dr. Morrow recalls. “We needed a way to keep them hydrated. We needed a way to keep their oxygen levels up.”

More than 30 years later, Dr. Morrow did not expect to see another outbreak, especially with the availability of the measles, mumps, and rubella (MMR) vaccine.

Cook Children’s has tested patients for the measles; there have been no confirmed cases at its  Fort Worth and Prosper medical centers.

“We are in such a good place from a standpoint of the science and the technology we have now, it can be prevented, ” Dr. Morrow said.

According to the Center for Disease Control and Prevention (CDC), measles was declared eradicated in the United States in 2000.

“We were the only country that didn't have a travel advisory for measles, because our rates were so low, because we had such good vaccination rates,” said Alice Phillips, M.D., Director of Ambulatory Quality and Safety.

The Texas Health and Human Services reported the first measles death on Feb. 26, A school-aged child who was not vaccinated died. The child had been hospitalized in Lubbock and tested positive for measles.

“I feel sad because measles is so easily prevented,” Dr. Morrow explained. “One dose of measles vaccine gives 93%. Two doses give people 97 to 99% immunity.”

As of Feb. 28, the state reported 146 measles cases, mostly in children. Rockwall County reported its first measles case on Feb. 25. Cook Children’s Medical Centers in Fort Worth and Prosper are prepared to treat patients.

Cook Children’s Health Care System is prepared

To prevent potential spread, Cook Children’s Medical Centers, primary care, and urgent care offices ask families to call ahead and inform staff if they believe their child may have measles.

“We will likely be donning all of our personal protective equipment (PPE) to go to the family’s car to screen children before bringing them into the waiting room, so as not to expose any other susceptible patients,” said Dr. Morrow.

If the child is taken into an exam room, the room will be closed for two hours afterward. Families will be provided with a handout on quarantine and measles information. 

Cook Children’s continues to monitor the cases in the state and will revise protocols as necessary.

Thirty-eight years ago, there was no rapid test. Doctors diagnosed patients based on symptoms.

“We now have better testing,” explained Dr. Morrow.

Now, patients are given a nasal or throat swab, similar to the tests used during the COVID-19 pandemic. The sample is sent to a lab. While patients await results, Dr. Morrow said families must quarantine.

“Measles virus is one of the most contagious germs on the planet,” said Dr. Morrow. “It would be very easy to spread it to someone whose immune system is not very strong, like a person who has finished chemotherapy, or has heart or lung problems. It would be very dangerous for a premature baby.”

Dr. Phillips understands that parents may have concerns about the science of vaccines and encourages them to discuss these concerns with their pediatricians.

The CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 - 15 months of age, and the second dose at 4 through 6 years of age.

“We are here to help them, for them to understand the science and to give them the vaccines that their children need,” Dr. Phillips said.

A native Texan, Dr. Morrow urges people to care for one another. The MMR vaccine provides 93% to 95% protection with one dose and 97% effectiveness with two doses.

She encourages families to have a plan in place if they are unable or reluctant to get the vaccine.

Vaccinations and immunizations

Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

As students gear up for summer break, it’s not too early to get a physical or the immunizations they’ll need before school starts again in August.

Incoming kindergarteners and seventh graders are due for routine vaccinations. Junior high and high school students need a physical before they can participate in athletics or marching band.

Cook Children’s neighborhood health centers and pediatric offices can help your family check these items off your to-do list. Make an appointment early in the summer, come in for the required shots or a physical examination, and beat the back-to-school rush.

Amy Medalie, RN, MSN, CPNP advises parents not to postpone scheduling those visits. She wants children and teens to stay on track for their vaccines – or get caught up if they’ve fallen behind.

“This is a topic we talk about all day,” said Medalie, a nurse practitioner at Cook Children’s Neighborhood Health Center Richland Hills. “I tell parents that vaccinations are our best defense at helping prevent illnesses.”

Vaccines to protect against certain contagious diseases – including measles, polio and chickenpox – are safe and effective at stopping the spread. The boosters required in Texas for kindergarten and for seventh grade can usually be administered in one visit to your pediatrician or neighborhood health center.

Before the final school bells ring this May, here’s a quick look at a few key points.

Immunizations

The 2024-2025 Texas Minimum State Vaccine Requirements chart lists in English and Spanish the number of doses that students need. If an incoming kindergartener has missed out on vaccines normally given at age 4, these additional vaccines are due now:

• MMR (measles, mumps and rubella)
• DTaP (diphtheria, tetanus and pertussis)
•  IPV (inactivated poliovirus)
•  Varicella (chickenpox)

And between the ages of 11-12 years, these additional vaccines are due:

• MCV4 (meningitis)
• Tdap (tetanus, diphtheria and pertussis)

How do vaccines work? If someone who’s been vaccinated comes into contact with that infectious disease, their immune system has already been primed to respond, Medalie said.

“Vaccines teach our bodies to recognize a certain bacteria or virus. If a person is exposed to those bacteria or virus, the immune system is already prepared to fight off infection,” she said.

Sites across Cook Children’s offer a Comfort Menu of items that help patients relax and feel less of a pinch when the needle goes in. Children can request cold spray or a buzzy tool on their skin for comfort and distraction. 

Medalie and her colleagues are happy to answer any questions to provide families with accurate information and reassurance about vaccines.

Sports Physicals

Early summer is also an ideal time to come to Cook Children’s for the physical exam UIL requires before participation in school athletics and activities such as cheerleading and marching band. The form contains two parts:

1. Medical history – a list of yes/no questions about headaches, dizziness, chest pain, seizures, allergies and more. This portion must be filled out every year by the student and parent or guardian.
2. Physical exam – performed by a health care professional to check the student’s lungs, joints, vision, weight, heart rate, blood pressure and more. UIL requires the physical exam before the 7th, 9th and 11^th grades. Some school districts require it annually.

The provider checks one of three options on the form: cleared for participation, cleared after completing additional evaluation or rehabilitation, or not cleared due to concerns.

Medale said the physical exams can identify issues such as irregular heartbeat, vision problems, spine curvature or uncontrolled asthma. A referral might be needed for follow-up testing, such as an electrocardiogram (EKG) if a possible heart rhythm disorder is noticed.

Sports physicals give also teens the chance to ask questions or report any problems that might impact their ability to practice or compete safely. Medalie urges her patients to speak up if something feels off … shortness of breath or a lingering sprain for instance.

“Be honest with yourself and your parents about how you’re feeling, so that you’re not just pushing through something that can contribute to reinjury,” she said.

As a mom, Medalie has seen in her own teens the endurance it takes for marching bands and drill teams to perform in the Texas heat. Connecting with student athletes for physicals early in the summer gives her the chance to remind them to stay hydrated, avoid excessive caffeine, and don’t skip meals.

National Infant Immunization Week (April 22-29) is a yearly observance highlighting the importance of protecting children 2 years and younger from vaccine-preventable diseases (VPDs). The Centers for Disease Control and Prevention and the American Academy of Pediatrics (AAP) recommend that children stay on track with their well-child appointments and routine vaccinations. On-time vaccination is critical to provide protection against potentially life-threatening diseases.

Measles is one of the most contagious infectious diseases on the planet. This year alone, there have been seven outbreaks across the United States, compared to four in 2023. An outbreak is defined as three or more related cases.

“If you’re in a room with someone who has measles and you’re not vaccinated or immune, there’s a 90-95% chance you now have the disease,” said Cook Children’s Infectious Diseases physician, Nicholas Rister, M.D. 

So far in 2024, there have been 121 cases of measles across 17 states, according to the Centers for Disease Control and Prevention. Ninety-five percent of these cases have occurred in unvaccinated or under-vaccinated populations. Fifty-six percent of cases, the majority of which have been in children under 5 years old, resulted in hospitalization due to severe complications. Though no cases have been reported in Texas, the virus is spreading rapidly and the Cook Children’s team is prepared. 

“Hopefully we won’t need it, but we are developing a workflow so that our clinics know exactly how to recognize, handle, test for, and guide our families through measles,” said Cook Children’s Medical Director for Ambulatory Quality, Alice Phillips, M.D.

Because cases have remained relatively contained over the last few decades, Julee Morrow, M.D. is one of the very few pediatricians at Cook Children’s who has cared for measles patients. She saw an influx of the disease during the last major outbreak from 1989-1991, during which cases in the U.S. spiked to roughly 55,000. 

“My partners and I diagnosed about 30 cases here in Fort Worth, and every single one of them had to be admitted to the hospital due to the severity of their infection,” Dr. Morrow said. “If another major outbreak happens, there’s a possibility we could run out of beds.”

Measles is not to be taken lightly—but it is easily preventable. Dr. Rister, Dr. Phillips, and Dr. Morrow shared vital information about the virus, its risks, and vaccination protocols to help families be proactive in protecting their children. 

What is measles? 

Measles is a highly contagious virus that spreads through the air via coughing and sneezing. It can even enter the body through the mucus membranes of the eyes. 

Common symptoms include:  

• Fever
• Cough
• Conjunctivitis (red eyes) 
• Coryza (runny nose)
• Sore throat
• Rash (after 3-4 days)

What are the risks of measles? 

While most people fully recover from measles, it can still pose life-threatening and potentially fatal risks. For every 1,000 children who get measles, one to three will die, even with the best care.

As many as one out of 20 children with measles will also develop pneumonia, which is the most common cause of death from the virus in infants.

One in 1,000 children with measles will develop encephalitis, or severe brain inflammation, which can lead to convulsions, deafness, disability, or death.

Though it is extremely rare, a fatal disease of the central nervous system, SSPE, can appear as late as seven to 10 years after a child is infected. 

Who is most at risk? 

Any unvaccinated or non-immune person of any age can contract measles, but it is most common in children. Unvaccinated children—particularly infants under 1 year of age—are at the highest risk of severe complications or death. 

“Who we need to worry about is not so much ourselves and our staff, but our tiny patients coming through the door,” Dr. Morrow said. “Measles is a disease of unvaccinated people, and our biggest concern is infants and immunocompromised kids.” 

Dr. Rister pointed out that unvaccinated pregnant women are also at high risk, as measles can have devastating effects on a developing fetus.

What is the MMR vaccine? 

The measles, mumps, and rubella vaccine is a safe, tried-and-true immunization that prevents people from contracting and spreading measles. It is 93% effective after one dose and 97% effective after the recommended two doses. 

“There is no reason a disease that is preventable with a safe and effective vaccine should harm one of our children,” Dr. Phillips said.

When should my child get vaccinated? 

The CDC recommends that children receive two doses of the MMR vaccine—the first between 12 and 15 months old, and the second between 4 and 6 years old.

If you’re an adult and you’re unsure if you’ve completed your vaccines—especially if you are pregnant—ask your doctor to check your vaccination records and make sure you are up to date. 

Can my child get vaccinated early for international travel?

If your child is at least 6 months old, they can get one dose of the MMR vaccine before traveling internationally. Plan to get your child fully vaccinated at least two weeks before your trip. Follow the below vaccination schedule from the CDC based on your child’s age:

Infants Under 12 Months Old: 

• Get an early dose at 6-11 months
• Follow the recommended schedule and get another dose at 12-15 months and a final dose at 4-6 years

Children Over 12 Months Old:

• Get first dose immediately
• Get second dose 28 days after first dose

Teens and Adults With No Evidence of Immunity*:

• Get first dose immediately
• Get second dose 28 days after first dose

*Evidence of immunity includes at least one of the following: Written documentation of adequate vaccination, laboratory evidence of immunity, laboratory confirmation of measles, or birth in the U.S. before 1957. 

What if my child is immunocompromised and can’t get vaccinated?

Dr. Rister said the best way to protect your immunocompromised child is to ensure everyone surrounding them is fully vaccinated—including family, friends, and classmates. 

If a case appears in your area and your child is in daycare or another environment around other children, consider keeping them home until the outbreak passes.

What should I do if my child is exposed to measles?

If you think your child has been exposed, call your pediatrician right away. It’s important to alert your doctor before bringing your child to the office. That way, staff can take precautionary measures to prevent further spread and ensure they have the necessary supplies to care for your child.

If your child has a confirmed case of measles, don’t panic—you will receive step-by-step guidance from your physician and the Texas Department of State Health Services. They will evaluate the individual risk of everyone in your household and tell you the exact steps to take to keep everyone safe.

Information from Cook Children’s and the Centers for Disease Control and Prevention:

• CDC: Top 4 Things Parents Need to Know About Measles
• CDC: Measles
• Go here to view photos of measles from the CDC.
• What to know about vaccines and immunizations | Vaccine fact and fiction | Cook Children’s

Related content on CheckupNewsroom.com:

• Infectious Diseases Doctor Shares Why Measles Vaccination is So Important (checkupnewsroom.com)
• Infant Immunization Week Encourages Babies' First Shots (checkupnewsroom.com)
• Get Immunized for a Healthy School Year (checkupnewsroom.com)

A new school year is just around the corner and it’s time for incoming kindergarteners and seventh-graders to get caught up on their routine immunizations.

Vaccines to protect against certain contagious diseases – including measles, polio and chickenpox – are required for students in Texas. Your child or teen might need a few boosters depending on their grade and whether they’re behind on their shot schedule.

Cook Children’s wants parents to know that vaccines for school are safe and proven tools to prevent diseases from spreading through the classroom and beyond.

“These vaccines have been around for a long time. There's nothing new to these vaccines, and they're as safe as they've ever been,” said Erin Bridgewater, M.D. at Cook Children’s Pediatrics in Celina.

The 2023-2024 Texas Minimum State Vaccine Requirements lists the number of doses that students need. If an incoming kindergartener has missed out on vaccines normally given at age 4, these additional vaccines are due now:

• MMR (measles, mumps and rubella)
• DTaP (diphtheria, tetanus and pertussis)
•  IPV (inactivated poliovirus)
•  Varicella (chickenpox)

And between the ages of 11-12 years, these additional vaccines are due:

• MCV4 (meningitis)
• Tdap (tetanus, diphtheria and pertussis)

About 7% of seventh-graders statewide either submitted exemptions or were delinquent in their meningitis and Tdap vaccines in the 2022-2023 school year. The concern is that a decline in the vaccination rate makes the general population more vulnerable to a disease catching hold.

“These illnesses are still very much present and could possibly cause serious illness in our children, especially if we don't continue to vaccinate and keep that high level of herd immunity that keeps these things from spreading,” Dr. Bridgewater said.

For example, a pediatric patient in June 2023 was diagnosed with the first confirmed measles case in Texas since 2019. And in New York in 2022 an adult was diagnosed with the first case of polio identified in the United States in nearly a decade.

Making an Appointment

If your child or teen needs an up-to-date shot record before school starts in August, it’s best not to put it off. Schedule your child's appointment earlier in the summer to get what you need for the school year. A spike in appointments and rush for vaccinations and school physicals can cause delays at Cook Children’s pediatrics offices. You can make an appointment at any Cook Children’s neighborhood clinics or pediatric office, including the site in Celina, which opened in April.

Dr. Bridgewater understands that it’s easy to lose track of checkups and shots -- especially for families in transition, like the influx of residents moving into the fast-growing area around Celina and Cook Children’s Medical Center - Prosper.

“A lot of parents meant to come in,” she said. “Things got busy and so they just kind of forgot. We certainly want to help people in those situations.”

The boosters required for kindergarten and for seventh grade can usually be administered in one visit to the clinic or office.  If the patient needs a checkup, it’s an appointment with the doctor. If the patient needs vaccinations only, it’s an appointment with the nurse.

How do vaccines work? The needle injects a portion of a pathogen into the body so that the immune system learns to recognize the virus or bacteria, Dr. Bridgewater said. Vaccines don’t cause infection.

“It's kind of like we're giving their immune system a snapshot of the most important piece of the puzzle so that if their immune system sees that piece again, they already know how to respond,” Dr. Bridgewater said.

She explains to her patients that it’s better to get one preventive poke than to catch a disease that might put them in the hospital. She welcomes any questions they or their parents want to ask so that they can feel confident and informed. Dr. Bridgewater wants to dispel any myths and misinformation that might be a stumbling block.

Dr. Bridgewater believes in vaccines not just as a pediatrician, but as a mom. She points out that her own two kids in recent years got the shots they needed for school.

“I want other parents to have the same reassurance that I have,” she said. “If they've heard anything at all that makes them concerned, I really encourage them to reach out and ask those questions instead of living in fear and then maybe avoiding something that could truly be lifesaving for their children.”

The first vaccine to protect babies from the respiratory syncytial virus (RSV) is one step closer to approval after the Food and Drug Administration’s advisory committee met to discuss the efficacy and safety of the vaccine.

If approved by the FDA later this year, this could be the first vaccine to protect infants from RSV, which is a leading cause of hospitalization for infants. The vaccine would be issued to expecting mothers during the second or third trimester of pregnancy to prevent RSV and prevent severe RSV from birth through six months of age.

The Centers for Disease Control and Prevention is also weighing recommendations for a monoclonal antibody for babies and toddlers, as well as a RSV vaccine for older adults.

Virtually all children get an RSV infection by the time they are 2 years old. RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV can also cause severe illnesses such as bronchiolitis and pneumonia. The risk is especially high for premature infants.

Some children require hospitalization, but most do not. Currently, there is no vaccine to prevent RSV infection. To prevent RSV infection, Cook Children’s encourages children to continue health habits learned in the pandemic, including hand hygiene, coughing/sneezing into a tissue and staying home if you or your child feel sick.

There are limited treatments for RSV; most are available only for premature infants, infants with other lung diseases, infants who are considered immunocompromised, or patients with congenital heart disease.

In fall 2022, Cook Children’s experienced an early spike in RSV and influenza A cases. Our Emergency Department and Urgent Care Centers were overwhelmed with patients. By November 2022, our patient census was full across the board due to many patients with flu, RSV and respiratory illnesses. If patients were inoculated with the RSV vaccine, this could help alleviate stress on our health care system by keeping children out of the hospital.

During the FDA’s advisory committee meeting, the discussions were complicated so the recommendations were split to vote on efficacy and safety. They unanimously approved based on the efficacy of the vaccine. However, based on available safety results, the decision was split (10 would approve, 4 would oppose).

The vaccine had serious safety concerns in the elderly patient trials that were submitted with 1 patient out of 2,500 having Guillain-Barre syndrome and another with acute disseminated encephalomyelitis (ADEM), both serious central nervous system diseases. Both diseases occur outside of trials in this population, but they are also known to be rarely related to both vaccines and due to the diseases they help prevent. There are post-marketing studies in place in elderly patients to further evaluate the exact risks of these diseases.

Additionally, a pregnancy trial was in progress but it was paused due to safety concerns. In addition to the diseases noted, there were more preterm births in the vaccine group. These were mostly babies born a week or two early which is generally safe, but due to the trend, the trial was paused while the safety is better assessed.

Nicholas Rister, M.D., of the Cook Children's Infectious Disease team, shares what parents and caregivers need to know.

Why should I consider getting the RSV vaccine? Is it safe?

Right now, the vaccine is only approved for elderly patients over the age of 60. People in this age range should talk with their doctor about the vaccine.

There is an ongoing discussion about making the vaccine available for pregnant women so that the antibodies it induces can be passed to their infants via the placenta. It has been difficult to develop an RSV vaccine for very young infants since they do not react readily to the vaccines that have been developed. However, young infants are the group most at risk for severe and prolonged disease with RSV so providing them protection via their mother is an important opportunity.

The safety questions are the issue here. Right now, the vaccine is not approved for pregnant women so it is not an option. However, the vaccine appears very effective so it may still gain approval in some form once the exact risks are better understood.

Importantly, this is not a vaccine that is going to be mandated for pregnant women. The ethical issues with having a person get a vaccine (the mother) to provide protection for someone else (the infant) and the risks assumed between them is going to make this a more nuanced discussion between OB/GYNs, pediatricians, and families.

How long and how strong is the protection against RSV infection if vaccinated?

Initial results from pregnancy trials showed 82% protection from severe RSV disease from 0-3 months of life and still 69% percent at 6 months of life. While this doesn’t prevent disease or even all severe disease, since RSV is so common in infants and particularly dangerous in preterm infants, this level of protection is very significant and dramatic.

What should parents of toddlers and young children know about the RSV vaccine since, if approved, it would only pertain to pregnant women?

RSV is a very low-risk infection for children outside of the first year or two of life and in younger adults. Until vaccine risks are clarified, there likely will be no push for using this vaccine outside of infants (via pregnant mothers) and elderly adults. Should further evaluation (or a new vaccine) emerge to show minimal risk to getting the vaccine, there may be a role in vaccinating older children to prevent the spread within families to high-risk groups. But, for now, the discussion is likely to stay with pregnant women and older adults.

Why is there a need for the vaccine? How will this impact health care systems?

The Centers for Disease Control and Prevention reports that per year, there are between 58,000 and 80,000 hospitalizations for RSV among children under 5. Because so many children get RSV every year, the actual number of children with severe disease is very high. This leads to a massive use of health care resources each year. That’s why there is so much effort into evaluating the vaccine despite some significant safety questions that need answering.

Go here to view more info about RSV from the CDC.

According to the CDC, those at greatest risk for severe illness from RSV include:

• Premature infants
• Infants, especially those 6 months and younger
• Children younger than 2 years old with chronic lung disease or congenital (present from birth) heart disease
• Children with weakened immune systems
• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

By Jean Yaeger

National Infant Immunization Week amplifies a key point: Vaccines safely and effectively protect babies against various diseases.  

This campaign of awareness, which runs April 24-30, emphasizes the proven track record of shots that fight vaccine-preventable diseases such as polio, Hepatitis B and measles. Who benefits when an infant is immunized? The child, their family and the wider community.

Parents should know that vaccines work to stop the spread of infectious diseases at home, in daycare and school settings, and in the general population. Certain shots are needed before kids enter kindergarten, seventh grade and college. But babies and toddlers need shots too before they can be enrolled in a child care center or pre-kindergarten program.

In order to start or stay in daycare in Texas, state law requires proof of up-to-date records for eight vaccines, including periodic booster shots. Regular visits to the pediatrician’s office can help children and teens stay on track for their vaccines – or get caught up if they’re behind. 

The Texas Department of State Health Services (DSHS) ensures compliance during licensing visits by checking the immunization records that the daycare centers keep for each child. Records should include the child’s name, the date the vaccine was received (month, day and year), the provider’s initials or stamp to validate, and clinic contact information.

A conscientious exemption affidavit should be submitted if a child is following an alternative vaccine schedule. According to DSHS rules, a current record or exemption must be on file; otherwise, the child in daycare is considered “vaccine delinquent.”

The DSHS website lists the 2022-2023 minimum vaccine requirements in a chart, in English and Spanish. The chart covers:

• DTaP (Diphtheria, tetanus, and pertussis) – doses by 3 months, 5 months, 7 months and 19 months
• Polio – doses by 3 months, 5 months and 19 months
• HepB (Hepatitis B) – doses by 3 months, 5 months and 19 months
• Hib (Haemophilus influenzae type b) – doses by 3 months, 5 months and 16 months
• PCV (Pneumococcal conjugate) – doses by 3 months, 5 months, 7 months and 16 months
• MMR (Measles, mumps and rubella) – one dose by 16 months 
• Varicella (Chickenpox) – one dose by 16 months
• HepA (Hepatitis A) – doses by 25 months and 43 months

Flu and rotavirus vaccines are not required but may be recommended by the child’s health care provider.

Christina Sherrod, M.D. and the staff at Cook Children’s Pediatrics Southlake will make copies of the patient’s vaccine record and also fill out a health statement form for the daycare if requested. Dr. Sherrod said the vaccine requirements serve as a safety net to help families know when to bring in their babies and toddlers for shots. “That’s the practical side of it,” she said.

For instance … Kids' Place, located across the street from Cook Children's Medical Center in Fort Worth, sends reminder notifications to parents whenever a child is due for their next vaccines.

But the ultimate goal is preventing an outbreak of disease. “If you have a daycare full of 400 kids, and fewer than 95% are vaccinated against measles, that could easily lead to an outbreak in the daycare and in the community,” Dr. Sherrod said.

At Cook Children’s neighborhood clinics across Fort Worth and nearby cities, the medical teams also promote immunizations as recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. 

“Adhering to this vaccine schedule is the best way to protect children and keep them healthy,” said Sharhonda Ansley, M.D. at Cook Children’s Neighborhood Clinic Northside. “By keeping up with their child’s regular checkup visits, parents will help ensure they are prepared for daycare and kindergarten. And the healthier we will all be!”

Dr. Ansley and Dr. Sherrod both pointed out that the symptoms of some diseases can be mild for some patients but serious or even fatal for babies. 

Your Questions Answered

How do vaccines work? Dr. Sherrod puts it this way: “A vaccine injects a protein or molecule into your body that tricks the immune system to make your body think you're getting that disease. It makes your immune system ramp up and build antibodies and memory T cells to prevent getting ill in case you're exposed to the real disease later on.”

What's it like to immunize an infant? Some vaccines are given orally. If it’s an injection, the needle goes into the thigh, and a Band-Aid is applied. The baby usually cries. “You can't warn a baby that the shot is coming, and you can't explain to them why,” Dr. Sherrod said. “The truth is they do really well and they usually calm down very quickly.”

What are some tips to help with discomfort afterward? Breastfeeding or a bottle can be soothing. Don’t give Tylenol right away. “Usually if the baby needs Tylenol, it's that evening or maybe even the next day. I tell parents to go home and see how their baby does. A lot of babies get kind of sleepy the day after their shots. If they have a fever and they're fussy, go ahead and give them Tylenol. But a lot of babies never need it. They just go home, maybe sleep a little bit more, and are fine.”

Anything else? The bacteria that might cause an ear infection or sinus infection in an older child can cause brain damage or even death to a 2-month-old, whose immune system is more immature.  Vaccines benefit the babies who receive them as well as the bigger picture of public health in our country. “It's a privilege that we have these vaccines,” Dr. Sherrod said. “As a nation, we really don't know how bad it can be without these vaccines. I just hope enough people keep getting them that we can continue to see that disease prevention.”

The CDC recommends a longer interval between the first and second dose for people 12 and up, and recommends a shorter interval for fourth doses for the immunocompromised population.

The CDC emphasized that COVID-19 vaccines have been a critical tool in this pandemic, preventing millions of COVID-19 associated hospitalizations and deaths. To date, hundreds of millions of doses of mRNA COVID-19 vaccines have been given with over a year of closely monitored real-world safety and effectiveness data, the CDC said.

There are known cases of myocarditis in a small number of people ages 18-39 believed due to the mRNA vaccines. Per million second doses administered, 33 cases were reported for Moderna and 24 for Pfizer, according to the CDC. 

Second Dose Recommendations

Recent studies revealed that rates of myocarditis/pericarditis were lower with extended interval between first and second dose of mRNA vaccine primary series.  Extended primary series interval may also improve immunogenicity and vaccine effectiveness. 

Because of this, an eight-week interval for second doses may be optimal for some people ages 12 years and older, especially for males ages 12 to 39 years old, the CDC said.

“In a very tiny number of young people, especially males age 12-39, COVID mRNA vaccines can cause a mild inflammation of the heart muscle," says Pediatrician Diane Arnaout, M.D., of Cook Children’s Pediatrics Forest Park. "This is called myocarditis, and just means that the immune system got really worked up really quickly. Thanks to the ongoing and constant safety studies done on vaccines, this small tweak to the regimen will likely mean less incidents of an already rare problem.”

The CDC still recommends the shorter second-dose interval for people who are moderately or severely immunocompromised; adults 65 years and older; and others who need rapid protection due to increased concern about community transmission or risk of severe disease. That interval is three weeks for Pfizer-BioNTech and 4 weeks for Moderna after receiving your first dose.

The shorter interval is still recommended for:

• People who are at higher risk of having an inadequate response to the first mRNA vaccine dose 
• People who are moderately or severely immunocompromised
• Are at higher risk for severe COVID-19
• Adults ages 65 years and older
• Need rapid protection, such as during high levels of community transmission
• Children ages 5–11 years 

4th Booster Shots for Immunocompromised

People who are moderately or severely immunocompromised should receive a booster dose at least three months after the last (third) dose of an mRNA COVID-19 vaccine, the CDC said this week.  Previously recommendations were set for at least five months.

RELATED: COVID-19 Vaccination for Children 5 to 11: Your Questions Answered (checkupnewsroom.com)

Mixed emotions including frustration, worry and anxiousness (to name a few) fill my being yet again on the eve of the day my kids return back to school. It is no longer a new experience for me or the many other parents who have experienced the same feelings over the last 22 months.

 The significant positivity rate in our community and the marked rapid increase in the pediatric cases and pediatric hospitalizations in the last week and a half (all while kids are out of school) is what causes some of my angst. Unfortunately, now it is not too uncommon to hear situations in which people “did all the right things” but COVID still veered its way in. So while I have been able to shield and protect my own children from being infected during the pandemic so far, I fear that the time will come when the inevitable will happen to my own. What’s different now?

 In the midst of all these emotions, I look for the silver lining in our current situation. My kids are NOW vaccinated! Although we are well aware that even fully vaccinated people are susceptible to infection they are less likely to develop severe disease and the need for hospitalization. So in the midst of the mixed emotions I have come to the point of realization and acceptance that this time around I will not likely be able to shield my own children from becoming infected with the current COVID omicron variant.

 The current significant community positivity rate makes exposure and subsequent infection while attending school more likely in the era of optional masking and confusion regarding isolation/quarantine recommendations. In the midst of an ongoing roller coaster of emotions, I will hold on to what I can control and continue to practice and encourage my own children to practice preventive precautions as best we can, including vaccination (done), hand washing and mask-wearing.

 I make the same recommendations to my own patients and their families including the following disease prevention strategies:

• Eat a balanced diet and exercise regularly
• Get plenty of sleep
• Drink plenty of water
• Do not send sick children to school (regardless of COVID exposures or not). Keeping sick children home is the best way to prevent spread in the school setting. 
• Get yourself/or your child tested if you/they develop any symptoms of COVID-19. Testing and identifying infections and subsequent proper isolation practices will prevent further spread.
• Get vaccinated if you haven't already and get a booster if you or your child are eligible (primary series approved for 5 years old and up, boosters approved from 16 and up and anticipating approval for 12-15 year olds soon).
• Practice good hand hygiene, wear a mask and avoid large crowds.

 Given the ongoing change and updates to guidance regarding isolation/quarantine guidelines for different populations of the community, we know that navigating these situations can become confusing and overwhelming. For questions regarding testing, length of quarantine or isolation, and the COVID-19 vaccine for your child, please ask your pediatrician for guidance.

 Wishing you a Happy and Healthy New Year!

Dr. Soria-Olmos

Get to know Bianka Soria-Olmos, D.O.

Dr. Soria-Olmos is a Cook Children's pediatrician in Haslet. She was born and raised in Fort Worth, Texas, so Cook Children's has always had a special place in her heart. She came to know Cook Children's when she was just a kid herself. She went to the medical center a number of times with her active younger brother, who needed care following several mishaps with broken bones. The visits inspired her to decide, "I want to be a Cook Children’s doctor one day."

In pursuit of her dream, Dr. Soria-Olmos attended Texas Christian University (TCU) for a degree in biology and to fulfill the pre-medical school requirements. After graduating from TCU, she chose to stay local and attended medical school at the University of North Texas Health Science Center/Texas College of Osteopathic Medicine in Fort Worth. She completed part of her pediatric clerkship at Cook Children's, learning about pediatric medicine by attending rounds with pediatric hospitalists. It was then she knew she wanted to be a pediatrician.

She began her career with Cook Children's in 2014 as a pediatric hospitalist caring for sick children admitted to the hospital. Today, she works at Cook Children's primary care office in Haslet. Her special interests include child safety, child development and asthma.

But many people question the safety of a novel immunization for a novel virus, especially parents with young children. Moderna recently announced plans to begin testing its coronavirus vaccine in children between the ages of 12 and 17, while Pfizer and AstraZeneca began their pediatric trials in October.

We were able to talk to Jason Terk, M.D., physician at Cook Children’s Pediatrics Keller Parkway and a nationally known advocate for vaccines, who answered a few questions about the COVID-19 vaccine.

Tell us about the COVID-19 vaccine and why people should feel safe receiving it.

The vaccine is really showing a lot of promise because we've gotten data that shows that the efficacy (that's how well the vaccine works at protecting against COVID-19 disease), is much more effective than what we might've expected. We were hoping to get something around 70% and the two vaccinations that are being considered for emergency use authorization have efficacy of about 95%, which is really fantastic. I think that that bodes well for the potential of these vaccinations to make a real difference for us.

While trials in children are just beginning, should parents go ahead and get the vaccine?

Well, the quantity of vaccinations that we have available is going to be limited initially. The CDC, FDA and the state health departments are all working together to determine what priority groups need to be getting it first. The elderly nursing home population, healthcare workers, and first responders are going to be the first individuals recommended to get the vaccination. Obviously we need to protect the health care workers so that we can continue to do our jobs providing care to our patients. Unless you have some serious underlying health condition that makes you high risk for complications from COVID-19, you will not as a parent be among the first groups of individuals  recommended to get the vaccination. But once we have plenty of supply, I certainly encourage parents to get the vaccination for themselves.

When is the vaccine going to be available for children?

Trials in children are only just beginning. We need to prove that the vaccine is just as effective and just as safe in children because children are not little adults. We also need to make sure that it works as well for them too. I have no reason to expect that it will not be as effective for children. It's going to be important to stay tuned for that. Once the vaccine is available for myself, I'm definitely going to be in line to get it. And I am unreservedly optimistic about its impact for myself and for the rest of us.

What gives you that confidence that it is a safe choice for you to get the vaccine?

In medicine, we're data driven and we have really good data that shows its effectiveness, as well as what the safety profile is with the 30-40,000 individuals who were involved in the Phase 3 trials. Right now, what we've seen from a safety point of view, is that it is producing some side effects that are very similar to other vaccinations out there that are routinely recommended and they're fairly mild for most people. The two vaccinations that are currently under consideration for emergency use authorization require two doses. One of them requires two doses separated by 21 days. The other one requires two doses that are separated by 28 days. It appears that after that second injection, that maybe about half of the individuals have some side effects like achiness and, and maybe sore joints and, and some injection site soreness and things like that, but it doesn't last very long. It's generally gone after a few days. We've had the pandemic going on now for about a year. And we've had these vaccines that are under consideration now for about six months in the clinical trials. People in those clinical trials will be followed for at least 2 years to monitor for any problems. I have no reason to expect that there will be safety concerns.

Will children receive the same vaccine as adults?

Very good question. We won't really know the answer to that until the clinical trials are completed in children. Sometimes kids require lower doses of the same vaccination that we need to get as adults. And sometimes they get the same dose. What you're looking for is to get the desired therapeutic point of protecting against the disease at the lowest dose to minimize side effects. So that's what they'll be working on for kids too.

Should people who have already had COVID-19 get the vaccine?

So the current recommendations coming from the CDC is that prior COVID-19 disease should not be a determining factor about whether you should get the vaccine, because we do not know how long natural disease will give you immunity. It certainly gives you some protection for a period of time, but how long that lasts? We really don't know. Probably because of limited supply, individuals who were shown to definitely have had COVID-19 will probably not be the first ones that will be recommended to get the vaccination. That’s getting kind of ironed out right now and we'll get more specific information on those recommendations in the next several weeks I expect.

Where should people look for more information as they make the decision on getting the vaccine?

I think that it's important to talk about information and how people get information. Unfortunately, there is organized resistance against vaccinations generally, and against efforts to try to vaccinate the population against COVID-19 specifically. Consumers of this information need to know that that those sorts of agenda-driven organizations are working to prevent the end of the pandemic. We really need to be very careful and make sure that the things that we're reading or watching on social media are evidence-based. These vaccinations are going through the same – and even greater – rigorous processes and scrutiny that all the other vaccinations that we have gone through. I have every confidence that this is going to be a game changer for the human population. We all need to get vaccinated and support this challenging effort.

Are you hopeful that a COVID-19 vaccine can help end the pandemic?

Absolutely. This is our way forward to try to get back to normal. It's not going to be an immediate thing, but it's going to be a lot quicker now that we have such effective vaccinations. It will take some time for us to really get back to normal as we know it, but we're getting there.

For more information about vaccines and COVID-19, visit https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.

For the latest on how COVID-19 is impacting kids and Cook Children’s work to protect them, visit the medical center’s newsroom at checkupnewsroom.com.

Now that schools have opened, who needs COVID-19 testing?

Rapid testing for COVID-19 can be helpful to promote isolation for positive cases, and to prevent prolonged unnecessary isolation for those children exposed to COVID-19 or with questionable symptoms. The symptoms that most likely warrant testing are combinations of the following: fever and headache, vomiting, diarrhea, congestion, loss of taste or smell, cough, muscle soreness, extreme fatigue and shortness of breath. Children with diabetes may see unexplained difficulties with sugar control. Any combination of these symptoms should be taken more seriously if there has been a known contact with a COVID-19 case.

Does a child who has had COVID-19 need a negative test to return to school?

While we have seen some schools and athletic programs requiring a negative test in order to return, this is based on outdated guidance. Testing may remain positive for weeks after symptoms have passed but does not mean that the child remains contagious. The current guidance is that students may return when their symptoms have resolved for 24 hours AND they are 10 days since the start of symptoms. In practicalities, most of these students will be waiting until the 10 days pass. If a child was hospitalized, it is recommend that they wait 20 days from the start of symptoms.

If a child is exposed to COVID-19, can we end their quarantine early with a negative test?

Testing is reasonable if symptoms develop to make a diagnosis, but quarantine should continue for 14 days from the end of the last contact. A negative test should not provide false reassurance as symptoms could continue to develop throughout the 14 day period despite a negative test.

Many parents are concerned about whether their child is at more risk for COVID-19. Which patients are at risk for more severe disease?

Risk factors for severe disease at any age include: cancer; COPD; immunosuppressed state due to organ transplant; obesity (BMI >30); serious heart disease such as heart failure, coronary artery disease, and cardiomyopathies; sickle cell disease; and type II diabetes.

Individuals with the following conditions MAY be at increased risk for severe diseases: asthma; stroke; cystic fibrosis; hypertension; immunocompromised state due blood or bone marrow transplant, steroids, or immunosuppressing medications; neurologic conditions; HIV; liver disease; pregnancy; pulmonary fibrosis; smoking; thalassemia; and type I diabetes.

Children who are medically complex, who have serious genetic, neurologic, metabolic disorders, or congenital heart disease might be at increased risk for severe illness from COVID-19, as well as children with obesity, diabetes, asthma and chronic lung disease, or immunosuppression.

What do you do when a child has a family member who is at risk for severe disease? Does the child’s age matter?

In this situation, distance learning might remain the best option for this family. Because the disease can be contracted at any age, this should not factor into the decision. While child to adult spread may not happen as easily as adult to child, there are studies that show it does occur.

Do children who are planning to do virtual learning need to have their vaccines updated?

According to the Texas Department of State Health Services (TDSHS), vaccine rules are still in effect regardless of whether a student is participating in on-campus or virtual learning.

Read more about Cook Children's recommendations for safely returning to school on our website.

*This post includes information provided by Marc Mazade, M.D., medical director of Infection Control and Prevention at Cook Children’s and Justin Smith, M.D., pediatrician at Cook Children’s Pediatric Trophy Club.

When it comes to going to the pediatrician’s office, one of the first questions your child may ask is, “Am I going to get a shot?” And as parents, we generally say, “I’m not sure.”

That answer leaves us typically feeling uninformed and helpless. But if your child is less than 6 years old, they are likely to get an immunization that is injected, not including the flu vaccine or HPV vaccine.

From birth to age 18 years of age, a child receives approximately 56 doses of immunizations covering 16 different disease states. While most of us understand the importance of vaccines, especially in the current health crisis, many parents refuse or delay immunizations due to Injection-induced anxiety and pain. Vaccinations are actually considered the most common painful needle procedure worldwide, with an estimated 12 billion injections given per year.

A recent study from the University of Toronto surveyed a total of 1,973 individuals. The study found that:

• 24% of parents and 63% of children reported having a fear of needles.
• 7% of parents and 8% of children reported noncompliance to vaccines due to needle fear.
• Regarding influenza immunization specifically, an absolute 10% increase were willing to be immunized if the vaccine could be administered in a non-painful way compared to usual practices.
• 46% of parents reported being very confident in their ability to make their children’s immunization injections less painful and frightening.
• 70% reported they never received any education on how to reduce pain.
• 79% reported they would like to learn ways to do so.
• 70% of parents reported they would be less anxious about their children getting immunizations if they were given in a non-painful way.

Although pain from needles typically resolves fairly quickly, the emotional trauma of unmanaged pain, most notably a fear of needles, can have a much longer lasting impact.

For some, pain and fear are not over when the needle procedure ends because the memory of the experience lingers.

A fearful event can occur through a direct experience (such as experiencing pain or bleeding), watching someone else (like an older sibling) have a bad experience, or simply being given negative information.

As a consequence, this leads to significant needle fear and health care avoidance into adulthood. Needle fear typically develops in early to middle childhood with a peak age of onset between 5 and 10 years of age.

In addition to fear of pain, children may also be apprehensive regarding other factors related to needle procedures, such as sitting in the waiting room, seeing blood, seeing the point of the needle, seeing the needle inserted, being “poked” multiple times, and being restrained.

Over time, unmitigated pain may increase fear, which in turn, may increase pain at future procedures. Parents may struggle with a flailing child, a child running away, hiding under a desk (I did that as a child!), fainting, and/or requiring restraint to successfully complete the procedure. These consequences result in an unpleasant, potentially traumatic, experience for the child, the health care provider, and the caregivers.

To mitigate these negative effects, the providers of Cook Children’s Health Care System advocate for their patients by utilizing a tool called “The Comfort Menu.” Ideally, parents collaborate with their medical team to acknowledge that unmanaged pain hurts more than just the child’s body. So, how do we (parents and health care team) make it less scary:

At Cook Children’s we believe that every child should have equal opportunity pain management, every time.

Artee Gandhi, M.D., Medical Director Cook Children’s Pain Management/Endowed Chair Center for Pain Management and Integrative Health

Whitney Brosey, CCLS, Comfort Menu Program Coordinator

For more about the Pain Management Program at Cook Children's, click here.

REFERENCES:

Taddio A, Ipp M, et al. “Survey of the prevalence of immunization non-compliance due to needle fears in children and adults.” Vaccine 30 (2012) 4807–4812.

Kennedy A, Basket M, Sheedy K. “Vaccine attitudes, concerns, and information sources reported by parents of young children: results from the 2009 HealthStyles Survey.” Pediatrics 2011;127:S92–9.

Taddio A, Chambers CT, Halperin SA, Ipp M, Lockett D, Rieder MJ, et al. “Inadequate pain management during routine childhood immunizations: the nerve of it.” Clin Ther 2009;31:S152–67.

Jacobson RM, Swan A, Adegbenro A, Ludington SL, Wollan PC, Poland GA, Vaccine Research Group. “Making vaccines more acceptable-methods to prevent and minimize pain and other common adverse events associated with vaccines.” Vaccine 2001;19:2418–27.

Woodin KA, Rodewald LE, Humiston SG, Carges MS, Schaffer SJ, Szilagyi PG. “Physician and parent opinions: are children becoming pincushions from immunizations?” Arch Pediatr Adolesc Med 1995;149:845–9.

Madlon-Kay D, Harper P. “Too many shots? Parent, nurse, and physician attitudes toward multiple simultaneous childhood vaccinations.” Arch Fam Med 1994;3:610–3.

Diekema DS. “Improving childhood vaccination rates.” N Engl J Med 2012;366:391–3.

Guerra FA. “Delays in immunization have potentially serious health consequences.” Paediatr Drugs 2007;9:143–8.

Craig KD. “The social communication model of pain.” Can Psychol. 2009;50:22–32. 40.

Hadjistavropoulos T, Craig KD, Duck S, et al. “A biopsychosocial formulation of pain communication.” Psychol Bull. 2011;137:910–939.

Pillai Riddell RR, Racine N, Craig K, et al. “Psychological theories and biopsychosocial models in paediatric pain.” In: McGrath PJ, Stevens BJ, Walker SM, et al, eds. Oxford Textbook of Paediatric Pain. Oxford, UK: Oxford University Press; 2013:85–94.

McMurtry C, Riddell R, et al. “Far From “Just a Poke” Common Painful Needle Procedures and the Development of Needle Fear.” Clin J Pain Volume 31, Number 10S, October 2015

Since the arrival of COVID-19, a desperate search for a vaccine to fight the pandemic has ensued worldwide. However, despite this present-day example of the importance of vaccination, immunization rates at Cook Children's have dipped.

From March 1 through May 31, 2020, 66,049 children received their vaccines at either a Cook Children's primary care office or a neighborhood clinic. That's compared to 81,984 in those same months in 2019.

While some of the decreases in numbers are due to families staying at home because of the pandemic, pediatricians want parents to know it's essential to get your vaccines, perhaps now more than ever. Data from Scientific American found that during March 2020, vaccination rates dropped to 44.7% in Texas, the second-lowest in the nation behind Washington D.C. (44.4%).

The Centers for Disease Control and Prevention (CDC) reported a 2.5 million decrease in non-influenza vaccines ordered from the federal Vaccines for Children Program between January 6 and April 19 of this year. The CDC adds there was a 250,000 drop in the number of measles vaccines ordered during that time.

"Immunizations are the safest, easiest way to protect your kids from unnecessary and sometimes fatal childhood diseases," said Jason Terk, M.D., a Cook Children's pediatrician in Keller and a national advocate for vaccines. "We all desperately want a vaccine to protect us from COVID-19. But I think it's important to focus on what we do have right now, and that's vaccines for 16 different diseases. These vaccines are tried and true. We have had many years of experience with them, and we know that they are safe."

Doctors stress vaccines to protect not only your child but other kids as well. Immune-suppressed people have a higher risk for the deadlier complications of measles infection, such as encephalitis and pneumonia. Vaccines protect your child and those who may come into contact with them.

Dr. Terk said, "the best course of action is to make sure that all persons in close contact with babies less than 6 months of age are properly vaccinated against measles and avoid situations where larger groups of unvaccinated people are likely to be."

While the overwhelming majority of parents do choose to give their children vaccines, some have decided not to, ignoring leading health care organizations.

"Vaccines are safe and effective," said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. "There are decades of sound scientific research to support this. We recommend that all children be vaccinated as recommended by the American Committee on Immunization Practices schedule to help keep them safe."

With so much misinformation online undermining the safety and importance of immunizations, it can be difficult for parents to separate the facts from fiction.

Pediatricians and other health care providers at Cook Children's are concerned about the potential rise in preventable diseases and even more concerned about the risks they pose to babies, kids, teens, and adults.

Alice Phillips, M.D., a Cook Children's pediatrician, welcomes a conversation with her patient families. She said her job is to listen to concerned parents in a respectful way to provide facts and calm their worries.

"I try to answer them with what my experiences as a practitioner have been. I tell them not only what I've seen as a physician and explain all the science supporting immunization, but what I've done as a mom," Dr. Phillips said. "My children are vaccinated. I believe in vaccines. Often, a parent needs kindness, compassion, and assurance that they are making the right decision for their child. I truly want them to know that receiving a vaccine is the right decision for your child."​​

Important Resources

• Immunization Schedule for Your Child
• Calendarios de vacunación
• Common Questions Answered About Immunizations
• Immunization Collaboration of Tarrant County
• Immunization Collaboration of Tarrant County - Schedule of Events

When I first met little Pierce a few days after he came home from the Neonatal Intensive Care Unit, I noted two things: Pierce was a tough little guy, a real fighter, and his parents were two of the most caring, loving and excited first-time parents I had ever met.

So you can imagine my horror to learn that my new sweet little buddy had contracted the potentially deadly disease called whooping cough (pertussis) before he was even 7 weeks old.

Pierce was born 5 weeks early, was very small, and had respiratory distress at birth. After spending 18 days in the NICU, our little fighter was healthy enough to go home.

His parents worked really hard at getting enough calories in him daily, and I saw him in my office a lot to assure he was growing well and thriving. And he was.

A few days before Christmas, Pierce’s mom, Whitney, emailed me on our portal system to let me know he had some congestion, but seemed to be OK otherwise. Cool. No biggie! Baby’s first cold. Keep him drinking, watch for fevers, watch his breathing closely. Lots of kids have colds right now. Keep me updated.

A couple days later, he had a tiny temperature elevation to 99-100. Since he was born so early, and so small, I asked them to come in so I could check him. He looked great! So I sent them home.

Pierce’s cough was getting worse. Really junky. I checked on him again a few days later in my office. He seemed fine. We talked about what to watch for:

• A dusky color to gums and tongue.
• Chest muscles working hard to breathe.
• Not wanting to drink.
• Fever coming back.

Let me know if these things happen. I sent them home and asked them to email me updates over the next few days.

I didn’t like what I read in those updates in the next 24 hours.

“He’s starting to turn blue with this cough, Dr. Diane.”

“His cough is coming in huge fits, and it’s making him throw up.”

Pierce’s mom Whitney told me, “The moment we became super worried was when we started realizing how hard he was working to breathe. He was turning blue and dusky. He was choking. He was coughing until he would just gasp for air.”

They went to a Cook Children’s Urgent Care center that weekend, because things were getting worse. A nasal swab was done there for whooping cough, since his fits were getting so bad. The results would take a few days to come back.

But surely it wasn’t whooping cough, his parents (and I) thought! His parents had gotten their pertussis (Tdap) boosters when his mom was pregnant. And they’d asked all grandparents, aunts, uncles, and a cousin to all get their shots too. They wanted to protect their precious new baby from a known danger.

The day the whooping cough test came back positive on a Sunday, Pierce turned really blue with a coughing fit. The family went to the Cook Children’s ER immediately. I called the hospital doctor to let them know he was coming, and that I was worried about him. I sent in antibiotics for his family to take, with the hopes they wouldn’t catch it too. Pierce took antibiotics too, which made his pertussis not “spreadable,” but unfortunately this does not cure or even improve the illness once you’ve started coughing.

Whooping cough is a bacteria that we have a vaccine for. However, babies can’t get their first vaccine until they are about 2 months old. Infants are usually the hit the hardest by pertussis. They often have to be on ICU support, and 1% of infants who contract it will die.

Sweet Pierce was scheduled to get his whooping cough vaccine (Dtap) with me in my office the day after he was admitted to the hospital.

Pertussis is spread by microscopic droplets in the air. Someone coughing or sneezing near you can pass it to you. Or, just being in the same part of a room, breathing the same air, can pass the disease on to someone. It is HIGHLY contagious.

It starts with cold symptoms for 1-2 weeks. Then, the horrible coughing fits start. Adults and older kids can break ribs and pop lungs because they cough so hard. And it’s known as the “100 days cough” because it can last a long time.

Listen to Pierce’s cough in the video. You hear how he struggles to take in some breath between coughing fits? The “whoop” sound? This is how the disease got its name.

Our little hero spent a full week at Cook Children’s. He needed oxygen, fluids and supportive care. They assured he was able to drink and was breathing comfortably. They helped support him through the coughing fits and assured his oxygen levels never went too low.

“Cook Children’s was just as amazing as I knew it would be. I had heard from friends and family that the care they got there was truly the best, and we can agree with them now based on our experience,” Whitney said. “Everyone was so sweet and thoughtful. Some nurses and techs went above and beyond when they knew we were exhausted, rocking our baby so we could get some sleep. They didn’t just look after Pierce’s well-being, they looked after ours, too!”

We’re not sure how Pierce contracted whooping cough. It is such a contagious disease. It could have been at the grocery store as he napped. It could have been a well-meaning family member who hadn’t been vaccinated in a while. It could have been a bystander at the post office. Just waiting in line at a doctor’s office or sitting next to a table full of people at a restaurant can spread the disease.

Dr. Susie Whitworth, the director of the Infectious Disease clinic at Cook Children’s, told me “I wish the public understood how very safe the vaccine is, how very commonly we still see children with pertussis, and how infants still die of this vaccine-preventable disease. “

The most important thing YOU can do to protect babies like Pierce is to vaccinate yourself and those you love. The vaccine is 89% effective in children if they get all the boosters, but the effectiveness slowly wanes over time. This is why we give boosters to kids at age 4 and 11,  and why we recommend getting the vaccine at least every 10 years as an adult. So the MORE of us that get the vaccine, the LESS chance this disease can penetrate a community. And, if you’re vaccinated and do catch pertussis, several studies have shown the length and severity of illness is much less severe.

Pierce is now at home, and is feeling great. He survived a disease that so many infants do not. He came to my office a week after going home from the hospital and got his first set of vaccines. His parents told me, “We want to tell his story. We want people to understand what he’s been through. If it’s read by even one person who is on the fence about vaccines, and we change their mind, it will be so worth it.”

For More On This Topic:

• Immunization Schedule
• Calendario de vacunación
• Let's Learn ABout Whooping Cough
• Vaccines and Immunizations Information
• Pertussi (Whooping Cough)
• Is It Croup or Whoop?

As a pediatrician, I have been lucky to practice medicine in the post-vaccine era. Although I have watched kids struggle with whooping cough, meningitis, mumps and pneumonia, I am happy to say I have never seen many of the vaccine-preventable diseases. I rely upon my education and training to know about the diseases and recognize them should the need arise.

I do frequently wonder, ‘What was life like for families and children before vaccines were introduced?’ How did people manage the illnesses and anxiety that came with the disease?

For a firsthand answer, I only had to talk to the person sitting at my dining room table during a typical weekend family dinner – my mom.

It was the summer of 1949. While other children were skipping rocks and riding their bikes, my mom was lying in a hospital bed as one of many children struck down by polio.

The illness began as a fever with trouble swallowing and weakness in her left leg. The doctors quickly admitted her to the hospital for quarantine and treatment. Her most vivid memory of the time has to be of the spinal tap used to aid in her diagnosis. At the time, there were no child life specialists to comfort her. She was told to hold still and if she moved the test might kill her.

After 3 months in the hospital with only her mother allowed to stay, her symptoms seemed to be worsening. Her kind physician came into the room one day to visit and cheer up the family. His kindness unfortunately, resulted in him contracting the disease and being confined to a wheelchair for the remainder of his days. After all, back then doctors did not even realize the value of handwashing.

I asked my mom what people thought about polio in the pre-vaccine era. “Everybody was scared to death of catching it! They did not know how they got it but knew it was prevalent in the summer months. They tried to avoid the sun and swimming holes since those seemed to be related.”

We now understand the transmission of polio much better. Polio comes from a virus that is highly contagious. It is spread person to person through sneezing, coughing or contact with human feces. Before the successful introduction of the polio vaccine in the 1950s, the disease resulted in the paralysis of 15,000 people per year. Since 1979, no cases of polio have originated within the United States but cases can be brought in by travelers with the disease.

My mom was one of the lucky ones. Just as a conversation with her medical team was turning to placing her in an iron lung to support her breathing she began to recover. The impact of the illness, however, continues to this day with residual weakness in her legs that makes walking for her a constant challenge.

I asked her what she thought about vaccines as a mom and a grandmother. She responded, “I experienced polio and its effect on my life. I want all my kids and grandkids protected so they don’t have to go through what I did.”

Vaccine-preventable diseases such as polio and the re-emerging measles and mumps are not historically that far away from us. We cannot forget the tremendous impact these diseases have had on the lives of so many before the introduction of vaccines.

If you want to learn more, you can check out the CDC website on polio. 

Better yet, just look across the table on a sunny Saturday afternoon and if you are fortunate to do so, ask the folks who lived it. Their stories and experiences are powerful.

More Information On This Topic

• 'I'm Worried Too.' Pediatricians Concered As Texas' Nonmedical Vaccine Exemption Rates Hit All Time-High
• 5 Questions We Get Asked About Vaccines Answered
• Vaccines for Your Children: 9 Facts Parents Need To Know
• Vaccines and Immunizations
• Information for Parents

Regardless of statistics, research or science, some parents will never change their minds.

But for the vaccine-hesitant parents who are truly trying to make the most informed decision for their child, let’s take a look at some of the most commonly asked questions and concerns we read on social.

The responses to these questions are based on extensive research conducted by the Cook Children’s Vaccine Clinical Guideline teams, comprised of primary care and specialists in their field. The team cited 99 different sources during their research and their work was approved by the Cook Children’s Medical Center’s Clinical Excellence Committee.

We hope this helps to answer some of your questions.

1. Do vaccines work?

Immunizations are considered to be one of the greatest accomplishments of modern medicine. Compared to pre-vaccine statistics, we’ve seen a reduction in the number of cases of measles by 99.9%, mumps by 95.9%, pertussis by 92.2% and rubella by 99.9%.

This is important because many vaccine-preventable diseases require high vaccination rates to maintain community immunity. For most of the vaccines that are currently available, there must be a population immunization rate for at least 90% to ensure consistent community immunity and some diseases that are highly contagious, such as pertussis or measles, require population immunization rates of at least 95%.

The maintenance of community immunity protects people who received the vaccine but were unable to generate a lasting immune response to the illness, as well as those individuals who are too young to receive a vaccine or have medical reasons that prevent them from receiving a vaccine.

2. Do vaccines cause autism?

This is a most difficult subject to approach because some parents make the direct link to their child’s autism to the vaccines they received.

Because MMR is one of the vaccines that is given to children between 12-18 months and signs of developmental conditions such as autism develop around the same time, it’s easy to see why families would perceive a cause and effect relationship between the two.

This argument was strengthened when Andrew Wakefield published an article in The Lancet in 1998 that claimed a link between the MMR vaccine and autism. Since his initial article was published, investigations have found that Wakefield’s study was flawed by research misconduct, conflicts of interest and lies. This ultimately led the Lancet to retract his original article. In 2010, Wakefield was barred from practicing medicine in Britain.

Dozens of studies have been conducted to look for any possible link between vaccines and autism and these studies continue to confirm no link exists, and that vaccines are safe and effective.

3. If children receive too many vaccines, can it overload their system?

While the number of vaccines that children are given has increased over time, children are actually being exposed to fewer antigens than they had been previously – thanks in large part to the increased purity of the pertussis vaccine.

Some parents may have concerns that vaccines can overwhelm a child’s immune system, but this simply isn’t true. When a child is born, they leave a relatively sterile environment and within hours their GI tract becomes heavily colonized with bacteria. They begin to produce what’s called a specific secretory IgA against these bacteria within the first weeks of life. A 2002 study, published in Pediatrics, states that an infant has a theoretical capacity for up to 10,000 vaccines at any one time.

Multiple studies have been done that show vaccines do not cause an increased risk of infection for children. One study even found that children who received vaccines had a lower rate of infections from vaccine-related and unrelated pathogens. There is also no evidence to support the idea that vaccines lead to increased risk of SIDS. Research has found that vaccines significantly reduced the risk of SIDS.

Children with severe immunodeficiencies who receive live viral vaccines may be at risk for developing an infection or disseminated disease. The biggest concern would be children with T-cell immune deficiencies receiving live virus vaccines. Fortunately these immune deficiencies are usually diagnosed around 6-8 months well before the first live virus vaccines are scheduled (12 months). 

With all that being said, many children with immunodeficiencies can receive vaccines safely, such as certain children with HIV or certain children with malignancies.

4. Is it really hygiene and better nutrition that caused disease reduction and not vaccines?

Statements like this are commonly found in anti-vaccination literature and it implies that vaccines are ineffective and unnecessary. While better hygiene and nutrition have certainly helped to improve the health of our population, it ignores the dramatic effects of vaccination.

If hygiene and nutrition were responsible for disease reduction, you would expect all disease incidence to decrease at around the same time, but this is not what we have seen. Instead, we have seen a recurrent pattern of disease reduction shortly after a vaccine against that disease has become available.

For example, while there was yearly variation in rates of measles, it wasn’t until a vaccine was released and widely distributed in 1963 that we saw a permanent drop in measles cases. Another example is Haemophilus influenza type b, which remained prevalent until the early 1990s when a vaccine that could be used in infants was developed.

Another way of debunking this myth can be to look at individual countries who saw a decrease in their immunization rates. Great Britain saw a dramatic drop in their immunization rates for pertussis in 1974, which was followed by a pertussis epidemic with more than 100,000 cases and 36 deaths by 1978.

In Japan, a drop in pertussis vaccine rates around that time from 70% to below 40% resulted in an increase of pertussis cases from 393 in 1974, to 13,000 in 1979.

5. If your child is vaccinated, why do you care if my child isn’t?

The increasing prevalence of vaccination acts to prevent the circulation of an infectious organism within the community provides benefit to everyone, even those who aren’t vaccinated. This is referred to as community immunity. Community immunity is an important means of protecting the elderly, the young and those with medical conditions that prevent them from receiving vaccines.

For most of the vaccines that are currently available, there must be a population immunization rate of at least 90% to ensure consistent community immunity and some diseases that are highly contagious, such as pertussis or measles, require population immunizations rates of at least 95%.

The maintenance of community immunity is important to protect those individuals who received the vaccine but were unable to generate a lasting immune response to the illness, as well as those individuals who are too young to receive a vaccine or have medical reasons that prevent them from receiving a vaccine.

More on This Topic:

• Vaccines for Your Children: 9 Facts Parents Need To Know
• Vaccines and Immunizations
• Information for Parents
• Immunization Collaboration of Tarrant County
• Childhood Vaccine Assessment Tool (CDC)
• American Cancer Society and HPV
• Centers for Disease Control and Prevention
• Vaccinate Your Family
• Voices for Vaccines
• Allied Vaccine Group
• Texas Department of State Health Services

It was also during this time that measles showed up in Texas and when I received my second MMR.

My sister had been in San Antonio with my mother for two months receiving care at a Bone Marrow Transplant center. While she had no memory of her twenty-third birthday, I saw pictures of the nurses and doctors surrounding her with a cake.

Later when she returned home, she commented on this nice shirt she had found in her suitcase as she had not seen it previously. I did not have the heart to tell her that it had been a gift from me for her birthday, she just had been so ill she did not remember.

As the number of measles cases in Texas were climbing, her doctors became fairly insistent that I receive a second MMR. They really didn’t want me to be around her without being protected.

Some may feel that wasn’t their decision to make. However, those doctors were not only scientifically correct but they cared deeply for my family. They knew me well enough to know that if I gave anything to my sister that would have hurt her, I likely would have never recovered from that guilt.

While measles can harm anyone, it likely would have been a death sentence for my sister. Initially, my mother was concerned about any possibility of me developing measles after the vaccine and giving it to my sister. The doctors reassured her and said the only way to protect her was to protect me. My mom had to make so many difficult decisions that year. Sometimes she did what the physicians recommended and sometimes not. Her goal everyday was to advocate and protect her daughter. So I was vaccinated based on the new two dose MMR policy.

Then I was able to be with my sister. I was with her when they told her that cancer returned. I was there to watch my platelets infuse into her weak body. I was there on the morning she died. Holding her hand. It would have been too risky during the measles outbreak for me to be around her that summer if I had not received that vaccine. While I grieve the loss of her beautiful mind and spirit still after almost 30 years, I realize that experience inspired me to enter medicine and advocate for children.

It is so unfortunate that the discussion around vaccination has become so volatile. Like my mom, parents are just trying to make the best and safest decisions for their children. They have to navigate a much more complex world of information available to them. At my clinic, we spend a good amount of time discussing questions and concerns regarding vaccines. While I try to work with families and guide them, in the final discussion, vaccinating children is the healthiest choice for them. Not just for their own disease prevention but for all of those who cannot receive certain vaccines through age or medical condition.

Honestly, I was a bit nervous writing this realizing potential backlash from those not agreeing with vaccinations. Yet as I was looking through my closet the other day, I saw that shirt I gave my sister. It made me smile remembering her wearing it and it reminded me of how all of us had to be brave in different ways that year. In her memory, I will continue to try and be brave.

Vaccinate. It saves lives.

Believe it or not, summer’s almost over and the new school year will begin before you know it.

Are you ready? Or are you like a certain dad I know who usually waits until the last minute? Last year, this dad forgot:

• To book his child's physicals so he had to scramble to get checkups before flu shots.
• His daughter has some pretty significant fears about going into school the first day and he didn’t take the time to properly prepare her.
• To get his son's asthma inhalers refilled and the forms on file so that he could have it at school (until April when he was having a flare).

Don't be like me…here are 10 steps you can take to make sure you and your child are ready for back to school.

1. Vaccines - Make sure that your child is up to date on vaccines. As your kids get older, your school might prevent them from enrolling in classes or other benefits, which might make it difficult to get their classes scheduled, etc. Vaccines are routinely scheduled at 4 years old (measles, whooping cough and polio among others), 11-12 (whooping cough and meningitis) and 16 (meningitis). At Cook Children's, we also recommend the HPV vaccination starting at age 11.
2. Physicals - If your child plans to participate in a sport or marching band they may need a sports physical form to be completed by your child's doctor. This requirement is required by the UIL before junior high, ninth and eleventh grade but many schools ask for it each year. The marching band requirement is new so not as many parents are aware. I expect we'll be doing a lot of those in the first few weeks of August. Students who are attending private schools or participating in sports that aren’t governed by the UIL may have other physical exam requirements. Many of these kids are already out in the heat working hard preparing for their upcoming season, so I recommend getting these as soon as possible.
3. Forms - Don't be that parent who realized in April that their child doesn't have his inhaler or the form required to take it at school (ahem ... me). Here are some common medications your child might take which might need to be administered at school: inhalers/nebulizers for asthma, insulin, ADHD medications and pain reducers.
4. Sleep - Transitioning back to a sleep schedule that works for school might be the most difficult transition in prepping for back to school. The older your child, the more likely they are to be going to bed too late and sleeping in. Start making subtle changes in their bedtime over the next few weeks. Rolling bedtime back 30 minutes at a time can make the transition to early morning easier.
5. Screen time - Just like sleep, screen time can get away from us a bit over the summer (Fortnite! I’m looking at you). An immediate drop off in daily screen time can be a struggle so starting to make changes now can help your screen junkies detox a bit before they go back to school.
6. Your child’s back to school fear or anxiety - Many children deal with some fears about going back to school. These fears can be mild or they can be more severe, almost debilitating. Helping your child prepare for the transition by talking them through their day, setting up a play date with classmates ahead of time or taking a tour of the school can orient (or re-orient them) back to school in a way that can be helpful. If the anxiety is more severe, consider talking with your pediatrician or a play therapist in advance to help them and you prepare.
7. Your back to school fear or anxiety - Getting yourself prepared for back to school is almost as important as preparing your child. Some parents will kick their kids out the door and drive off to their gym class without a second thought. For others, the transition can be just as hard on the parent as the child. Begin now to prepare yourself for what it will feel like those first few days at drop off. Showing emotions with your child is certainly OK, but a prolonged, tearful drop off can make things harder on your child.
8. Supplies - Get your child ready for back to school by buying their school supplies in advance whenever possible. Whether you buy the prepared packet from school or enjoy the process of shopping for individual supplies doesn't matter, just make sure your child is well prepared with what they need to start the year off right. Buy some extra tissues or hand sanitizer to help the teacher out.
9. Set goals - My favorite part of a new school year is the fresh start that kids can get. Whether last year was amazing or a huge struggle, it's a great opportunity to help our kids realize that they can always work on something to make themselves better. Using last year as a guide, help them set some goals that focus both on their strengths and challenges.
10. Attend meet the teacher night - Sometimes these events occur before school and sometimes they occur a little after school starts. Use meet the teacher night strategically to help frame your child in a positive light. This can go a long way to helping your child accomplish their goals for the year.

Whether you're counting the hours until you can send the kids back or dreading the return of early mornings, hopefully, these tips will help you think through some of the things you need to consider. I know it did for me.

What topics did we miss?

Related To This Topic:

• Vaccines and Immunizations
• Immunization Schedule
• Common Questions About Immunizations
• Knowing Your Child's Medical History
• Sleep Center
• Your Kids Are Ready For School. But Are You?
• 5 Questions Every Parent Should Ask Their Child's Teacher
• 6 Ways You Can Help The Teacher Understand Your Child

Alice Phillips, M.D., a Cook Children’s pediatrician in Fort Worth – Cityview, hears the worry in the voices of many of her patient families. They’re afraid their child may contract measles or some other contagious disease.

“I like to reassure them,” Dr. Phillips said. “And currently, I can say there is no indication of a major outbreak threatening the health of their children in our area. But I understand their apprehension and I admit I’m worried too.”

Measles cases have hit a 25-year high in the United States, and Texas already has reported 15 confirmed cases of measles in 2019, six more than in all of 2018.

And yet as the number of cases have gone up, Texas vaccine exemption rates have reached an all-time high. According to a report in the Texas Tribune, “the number of individuals who have had at least one vaccine exemption affidavit requested on their behalf has grown more than tenfold, to more than 70,000 in the 2018 fiscal year.”

Texas is one of 16 states to provide vaccine exemptions for conscientious, philosophical and/or religious beliefs. In our state, kindergartners must have 10 immunizations to be enrolled in school. The Tribune found that since 2006, when Texas first started reporting data, the exemption rate for kindergartners has risen from 0.3% for the 2005-2006 school year to 2.15% for the 2018-2019 year.

“I’m very concerned by these numbers,” Dr. Phillips said. “I truly believe vaccinations are the greatest public health advancement seen in my lifetime. This trend toward opting out of vaccines threatens the health of all of our children.”

The Texas Tribune article allows readers to type in their school district and see the vaccine exemption rates for kindergartners, those who aren’t receiving vaccines by claiming a conscientious exemption (along with citing medical or religious concerns). The story mentions that Alliance Christian Academy had the second highest vaccine exemption rate by percentage in the state last year with 40.6% of their students (13 of their 32 kids).

In Fort Worth ISD, 1.39% of kindergartners (84 of 6,031) received non-medical vaccine exemptions. Dr. Phillips knows that some will say that’s only 84 kids in Fort Worth or 13 at Alliance Christian, but those numbers add up.

“You may say only 2% of the population isn’t vaccinated, but that 2% is often times happening in clusters,” Dr. Phillips said. “We have seen those areas with clusters of a population are where we are especially primed and ready for an outbreak. That’s what we’ve seen recently in New York City. There was a cluster of people who didn’t vaccinate. I worry that’s what we are at risk for in Texas.”

Dr. Phillips hopes healthy people who can receive immunizations take that responsibility seriously. Community-wide protection depends upon a high percentage of the entire population receiving vaccines in order to protect children who are immune compromised and or can’t receive vaccines for health reasons.

“Those children rely on us to protect them,” she said. “They can’t have the vaccine, so they rely on the rest of us to stand up and protect them and keep these illnesses from them. That’s the herd immunity. That’s simply not happening as much as it should in this country. The measles cases in this country are startlingly high.”

With so much misinformation on the Internet or even among their friends, Dr. Phillips welcomes a conversation with her patient families. She said her job is to listen to concerned parents in a respectful way to try to provide facts and calm their fears.

“I try to answer them with what my experiences as a practitioner have been. I tell them not only what I’ve seen as a physician and explain all the science supporting immunization, but what I’ve done as a mom. My children are vaccinated. I believe in vaccines. Many times, a parent just needs kindness, compassion and assurance that they are making the right decision for their child. I truly want them to know that receiving a vaccine is the right decision for your child.”

For more on this topic:

• The Texas Tribune Story: Texas vaccine exemption rates have reached an all-time high. Did Texas make it too easy for parents to opt out?
• Vaccines and Immunizations
• Common Questions About Immunizations
• Measles
• Immunization Schedule
• From Vaccine Hesitant to Pro Vaccines. Why This Mom Changed Her Mind.
• Pediatricians Remember Experiences with Measles
• What The First Measles Case in Tarrant County Means for Your Child
• 'Vaccines Are Safe and Effective'
• When It Comes to Your Kids It's Never Just a Virus
• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles In the Classroom
• MMR/thimerosal/mercury: What you should know

Although she wouldn’t call herself “100% anti-vax” at the time, Amanda Carroll declined to give her first-born son his hepatitis B vaccine at birth.

With the next group of shots scheduled at his 2-month checkup, Amanda and her husband weren’t so sure what they would do next.

Amanda met with her pediatrician, Justin Smith, M.D., who was then in Abilene, and expressed her concerns. She talked about spacing out the vaccines or delaying them. She was concerned about the sheer number of pokes, the number of vaccines her baby would be given and wondered about a possible pharmaceutical company profit motive.

She figured she had two months to make a decision and began to read Dr. Robert Sears’ book that promoted a vaccine timetable contrary to the Center for Disease Control and Prevention’s schedule.

Amanda only made it halfway through the book.

At 3 weeks old, her son was rushed to a hospital in Abilene for emergency surgery. He needed a bowel resection after he was diagnosed with a strangulated inguinal hernia. After a code blue, the baby was flown to Cook Children’s by its Teddy Bear Transport team.

The little boy received two more operations at Cook Children’s, including another bowel resection from  pediatric surgeon Patrick Thomas, M.D. In all, the Carroll family’s son spent three weeks in the Pediatric Intensive Care Unit and two more weeks on the surgical floor.

During that time, Amanda and her husband developed a rapport with Dr. Thomas and felt comfortable expressing their concerns about vaccines.

“We talked to him about delaying or spreading out his vaccines,” Amanda remembers. “Dr. Thomas was so nice and he was very polite. He didn’t actually say these words. But in the nicest way possible he basically told us, ‘Really? I put so much work into saving your baby, you cannot do that. He needs to be vaccinated.’”

Because of his condition, the Carroll’s son had developed a blood infection and needed to see a doctor from Cook Children’s Infectious Diseases department. Dr. Thomas found out the physician would be Mark Shelton, M.D. Dr. Thomas told Dr. Shelton about the parents’ concerns.

“We spent an hour with Dr. Shelton. He was able to answer all of our questions in detail. I wish everybody who had the concerns we had about vaccines could have a similar experience,” Amanda said. “I wish they could sit down and talk to someone as knowledgeable about vaccines as Dr. Shelton.”

One memory that sticks with Amanda was when Dr. Shelton addressed Andrew Wakefield, the discredited British doctor and leading anti-vaccine activist. Much of today’s misinformation about vaccines began when Wakefield erroneously published a report linking vaccines to autism. That report has since been debunked.

Amanda recalls Dr. Shelton’s emotion at the mention of Wakefield’s name. He spoke passionately about the harm that Wakefield’s study had caused many children around the world.

Amanda is a sociologist and an educated person. Even after talking to Dr. Shelton, she still wanted to make the decision whether or not to vaccinate her son, using science as her guide.

“I looked at four or five other countries from around the world and found they had remarkably similar vaccine schedules in almost all of the western nations,” Amanda said. “When you looked at the CDC, the World Health Organization and other equivalent organizations, they all stressed vaccination.”

Then during her studying, another thought occurred to Amanda that chilled her to the bone. She had made the decision to not give her newborn boy the vaccine for hepatitis B. She realized after three surgeries and a blood transfusion there had been a chance, although small, that he could have gotten the disease because he was not vaccinated.

Once their son was discharged and recovered enough from his surgery, Amanda took her son to Dr. Smith for his full vaccine schedule.

She has continued to do so with her other two children, now 3 and 17 months old.

Amanda would be the first to describe her parenting choices as a “bit granola or hippie,” and she has several friends who are like-minded. But where she disagrees with some of her friends is about vaccines.

“I respect my friends’ opinions who are against vaccines or are vaccine-hesitant, although I disagree with them,” Amanda said. “I think they are absolutely trying to do what is best for their child, whether they are against vaccines or choose alternate schedules. My husband and I believe in the scientific research that says vaccines are safe. After our experience at Cook Children's, we felt comfortable going ahead with the schedule as is, and we have no regrets.”

For more information on this topic:

• Vaccines and Immunizations
• Common Questions About Immunizations
• Pediatricians Remember Experiences with Measles
• What The First Measles Case in Tarrant County Means for Your Child
• 'Vaccines Are Safe and Effective'
• When It Comes to Your Kids It's Never Just a Virus
• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles In the Classroom
• MMR/thimerosal/mercury: What you should know

To identify the hot spots, researchers from the University of Texas at Austin and Johns Hopkins University looked at each area’s volume of international travel from foreign countries with large measles outbreaks and the prevalence of nonmedical exemptions from childhood vaccinations.

The same researchers previously predicted outbreaks in Washington, Oregon and New York which are all experiencing an influx of measles cases.

“For measles, most experts believe that there will be one to two deaths per 1,000 cases, most likely infants. We are set to see over 1,000 cases in the U.S. in 2019. So, for the first time since the 1980s, we may expect infant deaths from measles in the U.S.,” said the study’s lead author, Sahotra Sarkar, a philosophy and integrative biology professor at UT Austin and an expert on public health, in UT news. “We have long known that vaccine avoidance is a critical public health issue in the U.S. and Europe. Our results show how travel from regions elsewhere compounds this risk.”

The Texas Department of Public Safety has confirmed 15 measles cases in Texas this year, including one in each: Tarrant, Dallas and Denton counties and two in Collin County. Comparatively, Texas had nine measles cases in 2018 and only one in 2017.

Already this year, more than 760 cases of measles have been confirmed in the United States, the highest number in decades.

Physicians at Cook Children’s call this news frustrating because measles is a disease once thought to be all but gone from the planet. Texas has one of the highest rates of unvaccinated children in the U.S., partly due to a 2003 state law allowing parents to opt out of getting their children immunized for reasons of conscience.

“It’s not a coincidence that as we have seen more people hesitant to receive the vaccine, we have seen the number of measles cases increase nationwide,” said Justin Smith, M.D., a pediatrician at Cook Children’s. “The numbers are very concerning.”

Measles is a highly contagious respiratory illness spread by contact with an infected person through coughing and sneezing. Measles is so contagious that if someone has it, 90 percent of the people around that person who are not immune will become infected.

The Centers for Disease Control and Prevention (CDC) recommends children who are older than 12 months get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.

Two doses of the MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

"Populations who choose to not follow the recommended vaccine schedule are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," said Jason Terk, M.D., a Cook Children's pediatrician.

Other Texas counties to make the Top 25 were Harris at No. 9 and Travis at No. 22.

To learn more about where you can receive vaccines in the Tarrant County area, visit the Immunization Collaboration of Tarrant County website.

For More on This Topic:

• 25 U.S. Counties Identified as Most at Risk for Measles Outbreaks
• Vaccines and Immunizations
• Immunization Collaboration of Tarrant County
• Common Questions About Immunizations
• Why Children Like Olivia Need You to Immunize
• From Vaccine Hesitant to Pro Vaccines. Why This Mom Changed Her Mind.
• Pediatricians Remember Experiences with Measles
• What The First Measles Case in Tarrant County Means for Your Child
• 'Vaccines Are Safe and Effective'
• When It Comes to Your Kids It's Never Just a Virus
• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles In the Classroom
• MMR/thimerosal/mercury: What you should know

Olivia is 7 years old and has fought a battle that most 7 year olds (and 70 year olds) have never and will never face.

Olivia has spent the last two years in and out of Cook Children’s battling neuroblastoma. It was a cancer that started in her adrenal gland and had spread by the time it was found – around her spine, and all over her stomach.

She is a tough cookie. Olivia has undergone countless procedures, tests and chemotherapy. And in 2017, Olivia underwent something called an autologous stem cell transplant.

This means that before chemo, her own stem cells (which you can think of as neutral “beginner” cells) were taken from her bone marrow, harvested, and after the chemo wiped everything out, put back into her bone marrow as a “fresh start” for her immune system! It was a huge part of her cancer treatment.

This also means that all of the “memory cells” she used to have are gone.

And it means that the vaccines she got as an infant and small child are “forgotten”.

So Olivia now has no protection against vaccine-preventable illness. Her immune system is like a baby’s again.

When she came to see me for her checkup last week, I hadn’t seen her in two years! She was bouncing all over the room, and smiling, and happy. Like 7 year olds should be! She’s doing great! Her oncologist is watching her very closely, but her cancer seems to be gone!

I know that’s a lot of exclamation marks, but all deserved for this awesome little girl.

We now have to start re-vaccinating Olivia. This is a slow process that will take a few years. Until she is fully vaccinated, she is susceptible to illnesses like whooping cough, pneumonia, measles and others.

I’m telling you Olivia’s story (at the urging of her father, who wants you to know her story) so that you understand why everyone should be immunized.

Olivia CAN’T be immunized fully yet. Her body needs time to re-learn all of her vaccine protection.

If all of us AROUND Olivia get vaccinated, we are creating an impenetrable wall of protection. The disease cannot get into our community to potentially attack Olivia’s brand new immune system.

When you make a choice to vaccinate yourself and your child, you also prevent something devastating to those who cannot protect themselves – like Olivia.

And she’s fought too hard a battle to look back now!

Learn more by clicking the links below:

• Vaccines and Immunizations
• Immune Suppressed Children and the Measles: What Parents Need To Know
• From Vaccine Hesitant to Pro Vaccines. Why This Mom Changed Her Mind.
• Measles In the Classroom
• Pediatricians Remember Experiences with Measles
• 'Vaccines Are Safe and Effective'
• Cook Children's Hematology and Oncology
• Bone Marrow and Stem Cell Transplant
• Neuroblastoma

This is the fourth case of measles confirmed in North Texas this year and the fourteenth in the state. Health officials say the patient recently traveled internationally to an area that has seen an uptick in measles and this case is not related to any previous infections reported in North Texas. 

“This is an important case to take note of because we already know that Tarrant County is a hot spot for potential outbreaks of diseases like the measles,” said Jason Terk, M.D, a Cook Children’s pediatrician and a nationally known advocate for vaccines. “Even though this is an imported case, we are more likely to have a wider outbreak of measles in our area because of the number of unvaccinated people and especially the people who are unvaccinated and live in unvaccinated clusters.”

Currently, there are no recommendations for early vaccination for babies who are not traveling to other countries.

"The scale of the problem is vastly different in other countries than these scattered cases here," Dr. Terk said. "Right now, and always, people need to make decisions based upon a thoughtful conversation with their doctor. We are seeing a signal of the problem we have been warning about. Even in the larger outbreaks in places like Washington, there are no recommendations for early vaccination for babies under 12 months of age. The health department follows this closely and will make formal recommendations if needed for any changes in vaccine schedule."

Peter Hotez, M.D., who is director of the Texas Children’s Hospital Center for Vaccine Development, co-authored a study in 2018 on vaccine exemptions published by the Public Library of Science Journal of Medicine.

Texas is one of 18 states that allows non-medical exemptions for vaccines and the report named Tarrant County and Fort Worth specifically as national “hot spots” for a potential outbreak.

In an editorial in the Star-Telegram, Dr. Hotez urged parents to provide immunization for their children, warning that “we are extremely vulnerable to a measles outbreak in Texas.”

Measles was declared eliminated from the United States in 2000 by the Centers for Disease Control and Prevention thanks to a highly effective vaccination program.

But as more parents are refusing vaccines for their children, despite scientific proof that they are safe and effective, measles has made a comeback. The CDC reports that there are more than 260 measles cases in 12 states with exemption rates continuing to rise.

Earlier this week, Collin County confirmed its second case of measles and Denton County confirmed a case in February.

Measles is an airborne disease spread by coughing and sneezing. It causes a reddish rash, high fever, cough, runny nose and watery eyes. It usually lasts one to two weeks. The rash begins on the face and head and then proceeds downward and outward to the hands and feet. It fades in the same order it began, from head to feet.

Measles is a vaccine-preventable disease. Adults who have received a measles vaccine series are considered immune. Those who have not been immunized against measles, or have never had measles, should contact their healthcare provider. Residents considering foreign travel should always check their health status beforehand.

Most people born in 1957 or after should have documentation of at least one dose of MMR (Measles, Mumps and Rubella) vaccine or other evidence of immunity to measles. The U.S. Centers for Disease Control and Prevention recommends two doses of the vaccine. The first dose should be given at 12 months of age and the second between the ages of 4 to 6 years.

I hate that phrase and I know it never gives parents comfort when they hear it from doctors.

Doctors (I’ll admit I’ve said it too) usually say “it’s just a virus” to let parents know we don’t see anything that suggests a bacterial infection so your child doesn’t need antibiotics or other specific treatment. This is an infection caused by a virus and should go away over time. It’s meant to comfort mom and dad.

Then the appointment usually ends with “if things don’t get better to let me know.”

But it’s never JUST a virus when it’s your child, is it? As parents we know that viruses aren’t always simple and that kids can be VERY miserable and even get VERY sick.

RSV and flu still strike fear in the hearts of many parents. So much so that they’ll choose to have me test for them, even if I assure them it won’t change the treatment either way. But sometimes, the knowledge and the ability to put a name to it provides some level of comfort or the negative test gives them the ability to take a deep breath and relax (even though a no-name virus can be as scary as a named one).

We should take viruses seriously, after all they’ve been the cause of many of the most serious conditions the medical community has ever faced. Like I said earlier, once you catch a virus there’s not a whole lot doctors can do. We have to wait it out, try to treat the symptoms as we can and simply let things run its course.

That’s why the advancements that have been made in vaccines have been so essential. They were created to prevent the viruses before your child caught them or to lessen their severity if they did.

We don’t often think that these very serious conditions are viruses, but fortunately we have a vaccine for them:

• Polio which for many children might cause no symptoms at all or a mild upper respiratory illness, can also lead to devastating, permanent paralysis.

• Measles which for many children cause a syndrome with fever, rash and upper respiratory symptoms, can also cause pneumonia, death and a severe neurologic disease called SSPE which develops 5-10 years after the infection.

• Mumps which for many children caused fever, muscle aches and headache, can also cause infertility in males, meningitis and hearing loss.

• Hepatitis B which many believe to be a disease of adults (because it can be sexually transmitted and needle-borne) actually caused many infections in babies who contracted it from their mothers. Hepatitis B was less likely to be cleared by children which led to a 40 percent chance of liver cirrhosis and liver cancer.

Fortunately, for these viruses along with the flu, chicken pox and Hepatitis A, we can now protect kids with vaccines. We can protect them, not only from the suffering associated with the illness but also the devastating complications that can arise as a result of them.

How would it have felt to live in a time when these viruses were common?

Think about how you feel when you read stories about the polio-like illness that has been spreading across the country or how you feel when you hear that there are cases of measles in your community. Then imagine that you know someone or at least know someone who knows someone who has suffered from one of these disease personally.

Terrifying.

Imagine a doctor telling a family it’s “just a virus” in this environment. It wouldn’t fly.

I promise I’ll try to avoid saying “just a virus” but I’m thankful that it’s easier for me to get away with it today … thanks to vaccines.

But it also raises important questions that need to be addressed.

Last week after the article 12 Facts About Measles You Need To Know ran, we received questions from concerned parents of more vulnerable kids, including immune suppressed children and newborn babies.

We were able to talk to Jason Terk, M.D., a Cook Children’s pediatrician in Keller and a nationally known advocate for vaccines, to answer a few of the questions we received last week.

1. How could the measles virus impact immune suppressed individuals?

Dr. Terk: People who are immune suppressed have a higher risk for the deadlier complications of measles infection such as encephalitis and pneumonia.

2. Even if your child is up to date on their vaccinations, if they have a low immune system due to organ transplant/cancer/other health incident, how at risk are they? Is the vaccine still effective?

Dr. Terk: Each circumstance is unique so a general answer that applies to every one of them is not possible. For people who are on immune suppressing drugs following organ transplantation, risk from infection is higher because of the higher risk of complications from measles infection. People who are significantly immune suppressed cannot get the measles vaccine either because the vaccine would present a risk to them or because they would not be able to mount an effective immune response to the vaccine which would protect them from infection.

3. What are the risks and best course of action for newborns/babies that are not old enough to receive the first MMR vaccine?

Dr. Terk: The best course of action is to make sure that all persons in close contact with babies less than 6 months of age are properly vaccinated against measles and to avoid situations where larger groups of unvaccinated people are likely to be. The CDC now recommends that babies between 6-12 month who will be traveling to countries with measles outbreaks receive an MMR vaccine to provide short-term protection. This does not count toward the recommended two dose series that starts at 12 months of age. So far, the recommendation has not been extended to the circumstances that are occurring in certain parts of the US.

4. The vaccine is 97 percent effective after two doses, but is that true for someone who is immune suppressed?

Dr. Terk: No. Depending on the severity, a person who is immune suppressed may not be able to mount a good response to the measles vaccine and be protected from measles infection.

5. Could the measles virus mess up a transplanted organ in any way?

Dr. Terk: There are reports in the medical literature of rejection of transplanted organs (specifically livers) following measles infection. In addition, there have been complications of measles infection seen in stem cell transplants.

6. Some people wrote in with the claim that boosting your Vitamin A levels and watching your sugar intake will prevent and/or treat measles. What are your thoughts on this claim?

Dr. Terk: Vitamin A is a treatment given during measles infection because it is known that Vitamin A deficiency increases the risk of severe complications for measles infections. But, this treatment does not actually fight the infection itself and treatment with Vitamin A does not eliminate the risk of complications arising from measles infection.

7. Important work is being performed at the Mayo Clinic where oncologists are treating cancer with the measles. But some have used the work at Mayo and a study from the NCBI as showing that vaccines aren't the way to treat a child with measles, but instead it can be handled by diet, such as skipping sugar. Is this the case?

Dr. Terk: The use of the measles virus to target cancers is one of the exciting new things about cancer treatment these days. However, the measles viruses being used are genetically altered in such a way that they cannot cause general infection. These altered viruses are tailor-made to attack a specific individual’s cancer. I do however recommend skipping sugar as a means to fight the epidemic of obesity.

For More Information On This Topic:

• Why Your Choice Not To Vaccinate Impacts My Child Too
• Measles: How To Protect Your Child
• Measles, Mumpes and Rubella (MMR) Vaccination: What Everyone Should Know
• Frequently Asked Questions about Measles in the U.S.
• Infant Immunization FAQs
• Understanding MMR Vaccine Safety
• MMR Vaccine: What You Need to Know (VIS)

DCPH says no further information will be released to protect private patient confidentiality.

“Vaccination is the most effective way to prevent measles,” stated Dr. Matt Richardson, Director of Public Health in Denton. “Unfortunately, people think that measles is just a rash and fever but measles can cause serious health concerns, especially in young children, and is highly contagious. Vaccination is incredibly effective at protecting those we love from this infection."

This information comes only days after a national study published in the Public Library of Science, names Fort Worth as a hot spot for the anti-vaccine movement. Texas is one of 18 states that allows kids to opt out of vaccines as a philosophical exemption.

In the year 2000, the CDC declared that measles had been eliminated in North America and we thought we were well on our way to relegating measles to the trash heap of history. Now, thanks to declining vaccination rates, measles is making a comeback. Along with the cases in Texas, 55 people in Washington and neighboring Oregon have gotten sick with the virus.

So, since we are starting to see measles again, we thought it would be important for people to know a few things about this incredibly contagious disease from Jason Terk, M.D., a Cook Children's pediatrician in Keller and a nationally known advocate for vaccines:

1. Measles starts out looking like a bad cold with runny nose, cough, red and watery eyes, and high fever.
2. Two or three days after the initial symptoms begin, tiny white spots may appear in the mouth that are only seen with measles called Koplik spots.
3. Three to five days after the initial symptoms begin, a rash will appear as flat red spots on the face at the hairline and spread downward to the neck, torso, arms, legs and then feet. Small raised bumps may appear on top of the flat red spots.
4. The spots may become so numerous that they combine to create an overall red appearance to the entire body.
5. Fevers as high as 104° F will be present when the rash appears.
6. Measles is the most contagious infectious disease known and is spread by coughing and sneezing. The virus particles are suspended in the air for up to two hours where an infected person has coughed or sneezed.
7. If you are exposed to the measles and have not been vaccinated, you have a 90% chance of getting the measles.
8. A person with measles is contagious from 4 days before through 4 days after the rash appears.
9. One out of every 4 people with measles will be hospitalized.
10. One out of every 1000 people with the measles will develop swelling of the brain which can lead to brain damage and death.
11. One out of every 20 children with measles gets pneumonia which is the most common cause of death from measles in children.
12. For every 1000 children who get measles, one to two will die from it.

So, if you don’t want any of the above, get yourself and your child vaccinated! Tarrant County has been identified as a location where a measles outbreak is considered likely. Only we can change that!

Learn more on this topic:

• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles
• Vaccines and Immunizations
• Frequently Asked Questions About Immunizations
• Immunization Schedule
• Information for parents
• Talking to your child about immunizations
• What teens should know about immunizations

According to the National Conference of State Legislatures, Texas is among 18 states that allow families to opt out of vaccines for personal or moral beliefs. The Morning News reports that Plano, Fort Worth, Austin and Houston all ranked among the 15 U.S. metro areas with the most such conscientious exemptions for kindergartners. Each had more than 400 kindergartners exempted from vaccines.

Fifteen years ago, about 2,300 students opted out of at least one vaccine. Today, that number has grown to 56,737 kindergarten through 12th grade students.

This has many doctors, including myself, worried about more measles outbreaks in Texas.

"Populations who choose to not follow the recommended vaccine schedule for themselves and for their children are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," Jason Terk, M.D., a Cook Children's pediatrician in Keller.

News about vaccine preventable diseases is important for us to share, but it brings up many strong opinions.

Here’s how the debate usually goes:

“Please vaccinate your children.”

“If your child is vaccinated and vaccines are such a good thing, why do you care if my child gets vaccinated?”

Most people don’t have a good answer for it so it tends to be a good trump card.

So why do I care?

There are two reasons.

1. I care about your child. I firmly believe that vaccination is the right thing to do. I vaccinate my children on time and on purpose. I would not want any child to receive less care than I would provide my own children.

2. Vaccines sometimes do not provide complete protection. Most provide protection in the 90-percent plus area (some nearly 100, some lower). Because of this, even a vaccinated child can contract the disease. I will go into this in more detail below, but the more children who are vaccinated for a disease the less likely it is that any child will contract that disease. This occurs through a process known as community, or herd, immunity.

Many people will stop reading right here because they have already decided or have read somewhere that herd immunity is not a real thing. Here are some of the arguments against herd immunity I come across from time to time:

• It’s not based on a science, but on epidemiology. Epidemiology is the study of the way diseases spread. It is a very complicated field, involves tons of statistics and research and IS science. To say that it is not science is a false comparison.
• We still have outbreaks even in areas where there are high vaccination rates. This is most definitely true, but does not prove that herd immunity is not real.

How does it work?

Since it's most timely, let’s use measles as an example. First, you need to know some things about measles…

Measles has an attack rate of a susceptible individual at 75 percent. This means that 75 percent of people exposed to measles who are not protected will contract the disease. I’ll use 70 percent to keep my numbers round and err on the side of people who would disagree with me.

Measles vaccination has a 95-100 percent protection rate. Again, I will use 95 percent so that I am not cherry picking the best results to prove my point.

There are two scenarios below. The first scenario has a case of measles in a classroom where everyone else is vaccinated. The second scenario is a case of measles in a class with one child who is not vaccinated.

Scenario No.1:

Scenario No. 2:

In scenario No. 1, all the children are vaccinated which means they have a 5 percent chance of catching measles. If that child goes to another class or event where all children are vaccinated, each of those children have much less than a 5 percent chance because the child doesn’t likely have the disease and they only have a 5 percent chance of catching the disease even if he did.

In scenario No. 2, one child in the classroom is unvaccinated. He thus has a 75 percent chance of catching the disease. He’s going to go to other locations with other children, even if those children are all vaccinated, we have potentially opened up a whole second circle of exposed children. Not to mention that the children in the first class have now potentially been exposed twice.

So, in scenario No. 2:

• If I gave you a choice, would you want your child in group A or B?

• Does it matter if your child is vaccinated or not?

• What if you also have a baby in your house who cannot be vaccinated?

• What if you child is in class B, but has a disease for which they cannot receive the MMR vaccine?

The answer is no, none of these things matter. Logically, we should all want our child in room A because it decreases the odds of our child being exposed. Is it 100 percent? No, but it doesn’t matter. Are you more likely to be angry about a measles outbreak if your child cannot be vaccinated? Yes, and I understand that.

For one last thought, consider this … a  study in Pediatrics described geographic clusters of people who choose not to vaccinate at all or to under-vaccinate their children. I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation. Let’s pray we don’t get there.

This is herd immunity and why the question, “If your child is vaccinated and they are such a good thing, why do you care if my child gets vaccinated?” doesn’t end the conversation.

That’s the concern of many of the state’s physicians based on new numbers from the Texas Health and Human Services department.

In its Annual Report of Immunization Status, 56,738 kindergarten through 12^th grade students were reported as having a conscientious exemption on file at the school. This number represents 1.07 percent of the number of students reported enrolled by schools in the survey.

This is on top of a recent report by the Centers for Disease Control and Prevention that states that Texas is one of 21 states that is currently being monitored for the spread of measles. The CDC says there has been 107 cases reported this year and that the majority of those cases weren’t vaccinated.

The amount of children who aren’t receiving at least one vaccination for a nonmedical reasons has been steadily on the rise since Texas lawmakers passed what’s known as conscientious exemption in 2003. Parents and legal guardians can choose for their child not to receive an otherwise required immunization for their child because of reasons of conscience, including religious beliefs.

Fifteen years ago, about 2,300 students opted out of at least one vaccine.

In an editorial in the Star-Telegram that urged parents to provide immunization for their children, Dr. Peter Hotez warned that “we are extremely vulnerable to a measles outbreak in Texas.”

Dr. Hotez, who is director of the Texas Children’s Hospital Center for Vaccine Development, recently co-authored a study on vaccine exemptions published by the Public Library of Science Journal of Medicine.

Texas was named one of 18 states that allows non-medical exemptions, and identified Tarrant County and Fort Worth as national “hot spots” for a potential outbreak. The study found that parents of at least 518 kindergartners in Tarrant County schools last year opted to not get preventive shots for their children.

“These numbers are very concerning,” said Justin Smith, M.D., a pediatrician and Medical Advisor for Digital Health at Cook Children’s. “In 2000, the United States declared that measles was eliminated from this country. Now, more and more kids aren’t getting immunized and diseases like measles has returned to this country. I don’t think that’s a coincidence. Measles is very serious. Measles can cause pneumonia and children under the age of 5 have a higher risk of hospitalization.”

Dr. Hotez’s study found that children not given the measles, mumps and rubella vaccine are 35 times more likely to contract measles than a vaccinated child.

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

"Populations who choose to not follow the recommended vaccine schedule for themselves and for their children are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," Jason Terk, M.D., a Cook Children's pediatrician.

No topic triggers as much controversy on our social media sites or Checkup Newsroom as vaccines. When it comes to the HPV vaccine, people are especially passionate.

You may have seen the comments on Cook Children’s Facebook page after we announced an upcoming Facebook Live event. “Take The Shot. Prevent Cancer. A Conversation About HPV” will feature experts from Cook Children’s and Baylor Scott & White at 1:30 p.m. CST on Thursday, April 12.

We know there is a small but aggressively vocal group of people who have made their mind up on this issue. No amount of science will sway their firm stance against vaccines.

However, we feel it’s important as a health care organization to provide facts for our readers. That’s why we are taking this opportunity to discuss some of the arguments against the HPV vaccine and debunk many of the myths being spread on the Internet.

Myth 1: The HPV Vaccine is New

The United States currently has the safest, most effective vaccine supply in history. Years of testing are required by law to ensure the safety of vaccines before they are made available for use in the United States. This process can take 10 years or longer. Once a vaccine is in use, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) monitor any possible side effects (adverse events) through the Vaccine Adverse Event Reporting System and other vaccine safety systems.

The HPV vaccine – Gardasil^® 9 – went through years of extensive safety testing before they were licensed by FDA. Tens of thousands of people participated in studies for the HPV vaccines. No serious safety concerns were identified in these clinical trials. FDA only licenses a vaccine if it is safe, effective and the benefits outweigh the risks. CDC and FDA continue to monitor HPV vaccines to make sure they are safe and beneficial for the public.

Click here to learn more.

Myth 2: The HPV Vaccine Causes Side Effects

While no vaccine or medicine is completely without risk, the Centers for Disease Control and Prevention (CDC) & the Food and Drug Administration (FDA) review all safety info on HPV vaccines. Most reported adverse events following HPV vaccination are considered minor. Pain at injection site, headache, nausea, fever & fainting are the most common adverse events after HPV vaccination. Fainting occurs in some people because the vaccine stings a little more when it is given. Keeping vaccine recipients in a seated position for 15 minutes after the injection prevents fainting episodes. Click to learn more.

Approximately 79 million doses of HPV vaccine have been distributed since the vaccine was introduced, and no serious side effects have been linked to HPV vaccination. The most common side effects after HPV vaccine are mild and include pain in the arm where the shot was given, fever, dizziness, and nausea. For more information, click here.

Myth 3: The HPV Vaccine Could Cause Fertility Problems For My Child

Currently, there no legitimate data or any evidence that suggest getting the HPV vaccine will have an effect on future fertility for women. In fact, getting vaccinated and protecting against HPV-related cancers can help women and families have healthy pregnancies and healthy babies.

Not getting HPV vaccine leaves people vulnerable to HPV infection and related cancers. Treatments for cancers and precancers might include surgery, chemotherapy, and/or radiation, which might cause pregnancy complications or leave someone unable to have children. Click here to learn more.

Myth 4: A Child 11 Or 12 Years Old Is Too Young To Receive The Vaccine

For HPV vaccine to be most effective, the series should be given prior to exposure to HPV. Most of our kids (80 percent) will become infected with the types of HPV that can cause cancer unless they get vaccinated. Waiting increases the chance that they will become infected before the vaccine can protect them. Click to learn more.

Like all vaccines, we want to give HPV vaccine earlier rather than later. If you wait, your child may need three shots instead of two. More information on this topic can be found here.

Myth 5: HPV Vaccination Gives My Child Permission to Be Promiscuous

Research actually shows the opposite. According to a study published by the American Academy of Pediatrics (AAP), HPV vaccination among 11 to 12 year olds did not increase sexual activity-related outcomes such as pregnancy, STD infection or testing or contraceptive counseling. Click here to read the study.

Studies tell us that getting the HPV vaccine doesn’t make kids more likely to start having sex. However, HPV is a very common infection in women and men that can cause cancer. Starting the vaccine series today will help protect your child from the cancers and diseases caused by HPV as an adult. Intimate contact that is short of intercourse (making out) is sufficient to transmit HPV. Click to learn more.

Myth 7: I Heard The Shot Causes HPV

The HPV vaccine does not cause HPV infection or cancer. The HPV vaccine is made from one protein from the virus, and is not infectious, meaning that it cannot cause HPV infection or cancer. Not receiving HPV vaccine at the recommended ages can leave one vulnerable to cancers caused by HPV. Click here to read about the science behind this statement.

Myth 8: The HPV Vaccine Is Too Expensive

Are you interested in getting HPV vaccine for your child but concerned about the cost? The Vaccines for Children (VFC) Program may be able to help. VFC provides vaccines for children ages 18 years and younger, who are uninsured, Medicaid-eligible, American Indian or Alaska Native. Learn more by clicking here.

Myth 9: The HPV Vaccine Damages Women’s Ovaries

The CDC is aware of public concern about the safety of HPV vaccine. Since the vaccine’s introduction in 2006, vaccine safety monitoring and studies conducted by the CDC, FDA and other organizations have documented a reassuring, excellent safety record. There is no current evidence that HPV vaccines cause reproductive problems in women.

Myth 10: The HPV Vaccine Contains Dangerous Amounts of Aluminum

Small amounts of aluminum have been used safely in vaccines for more than 70 years. It’s added to help the body build stronger immunity against the germ in the vaccine. Aluminum is one of the most common metals found in nature and is present in air, food and water. The amount of aluminum present in vaccines is low and is regulated by the U.S. Food and Drug Administration (FDA).

Aluminum is present in U.S. childhood vaccines that prevent hepatitis A, hepatitis B, diphtheria-tetanus-pertussis (DTaP, Tdap), Haemophilus influenzae type b (Hib), human papillomavirus (HPV) and pneumococcus infection. Click here to learn more.

Myth 11: The HPV Vaccine Doesn’t Really Prevent Cancer

Every year, more than 30,000 people in the US are diagnosed with a cancer caused by HPV. That’s one case every 20 minutes.

More Articles On HPV:

• New Study Says Boys Less Likely to be offered HPV vaccination
• ‘We Have a Vaccine That Can Prevent Cancer'
• Texas Ranks Near Last in HPV Vaccination Rate
• Study Finds 1 in 9 Males Infected with Oral HPV
• Pediatrician Leads New Initiative To Improve HPV Vaccination Rates
• Protection From HPV Now Easier For Kids
• Early Evidence Shows HPV Is Working
• HPV Raises Risk of Head and Neck Cancer Sevenfold
• What's New With the HPV vaccine?

The Dallas Morning News reports that person from another state who had mumps traveled to Dallas for the National Cheerleaders Association All-Star National Championship, which took place Feb. 23-25 at the Kay Bailey Hutchison Convention Center. 

At this point no Texas residents have developed mumps in connection with the case, but people are urged to watch for symptoms. 

This is another reminder about the value of vaccination in preventing what can be serious illness. Mumps cases decreased 99 percent after the introduction of a successful strategy for vaccination.

Here's a quick look at mumps cases over the years according to the CDC:

*Case count is preliminary and subject to change

** Cases as of Jan. 27, 2018 Case count is preliminary and subject to change

Mercury (Thimerosal)

Thimerosal is a preservative that was used in vaccines starting from the 1940s. The preservative contains a small amount of mercury and chronic mercury toxicity has been shown to be related to psychiatric problems and other medical issues. Because of this, it was brought up as a concern around 1999 because the overall number of vaccinations was increasing that perhaps over time the exposure to mercury could be a cause of autism.

Studies started quickly to determine if this could be the case, but in the meantime, the vaccine companies, at the request of the American Academy of Pediatrics (AAP) and the Food and Drug Administration (FDA), began to take Thimerosal out of their vaccines. Thus, by 2001, Thimerosal (and mercury) were removed from vaccines except for one exception (see below). Fortunately, in 2004, further studies released by Institute of Medicine determined that mercury was not a cause of autism.

Currently, the only vaccines that contain mercury that I offer in my clinic are seasonal flu vaccines when they are given in a mutli-dose vial. I try to order as much “preservative free” flu vaccine as I can so that this is not even a concern for my patients. However, because studies have shown that mercury is not a cause of concern, I do not worry that receiving their flu vaccine from a multi-dose vial would harm my patients.

MMR Vaccine

Autism is generally diagnosed around 15-18 months, right after the time when children receive their measles, mumps and rubella (MMR) vaccinations. I believe that is because of this relationship in time that MMR was ever thought to be associated with autism.

The original paper that reportedly found a relationship between MMR and autism by Andrew Wakefield was published in The Lancet. The research has now been completely discredited after multiple other scientists were unable reproduce the results and significant problems with the methods he used for conducting his research. In addition, further information has come out regarding Dr. Wakefield’s conflicts of interest and his motivation for publishing the paper. Over time, ten of the twelve authors involved in the writing of the paper retracted their support of its conclusion.

Finally, after many years, The Lancet published the following statement, “We wish to make it clear that in this paper no causal link was established between (the) vaccine and autism, as the data were insufficient. However the possibility of such a link was raised and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper.”

Despite this overwhelming criticism of his paper, the damage done by Dr. Wakefield and The Lancet still persists today. Parents continue to ask about and remain fearful of MMR and a possible (although incorrect) link to autism. His belief caused parents to fear the use of MMR vaccine and unfortunately, this often extends to all vaccinations.

“Too Much, Too Soon”

Are children getting too many shots too soon?

Will receiving all the scheduled shots, so many more than we got as kids, overload their immune systems?

This is a conversation I often have with parents of newborns. And despite the fact that I’m pro-vaccine, I am not afraid to have discussions with parents who have fears and simply want what is best for their child.

Because of that, I follow the evidence closely and love to see new studies that look at different angles of the vaccine discussion.

That’s why I was I excited to see a recent study in the Journal of the American Medical Association (JAMA) that analyzed children with infections not covered by vaccines to determine how many vaccines they had received and if that was a potential reason why they got the infection.

The research looked at around 200 children with diseases and compared them to 750 other children. Those who contracted the diseases had a total vaccine exposure of 240.6 antigens while those in the control (without the disease) group had 242.9.

So, it doesn’t appear that vaccine load on the immune system is a contributing factors towards children contracting other diseases.

This study is another perspective and further evidence that lends support to the idea that vaccines are one of the most successful, safest advancements in the history of medicine.

So why aren’t more people getting this vaccine?

According to NPR, a new analysis from the Blue Cross Blue Shield Association found only 29 percent of the teens its members insure receive a first dose of the human papillomavirus (HPV) vaccine by their 13^th birthday. The CDC found that nationally only 43 percent of teens are up-to-date on all the recommended doses of the vaccine.

Another recent study found that Texas ranks 47^th in the cancer-preventing vaccine. Out of the 50 states and the District of Columbia, Texas only ranked higher than Utah, South Carolina, Wyoming and Mississippi for HPV vaccination coverage.

“A simple vaccination can mean the difference between getting a deadly cancer or not. Unfortunately, not enough people are getting the importance of this message,” said Jason V. Terk, a Cook Children’s pediatrician.

HPV infection can cause cervical, vaginal and vulvar cancers in women and penile cancer in men. HPV can also cause anal cancer, throat cancer and genital warts in both men and women.

The HPV vaccine is recommended for preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. The CDC recommends that 11 to 12 year olds receive two doses of HPV vaccine at least six months apart.

Teens and younger adults who start the series later, at ages 15 through 26 years, will need three doses of HPV vaccine to protect against cancer-causing HPV infection.

The Texas System Offices of Health Affairs states that about 90 percent of men and 85 percent of women in the United States will contract HPV at some point in their lives. HPV is the most common sexually transmitted virus in the United States. Most sexually active people will have genital HPV at some time in their lives.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

Dr. Terk wonders if there’s a disconnect when parents think about their child receiving the HPV vaccination.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s what Dr. Terk wants parents to know: HPV infection can be prevented.

The vaccine is most effective when given in early adolescence.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends.”

More Resources:

• Vaccines and Immunizations
• HPV Vaccines: Vaccinating Your Preteen or Teen
• What is HPV?
• HPV Questions and Answers
• CDC approves 2-dose HPV vaccine schedule

Alani Murrieta, a 20-year-old mother, died only two days after she began feeling ill from the flu, according to the Washington Post. Her young children and other family members had become sick during a long Thanksgiving holiday. While the other family members got better, Murrieta became progressively worse.

She went to a nearby urgent care center where she was prescribed Tamiflu. By the next day, she was coughing uncontrollably and, at one point, she coughed up blood. She was admitted to Banner Estrella Medical Center, where she was diagnosed with pneumonia. Two days after she became ill, Murrieta died.

Her family told CBS News that Murrieta did not get a flu shot, but doctors couldn’t say for sure whether it would have made a difference.

Murrieta was the eighth flu death in the United States this season, according to a Fox News report. Five deaths were reported in North Carolina, two in Oklahoma and then the latest in Arizona. CBS News, citing data from the Centers for Disease Control and Prevention, reports that 7,000 cases of influenza have been confirmed in the U.S., more than double the number this time last year.

“What we do know is the flu vaccine is still the best form of protection we have to fight off getting sick,” said Justin Smith, M.D., a pediatrician at Cook Children’s in Trophy Club. “Even if you do get the flu, people who are vaccinated generally get a milder and less dangerous form of the illness.”

The flu has arrived in Fort Worth. Last week, 33 kids tested positive for the flu at Cook Children’s and 28 of those cases were Flu A, the more severe and dominant strain.

Some experts are predicting a potentially severe influenza season based on what has been seen in other parts of the world. This year, Australia saw record-high amounts of flu cases. The flu vaccine, which is the same one used in the U.S., was only 10 percent effective in preventing Flu A.

“The concern is when people hear that news, they wonder if they should even bother getting the flu vaccine for themselves and for their children,” Dr. Smith said. “We saw some of those comments posted on Cook Children’s Facebook page. The answer is without question, ‘Yes!’ Parents, should take every precaution to protect their children during this time of year and that begins with the flu vaccine.”

Another concern often voiced by parents is the risk of contracting the flu from the vaccine itself.

Mary Suzanne Whitworth, M.D., medical director of Infectious Disease, stresses a person cannot get the flu from the flu shot. They may feel achy for a day or two but that is very different from being in bed with a high fever for a week from a true influenza infection.

“We do know that thousands of deaths nationally are prevented every year by vaccination against the flu,” Mary Suzanne Whitworth, M.D., medical director of Infectious Disease said earlier this week. “It is important to note that although the vaccine has known side effects that are similar to all vaccines given, side effects are mild and uncommon. Serious side effects are very rare.”

Along with getting the flu shot, parents should take the following steps to protect their kids from the illness:

1. Teach your kids to cover their coughs. Remember to cough into the crook of your elbow and not into your hands. And throw away the tissues.
2. Wash your hands. Other than a vaccine, this is the most important thing you can do to protect yourself and your kids from the flu. Teach kids to use soap and wash their hands for at least 20 second or long enough to sing “Happy Birthday.
3.  Kids with the flu are usually sick 3-5 days and then start to improve. If you or your child’s symptoms are worse than you expect or last longer, please call your doctor to discuss.

Out of 50 states and the District of Columbia, Texas only ranked higher than Utah, South Carolina, Wyoming and Mississippi for HPV vaccination coverage, according to researchers at The University of Texas System and UT Health Northeast. HPV is the most common sexually transmitted infection and is responsible for 90 percent of cervical cancer cases as well as thousands of oral cancer cases each year.

The study found that only 39.7 percent of females and 26.5 percent of males in Texas between the ages of 13 and 17 were up-to-date with the vaccine in 2016. The national average was 43.4 percent.

“This study is particularly frustrating because a routine vaccine recommended by the CDC and other leading health organizations around the world can prevent HPV,” said Jason V. Terk, a Cook Children’s pediatrician. “A simple shot can mean the difference in life and death. Unfortunately, most Texans are not getting the importance of this message.”

The Texas System Offices of Health Affairs states that about 90 percent of men and 85 percent of women in the United States will contract HPV at some point in their lives.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s the good news that Dr. Terk wants parents to know: HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends.”

House Bill 2249 would require the Texas Department of State Health Services to provide reports every other year on vaccine-preventable outbreaks and the number of students at public schools who have vaccine exemptions.

“Parents want the choice about where to enroll their children to lessen the chance of their child contracting a vaccine-preventable disease from an unvaccinated child,” J.D. Sheffield, R-Gatesville and the bill’s author, said.

Lisa Pomeroy, a general pediatrician in Lubbock, spoke to the committee about this issue. Her daughter is in remission from leukemia, but remains immunocompromised because of the chemotherapy she must continue to receive.

“I don’t want to put my daughter in a dangerous environment,” said Pomeroy. “I want to keep her safe, and this information will let me decide what school is best for her.”

Jason Terk, M.D., a Cook Children's pediatrician in Keller and on the Committee on Federal Government Affairs for the American Academy of Pediatrics, says current school district information is not specific enough.

"The parent of a child with special needs, such as one with cancer or any disease which makes him or her more vulnerable to infections, needs to know if the school that child may attend is safe," Dr. Terk said.

"Currently the percentage of exemptions per district is available, but that information is not that helpful when you consider that many school districts cover large areas and may have a large number of individual schools," he added.

For example, the Keller ISD has 23 elementary schools, 6 intermediate schools and 4 high schools spread over a very large area.

"Knowing the district level exemption rate is not very helpful when the exemption rates may vary widely across all of the many schools," Dr. Terk said. "Risk is specific to the environment that your child learns in and that is what parents need to know about."

Since 2003, Texas has allowed parents to decline state immunization requirements for “reasons of conscience.” At the time, 3,000 kids were listed as exempt. In the 2015-2016 school year, the Texas Department of State Health Services reports 44,716 children from kindergarten to twelfth grade claimed exemption.

Of the state’s 10 largest school districts, three have vaccine exemption rates higher than the statewide rate of 0.84 percent:

• Austin ISD (Travis) – 1,582 students exempted (2.02 percent exempted)
• Katy ISD (Harris) – 866 students exempted (1.22 percent exempted)
• North East ISD (Bayer) – 657 (0.97 percent exempted)

Dallas ISD is eighth on the list with 497 students and 0.34 percent exempted, followed by Tarrant County as ninth with 197 students and 0.24 percent exempted.

Opponents of the bill say they fear families that opt not to have their children vaccinated will face harassment. Sheffield counters by saying no identifying information would be included in the information.

Keeping vaccination rates relatively high (somewhere around 90-95 percent) helps protect all children (vaccinated or not) from diseases, Justin Smith, M.D., a pediatrician at Cook Children’s, said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

“At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high,” Dr. Smith said. “My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together. What if an outbreak occurs in these schools?”

Jason Terk, M.D., a pediatrician at Cook Children’s, has received national attention for calling HPV vaccination rates an “epic fail.” Now, he’s steering a plan to improve HPV vaccination rates for pediatricians in each of Cook Children’s 27 primary care practices.

Using the reporting capability of the electronic medical record at Cook, Dr. Terk will calculate the HPV vaccination rate of each primary care pediatrician’s and practice’s 12-14 year old patients. Then, half of those pediatricians and practices will be given an educational session showing how they can improve their vaccination rates while the other half will serve as a control group.

The goal is to get more patients between the ages of 12 and 14 vaccinated against HPV.

“We will help lay out an action plan for the practices and set a goal of increasing vaccination rates by 10 percent over six months,” Dr. Terk said.

The physicians will then be given a progress report after 3 months.

“We will compare the vaccination rates between the group who received the educational sessions and those that did not both at 3 months and 6 months to measure the effectiveness of the educational sessions and action plan,” Dr. Terk said. “If the process improves vaccination rates, we will spread the education throughout the system with the goal of providing the best care for all of our patients.”

Vaccination rates for HPV are comparatively lower than other adolescent vaccines primarily because parents don’t perceive that their teens' physicians strongly recommend it. And, physicians may not provide an unequivocally affirmative endorsement of the HPV vaccine because they erroneously believe they will meet resistance from the parents of their teen patients.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

HPV is so common, in fact, that the journal JAMA Oncology reported in January that nearly half of American men may have an HPV infection known to cause cancer. This is based on a study of 1,868 men, ages 18 to 59. Among the group, only 10.7 percent were vaccinated against HPV while 45 percent reported having genital HPV.

The study shows that work still needs to be done to raise awareness about the dangers of HPV and how to prevent an infection with the highly effective HPV vaccine.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Unfortunately, waiting until HPV is contracted is not an option. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

Just in time for the holidays a reader wrote in with this question:

“My friend...was told by her grandson’s pediatrician that her grandchildren who are vaccinated should never be around any unvaccinated children. Well, the parents of her other grandchildren do not want to vaccinate their small children…As a result there are no more family gathering with all grandchildren. They have to spend holidays on separate days. My question is: Why would the pediatrician say this? If the children who are vaccinated and the children are not showing symptoms what’s the problem?”

This is definitely a sad and tricky situation and one that we should use extreme care when discussing.

One thing I will say is that no matter what one’s choice about vaccinating is, parents believe they are making the choice in the best interest of their child. Of course, I have strong opinions about how important it is, but this discussion is not for the faint of heart.

There are probably some doctors that would tell you it’s no big deal and you shouldn’t worry about it (I would disagree with them). There are other doctors that would say you should never have your child around children who are unvaccinated regardless of your child’s health (I recognize this is not reasonable in many situations).

Here are the questions to consider:

1. How old is the child? The younger the child, the more vulnerable they will be to infection. They cannot receive protection for chicken pox or measles before 1 year. Older children who are fully vaccinated have a significant amount of protection and they likely encounter an unvaccinated child at school every day.
2. Who isn’t vaccinated? This question is about family members which makes transmission of infectious diseases more likely than if you just walked by someone on the street and were not interacting with for longer periods of time.
3. Can you have an open conversation with those involved? The discussion is clearly more complicated than simple medical advice as it broaches on several tricky areas including family dynamics and vaccination.

The easy (get out of having to make a committed answer) is that there is no one answer to the question. The family should talk with their doctor about their specific concerns and make a decision with their counsel.

Should I stop the blog post there? Not so fast.

Instead, I want to give you a framework for having that discussion with your doctor.

What diseases should I be worried about?

I believe that all vaccines are important, period. But there are 3 diseases that jump to the top of my list when considering this issue:

1. Flu

Flu season is predictable in that it comes every single year at roughly the same time. It is unpredictable in that we never know how widespread it will be and how severe the cases will be when it does come around. Flu is particularly dangerous in babies and they cannot be vaccinated until they are 6 months old. Remember that the flu vaccine isn’t perfect, so I’m not saying that everything’s cool if we all have flu vaccines but it would seem logical to get as much protection surrounding the baby as possible.

2. Pertussis

Pertussis, or whooping cough, is still common and is a very serious disease for anyone who gets it. In children, teenagers and adults it tends to cause a very rough and painful cough that lasts for weeks to months. I know of adults who have had broken ribs because the coughing is so hard. The real danger for pertussis comes in small babies (less than 3-4 months). These babies commonly have spells of coughing that cause them to stop breathing; leading to ICU stays for intubation and unfortunately, death. Babies are vaccinated against pertussis at 2, 4 and 6 months which increases the number of children who are protected with each shot but they go on to get another vaccine at 4 and 11 years as well. So, when are they fully protected? It’s impossible to say. In addition, vaccines are not perfect so even vaccinated infants who are exposed could develop pertussis. Pertussis still occurs commonly in the United States and is generally carried by older children and adults who are coughing but do not know that they have pertussis. Just like flu, having the vaccine does not prevent disease 100% and I still feel that we need to do something better with the pertussis vaccine but again, it would seem logical to increase protection as much as possible.

3. Measles

Measles is another disease that still occurs in the United States. In 2014, there was a record number of 667 confirmed measles cases reported to the Center for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases (NCIRD). That’s the highest number of cases since measles elimination was documented in the U.S. in 2000. Measles can cause pneumonia and have a higher risk of hospitalization in children under 5. Children receive their first measles vaccine at 1 year of age, but they have no protection from measles until then.

What criteria should I use for being around others?

1. If your baby is under 6 months, use extreme caution. Many babies do not have full protection until after the 6 months shots. In addition, they cannot receive a flu vaccine until 6 months.
2. If your baby is under 1 year, I would also use caution. Your baby cannot be vaccinated against measles or chicken pox until 1 year.
3. After your child is vaccinated at 4 years, they have much of the protection that they need to protect themselves against the vaccine preventable diseases.
4. Babies or children who may not have a normal immune system-such as those with chronic illness or who were born premature deserve extra caution.
5. Anyone with symptoms of illness, especially fever, cough, congestion or rash, should not be around your baby or child regardless of your contacts’ vaccination status.

Can you get a definitive answer about when your baby can be around unvaccinated children? No, but you at least have some information to make an informed decision.

After you’ve discussed your plan with your pediatrician how do you handle the conversation with friends and family?

Here are some thoughts about some things you might say:

1. Our baby/child doesn’t have protection against many very dangerous diseases and we do not feel comfortable having her around people who could spread them to her.
2. Our baby/child has already been through so much, we can’t risk putting her through another medical problem. Especially something that we could have avoided.​
3. The doctor was emphatic that we cannot be out around anyone (especially someone who is not vaccinated or you could leave that out) until __________. (I’m fine with a family placing the “blame” completely on me.)

After more than 56 years as a pediatrician, Dr. Rogers, a Cook Children's pediatrician at the Forest Park practice in Fort Worth, knows first-hand the devastation of infectious diseases on children. During his long career, he’s seen the life-saving advances that immunization has brought to children around the world.

“It really irritates me that parents will listen to people talk about the dangers of vaccines, but you hear very little about the dangers of diseases,” Dr. Rogers said. “It astounds me that anyone would not get their child immunized. It can be so dangerous for children who are immunosuppressed because they have a disease that won’t allow them to get vaccines.”

Nearly 90 percent of pediatricians say they have encountered a parent who refused to have their child vaccinated, according to a 2013 survey released this week by the American Academy of Pediatrics. The most common reason parents provided for their decision was that vaccines are no longer needed because the diseases they prevent are no longer prevalent in the United States.

Oddly enough, the high success rates of immunizations may be what’s driving this apathy. Most Americans alive right now haven’t seen diseases like polio or even tetanus, but Dr. Rogers has. He remembers the chilling scene of an entire ward of children suffering from tetanus, while he was in Thailand as a young man. 

He recalls seeing the end of polio and watching kids in iron lungs, paralyzed from the waist down or on crutches and in wheelchairs because of the disease.

“These were terrible diseases and they are all gone, nobody sees them anymore,” Dr. Rogers said. “I hope we keep it that way.”

Vaccines have had a huge impact all over the world:

• In 1980, smallpox was declared eradicated globally at the Thirty-third World Health Assembly. It marked the first time that a disease had been vanquished.

• The Centers for Disease Control and Prevention (CDC) states that polio cases fell from an estimated 350,000 cases in 1988 to 407 in 2013.

• The CDC estimates 15.6 million deaths from measles and rubella have been prevented from 2000-2013.

But what happens if the trend of parents shying away from immunization continues?

According to the Houston Chronicle, the number of Texas public school children “whose parents decline vaccinations for non-medical reasons rose nearly 9 percent last school year.”

Since 2003, Texas has allowed parents to decline state immunization requirements for “reasons of conscience.” At the time, 3,000 kids were listed as exempt. The Chronicle reports that number has since multiplied to 45,000 last year.

Justin Smith, M.D., a pediatrician at Cook Children’s, believes parents should look at current examples of what’s happening in the world when making the decision to get their child immunized.

“I don’t think there are many parents out there who would choose to skip a shot for Zika if it were available,” Dr. Smith said. “But that fear we have about Zika is the same fear our parents felt for many of the diseases for which we vaccinate today. I'm not sure that fear remains for parents today.”

Related articles:

• The Devastating Consequences of Meningococcal Meningitis

• Let's Learn About Whooping Cough

• Let's Learn About Tetanus

• The Flu Can Kill - Why We Vaccinate

• Chicken pox: Why we vaccinate

• Vaccines saves lives, maybe even your own

That’s the concern of Justin Smith, M.D., a pediatrician at Cook Children’s. The Houston Chronicle reported “the number of children whose parents decline vaccinations for non-medical reasons rose nearly 9 percent last school year.”

Since 2003, Texas has allowed parents to decline state immunization requirements for “reasons of conscience.” At the time, 3,000 kids were listed as exempt. According to the Chronicle, that number has since multiplied to 45,000 last year.

“If you look at the statistics, you see a lot of geographic clusters of people who choose not to vaccinate at all or to under-vaccinate their children,” Dr. Smith said. “I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation. Let’s pray we don’t get there.”

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

Dr. Smith points to an NBC5 report last year on vaccination rates in local school districts that he found not only enlightening, but a bit frightening to him. The news focused on the growing number of vaccine exemptions in three public school districts (Frisco, Plano and Lewisville).

“At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high,” Dr. Smith said. “My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together.”

In the report, what’s happening in our area includes:

• Thirty schools in the DFW area have vaccination rates below 96 percent.
• Five schools in the DFW area have vaccination rates below 90 percent.
• The highest unvaccinated rate in our area is around 13 percent. The highest in the state is near 50 percent.

Why does it matter?

“If you read the names of the schools, you’ll see a trend,” Dr. Smith said. “They are private schools. They are schools that have a high likelihood of having people go overseas for mission trips or other opportunities. Traveling to countries where diseases are more common increases the likelihood of bringing a disease back to school. Waiting at school are their unvaccinated friends and their vaccinated friends who could even be at risk as the number of cases rise. Outbreaks are possible.”

Do you think this is far-fetched?

Dr. Smith points to the Tarrant County measles outbreak from 2013 that basically had all the characteristics that he’s describing. A large group of unvaccinated people, grouped together based on their faith that contracted measles from a visitor who brought measles into the United States after traveling overseas.

What can you do?

• Get the best start to protection by vaccinating your child.
• Be aware of the vaccination percentages of your child’s school, your church and your social community.
• Be especially cautious when your child’s unvaccinated contacts return from overseas travel. If they are sick, stay away.

About the source

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the fall of 2016.

I want to go over some general information about the varicella virus and discuss complications that can arise. Chickenpox is highly contagious. When one individual in a household had it, there is a 90 percent infection rate for those in the same household who have not previously had it or been immunized. It is spread through droplets (think body secretions – runny nose, sneezing, coughing) and direct contact of lesions on skin when in the ruptured vesicular stage. This virus has a really long incubation period, which means there is a long period between the time you are exposed and the time you develop symptoms. The average time is 14 to 16 days! Just when you think you are out of the woods, you can develop symptoms!

Varicella generally starts with 1 to 2 days of fever, fatigue, sore throat, and loss of appetite, followed by a rash. The rash starts as tiny red bumps to the face, spreading to the torso and then extremities. There are three stages of a chickenpox rash: maculopapules, vesicles, and crusts. The maculopapular rash appears as tiny red bumps from pinpoint to pea sized. Vesicles are typically pea sized and are fluid filled (blister like) on an red skin base. One description I like is “dew on a rose pedal” appearance. After several days the vesicles will rupture and leave crusts. The crusts usually resolve in 1 to 2 weeks and can leave areas of lighter colored skin that will eventually disappear. As I mentioned before, it will usually start on the face and move down to the torso and then extremities. There will be several “crops” of new papules, which allows there to be rashes in different stages of healing. Start to finish, chickenpox can last anywhere from 7-14 days. I missed 10 days of school when I had it! You are contagious 48 hours prior to rash appearance (usually when fever starts) until all lesions have crusted over.

But if chickenpox is so mild, why do we bother with vaccinating? Varicella can have severe complications that can cause as little as discomfort or as much as death. The most common complication is secondary bacterial infections. Here is a list of a few:

1. Soft tissue or skin infections: It’s hard not to scratch when you’re itchy, especially if you’re a child! This can lead to secondary skin infections. The common culprit is strep, a common bacteria that lives on your skin. There are even cases of flesh eating bacteria post chickenpox!

2. Encephalitis: Before vaccinations, this neurological issue accounted for 20 percent of hospitalizations and 50 percent of the deaths related to varicella. Encephalitis is swelling of the brain that can happen after or with a virus. It causes delirium, stroke like symptoms, and seizures.

3. Pneumonia: This is a common complications with lots of viral illnesses, and possibly one of the most feared. The mortality rate with varicella pneumonia is estimated between 10-30 percent. Typically you develop high fever, after initial fever has resolved, and cough.4. Hepatitis: This is a liver condition that can occur in our patients who contract chickenpox and already have a low immune system. Kiddos with cancer or who have had organ transplants are at highest risk.

In my prior work in the ED, I have unfortunately witnessed all of these complications with the exception of hepatitis. Complications can affect any age, regardless of current health. I have seen some previously healthy children develop encephalitis and have permanent neurological and seizure disorders after!

With the development of the varicella vaccine in 1995, chickenpox cases decreased 90 percent! The American Academy of Pediatrics and the Centers for Disease Control recommend two doses of the varicella vaccine at 12 months and 4 years.

As always, if you have questions, please call the office. I am happy to discuss things with you. Our goal is to keep your kiddos happy and healthy while avoiding potentially fatal outcomes from preventable diseases!

Tara, NP

About the author

Tara Haraldson is a nurse practitioner at Cook Children's Willow Park office. To make an appointment for back-to-school vaccines, contact your Cook Children's pediatrician. To find a pediatrician near you, click the following link. 

The physicians, nurse practitioners, and staff at Cook Children's Willow Park Pediatrics have all fully vaccinated their children. Every single child. Every single vaccine.

August is National Immunization Awareness Month.

Vaccines save lives. It is a thankless accomplishment.. We can't know the good they have done, as they are arguably the greatest preventative invention in the history of modern medicine.

The vaccines you've received may have saved your life. You will never know. Think about that - a shot you got on a random day, in a random year of your life, may be the reason you're still alive.

We've watched children die of vaccine-preventable illness. We've watched parents cope with the horrific loss of a child, knowing that what happened was preventable. We never want you or your children to go through that.

Let's learn about them. Tune in this month as we teach about the diseases we vaccinate against. Sometimes knowing the other side helps us remember why they're so important.

‪#‎savinglivessilently‬

Hugs,Dr. Diane

No.

So why are we discussing this issue again?

Because Donald Trump linked vaccinations to autism in last night's debate between Republican presidential candidates.

“Autism has become an epidemic, 25 years ago, 35 years ago, you look at the statistics, it’s not even close,” he said. “It has gotten totally out of control.”

He went on to say he had evidence of a relationship between autism and vaccinations.

I wish I had a voice in the debate last night, I would have been less political and more factual.

What can’t be debated are the facts on this issue: Multiple studies done by different people in different places have shown consistent results that vaccines do not cause autism.

There have been multiple theories proposed over time as to why vaccines might be a cause of autism. In my checkups and vaccine discussions, I generally address the issue of vaccine safety by answering three questions:

No. 1 - What does basic science say?

No. 2- Do studies of groups of children (vaccinated vs unvaccinated) show a problem?

No. 3 - What do you do with your own kids?

Basic Science

The basic science and scientific community has overwhelmingly supported the use of vaccines in children over time. Take a look at any major medical organization and they support vaccination. The overwhelming majority of pediatricians support vaccines according to the Centers for Disease Control schedule. Just so you don't think you’re in the minority, the overwhelming majority of patients have their child vaccinated according to the same schedule.

Over time, various concerns about vaccines have been brought up. Basically the way it happens is like this … someone comes up with a theory as to why vaccines might be a cause of autism. The scientific community starts to complete studies to determine if it could be a concern. Over and over, the theories have been disproven. Here are three specific examples of this pattern.

Population Studies

I believe that research has shown, through basic science, that vaccines are safe. But, there are studies that have looked at the problem from a different perspective.

In an example from 2010, two researchers from the University of Louisville, Dr. Michael Smith and Dr. Charles Woods, studied a group of over 1000 children to determine if delayed vaccination or on-time vaccination affected developmental outcomes. The study was published in Pediatrics (the journal of the American Academy of Pediatrics) in June 2010.⁵ The study compared children who were vaccinated “on-time” (received vaccinations within one month of the recommended schedule) with children who were not on-time.

The testing looked at multiple different tests, which included outcomes for speech, intelligence, memory and behavior control (among a few others). Results showed that children who were vaccinated on-time showed improved scores in intelligence and naming questions, all other testing showed equivalent scores. If delayed vaccines protected against autism or other developmental problems you would expect those vaccinated on time to show deficiencies in many of the areas tested.

Another study done in Australia, released in June 2014 looked at multiple combined studies totaling 1.2 million children. The findings were overwhelming supportive and showed no link to autism for any of the following: vaccination and autism, vaccination and autism spectrum disorders, and autism and MMR/thimerosal/mercury.

These are just two examples of many studies that have shown vaccines to be safe and not a cause of autism, even when looking at large studies of populations over time.

My Personal Practice

The science tells us that antigen load (and load on the immune system has actually decreased) and population studies have shown that children vaccinated on time do not have developmental problems.

But the real point I like to discuss with my families is this: I vaccinate my kids on time. Each of my children has been vaccinated on time without hesitation. I am confident that by doing so I have not harmed them in any way and I will continue to vaccinate them with all available vaccines according to the CDC schedule.

I am willing to have an open and honest discussion with any family about their choice to vaccinate, their choice to vaccinate on an alternative schedule, or any other issue surrounding vaccination but I do feel strongly that vaccines are safe and that I am not putting any child at risk by vaccinating and vaccinating on time.

In summary, I have studied this issue extensively and have seen no study that convinces me that vaccines are the cause of autism or any other concern. I consider them to be the most important thing that I do to prevent disease in my patients and will continue to vaccinate my children and my patients with confidence.

Vaccines work. Vaccines are safe. Donald Trump shouldn’t change your mind.

Human papilloma virus is a cause of warts that affect the genital areas of males and females. They can also cause infection of the mouth and throat.

HPV is the most common sexually transmitted disease in the United States.

HPV does not show symptoms for many people who are infected but it can lead to cancer of the cervix or penis. Every year approximately 17,500 women and 9,300 men will be affected by cancers that are caused by HPV.

HPV Vaccination

Fortunately, we now have a vaccine that prevents HPV. It was licensed for use in 2006 and targets four strains of the virus: 6, 11, 16 and 18. Types 6 and 11 account for 90 percent of genital warts and types 16 and 18 lead to cervical cancer.

Any time something is “new,” rumors abound. I was privy to an online discussion about HPV on Facebook this week ... because it’s not the best venue for having these discussions I had to hold my fingers (tongue).

But, here are some of the myths I saw that I felt needed to be addressed, beginning with the HPV vaccine has been proven ineffective.This myth takes on a few different forms. I’ll address each one.

HPV Vaccine Myths

1. Myth: The HPV vaccine does not decrease the amount of HPV disease.

Truth: In the United States, the percentage of cases of HPV caused by those strains in the vaccine dropped by 56 percent after the introduction of the vaccine. Other studies in the UK and Australia showed decreases in the number of HPV cases after introduction of the vaccine. The vaccine prevents HPV disease.

2. Myth: The effectiveness of the vaccine wears off over time.

Truth: This study in Pediatrics showed that, at the end of eight years of surveillance, those who received the vaccine continued to have antibodies to the virus. There is no indication that will decrease over time but studies continue. Even if we found a fall-off, a booster could be used to prolong coverage and if we could get protection for any period of time it would decrease the rates of HPV and cervical cancer.

3. Myth: Even if it prevents HPV, the vaccination has never been shown to prevent cancer so why get it?

Truth: Despite the logical conclusion that decreasing HPV infection rates should decrease the rate of cervical cancer, some challenge the HPV vaccine by saying that it has never been shown to decrease the rate of cervical cancer. This study in Denmark showed a 40 percent decrease in atypical cells found on Pap smears (a precursor to cervical cancer). I believe that more studies like this will show even more proof that it is preventing cancer.

4. Myth: The HPV vaccine is not safe.

Truth: This is perhaps the most pervasive of all the different myths about HPV vaccine. News reports and anecdotal stories of teenagers who have received the vaccine and then experience weird, otherwise unexplainable symptoms can be quite compelling. The problem with relying on those stories is that, even before the HPV vaccine, teenagers had events or health outcomes that were unexplainable. Even those who choose not to be vaccinated today have some of the same symptoms. Wouldn’t it be nice if we had some way to determine if these events were caused by the vaccine or were merely coincidental?

Fortunately, we do. If we look at a large population of teenagers who received the vaccine and compare them to another population who did not, we can see if the vaccine increased the risk for bad outcomes or if there were events that would have occurred anyway.

Multiple studies have done this. One of my favorites is one that included almost 200,000 girls who received one or more doses of HPV vaccine. It showed a slight increase in passing out after the shot (we ask girls to sit for a while after receiving it) and skin infection, but no other increase health risks. Another included almost 1 million and showed no increase in autoimmune, neurologic or blood clotting disorders.

I am not concerned about the safety of these vaccines. I understand that, with anything new, parents are going to have concerns but as more and more data come in, the safety of HPV vaccine is confirmed. My kids will get it when they are the right age.

5. Myth: The HPV vaccine allows or causes teenagers to be promiscuous. (Related: We shouldn’t vaccinate because it protects promiscuous kids.)

Truth: This is the most infuriating myth for me regarding the HPV vaccination debate. It angers me because it preys upon the fear of some parents that their child might take sexual risk as a result of something the parents have done. If that is a concern, it might be justifiable if it were true ... BUT it’s not.

Studies have shown that girls who receive the vaccine are no more likely to engage in risky sexual behavior or to have more sexually transmitted diseases. Using that myth to scare other parents is inappropriate, just stop.

6. Myth: Because I’ve raised my child “right,” they won’t be at risk for HPV.

Truth: What? This line of thinking has so many holes.

First of all, you won’t always know about your child’s activities. Trust me, you won’t always know. You may think you know, but I’ve diagnosed a pregnancy in more than one girl who “never had sex.” Stuff happens.

Protect your child even if you’re sure they’d never have sex or won’t until they meet “the one.” Why? You can’t predict you child’s future partner’s sexual behavior. Maybe your children will grow up, meet the partner of their dreams and only have sex with that person for their whole life. But, maybe their partner’s history isn’t the same. Their partner could carry HPV, could give it to your child and leave them at risk for cervical or penile cancer. Why risk it? By withholding the shot, you are only putting your child at risk.

These are some of the common myths I’ve heard about HPV. I’m sure there are many more out there. But I urge you to go in with an open mind and talk with your doctor about your questions or concerns. We’d be happy to help!

In the year 2000, measles were declared eliminated from the United States. This occurred because there was a 12-month period where no measles cases were contracted here, making the disease no longer native to the United States.

I hear this question often in my office and its logical based on the fact that measles was eliminated:

“We haven’t seen outbreaks of these diseases for years. Do we really need to continue vaccinating for them?”

The answer is yes and it's exactly because of what we've seen in the past two weeks. Measles are only a plane ride away. We live in a society with global mobility. People fly in and out of countries where measles continue to be a huge problem and then fly back to the United States. Measles are highly contagious via droplets from coughs and sneezes. In addition, people are contagious before they start to show symptoms. (Contrast that with another infectious disease we dealt with recently (Ebola) that requires blood or body fluid contact and is not contagious until there are significant symptoms.)

Continued vaccination programs protect our citizens when they travel abroad. It protects our citizens when travelers return to the United States. It helps to control outbreaks when they do occur.

Another common questions centers around the severity of these diseases.

I pulled this quote from an interview with The Today Show in Australia and Dr. Sherri Tenpenny:

“I don’t believe that measles, mumps, rubella or chicken pox are routinely fatal illnesses. If you ask any person over the age of 50…they had all those illnesses when they were children and growing up.”

There are so many false assumptions mixed in with this statement:

1. You cannot ask a person in their 50s that died from one of these diseases how serious it is.

2. Even if not fatal, the complications associated with these diseases can be very serious.

3. This completely discredits the suffering of any family member of someone who experienced complications from these diseases.

Just look at the stats. In the United States, prior to the introduction of measles vaccine in 1963:

• 3-4 million people had measles each year
• 400-500 died
• 48,000 were hospitalized
• 4000 developed encephalitis (brain swelling)

These complications don’t happen as much in the United States, but do continue to occur in areas where vaccination rates are not as high. There were 145,700 measles deaths worldwide last year. This is a 75-percent drop since 2000 due to efforts to make vaccinations available to children all over the world.

Continuing to vaccinate for measles is important because measles are serious and only a flight away ... and lately, even in our own backyard. 

This is part 2 of Dr. Smith’s series on measles. For more information about measles vaccination and herd immunity, click here.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.