Measles may sound like an outdated disease, but measles cases within the United States reached a notable 15-year high in 2011, according to the Centers for Disease Control and Prevention. In Tennessee alone, there were three reported cases in 2011, according to the Tennessee Department of Health. We asked Infectious Disease Specialist Keith English, MD, to weigh in. Why are we seeing so many cases? English says it’s because kids are not getting vaccinated as they should.

"The increase in measles cases is a reminder of how important it is to vaccinate our children against measles,” said English.  “Though measles is no longer an 'endemic' in the United States, cases still occur when people from other countries who are infected with the measles virus come to the U.S.”

U.S. citizens who’ve traveled or lived in a foreign country can return with the virus, and tourists traveling to the U.S. from another country can bring the virus here, he says. And because measles is so highly contagious, unvaccinated people can become infected without direct contact with an infected individual.

"Most of the 222 cases reported in the U.S. last year could have been prevented by simply following the recommendations for universal immunization against the measles virus," said English.

All 11- or 12-year-old boys should now receive the HPV vaccine in a three-dose series, America’s pediatricians said this week.

The recommendations are part of new vaccine guidelines released by the American Academy of Pediatrics (AAP) and include three major changes to your child’s previous vaccine schedule.

• The HPV guidelines were extended to include boys. The AAP already recommends girls receive the vaccine, which protects against human papilloma virus. The HPV-virus can cause cervical cancer in women.
• Children as young as 9 months old should receive the meningococcal vaccine if they live in or travel to countries with epidemic disease or are at an increased risk of developing meningococcal disease. Routine meningococcal vaccination should begin at 11 or 12 years. Sixteen-year-olds should be given a booster dose.
• Children ages 6 months to 8 years of age should get two doses of the flu vaccine this season (2011-2012) if they did not receive at least one dose of the flu vaccine last season (2010-2011). Those who did receive a dose last season only need one dose this year.

Read the full vaccine recommendations from the AAP.

Due to a now-retracted British study that linked autism to childhood vaccines, there is still anxiety among parents when it comes to immunizing their children. A recent article published in the Commercial Appeal discussed various stories of parents seeking alternatives to childhood vaccinations.

To keep our readers educated and informed on this subject, Dr. Keith English, Le Bonheur Children’s Hospital’s interim pediatrician in-chief and director of  Infectious Disease, gives his insight below.

My colleagues and I agree with the American Academy of Pediatrics (AAP) that vaccines are “one of the most successful medical advances of all time.”  Childhood vaccines have prevented millions of infections and saved hundreds of thousands of lives in the United States alone. They remain the greatest triumph of modern medicine and are the single most important way to protect our children from dangerous infectious diseases today.

There is no evidence that vaccines cause autism, period. Thousands of children have suffered and died from vaccine-preventable infectious diseases in the past 12 years because of the public concerns raised by an unethical and fraudulent claim.

At Le Bonheur, we recommend that parents make sure their children are fully immunized, according to the vaccine schedule published each year by the AAP. For reliable information about childhood vaccines, talk to your pediatrician or consult reputable sources such as the AAP.

The hustle and bustle of summer months leaves little time for parents and their teens to think about much else, let alone vaccinations. But Dr. Kip Frizzell, a pediatrician and Le Bonheur’s director of Coordination of Care, stresses the importance of knowing when to get vaccinated, especially when preparing to go back to school or off to college. Here’s what Frizzell had to say:

“The best way to make sure you have the most current record of your child’s immunization history is to schedule yearly checkups with his or her pediatrician.

Your child, and you for that matter, should have the flu vaccine. Anyone over the age of 6 months can receive the shot version of the vaccine, and healthy individuals ages 2-49 can receive the nasal mist vaccine.

For young ladies, the HPV vaccine is available to protect against the virus that can cause certain forms of cervical cancer. Gardasil is recommended to be administered routinely to girls 11 to 12 years of age. A health provider’s discretion is recommended for girls and women between the ages of 9 and 26.

Any adolescent or college-aged individual should receive the vaccine for Meningococcal disease and meningitis.  It’s important for parents to be informed about this potentially fatal, fast-moving disease. It can easily be mistaken for the flu, and although meningitis can strike at any age, teens and college students are at a particularly increased risk, as they often live in close quarters, such as dorms or military barracks. Protect yourself and your family by having your child vaccinated.”

Take these tips from Frizzell, if you are concerned about administering a vaccine to your child:

• The risks from vaccines are exceedingly small;
• Vaccines are the single best way to prevent acquiring one of these significant and potentially life-threatening diseases;
• Parents should check with their pediatrician on any concerns regarding diseases or vaccines. The American Academy of Pediatrics also offers excellent information.

A now-retracted British study that linked autism to childhood vaccines was an "elaborate fraud" that has done long-lasting damage to public health, a leading medical publication reported Wednesday. As reported in by the British medical journal BMJ concludes the study's author, Dr. Andrew Wakefield, misrepresented or altered the medical histories of all 12 of the patients whose cases formed the basis of the 1998 study -- and that there was "no doubt" Wakefield was responsible.
 
Le Bonheur Children’s Hospital Chief of Pediatric Infectious Diseases Dr. Keith English weighs in on the recent exposure of this fraudulent claim.

“My colleagues and I agree with the American Academy of Pediatrics that vaccines are "one of the most successful medical advances of all time."  Childhood vaccines have prevented millions of infections and saved hundreds of thousands of lives in the United States alone. T hey remain the greatest triumph of modern medicine and are the single most important way to protect our children from dangerous infectious diseases today.

A report published in the journal Lancet in 1998, authored by Andrew Wakefield, claimed to find a link between the childhood vaccine that protects against measles, mumps and rubella (MMR vaccine) and autism.  It was quickly recognized that the conclusions of the study were wrong (that is, they were not supported by the data presented in the article) and that the study should never have been published. Many of the co-authors later had their names removed from the paper, and, finally, last year, Lancet formally retracted the paper. During the past 12 years, dozens of studies have been performed and have failed to confirm any such link. Wakefield was wrong.

Now it turns out that more than bad science was involved. An investigation by the London Times and the British Medical Journal has concluded that the data included in the paper were fraudulent -- that Dr. Wakefield lied about the data in order to try to implicate the MMR vaccine in the pathogenesis of autism (while he was being paid by a lawyer who planned to sue vaccine manufacturers based on the bogus conclusions of Dr. Wakefield's fraudulent "study").

There is no evidence that vaccines cause autism – period. Thousands of children have suffered and died from vaccine preventable infectious diseases over the past twelve years because of the public concerns raised by this unethical and fraudulent publication.

My colleagues and I here at Le Bonheur all recommend that parents make sure their children are fully immunized, according to the vaccine schedule published each year by the American Academy of Pediatrics.

For reliable information about childhood vaccines, talk to your pediatrician or consult reputable websites such as this one at the American Academy of Pediatrics.   http://www.aap.org/healthtopics/immunizations.cfm

Our readers can learn more about the charges against this study by following the link at http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html.

Tennessee leads nation in vaccinations for kids
State, doctors partner to educate more parents
By Tom Wilemon • THE TENNESSEAN • December 16, 2010

 
"Now we rarely see bacterial meningitis in our infant population," said Dr. Eddie Hamilton, president of the Tennessee Chapter of the American Academy of Pediatrics. "It is clearly because of vaccinations."
The achievement, measured by America's Health Rankings, is the result of a partnership between the state and family doctors to better educate parents and to make free vaccinations readily available.
Persuading parents to have their children vaccinated isn't always an easy task. Many have unfounded concerns about the safety of vaccines or the materials in them, Hamilton said.
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"We have to refute the information they are being given from nonmedical sources," Hamilton said. "We see it surprisingly enough in the more educated and more affluent population than anyone else. I'm sure it's information they are getting off the Internet."
Tennessee, which ranked 23rd in 2005, now does a better job than any other state in vaccinating very young children, according to the report that was released this month by America's Health Rankings. The organization tracked vaccination rates among toddlers 19 to 35 months old for diseases such as whooping cough, diphtheria and measles.
Dr. Kelly Moore, the medical director of the immunization program for the state Health Department, said immunization is a year-by-year battle.
"With every new group of children born in Tennessee, it is hard work," Moore said. "Not only do the doctors need to know what they need to know, and the clinics — the parents have to get their children the shots on time and put up with the tears and the upset kids for a few minutes."
Education about the need for vaccinations begins with the pregnant mother and after birth with a congratulatory Hallmark card from the governor. The card is affixed with an immunization record for the parents to fill in and save.
But pediatricians and family doctors are the most effective communicators, Moore said.
The state has worked closely with the doctors to make free vaccines readily available. The federal Vaccines for Children Program covers the cost from infancy through age 18 when families don't have adequate private insurance or the means to pay for the immunizations.
Said Moore: "Cost should be no barrier to immunization."

Before children go to school this fall, parents should make sure they have the appropriate immunizations and documentation. For the first time in a decade, the Tennessee Department of Health has issued new immunization requirements.

Two things parents should know:

1. The state requires that children who start pre-school, pre-kindergarten, kindergarten, seventh grade, or a new student starting school in Tennessee for the first time, turn in an immunization certificate to the school or child care provider. This new form was distributed to physicians and health departments in April.  

2. The new requirements call for vaccines that previously were not required to enter school. However, these vaccines were routinely recommended for children by Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP). The school requirements reflect recommendations many physicians were already following, according to Keith English, MD, chief of Infectious Disease at Le Bonheur Children's Hospital.

Cost should not prevent parents from vaccinating their children. Children and teens younger than 19 years-old who have TennCare or don’t have health insurance can receive free vaccines through the federal Vaccines for Children (VFC) program in participating medical offices and health departments. Parents should ask their providers if they participate in VFC. If a child has insurance that doesn’t pay for vaccines and parents can’t afford them, local health departments can provide the vaccine. Health departments and VFC providers charge a small administration fee to give the free vaccine, which can be adjusted based on your income.

 For more information visit the Tennessee Department of Health’s web site at http://health.state.tn.us/CEDS/required.htm. If you have questions, please contact your child’s physician or the health department.

Le Bonheur Children’s Hospital wants to help parents learn more about back-to-school vaccines. Noel "Kip" Frizzell, MD, medical director of Care Coordination and local pediatrician, answered some frequently asked questions regarding immunizations.

From Practical Parenting Blog photos

 Q: At what age do children begin getting school immunizations?

A: The typical "school shots" are usually given anytime from age 4 to age 6.

 Q: Many children begin pre-school at the age of 3. Do their yearly vaccinations from wellness checkups cover the school vaccines, or do they need a separate round of school-specific vaccines

A: Most children who are entering pre-school will be up to date on their shots. They will have received all of the necessary vaccines by age 2 if they are getting the recommended checkups.

Q: What vaccines are included in school immunizations?

A: Most children entering kindergarten need four things: DTaP, IPV, MMR and Varicella vaccine. Beginning in January 2011, all children will need to have two documented doses of Hepatitis A vaccine. Children entering the seventh grade are now required to have a TdaP booster and a second dose of the Varicella vaccine.

Q: When should children receive the meningitis vaccine?

A: The meningitis vaccine is now recommended for children ages 11 and older. Younger children are not required to receive the vaccine because the risk of acquiring meningitis increases among teens and young adults.

 Q: What do colleges or universities require? 

A: College students will need to make sure they had a Tdap booster, a second MMR and a meningitis vaccine. Hepatitis A and B are recommended but usually not required.

Q: To avoid the back-to-school rush, is it appropriate for children  to receive their school vaccinations any time during the summer months?

A: Parents should be making these appointments for check-ups as soon as possible. The visit will include an exam, possible hearing and vision screen, vaccines and completion of all the school forms. For more information contact your pediatrician’s office or visit http://health.state.tn.us/CEDS/required.htm.