Is It More Effective to Delay MMR Vaccination?

Recently, I asked the question is it safer to delay MMR vaccination?  Many of those who are opposed to the current schedule of vaccinations or have heard anti-vaccine claims and fear that vaccines somehow overwhelm an infant's immune system may put off getting their children immunized until well after the age recommended by the CDC and AAP. This decision not only leaves a child at risk of infection for a longer period, but, as I discussed in that post, new research on the MMR vaccine indicates that there is an increased risk of seizures and fever associated with delaying that vaccine. So delaying might not necessarily be safer, at least in terms of adverse reactions to the MMR vaccine. The authors of the recent paper speculated that one probable cause of this increased risk is due to a more robust immune reaction the older a child is when they receive their first dose of measles-containing vaccine.

Another recent study, Measles in Children Vaccinated With 2 Doses of MMR, by F. Defay, G. De Serres, D. M. Skowronski, N. Boulianne, M. Ouakki, M. Landry, N. Brousseau, and B. J. Ward and published online on October 21, 2013 in Pediatrics, asked a related question: does delaying the first dose of measles vaccine improve efficacy? Well, really, the question they asked was, "does age of first MMR vaccination affect vaccine efficacy in children who received 2 doses", but my paraphrase is close enough.

For Graduate Practicum, George Washington University Earns an F

Recently, news came out that Mark Geier, the man who tried to treat autistic children's autism by using a powerful drug that suppresses testosterone (essentially chemically castrating these children), the man who lost every one of his twelve state medical licenses and had a 13th denied due to his medical misconduct (to put it lightly), served as a site preceptor for a graduate student at George Washington University. Autism News Beat rightly criticized the university. That Geier was able to serve as a preceptor for a student is pretty damning, since it means that GWU did not do its due diligence to ensure that individuals who apply to be a preceptor meet certain minimum standards. Either that, or someone at GWU was actively promoting Geier's nonsense.

The problem is that a site preceptor has a number of responsibilities, according to the GW SHHS Practicum Site Preceptor Guide:

1. Visit the Practicum Website http://www.gwumc.edu/sphhs/studentres/practicum/index.cfm and Register. (See Register: for instructions)
2. Review and approve the Student’s Practicum Plan
3. Negotiate payment/stipend with Student, if applicable
4. Engage student in work and provide constructive feedback and guidance to the student
5. Provide guidance for professional conduct
6. Complete the following on the Practicum Website:
   a. Midpoint evaluation form in conjunction with the student
   b. Final site preceptor evaluation of student and practicum
7. Address student’s reports of problems, including site safety issues and/or harassment

Take note of numbers 2, 4, 5 and 6. Mark Geier is not fit to fill those responsibilities, having been stripped of his medical licenses and being found by several Special Masters of the vaccine court to lack expertise in many different areas relevant to epidemiology, biostatistics and immunology. Coupled with his lack of medical ethics, it is grossly irresponsible to allow him to serve as a site preceptor for any student. Orac and Reuben Gaines have both chimed in, as well, castigating George Washington University for allowing this to happen.

And now it looks like GWU has taken notice.

More VPD Cards Available

[UPDATE 3/8/16: I am out of VPD wanted poster card sets. Thank you to everyone who requested a set! You made it all worthwhile.]

In March of this year, I announced that I was making prints of an art project of mine available for free. These were sets of sixteen 4" x 5" cards with information about each of the diseases that is prevented by a vaccine on the current childhood immunization schedule. The cards are modeled after wanted posters, complete with mug shots and vital statistics of each virus or bacterium, as well as a description of what the disease does (its modus operandi, if you will). I received a lot of positive feedback on them, and I recently sent out the last of my initial 100 sets.

Because of continued requests, I've decided to do another printing. If you would like a set of VPD cards, click on that link or click the button below or in the sidebar to the right. Remember, it's absolutely free, though if you'd really like to open your wallet, please make a donation to a science-based autism charity or to support vaccine research. Here are some suggestions, which I have supported myself, or give to your favorite charity.

Much of the information is drawn from the CDC's Pink Book chapters on each disease, which I've tried to summarize in an easy-to-read format. These cards are a great way to learn about vaccine preventable diseases. Some people have even turned the cards into a game, shuffling and dealing them out, then playing hands of "who has the worst disease".

Is It Safer to Delay MMR Vaccination?

Most people follow the recommended schedule of childhood immunizations. They understand the importance of immunization, not only for their own children, but for their communities as well. Certainly, parents put varying degrees of thought into their decision. Some simply go along with whatever their pediatrician recommends, while others thoroughly research the vaccines their child will receive before accepting the science-based recommendations behind the current vaccination schedule. Whatever level of scrutiny they give to the issue, the majority immunize their children fully and on-schedule, barring valid medical reasons to the contrary.

Then there's the minority, the parents who either delay vaccines, spreading them out over a much greater timeframe than recommended by the Centers for Disease Control and Prevention and the American Academy of Pediatrics, the parents who only allow some vaccines, and those who eschew vaccines altogether. Some are strongly committed to the ideology that vaccines cause all manner of maladies, often becoming quite vocal about it. Their views stem from misunderstanding of the science, confusing correlation with causation, and distrust of large corporations and the government. Some parents have simply been misled by those anti-vaccine activists. The arguments resonate on an emotional level, despite being void of scientific validity. And finally there are those who delay or skip vaccines because they lack access or the resources to keep up. They cannot afford insurance to cover the vaccines. They may not be able to take the time off from work to take their children to the doctor's office. In short, through failures of the health care system, rather than any fear or distrust of vaccines, their children are under- or unimmunized.

Whatever the reasons, the decision to delay or avoid vaccinations carries certain risks. Most readily apparent is the increased risk of infection, contributing to outbreaks in regions of low vaccination. We need only look, for example, at recent measles outbreaks (Minnesota, New South Wales, Australia, Massachusetts, Indiana, North Carolina and New York, Pakistan and Wales, Texas) to see how lack of immunization increases the risks of infection and spread of disease. Not so obvious is that delaying some vaccines increases the risk of not being fully immunized.

And now there's another risk to add to the list, at least as regards measles vaccines.

B-lyme-y!

The last couple weekends in July and the first weekend of August, I helped out with a project down in Connecticut. It allowed me to tap into my woodworking interests and challenged me with techniques I hadn't done a great deal of before, like sculpting with a chisel and lashing several different ways. Because of time constraints, I made use of some power tools (saws, screwgun and sander), hand tools (axe, chisel, knives) and some more unusual tools (like a blowtorch). Most of the work used rough branches, rather than lumber, and some didn't involve wood at all.

The project was also a great excuse to get outside to enjoy nature, as it took me into the woods quite a bit. That was both good and bad, because, unlike the Disney (and quackery) version where nature is all happy and fluffy and nary a hair on your head will be harmed, I encountered the real nature. The more immediate problem was relatively minor: it was hot. Really, really hot. And humid. But I could live with that. I could even live with the little bit of contact dermatitis I got from either poison ivy or poison sumac that brushed my wrist against at some point without knowing it. Itchy and ugly, but luckily I'm not hypersensitive to it. What was more concerning was what I got, much like the dermatitis, without knowing it. I never noticed that I'd had a visitor that came for a bite to eat, then left without so much as a "how d'you do?". The only indication I had of the encounter came weeks later: a characteristic bulls-eye rash. I had lyme disease.

Didn't get a photo of my rash, but it looked like this.
Photo credit: James Gathany. Source: Public Health Image Library

Since there is a great deal of misconception about this disease among the public, and because more than a few people were gravely concerned when I told them, thinking that I would be in extremely poor health because of it, I figured it might be good to share my experience.