All posts by Cynthia Callaghan

Support for Vaccines Continues Downward Trending in US, Poll Shows (Medscape 1/16/2020)

A new Gallup survey shows that support for vaccination in the United States is declining, particularly among parents of young children.

The survey, conducted in December 2019, shows that 84% of Americans feel it’s extremely or very important that parents vaccinate their children. That matches Gallup’s prior reading in 2015, but is down 10% from 2001, when 94% of Americans felt this way.

“Widespread public support for childhood vaccines creates a wall preventing contagious diseases like measles and polio from spreading in the US, but a breach in that wall appeared in 2015 and it has not been repaired,” Gallup said in a news release.

Among parents of children younger than 18 years old, 77% feel vaccination is important in 2019, down from 92% in 2001.

The decline in Americans’ belief in the importance of vaccinating children between 2001 and 2015 occurred among almost all subgroups of the public.

Highly educated Americans with postgraduate degrees is the only group that has maintained its 2001 level of support for vaccines; 90% of this subgroup continues to believe vaccination is important, essentially unchanged from the 92% in 2015 and 2001. Perceptions of the importance of vaccination declined by at least 5 percentage points among all other education subgroups, Gallup reported.

Public Awareness Campaigns Working?

Most Americans say they are aware of the advantages and disadvantages of vaccines. In the latest survey, nearly 9 in 10 (89%) say they have heard “a great deal” or “a fair amount” about the advantages of vaccinations, up from 83% in 2015 and 73% in 2001

More than three quarters (79%) say they have heard a great deal or a fair amount about the possible disadvantages of vaccines — up modestly from 73% in 2015 but a substantial increase from 39% in 2001.

“Pro-vaccine public awareness campaigns appear to be working to the extent that more Americans — now a majority for the first time — report having heard a lot about the medical advantages of vaccines for children,” Gallup reports.

“However, more have also heard about the disadvantages. While they are not as pervasive and are being exposed as untrue, these counterarguments are still getting through, perhaps explaining why public support for vaccines remains lower than at the start of this century,” they point out.

Uncertainty on Vaccine-Autism Link Persists

Although many Americans who oppose vaccinations argue that they are more dangerous than the diseases they prevent, the vast majority of Americans (86%) continue to disagree. This is unchanged from the 87% who felt that vaccines were less dangerous in 2015 and only modestly lower than the 90% in 2001.

Currently, 11% of US adults think vaccines are more dangerous than the diseases they prevent.

Although the vast majority of Americans see vaccines as less dangerous than the diseases they prevent, only 62% feel the federal government should make all parents get their children vaccinated. In a 1991 Princeton survey, 81% felt the government should require vaccination.

Despite the well-publicized and debunked claim that vaccines cause autism, 10% of US adults still believe that vaccines cause autism in children, marking a modest increase from 6% in 2015. Nearly half (45%) do not think vaccines cause autism, up modestly from 41% who said the same almost 5 years ago, whereas 46% still aren’t sure. In 2001, 94% of Gallup survey respondents were unsure whether vaccines cause autism.

Americans with more formal education were more apt to say vaccines do not cause autism. The figure is 73% among those with postgraduate education, falling to 61% among those with a college degree only, 42% of those with some college, and 28% of those with no college experience.

Lesser-educated Americans were much more likely to have no opinion than to say they believe vaccines do cause autism. The percentage making the causal connection tops out at 12% among Americans with no college education vs 5% of postgraduates.

There was also a partisan split in opinions, with 55% of Democrats saying vaccines do not cause autism, compared with 37% of Republicans, according to Gallup.

The results are based on telephone interviews with a random sample of 1025 adults, aged 18 and older, from all 50 US states and the District of Columbia, with the margin of sampling error of ±4 percentage points.

Dr. Peter Hotez, New York Times Op-Ed 1-9-2020

You Are Unvaccinated and Got Sick. These Are Your Odds.

Comparing the dangerous effects of three diseases with the minimal side effects of their corresponding vaccines.

By Peter J. Hotez
Dr. Hotez, a vaccine scientist and pediatrician at the Baylor College of Medicine, is the author of “Vaccines Did Not Cause Rachel’s Autism.”

Jan. 9, 2020 []

Vaccines prevent diseases, and being unvaccinated carries a risk. Last year, the World Health Organization ranked vaccine hesitancy, a “reluctance or refusal to vaccinate despite the availability of vaccines,” among the top 10 health threats worldwide, alongside Ebola, H.I.V. and drug-resistant infections.

To state it bluntly, being unvaccinated can result in illness or death. Vaccines, in contrast, are extremely unlikely to lead to side effects, even minor ones like fainting.

As vaccination rates have fallen, highly contagious illnesses like measles have resurged globally. For instance, measles is now widespread in several European countries. In Samoa, a Pacific island nation of about 200,000 people, almost 5,700 measles cases have been recorded since September, resulting in at least 83 deaths. Almost all of those who died were young children.

These deaths did not have to happen. In the United States, vaccine hesitancy is contributing to three public health threats: the return of measles, deaths from influenza and needless future cases of cervical cancer.

Some legislators and religious leaders question the safety of vaccines, despite scientific evidence to the contrary. In New Jersey, an effort in December to pass a bill that would end religious exemptions and require students enrolled in any school or college, public or private, in the state to be vaccinated failed to get enough votes; supporters say they will try again in the next few days to pass the bill.

Often, skeptics do not appreciate the vastly greater dangers of the diseases that vaccines prevent.

We accumulated and evaluated data from leading medical journals, the most recent edition of the reference work Plotkin’s Vaccines and the Centers for Disease Control and Prevention to compare the risks of becoming ill with measles, flu or cervical cancer to the minute chances of experiencing side effects from their corresponding vaccines.

Here is what your odds look like.

Measles Risks: Pneumonia, Infection, Death

The United States eliminated measles in 2000, but in 2019 the number of cases increased greatly, largely because of public resistance to receiving the measles-mumps-rubella vaccine.

When the disease was imported from abroad and spread across the country, unvaccinated children (and some adults) got sick. Outbreaks were concentrated in New York, Michigan, Oregon, Texas, California, Illinois, Georgia, New Jersey, Pennsylvania and Washington. In some or all of these communities there was a rise in vaccine exemptions.

In reality, the risks of side effects from a measles-mumps-rubella vaccination are vanishingly small, especially compared to the devastating effects of measles.

The measles virus is highly contagious, and is often the first childhood infection to return after vaccinations decline. And measles is a serious disease. The 2018-2019 measles epidemic in New York City resulted in 52 hospitalizations, including 16 admissions into an intensive care unit (there were no deaths). About 95 percent of those sickened were unvaccinated, incompletely vaccinated, or did not know their vaccination status.

Moreover, new research reveals that, even when patients recover, the measles virus can suppress the immune system, rendering children susceptible to serious infections like pneumonia and the flu.

In the first nine months of 2019, nearly 1,250 measles cases were reported nationwide, the highest number in 27 years. Among those cases, 89 percent were in patients who were unvaccinated or had an unknown vaccination status.

Why did this happen? Starting in the late 1990s, some parents refused the measles-mumps-rubella vaccinations for their children because of fears that vaccines can cause autism, a central tenet of the anti-vaccine lobby.

This misinformation spread after an article implying a link between the measles vaccinations and autism was published in The Lancet in 1998; it was retracted in 2010 over concerns about the validity of the results and the conduct of the study. Nevertheless, the false claim that vaccines cause autism continued to circulate on the internet and social media.

The truth is that we have overwhelming evidence from at least six studies involving more than one million children that measles-mumps-rubella vaccinations do not cause autism.

Scientists are also learning about the genetic causes of autism and have identified more than 100 genes linked to the disorder. I’m the parent of an adult daughter with autism. Through one of the most extensive genetic tests available, whole exome sequencing, we’ve now identified her autism gene. Evidence points to neurodevelopmental processes leading to autism that begin in pregnancy, well before children receive their first vaccine.

Flu That Sickened 1 in 7 Americans

The 2017-18 influenza epidemic was an especially bad one, resulting in an estimated 45 million illnesses nationwide, according to the C.D.C. An estimated 810,000 people were hospitalized and 61,000 people died, including 643 children. The majority of children who die from influenza have not received the flu vaccine.

Even though influenza ranks among the leading killers of Americans, many choose not to vaccinate, believing that the vaccine is dangerous or that it can even cause flu. (The flu vaccine cannot cause the flu because it contains only inactive or, in the case of nasal spray vaccines, weakened viruses, or is made with proteins from a flu virus.)

The risk of a severe reaction from the flu vaccine, such as Guillain-Barré syndrome (an autoimmune condition of the peripheral nervous system that can cause tingling, limb weakness or paralysis) is tiny, roughly equal to the likelihood of being hit by a lightning strike. Influenza itself can bring on Guillain-Barré syndrome; the vaccine is more likely than not protecting you from this condition.

Deadly Cervical Cancer vs. Fainting

Australia is positioned to effectively eliminate cervical cancer over the next two decades, through a vaccination campaign and increased cervical screenings. The United States is not even close to that goal because the rates of vaccination for HPV, or human papillomavirus, among teenagers has been low in many states compared to other common vaccines. Reasons for this low vaccination rate include cost and lack of access, especially in rural areas.

The HPV vaccine has also been a target of a misinformation campaign, with books and internet posts asserting that the vaccine causes teenage depression and suicide. But there is no evidence of such links. Social conservatives also claim that the vaccine encourages sexual promiscuity, but the evidence does not support this.

The actual risk? Fewer than 1 in 10,000 vaccinated people, mostly adolescents, will faint, perhaps related to fear of the injection. There is also a risk of allergic reaction, as with most vaccines — but again, this is no more likely than being struck by lightning.

Sources: Based on publicly available information from the Centers for Disease Control and Prevention and other federal agencies, with information from Plotkin's Vaccines, 7th Edition, and more than a dozen studies published in leading journals identified on the National Center for Biotechnology Information PubMed data base. These studies involve approximately 1 million human subjects. Other sources: Dr. Daniel A. Salmon and Dr. Matthew Z. Dudley, Johns Hopkins University Bloomberg School of Public Health; “The Safety of Influenza Vaccines in Children: An Institute for Vaccine Safety White Paper,” National Center for Biotechnology Information, National Institutes of Health; World Health Organization; National Safety Council (lightning deaths); Clinical Infectious Diseases (Guillain-Barré Syndrome and influenza); ReliefWeb (Samoa figures)

Thousands of young women in this country are being condemned to cervical cancer (and both men and women to throat, anal and other cancers) by being deprived of the HPV vaccine, which is both highly effective and safe.

As a vaccine scientist, pediatrician and the parent of an adult daughter with autism, I meet regularly with pediatricians, nurses and worried parents. Parents want to do what’s best for their child, but too often they become the victims of anti-vaccine misinformation campaigns.

Medical professionals need to find a way to counter the anti-vaccine media empire by mounting a vigorous pro-vaccine advocacy response that rebuilds public trust.

In my experience, once I explain how vaccines save lives with minimal risk, it is possible to overcome the fears and apprehensions that parents have about vaccines.

As New Jersey legislators return to work, I hope that they will consider the true risks of religious exemptions for vaccines. Our children’s lives are on the line.

Peter Hotez (@PeterHotez), a pediatrician and the dean of the National School of Tropical Medicine at Baylor, is the author of “Vaccines Did Not Cause Rachel’s Autism.”
Bill Marsh is a graphics editor for the Sunday Review. After 14 years with The Philadelphia Inquirer, he joined The Times in 2001, working on the Science desk and later for the Week in Review.

CDC Pink Book Webinars


Pink Book Webinar Series

Epidemiology and Prevention of Vaccine-Preventable Diseases Pink Book cover

This online series of 15 webinars provides an overview of the principles of vaccination, general recommendations, immunization strategies for providers, and specific information about vaccine-preventable diseases and the vaccines that prevent them. Each one-hour webinar explores a chapter from the 13th edition of “Epidemiology and Prevention of Vaccine-Preventable Diseases,” also known widely as “The Pink Book.”

2019 Pink Book Webinar Registration


Immunization providers: Physicians, nurses, nurse practitioners, pharmacists, physician assistants, DoD paraprofessionals, medical students, state and local immunization programs, etc.

Continuing Education

Continuing education will be available for each event.

2019 Webinar Schedule & Archives

(All events begin at noon eastern time.)

2018 webinar schedule with presentation information
Date Topic
June 5 Principles of Vaccination
June 12 General Best Practice Guidelines, Part 1
June 19 General Best Practice Guidelines, Part 2, and Vaccine Safety
July 10 Immunization Strategies
July 17 Vaccine Storage and Handling and Vaccine Administration
July 24 DTaP/Tdap
July 31 Rotavirus and Hepatitis A
August 7 Meningococcal Vaccines
August 14 Measles, Mumps, Rubella
August 21 Polio and Hib
August 28 Varicella and Zoster
September 4 Hepatitis B
September 11 HPV
September 18 Pneumococcal Vaccines
September 25 Influenza


St. Margaret Bloomfield Garfield Family Health Center Recognized

2019 HPV Vaccine is Cancer Prevention Award Winner Spotlights


University of Pittsburgh Medical Center— St. Margaret Bloomfield Garfield Family Health Center

University of Pittsburgh Medical Center— St. Margaret Bloomfield Garfield Family Health Center
Pittsburgh, PA

The University of Pittsburgh Medical Center (UPMC) St. Margaret Bloomfield Garfield Family Health Center was established in 1984, in a disadvantaged urban neighborhood in Pittsburgh, Pennsylvania. The health center serves predominantly low income and African American patients, registering 10,000 patient visits per year. It also serves as headquarters for the school health partnership with five East End Pittsburgh schools.

Over the past few years, the health center pursued two successive quality improvement projects to increase HPV vaccination rates for their patients. These projects have been successful due to strong leadership and enthusiastic participation of the entire staff. Serving as the health center’s vaccine champion, Dr. Donald Middleton teaches residents and faculty to make an effective recommendation using presumptive language. In addition to being a champion for the health center, Dr. Middleton also shares his expertise on how to make effective vaccine recommendations at local, UPMC system, county, regional, and national meetings.

Staff at the health center take prevention seriously, while addressing it in fun, engaging ways. Creativity and perseverance are the hallmarks of their HPV vaccination improvement project. One of the health center’s pharmacists interviewed students at a local high school; the students recommended posters containing facts about HPV consequences, an immediate reward for vaccine receipt, and text messaged vaccination reminders. The health center also sponsors an HPV poster contest in the local community; the winning posters are included in their fifth-grade puberty classes and educational materials.

These efforts led the health center to an impressive 77% completion rate for both male and female patients. For their innovative approach to improving vaccination rates in their community, the UPMC St. Margaret Bloomfield Garfield Family Health Center is Pennsylvania’s 2019 HPV Vaccine Is Cancer Prevention Champion!

More information on the winners from the other states can be found at:

Vaccine App from the Vaccine Education Center at CHOP

Free Mobile App – Vaccines on the Go: What You Should Know

It’s easier than ever to get health information. But sometimes, it’s difficult to weed out the “good” information, which is scientifically accurate, from the “bad” information, which is not based on science. This is especially true for vaccines.

In a continued effort to provide the public with information about the science, safety and importance of vaccines, the Vaccine Education Center at Children’s Hospital of Philadelphia (VEC) recently updated its popular app, called Vaccines on the Go: What You Should Know, so anyone can access vaccine information wherever and whenever they need it.

Vaccine app features

The redesigned Vaccines on the Go: What You Should Know mobile app continues to offer information about:

  • Vaccines and the diseases they prevent
  • Recommended immunization schedules for children, teens and adults
  • Vaccine safety concerns, including autism, thimerosal, and too many vaccines

New information includes:

  • How the immune system works, including what happens during an infection or when a person is immune compromised
  • Disease and vaccine information related to travel, including descriptions of cholera, Japanese encephalitis virus, typhoid and yellow fever
  • Enhanced video offerings, including animations related to how viruses attack cells, maternal antibodies and immunizations, and more

Additional features include:

  • Updated graphics depicting disease characteristics, such as levels of contagiousness and typical disease timelines
  • An opportunity to receive updates through the app
  • Vaccine-related trivia
  • A place to record notes or questions for the next doctor’s visit
  • Ways to stay connected with the VEC, including sending us vaccine-related questions or signing up for Parents PACK, our free monthly e-newsletter
  • Links to a variety of online resources, including booklets and Q&A sheets

Providers: Get free posters to share with your patients

If you would like to share information about this app with your patients and their families, you can order free updated posters from the VEC. Posters are 8.5”x11” in size, making them easy to hang in waiting or exam rooms or to add to patient information packets.

App wins “Award of Distinction”

VEC Communicator Award Badge In 2014, the Vaccines on the Go mobile App was selected among 6,000 entries as an “Award of Distinction” winner in the annual Academy of Interactive and Visual Arts’ Communicator Awards.

Reviewed on October 23, 2019

Dengue Vaccine Update

Takeda’s tetravalent dengue vaccine candidate effective in children

Photo of Derek Wallace

Derek Wallace

Results of an ongoing phase 3 trial of Takeda’s tetravalent dengue vaccine candidate, known as TAK-003, suggest that the vaccine is effective in children and adolescents aged 4 to 16 years.

The findings, which were presented previously at the annual meeting of the American Society of Tropical Medicine and Hygiene, have now been published in The New England Journal of Medicine.

“It is important that there are multiple options to fight dengue, as it is the fastest spreading mosquito-borne disease and one of the top 10 threats to global health, according to WHO,” Derek Wallace, MBBS, vice president and global program lead in dengue for Takeda, told Infectious Diseases in Children. “In the absences of a specific treatment, prevention of dengue becomes very important.”

Wallace stressed that vector control and personal measures to reduce exposure to mosquitos have not been sufficient in preventing disease.

One other tetravalent dengue vaccine, known as Dengvaxia (CYD-TDV, Sanofi Pasteur), has been used in children in Asia and Latin America. However, Wallace and colleagues wrote that the vaccine increased the risk for severe dengue and dengue-related hospitalizations in children who had never been infected with the virus. Because of the increased risk for severe outcomes, Dengvaxia is only recommended for those with confirmed previous dengue virus infection.

“This leaves a significant unmet need for a vaccine that is safe and protects those at risk for dengue regardless of previous dengue exposure,” Wallace said.

For the trial, the researchers administered TAK-003 to healthy children and adolescents residing in endemic areas in Asia and Latin America. Participants received either two doses of the vaccine or placebo, with 3 months between each dose.

More than 20,000 children and adolescents were administered at least one dose of the vaccine or placebo, and nearly all (94.8%) received both doses. Wallace and colleagues wrote that one dose of the vaccine was 80.9% effective (95% CI, 75.2%-85.3%). Compared with placebo, the rate of infection was lower among children who received one dose of the vaccine (0.5 vs. 2.5 cases per 100 person-years).

Wallace said that the efficacy between the first and second dose of TAK-003 was “important and unexpected.”

“While this may have relevance for travelers and in outbreak settings, long-term safety and efficacy is assessed after two doses,” he said. “We therefore intend to file with a two dose regimen.”

Two doses of the vaccine were 80.2% (95% CI, 73.3%-85.3%) effective at preventing infection . The researchers identified fewer cases of virologically confirmed dengue virus infection among those who received two doses of the vaccine compared with placebo (61 vs. 149), and there was a 95.4% (95% CI, 88.4%-98.2%) reduction in hospitalizations due to dengue among recipients of TAK-003.

That last finding has “significant potential relevance,” according to Wallace.

“Dengue is an epidemic disease and creates huge pressure on public health infrastructure,” he explained. “There are an estimated 500,000 hospitalizations due to dengue each year. A reduction in hospitalization is therefore relevant both to the individual and to the public health systems in dengue-endemic areas. We are especially encouraged to note that the reduction in risk of hospitalization was observed in both seropositive and seronegative individuals.”

Before vaccination, 27.7% of participants who received both doses of TAK-003 were seronegative at baseline. Wallace and colleagues wrote that the vaccine demonstrated 74.9% efficacy in these children and adolescents (95% CI, 57%-85.4%), with 20 cases of virologically confirmed dengue virus infection occurring among those who received the vaccine and 39 cases among those who received placebo.

The researchers identified similar rates of adverse events among those who received the vaccine (3.1%) and those who received placebo (3.8%).

Wallace said the next steps in the trial include an analysis of an additional 6 months of data to determine the vaccine’s efficacy by serotype, baseline serostatus and severity of disease. He said these data will be presented at the upcoming American Society of Tropical Medicine and Hygiene annual meeting. A third analysis will examine the vaccine’s efficacy and long-term safety after an additional 3 years.

“We continue to collaborate with governments, nongovernmental organizations, policy organizations and dengue experts to ensure they have early and ongoing access to our data,” Wallace said. “These are the individuals and groups that are most important in defining how the vaccine candidate could potentially best be used. We will focus on filing in dengue-endemic countries where there is the greatest need in parallel with filings in nonendemic countries. The planned dossier will include safety and efficacy data from our trial and supporting data from our other phase 3 studies.” – by Katherine Bortz

Disclosures: Wallace is an employee of Takeda. Please see the study for all other authors’ relevant financial disclosures.

Contact your Representatives to Support the Vaccine Act


June 12, 2019

Urge Congress to Support the VACCINES Act

Please take two minutes to click here and encourage your US Representatives and Senators to cosponsor the bipartisan VACCINES Act, a bill to study, track, and address vaccine hesitancy and barriers to vaccination with federally supported evidence-based responses. VACCINES—the Vaccine Awareness Campaign to Champion Immunization Nationally and Enhance Safety Act—includes priorities identified by IDSA that will strengthen the U.S. public health system’s capacities to predict and prevent vaccine-preventable outbreaks and support health care providers with educational tools to discuss vaccination with families.

The House bill was introduced by Rep. Kim Schrier (D-WA) and is co-led by Rep. Michael Burgess (R-TX), Rep. Eliot Engel (D-NY), Rep. Kurt Schrader (D-OR), Rep. Gus Bilirakis (R-FL) and Rep. Brett Guthrie (R-KY). The Senate bill was introduced by Sen. Gary Peters (D-MI) with Sen. Pat Roberts (R-KS) and Sen. Tammy Duckworth (D-IL).