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Mumps Outbreak in Ohio

Wednesday April 16, 2014

In addition to the ongoing measles outbreaks across the country, there is currently a large mumps outbreak in central Ohio.

Although not getting as much attention, the mumps outbreak, which began in January, has grown to include 230 people.

Ranging in age from 9-months to 80-years, at least 60% of the cases are linked to an outbreak at Ohio State University, including 105 OSU students and 14 staff members. At least 7 people have been hospitalized.

Unfortunately, although the MMR vaccine has helped decrease mumps cases more than 99% from the pre-vaccine era (about 212,000 cases a year), as we have seen in recent years, it is still possible to have mumps outbreaks in highly vaccinated communities. While two doses of the MMR vaccine are over 99% effective at protecting against measles, they are only about 88% effective at protecting against mumps. Add in those people who are intentionally not vaccinated and travel to areas outside of the United States were mumps is still endemic and it is not surprising that we still have outbreaks each year.

To help combat these outbreaks, in addition to encouraging everyone to get vaccinated, area health department officials may start to quarantine unvaccinated students for up to 25 days if the outbreaks spread to area schools. As in most outbreaks of vaccine-preventable diseases, so far, most of the children caught up in these mumps outbreaks have been unvaccinated or incompletely vaccinated.

Of course, quarantining intentionally unvaccinated kids is not a new practice. Many unvaccinated kids have been made to stay out of school for weeks at a time during recent outbreaks of measles and chicken pox. It is important to remember that getting an vaccine exemption might get you into school in some states, but it doesn't necessarily mean that you will get to stay in school.

Get Educated. Get Vaccinated. Stop the Outbreaks.

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More Car Seat Recalls

Wednesday April 16, 2014

TrendZ Fastback Car Seat Recall - Photo courtesy of the NHTSABaby Trend, Inc., in collaboration and cooperation with the National Highway Traffic Safety Association, is recalling about 16,655 of their  3-in-1 child restraints because, because like a recent Graco car seat recall, "it may be difficult to remove the child from the restraint, increasing the risk of injury in the event of an emergency in which a prompt exit from the vehicle is required."

Included in this car seat recall, are the 2011 and 2012 TrendZ Fastback 3-in-1 child restraints, including:

  • model FB60070 (Granite)
  • model FB60408 (Jellybean)

It is important to note that there have been no actual reports of incidents with the TrendZ car seats. The car seats are being recalled because they use the same QT harness buckles made by AmSafe Commercial Products, Inc. as the recalled Graco car seats.

Baby Trend will soon be offering owners of these car seats a free repair kit, including a replacement harness buckle.

This recall from Baby Trend follows an even larger recall by Evenflo, who recalled 1,368,649 car seats a few weeks ago, including, their:

  • Momentum 65 (including LX and DLX)
  • Chase (including LX, DLX, and Select)
  • Maestro (including Performance)
  • Symphony (including 65, LX, 65 E3, and DLX)
  • Snugli All-In-One, Snugli Booster
  • Titan 65, SureRide DLX
  • Secure Kid (including LX, DLX, 100, 300, and 400)

The recalled Evenflo convertible car seats and harnessed booster seats included those with model numbers that start with 306, 308, 310, 329, 345, 346, 371 or 385. Again, the recall is related to the AmSafe QT harness buckle, which Evenflo will be replacing with their free replacement repair kit.

Both companies state that there is no risk to continuing to use their car seats if the harness buckles are functioning normally.

The recall is also a great reminder to register your car seat and other baby and child products when you buy them. It is the best way to be notified when products you have are recalled.

And also read your owner's manual for the new "enhanced" buckle cleaning instructions for Graco car seats. The manual might also include Graco's instructions for getting a child out of a car seat with a stuck harness buckle in an emergency situation (like after a car accident) - "the child occupant of the car seat can be extricated from the car seat by loosening the harness assembly, unlatching the chest clip and removing the child from the seat with the harness still buckled." Or if that doesn't work, "the entire car seat can be disconnected from the vehicle and the car seat and child could be removed from the vehicle as one single unit."

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Do Not Track Kids Act of 2013

Wednesday April 9, 2014

The Do Not Track Kids Act of 2013 (S. 1700) was introduced in the United States Senate and in the House as HR. 3481 last November.

The bill "amends the Children's Online Privacy Protection Act of 1998 to extend, enhance, and revise the provisions relating to collection, use, and disclosure of personal information of children, to establish certain other protections for personal information of children and minors, and for other purposes."

Do you have questions about the Do Not Track Kids Act of 2013?

Join Senator Ed Markey (D-MA) and Congressman Joe Barton (R-TX) today for a #AskKidsPriv Q&A at 2pm EST today and ask them your questions, such as:

  • @MarkeyMemo @RepJoeBarton What can we do to make this bill law? #AskKidsPriv

In addition to the AAP, organizations that support the Do Not Track Kids Act Act of 2013 include the American Academy of Child & Adolescent Psychiatry, Campaign for a Commercial-Free Childhood, Common Sense Media, and the Parent Teacher Association.

You can take action to help protect your kids online by supporting the Do Not Track Kids Act Act of 2013. Contact your senators and representative and urge them to become a cosponsor of the Do Not Track Kids Act of 2013 (senate bill: S. 1700 and house bill: H.R. 3481).

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World Health Day 2014

Monday April 7, 2014

World Health Day - Photo courtesy of the WHOIt's World Health Day and the focus this year is on vector-borne diseases, or diseases that can be transmitted by the bite of mosquitoes, ticks, fleas, and water snails.

Unfortunately, while the CDC states that "vector-borne diseases account for 17% of the estimated global burden of all infectious diseases," it is important to remember that there are no vaccines to help prevent most of them. These diseases include dengue, schistosomiasis, leishmaniasis, Lyme disease, West Nile virus, Rocky Mountain spotted fever, Chagas disease, and malaria, which remains "one of the most severe public health problems worldwide."

The World Health Organization, which was founded 66 years ago, states that "more than 50% of the world's population is at risk from these vector-borne diseases."

In addition to being to possibly being a problem where you live, for many of us, these vector-borne diseases become even more of a threat when we travel.

This year, on World Health Day, learn what you can do to protect yourself and others from these vector-borne diseases.

According to Dr Margaret Chan, WHO Director-General, "A global health agenda that gives higher priority to vector control could save many lives and avert much suffering. Simple, cost-effective interventions like insecticide-treated bed nets and indoor spraying have already saved millions of lives. No one in the 21st century should die from the bite of a mosquito, a sandfly, a blackfly or a tick."

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Update on New Meningitis Vaccines

Monday April 7, 2014

While there are more than a few meningitis vaccines already available, some recent outbreaks of meningococcal meningitis and meningococcemia highlight the fact that at least one is sorely missing.

In addition to many sporadic cases, last year, eight students and one prospective student at Princeton University developed meningococcal disease in an outbreak that began in March 2013. At University of California, Santa Barbara, there were four confirmed cases in November 2013, including one student who became so sick that he had to have both of his feet amputated. Both outbreaks were caused by different strains of the serogroup B meningococcal bacteria, which isn't included in our current meningococcal vaccines (Menactra and Menveo).

Students at these universities were able to get a serogroup B or MenB vaccine though. Bexsero, a vaccine that isn't approved in the United States, but is approved in some other countries, was given to students under the FDA's expanded access program for investigational products.

But what about students at other universities who might want to get protected against this bacteria?

When a student at Drexel University died of meningococcal disease a few weeks ago after having contact with students from Princeton,  some parents and students likely wanted to get a MenB vaccine, even though the CDC said they weren't at high risk.

While a MenB vaccine isn't available to everyone outside of the DA's expanded access program for investigational products, one or two will hopefully be available soon. The FDA has announced that both Bexsero and a new MenB vaccine from Pfizer have been given breakthrough therapy designations, "a process designed to expedite the development and review of drugs that are intended to treat a serious condition."

Keep in mind that since neither company has actually submitted their Biologics License Application to the FDA and even the faster review with a Breakthough Therapy designation can take up to 60 days, it may still be some time before these vaccines are widely available. We are certainly a big step closer though.

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Walking to School Safely

Monday April 7, 2014

Walking to School - Photo by Getty ImagesPeople often bemoan the fact that it doesn't seem like as many kids walk to school like they used to in the 'good old days.'

It would certainly be good if they did. Most kids need more physical activity, especially those who aren't involved in youth sports.

While some people consider safety a barrier to letting their kids walk to school, a new study that will appear in the May issue of Pediatrics, "Motor Vehicle-Pedestrian Collisions and Walking to School: The Role of the Built Environment,"concluded that "pediatricians can counsel parents to encourage children to walk to school as a healthy lifestyle choice."

They found that any increased risk of injury for kids walking to school was strongly associated with built environment features of the area, such as multifamily dwelling density, traffic light, traffic calming and 1-way street density, school crossing guard presence, and school socioeconomic status.

Do you want more kids to walk to school and to walk to school safely? Then we need to do more work on the walkability features of our neighborhoods and on "minimizing or mitigating road crossings."

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Autism Group Awareness

Sunday April 6, 2014

Autism Speaks kids off World Autism Awareness Day on the NYSE - Photo by Astrid Stawiarz/Getty ImagesThis year, for Autism Awareness Month, how about being a little more aware of the differences in all of the autism organizations out there.

The very recent Chili's public relations blunder, in which they were planning to donate 10% of sales on April 7 to the National Autism Association, an anti-vaccine autism organization, highlights how important it is to know the organization you are supporting and or visiting information and advice.

The organization in question, in addition to promoting unproven autism treatments, like chelation, clearly states that they believe that "vaccinations can trigger or exacerbate autism in some, if not many, children, especially those who are genetically predisposed to immune, autoimmune or inflammatory conditions." They also state that "research to investigate, and reduce, adverse events in immunized individuals is currently nonexistent."

The National Autism Association is the same organization that used anti-vaccine talking points to attack Dr. Paul Offit and his appearance on Dateline in an appearance with Matt Lauer that was critical of Andrew Wakefield. And it is the same organization that has tried to defend Andrew Wakefield's fraud.

While many other autism organizations have distanced themselves from the idea that vaccines cause autism, this group is pressing on with the idea.

Why is that a problem? Keeping the focus on vaccines, after so many studies have shown that there is no link between vaccines and autism, diverts resources away from services and support for children and autistic adults.

Especially with the rise in vaccine-preventable diseases, including the large measles outbreaks in New York City and Orange County, California, and smaller outbreaks that have driven the national case count to 108 so far this year, it is very disappointing that Chili's chose this organization to support.

Chili's would have done much better donating the sales to a more reputable autism organization, such as the:

  • Autistic Self-Advocacy Network (ASAN) - Our projects seek to improve public understanding of autism, to involve the Autistic community in research that is relevant to the community's needs, to empower Autistic people to take leading roles in advocacy, and to promote inclusion and self-determination.
  • Autism Network International (ANI) - has an annual retreat-style conference run by autistic people, for autistic people and our friends.
  • Autism Society of America - Founded in 1965, the Autism Society helps over a million people each year through a grassroots nationwide network of local and state affiliates.
  • Autism Women's Network (AWN) - a supportive community for Autistic women of all ages, our families, friends and allies.
  • The Global and Regional Asperger Syndrome Partnership (GRASP) - works to improve and enrich the lives of adolescents and adults on the autism spectrum, and their families through, community advocacy & outreach, education, peer supports, programming and services.
  • The Arc and autism NOW - provides high quality resources and information in core areas across the lifespan to individuals with Autism Spectrum Disorders (ASD) and other developmental disabilities, their families, caregivers, and professional in the field.
  • Autism Science Foundation - supports autism research by providing funding and other assistance to scientists and organizations conducting, facilitating, publicizing and disseminating autism research
  • Golden Hat Foundation - changing the way people on the autism spectrum are perceived, by shining a light on their abilities and emphasizing their great potential.
  • Simons Foundation Autism Research Foundation (SFARI) - sponsors research that promises to increase our scientific understanding of autism spectrum disorders, thereby benefiting individuals and families challenged by these disorders
  • Academic Autistic Spectrum Partnership In Research and Education (AASPIRE) - brings together the academic community and the autistic community to develop and perform research projects relevant to the needs of adults on the autism spectrum.

In response to a backlash from many people who support protecting children from vaccine-preventable diseases, Chili's at first claimed that donations would only go towards the organization's program to prevent wandering.

That still doesn't answer to the fact that there are better organizations to support and that they are giving the organization a lot of publicity to further their dangerous ideas.

Amid loud protests from the autism and pro-science community, they have since canceled the event all together. They reversed a bad decision, but it is still unfortunate that they made that decision in the first place.

What about Autism Speaks? Many people will likely be surprised that there isn't universal support for the 'light it up blue' campaign of Autism Speaks to 'shine a light on autism' on World Autism Awareness Day either. Instead, in addition to the many people who think that April should be more about Autism Acceptance and less about autism awareness, there are many people who think that "Autism Speaks' statements and actions do damage to that work and to the lives of autistic people and those with other disabilities" because they:

  • do not include an autistic person among their senior leadership
  • have advocated anti-vaccine ideas
  • use a very small amount of their budget to directly help autistic people pay for the services and supports that they need

This month, visit these other organizations and spread the word about the good work that they do.

On Monday, instead of eating at Chili's, consider eating at home and donating all of the money you saved to one of the more reputable autism organizations listed above.

And Chili's will hopefully rethink their corporate giving strategy. Take Johnny Carino's for instance. In addition to giving money to the Autism Society, they have worked together to create sensory friendly nights at their restaurants. The Autism Society has also worked with AMC Theatres, also a contributor, to bring sensory friendly film nights to their theatres every month.

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Measles Count Up To 108 Cases

Thursday April 3, 2014

A measles alert posted on a home of a child with measles by the health department. - Photo by Buyenlarge/Getty ImagesThe CDC has released the latest measles case count for the United States.

We are now up to 108 cases.

While that still may not seem like a lot to some people, to keep that number in perspective, consider that in 2011, which was a record year for measles:

  • we had only seen 39 cases at this same point in the year
  • it wasn't until mid-June that we broke 100 cases (105 on June 5)

Of course, we ended up with 220 cases in 2011, the most in a single year since 1996.

Since measles is a disease that classically begins to spread in late winter and early spring, that would certainly make it seem like we have a long way to go this year.

And it would certainly make it seem like this would be a good time to get your kids and yourself caught up on the MMR vaccine. Remember, children usually get their first dose at age 12 to 15 months and a second dose between ages 4 and 6 years. This is also a good time for unvaccinated adults who were born in 1957 or after to get immunized.

Get Educated. Get Vaccinated. Stop the Outbreaks.

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Update on the Measles Outbreaks of 2014

Wednesday April 2, 2014

A measles alert posted on a home of a child with measles by the health department. - Photo by Buyenlarge/Getty ImagesNot expectantly, the measles outbreaks of 2014 continue to grow larger.

We now have at least 89 cases in the United States, including:

  • at least 25 cases of measles in New York City, including 13 adults and 12 children, with 6 requiring hospitalization.
  • at least 21 cases in Orange County, California, with 7 requiring hospitalization.

As in most other outbreaks of vaccine-preventable diseases, unlike the anti-vaccine propaganda going around stating that 90% of the people in these outbreaks were vaccinated, many were too young to get their first dose of the MMR vaccine, had just not been vaccinated yet, or had parents who had refused to get their child vaccinated. In the New York City outbreak, only one of the children was vaccinated, but had just received one dose of MMR, so was actually just partially vaccinated and not fully protected against measles.

To help control the New York City outbreak, a health alert is advising that children in certain high risk zip codes in Northern Manhattan, the Bronx, and the Lower East Side (10034, 10040, 10033, 10032, 10451, 10453, 10002) get their first dose of MMR at 12 months. Doctors in the area should be calling all of their unvaccinated children to them get up-to-date and protected against measles.

Older children between the ages of 12 months and 4 years can get their second dose of MMR as long as it has been 28 days since the first dose. These children should not wait until they are 4 years old, as is routinely recommended. This recommendation is just for kids who show up for "routine health care services" though. The health alert is not advising that all of these children be called in to get vaccinated.

So what's next? While it is impossible to predict, we should note that most measles cases in the US are imported from other countries, where the reports of international measles outbreaks include:

  • at least 3,734 confirmed cases in the Philippines and an additional 9,568 reported cases in early January 2014 through February 24 and at least 23 deaths - CDC Watch Level 1 Travel Health Notice
  • at least 40 cases in southern Alberta alone, 10 in Saskatchewan, and at least 320 cases in an outbreak that began in a Christian school in British Columbia, Canada but has now spread to the general community (and to Washington State - 4 cases)
  • at least 180 cases already in Japan in 2014 (232 cases in all of 2013), including at least one case of measles encephalitis and almost all unvaccinated or partially vaccinated
  • large outbreaks in at least six countries in the European Union, even though, according to the European Centre for Disease Prevention and Control "the measles transmission season has not yet started"

Has measles season started in the US? High vaccination levels had seemed to interrupt the old 2-3 year cycles of high "measles years" and measles seasons. If we are getting back to those cycles, then you have to think that we are nowhere near the end of the outbreaks this year. In 2011, when we hit a record high of 220 cases, it is important to note that most of those cases came after April and May. And it shouldn't be surprising that we saw much the same patterns in the other two big years for measles, in 2008 (140 cases) and 2013 (189 cases).

Get Educated. Get Vaccinated. Stop the Outbreaks.

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Responses to the latest CDC report on Autism Prevalence

Thursday March 27, 2014

When commenting on the 2012 CDC report on autism prevalence, I included the quote that autism spectrum disorders (ASDs) continue "to be an important public health concern" and we need a "coordinated response to identify risk factors for ASDs and meet the needs of persons with ASDs and their families."

And I concluded that "Unfortunately, while many organizations are strong advocates for children with autism, some people and their organizations continue to make divisive statements that will do little to encourage a coordinated response."

The CDC has published their latest report, "Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years -- Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010," which found that the overall prevalence of autism spectrum disorders among children in the Autism and Developmental Disabilities Monitoring (ADDM) Network was 14.7 per 1,000 (one in 68). This is an increase from the previously reported prevalence of 11.3 per 1,000 (one in 88) children aged 8 years.

So what is everyone saying about the new CDC report on the rising rates of autism this time?

Dr. James Perrin, MD, FAAP, president of the American Academy of Pediatrics, states that "These rising rates certainly underscore the need to improve our understanding of the causes of autism and to work on prevention."

Emily Willingham, a contributor to Forbes and the Thinking Person's Guide to Autism notes that "From the data, it looks like a lot of sociocultural factors enter into the values. Given the huge variability from site to site and the ethnic differences, recognition and service availability are probably factors. Dr. Boyle referred repeatedly to the evolution of our understanding of autism and used the large percentage of children included in these values who have average to above-average intelligence as an example of that. Unlike numbers from a decade ago, these values include children who previously might not have been recognized as autistic."

In response to the 'staggering' new numbers, The Arc wrote that "Today's data showing nearly double the prevalence since then (2008) emphasizes the immediate need for better services and supports for people with autism and their families. Autism is clearly part of the human condition and people with autism live in all of our communities. While we have made progress in recent years to raise awareness and improve services and supports for individuals with autism, it's simply not enough."

Autism News Beat noted that "The upward trend in prevalence is consistent with recent studies conducted in the US and Canada. It can be attributed in large part to a combination of better detection methods, increased training of medical professionals, diagnostic subsition, and greater public awareness of the disorder."

Alison Singer, President of the Autism Science Foundation, states that "the data are important because they help us plan for the types of services we should be building based on the needs of the kids." Like many other experts, she is concerned that many of the children in the report were not diagnosed until after age 4 years, even though autism can be diagnosed much earlier, often by age 2 years. She also states that "people with autism and intellectual disability have very different services and supports needs than people with autism who don't have intellectual disability. The data also drive research. We learned nothing from this data about what causes autism or what causes different types of autism, but the data provide important clues about how we should be approaching those questions."

Liz Feld, President of Autism Speaks calls for "a comprehensive strategy that includes the research community, policymakers, educators, and caregivers coming together to address our community's needs across the lifespan."

The AAP, Autism Speaks, and The Arc all urge Congress to reauthorize the Combatting Autism Act, which the AAP states "has led to significant advances in early intervention, behavioral treatments, and understanding of the causes of autism."

Scott Badesch, President and CEO of the Autism Society of America, which was founded in 1965, states that "The Autism Society continues to be concerned with the increasing prevalence of autism." He also states that "Better services and supports are needed. With the cost of care for a lifetime as high as $3.2 million for one individual with ASD, the challenges in meeting these costs are overwhelming for most families, and the need for equity and increased family services is paramount. As a nation, we must continue to close the gaps in autism services, particularly for minority communities. There must be a national commitment to be more responsive to the daily needs of each person living with Autism Spectrum Disorder."

"These numbers are in line with our expectations based on previous studies showing that autistic people represent between 1 and 3% of the population," said Autistic Self Advocacy Network President Ari Ne'eman. "The CDC numbers show that while we are gradually improving diagnosis and identification of autistic people, significant disparities persist. African-American and Hispanic autistic children continue to go under-diagnosed, as do women and girls on the spectrum."

Julia Bascom, ASAN's Director of Programs added that "The lack of any data on adults represents a serious gap in CDC's efforts. When the United Kingdom conducted an adult prevalence study, it found the same rate of autism in adults as children, helping to debunk public hysteria over a so-called 'autism epidemic'."

You can contrast those statements with some others...

Anne Dachel, a contributor to the anti-vax site Age of Autism writes - "They're using the word "surge"...not too scary, is it? Notice Dr. Boyle says that "the number of children diagnosed with autism continues to rise," not the number of children with autism. She still claims it's "more awareness." I just have one thing to say to Dr. Boyle: SHOW US THE MISDIAGNOSED ADULTS."

The AOA website wants "President Obama to fire the autism epidemic deniers from CDC and NIH," and is "demanding accountability for this tragic increase in autism that is radically altering the American family - unabated." They fail to mention that they and other anti-vaccine organizations have tried to keep the focus on a link between autism and vaccines for years.

Wendy Fournier President of the National Autism Association concludes a press release discussing that "44 U.S. children with autism have died after wandering away from a safe environment." She states that "Our federal government must recognize these deaths, and the urgent needs of our most profoundly affected population. They suffer silently in pain from untreated medical issues; they are abused, bullied, and may be at increased risk of suicide. Their deaths and injuries are preventable through an appropriate federal response, which our coalition is dedicated to securing."

SafeMinds offers "Top Ten Things to Know About the CDC Report on Autism Prevalence," with three having to do with thimerosal and vaccines, even though thimerosal was removed from most vaccines before the children in this report were even born.

Should that be the take home message about the new report? More misinformation about vaccines?

Or should we focus on how the CDC reports "have motivated research to understand who is likely to develop ASD, why ASD develops, and how to best support individuals, families, and communities affected by ASD."

Susan Hyman, MD, FAAP, chair of the AAP autism subcommittee, reinforces the idea that "The prevalence data makes even more important the Academy's focus on early screening, identification and referral for intervention for all children, and our work to support collaborative medical homes for children, youth and adults with autism spectrum disorder."

What is your response to the new report?

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