Vaccinations for Costa Rica trip

We are traveling to Costa Rica with our 2 girls in May. Kaiser recommends that the 4 year old have a typhoid vaccine and that both kids take 7 weeks of an antimalarial (methloquine, I think). Right now I am thinking they will take the antimalarials but am iffy on the typhoid. Has anybody taken kids to Costa Rica recently? Any advice? Also, I am looking for an effective, but not-too-toxic insect repellant. Thanks, Jill

Public health aspect of not vaccinating

okay-here i go dredging up the old vaccination debate again...my child is three now and i plan on finishing the series of DP that she has already started. i'm trying to figure out which of the other vaccines to do with her. i'm really confused about the public health aspect of choosing to or not to vaccinate. in the archives i read a post about an ''irresponsible mom'' who let her unvaccinated child play with kids who had measles and then took her to a party two weeks later where she created a massive measles outbreak. wouldn't only the unvaccinated get the disease? or do the vaccines not work that well. and then is the logic that i should vaccinate my child because they don't always work?

there was another post from a mom making an impassioned plea for folks to vaccinate their kids because she couldn't vaccinate her immune-challenged child. it really affected me but then i couldn't figure out how vaccinating my child would really help her. if vaccinated kids can get the measles wouldn't they be just as risky to her child as unvaccinated kids would be? or is it that only unvaccinated children can spread the disease and vaccinated kids just get it? does anyone know how this really works? Is it really true that if everyone vaccinated that these diseases would disappear? what about natural immunity-would that disappear too?

my plan was to wait until she was past 2 years old and she is so now i'm just trying to figure out what to do. the public health part is really hard for me to debate in my head and with others because i just dont get it. thanks in advance for your non -judgemental input. on the fence

My daughter was sick for over a month, and coughed so hard at night that she would vomit. She had broken blood vessels around her eyes from coughing so hard. We had to keep her largely isolated for most of a month, despite it being the middle of sunmmer. It was heartbreaking to watch her go through such a horrible illness and not be able to help her. Despite how sick she was, Annemary told us she actually had a much lighter case than she would have had without the two shots she received.

I'm trying hard not to be judgmental in my response and report just the facts to you, but I think it's obvious how this experience has shaped my opinion. it should be mandatory

1. Yes, there is risk in vaccination, namely a allergic reaction to the vaccine. BUT, the risks are tiny, for example, the MMR vaccine has been linked to 1 death per 2,000,000 doses.

So, if you're rather uneasy about the potential risk to your child, you can ask the doctor, if that particular vaccine has been out in the market in a while and what the fatal/severe allergic reaction rate is. Brand new type of vaccine might have unknown side effect, for example, DTP has been replaced by DTaP, which causes far fewer reactions.

2. There is only 1 vaccine required at birth, that is Hep B vaccine. Since a high fever (most common severe reaction) is much more dangerous for newborn, one might want to wait until the infant is 2 MO-old. However, it's best that the rest of the family members are screened for their potential to be carriers (the test is not foolproof, though). Of course, if the baby goes to any child care (albeit part-time), it's better to get the vaccination (remember that the risk of reactions is such a small percentage).

3. Now, of course the questions are: Is it worth risking the potential allergic reactions, albeit small, on your child? Are the benefits outweigh the risks? Are the benefits only for my child or for the greater good of the overall public health?

Most studies have shown that vaccines can prevent unnecessary illness and tragedies. Smallpox is gone from the entire planet (aside from what few labs might still keep), and who can argue for the horror smallpox gave to human being. Polio is almost gone from the entire earth (well, beside current outbreaks in Africa due to wars). [USA: Before the polio vaccine in the 1950s, 1000 people dies and 20,000 more were paralyzed from the disease each year; around 1980, zero]. Tetanus is also completely useless thing to get and so easy to prevent. And so on, so forth.

So, yes, I think the benefits of vaccination are greater than the risks.

Now, that you have taken the risk for your child, is there any benefit for the overall public health. Or is my child 100% immune from the disease, thus I do not have to worry about the unvaccinated children?

The answer for the later is NO. Your child might not 100% immune because about 5% of cases -- up to 20% for pertussis -- a vaccine does not fully ''take''. So, in event of exposure or outbreak, there's no way to know in advance which vaccinated child might get ill.

So you will think: ''After taking the risk of vaccination, my child is still carrying 5% risk of getting the disease? So why should I take the risk to begin with?''

This bring us to the topic of the overall public health. Here what the article says:

''Vaccines are made from weakened or killed viruses (or bacteria) that stimulate the antibody formation without the illness. Once nearly everyone is immunized, it's difficult for the viruses to keep the disease cycle going, a phenomenon known as 'herd immunity'. That's why even unvaccinated kids in the US are far less likely to contract a serious illness that they were just a generation ago, when vaccination rates were much lower. Ironically, herd immunity is also what makes it easier for individuals to opt out. People don's see the disease that vaccines prevent anymore, so they don't think there are compelling reasons to be immunized.''

''But herd immunity can disappear. Last Sept and Oct, in adjoining Westchester and Putnam counties in New York, 33 children and 6 adult caregivers got whooping cough; by Feb, another 34 cases were reported. Health officials traced the outbreak's origin to 4 children in 2 families whose parents chose not to have them vaccinated.''

''Two years earlier, in a county in Germany where the immunization rate for measles was only 76%, a measles epidemic sickened nearly 1000 children. The rest of the country, where the rate averaged 90%, was unaffected''

The article concludes by saying:

''So all kids - those who get their shots; those who can't get their shots due to medical conditions that affect the immune system; and those whose parents refuse shots - rely on our society's near-universal immunization. When children around them don't get sick, the won't get sick, either''.

The last paragraph can be rewording as (I'm sorry if it's too strong to some members of the BPN): Those who chose to opt-out are free-riders of the society since they can afford to opt-out and most of time their kids are OK, because majority of parents chose to take the risk of vaccinations.

Those who can not get the shots due to their medical conditions are in the total mercy of the rest of the population. More parents opt-out, the more dangerous situation their kids are in. Having taking the risk

One of my children had a liver transplant as a baby, and so is not able to be vaccinated against chicken pox or MMR. He is now a thriving 5 year old, but these diseases could be serious and even deadly to him. As you can see, we are literally at the mercy of the community and can only hope that all parents choose to immunize.

Our pediatrician has told us that no medical intervention, Eastern OR Western, has improved health on the scale that immunizations have. It is difficult for some parents, who have never seen the impact of such diseases, to imagine and they worry more about the possible reactions.

Another doctor told us that she saw a child with whooping cough, a very rare disease, in the Children's Hospital ICU because a significant number of the population in this area is choosing not to immunize their kids.

By all means, find answers to your questions and concerns from your child's pediatrician, but PLEASE immunize! julie

Here is the bottom line of our family discussions: all of these diseases that the CDC recommends vaccinations for have been seen somewhat recently in Alameda county. They exist here. Period. Unless your child lives in an isolation bubble (think of that 70's TV movie The Boy in the Bubble), they are at risk of exposure. This is what got me: the standard of care in the emergency department for an infant under 6 mo. with a fever of 102+ and not current on immunizations - is a spinal tap/lumbar puncture. A parent CAN NOT refuse this.

So here is what we negotiated: delay hep B until 1 yr or plans to travel out of the country (I believe we are the only country that screens blood for hep B) and test our caregiver. No more than two immunizations at a time and space them at 6 weeks to try and stay in 'recommended' timeline. We started with Hib and Prevnar. Always do thimerosal free vaccines if available. I have tried to find a separated MMR but it no longer exists in this country, so I am contacting friends abroad. We put off the flu vaccine last winter because by the time our daughter was old enough (my husband wanted it twice and kept arguing with the ped's office about our daughter's weight vs. age) the flu had already peaked. But we will be getting the flu vaccine the first week it is available in the fall. (this is hard for me because I work with teenagers, never get the vacccine, and never get the flu)

I wish you and your baby all the best. found a middle ground that works

UC Childcare & Immunizations

Does anyone know the official and practiced immunization policy of UC Childcare? Does anyone have a non-immunized child that attends, and if so, what was the process of getting them in once you were offered a slot?

How do I exempt out of vaccinations for preschool?

I realize that vaccinations are a hot topic and I'd like to clarify that this question concerns a child who is not able to be fully vaccinated for medical reasons. My question is concerning vaccines and preschools, not the pros and cons of vaccinations. I heard that the Director at a preschool said it is a licensing requirement that if a child is not vaccinated and there is an outbreak of chicken pox, etc., he/she will not be able to return to preschool until they either get and recover from the disease, or wait approximately four weeks until the incubation period has passed. Does anyone on this list know the licensing rules for preschools re: outbreaks and children who are not vaccinated? Concerned.

My 2.5 yr old is going to preschool in the summer and they want the medical forms filled out and turned in. We've decided not to vaccinate her for MMR or Varicella. I understand that legally we're allowed to do this, but how do we get the forms for this? Will a preschool allow us in if we don't do the vaccinations but have the proper forms? Any advice welcome, thanks.

YOu can read the full text of the Immunization Safety Review by the CDC: http://www.iom.edu/IOM/IOMHome.nsf/Pages/MMR+Autism+Summary http://www.cdc.gov/nip/news/iom-04-24.htm

http://www.msnbc.com/news/793320.asp?cp1=1 NEW DELHI, India (AP) Polio cases in India have nearly tripled in the first half of this year compared with the same period a year ago, a jump that could set back the world's drive to wipe out the crippling virus by 2005. The new figures were dismaying for India, which only two decades ago saw tens of thousands afflicted with polio every year, but was now thought to be on the last lap in the race to wipe out the disease after an ambitious immunization campaign.

In some rural areas, Muslim clerics tell their brethren to shun the vaccine, calling it evil and part of a conspiracy by the Hindu-dominated government to limit the birth rate of Muslims, India's largest minority. Most of the new cases were in Uttar Pradesh and Bihar states, according to the Indian government.

Rubella (German measles) is a mild childhood illness that poses a serious threat to the fetus, if the mother contracts the illness during pregnancy. More than 20,000 babies were born with birth defects during an outbreak of rubella in 1964-65. The same outbreak also resulted in at least 10,000 miscarriages and stillbirths.

Fortunately, major outbreaks of rubella no longer occur in this country. Since 1969, when a vaccine for rubella became available, children have been routinely vaccinated, helping to prevent the spread of the illness to susceptible pregnant women. Most women of childbearing age are immune to rubella because they either were vaccinated or had the illness during childhood. Because of widespread use of the vaccine, birth defects caused by rubella have become rare.

However, since small outbreaks of rubella continue to occur, the potential for susceptible pregnant women to become infected continues to exist. As many as 2 in 10 women of childbearing age are susceptible to rubella. Women can protect their future children from the effects of rubella by getting tested for immunity prior to pregnancy and being vaccinated if they are not immune.

Mumps in young adult males (and older) may result in the development of orchitis, an inflammation of the testicles - a condition that ultimately can lead to a decreased sperm count. Usually one testicle becomes swollen and painful about 7 to 10 days after the parotids swell. There is a high fever (often to 106 degrees Fahrenheit or 41.1 degrees Celsius), with shaking chills, headache, nausea and vomiting. After 3 to 7 days, testicular pain and swelling subside, usually about the same time as the fever passes. In some cases, both testicles are involved.

Mumps may also lead to encephalitis or meningitis (inflammation of the brain or the lining of the central nervous system). Symptoms appear 3 to 7 days after parotid swelling begins and may include: high fever, stiff neck, headache, nausea and vomiting, drowsiness, convulsions, loss of consciousness and other signs of brain involvement.

http://www.nytimes.com/2003/02/20/health/20VACC.html

http://www.centerforhealthstudies.org/news/010312.html

http://www.helioshealth.com/cgi-bin/news/news.cgi?212

http://news.bbc.co.uk/1/hi/health/1170424.stm

susan

Exemptions: There are three exemptions to the general rule.

1) Any person 18 years or older, or those seeking admission to a community college. Health and Safety 3384.

2) If the parent or guardian files with the governing board of the respective school district ''a letter or affidavit stating that such immunization is contrary to his or her beliefs.'' ''However, whenever there is good cause to believe that such person has been exposed'' to a communicable diseases ''that person may be temporarily excluded from'' school. Health & Safety 3385.

3) If the parent or guardian files with the governing board a statement by a licensed physician who believes that the immunization wouldn't be safe for the person, along with the nature, duration and contraindications of the medical condition. Health & Safety 3386.

Designated Diseases: Diphtheria, pertussis, tetanus, poliomyelitis, measles and mumps. Additionally, any other disease consistent with recommendations by the US Public Health Service, will require immunizations. Health & Safety 3380(a). (Immunization from Rubella was effectively eliminated. Health & Safety 3381.) Tuberculosis is added under Health & Safety 3400. A ''contrary to his or her beliefs'' exemption is allowed under Health & Safety 3406.

Philosophical Exemption: The following 17 states allow exemption to vaccination based on philosophical beliefs: Arizona, California, Colorado, Idaho, Louisiana, Maine, Michigan, Minnesota, New Mexico, North Dakota, Ohio, Oklahoma, Rhode Island, Utah, Vermont, Washington and Wisconsin.

In many of these states, individuals must object to all vaccines, not just a particular vaccine in order to use the philosophical objection or personal conviction exemption. Many state legislators are being urged by federal health officials and medical organizations, to revoke this exemption to vaccination. If you are objecting to vaccination based on philosophical or personal conviction, keep an eye on your state legislature as public health officials seek to amend state laws to eliminate this exemption.

Medical Exemptions: All 50 states allow medical exemption to vaccination. Proof of medical exemption must take the form of a signed statement by a Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.) that the administering of one or more vaccines would be detrimental to the health of an individual.

Most doctors follow the AAP and CDC guidelines. Most states do not allow Doctors of Chiropractic (D.C.) to write medical exemptions to vaccination. Some states will accept a private physician's written exemption without question. Other states allow the state health department to review the doctor's exemption and revoke it if health department officials don't think the exemption is justified. [In California, DCs can] Anon

Now if this is a Private school, they may have made it manditory that you must vaccinate to attend their school . If you are not going to comply, simply let them know that you are not going to attend this school because of their ruling on this matter and hope that they bend the rules for you. If not, you have no legal rights to push the issue with a private school. Please, if you are still stuck with this one, give us a call, we will help you. Anything to support your choice. Good luck. Dr. Eileen

We, living in the US, so rarely encounter vaccine-preventable diseases, our society has largely forgotten that unvaccinated people are sometimes left with mental and/or physical disabilities, disfigurement, and some die due to vaccine- preventable diseases such as measles, mumps, rubella, and chicken pox. These and other results of vaccine-preventable diseases occur in children as well as adults, and in developed countries as well as developing countries.

Associations that have been made between childhood vaccinations and chronic diseases or conditions (such as autism) have been dispelled through solid epidemiologic investigations, and results have been published by the Centers for Disease Control and Prevention (CDC), and peer-reviewed pediatric journals.

I encourage you to review CDC's website at www.cdc.gov for more information about vaccine-preventable diseases, vaccinations, and investigations into associations between vaccines and other illnesses. Amy

If you do have your child vaccinated, know all the ins and outs of that vaccine, and know the potential side effects of giving them, especially when giving more than one at once. Has anyone wondered why a Rider was added to the Homeland Security Bill that basically protects vaccine manufacturers from major lawsuits (I think class-action ones)? And why they do not properly fund longitudinal studies of side effects, while claiming that they are totally safe? Anyhow, obviously the issue is complex. But respect those of us who question vaccinations. We care about kids just as much as anybody else, and want all kids to be as healthy as they can be. Allisong

Do you realize, that while vaccines are safe for most children they are not safe for me, or my kids. We are allergic to a component in several major vaccines. Because we aren't sure what that is, it's safer not to vaccinate. At least not with the normal guidelines. After my daughter almost died from the allergic reaction, we've worked with her doctors to selectively vaccinate. Her brother will not be vaccinated until he is 2 years old, even then, it will be a case by case basis. It would be really nice to see more people take personal medical history into consideration before judging others. Rachel

Anyway, it is no fun to acquire immunity to these diseases naturally and your child could die or suffer permanent disability by not being vaccinated. So you have to seriously consider those risks as well as the risks your child would pose to your own family and other children if they did come down with one of these preventable diseases. (I was also quarantined in our home for 2 weeks or when I was in kindergarten because of the scarlet fever - along with the other kids in my family). Please be careful about the information you read - there is a lot of misleading information circulating (on both sides of the story). anon

Homeopathic Alternatives to vaccinations

We are not doing any routine vaccinations on our 4.5 month old son for the time being. I am interested in an alternative, homeopathic nosodes. If anyone has done these in lieu of traditional immunizations or who knows of a reputable practioner, please let me know. Melissa

Where Can I get Balanced Info about Vaccinations?

My first baby is due shortly, and I am wrestling with the issue of whether or not to vaccinate (and if I do, which ones might I want and which not?) The fact that people are so polarized on this issue makes the decision(s) that much harder. I know where to find plenty of info at the extreme ends. Does anyone know where I could find a resource who discusses BOTH pros and cons?

There was a mothering magazine special issue on vaccines which is worth reading. They had a panel with 3 pro and 2 con interviewees. It's worth reading this as well as the letters to the editor which followed.

There was also a misc.kids faq on immuniztions a while back. I don't know if it's been updated. I found it quite interesting to read plus it had indivuals describing their own decisions and how they made them.

Good luck in your pursuit of info.

These were some of the onlne resources listed at the end:

     HAVE YOUR SAY

     --To reach us: Respond to THIS WEEK'S TOPIC at sunday AT sfgate.com,
     or join the discussion at sfgate.com/vent/ sunday. For other ways
     to reach us, see Page 5. See inside for feedback to recent
     sections.

     --To learn more about the medical arguments for vaccines, visit
     the web sites for the U.S. Centers for Disease Control at
     www.cdc.gov/nip/vacsafe or the World Health Organization at
     www.who.int/gpv-safety/index.html.

     --To read more about criticisms of vaccines, visit The Global
     Vaccine Awareness League at www.gval.com.

     --To read more about vaccine requirements for California
     students, visit the California Department of Health Services at
     http://www.rain.org/~medmall/specialties/immune/cdhs/ .

     Tim Vollmer is a medical anthropologist and writer based in the
     Bay Area.

There are many problems with vaccinations, but even though we felt very concerned after reading a book about vaccinations from a homeopathic perspective, we agreed that we couldn't live with the possibility that our son would die from an illness we could have vaccinated him against. Once we decided to vaccinate, we focused on HOW to do it. One of the problems with vaccinations is that they are given so early -- earlier than (in some opinions) the baby's own immune system is ready to handle them. A second problem is that they are given in groups, which makes it hard to know what the baby reacts to if there is a reaction.

To address both these problems, we decided to start vaccinations a few months late, and stagger them so he only got one shot per visit. The decision when to start and in what order can be made based on: 1) discussion with your doctor, 2) information about the risk from the illness vs. the risk from the shot, 3) your own anxiety/gut feelings about how long you can wait, and which illness you're most afraid of. We factored all these in and decided to start at 4 months and add another shot every few weeks thereafter. A couple of the vaccinations our doctor agreed are unnecessary for infants altogether so we're skipping them.

The only thing I'd do differently is that I may start a little later. At the time, however, we got anxious about winter coming and potential illnesses.

As an unexpected side benefit, I found giving the baby one shot at a time much more humane than three shots. From friends' stories, I got the impression that it's the second and third shots that really get the babies scared, as opposed to the pain of one shot that does not induce the same fear reaction.

Lastly, make sure you have a flexible, knowledgeable doctor who can accept and support your decision even if he or she does not agree with it. One doctor's office told us on the phone that the doctor would not agree to us not vaccinating our baby -- needless to say, we chose another doctor. We wanted to make sure that whichever way we decided to go, we'd have the doctor's respectful support. Good luck to you, whatever you decide.

           FREE ABSTRACT

           October 3, 2000, Tuesday 
           PERSONAL HEALTH; For the Vaccine-Wary, a Lesson in History 
           By JANE E. BRODY 
           Source: The New York Times
           Section: Health & Fitness 
           1249 words

           Abstract Jane E Brody Personal Health column says most
           parents now raising questions about safety and wisdom of
           childhood immunizations have never seen a case of whooping
           cough, polio, measles or mumps, having been protected
           against such serious infections by series of vaccinations
           administered early in life; warns that ill-informed
           hysteria about safety of current vaccines could once more
           bring these awful childhood diseases to the fore (M)

We are going to be traveling to Dharamsala, India, in late May with our two year old daughter and staying put there for up to six months. Does anyone know if Malaria is a risk in Dharamsala? For the most part it seems like it's not, but if anyone has any personal experience with this I'd appreciate hearing about it. Currently we are giving her all the regular childhood vaccinations as well as Typhoid and Hep A for our travels. Does anyone know if the meningococcal meningitis shot is safe for a child just turned two? Is there any protection from tuberculosis available? Lastly, if anyone has traveled to this area with a small child i'd love to hear about your experience. Zoe