Immunization: Childhood and Travel Health, Fourth Edition


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Our Vaccine Philosophy

The book gives a thorough introduction to the history of immunization, vaccine technology and immunology, and compares international schedules of routine immunizations. Each vaccine is then presented separately, including contraindications, local and general side and adverse effects, administration advice, special precautions and notes, vaccine availability, storage, and well-referenced comments on issues surrounding each vaccine, including controversies.

A description of the infection caused by the relevant microorganisms follows, together with data on disease notifications and immunization coverage. A considerable number of maps illustrate endemicity of diseases. One section is dedicated to issues relevant to primary care such as immunization fees and targets, audit, electronic recall systems, patient group directions and issues surrounding the immunization work of the practice nurse.

The Fourth Edition includes an extensive section on travel health, which includes the latest travel statistics, travel clinics, detailed advice to travellers and legal issues that may arise. A considerable amount of information is included on air travel, contraindications to travel, and high altitude sickness. Specific information is given on advising travellers at risk because of pre-existing conditions, and how to best deal with the returned traveller. Advice is provided for each disease, including malaria, which is covered in detail. The last section contains information on notifiable diseases, reciprocal healthcare agreements, contact numbers for Embassies and High Commissions in London, a world travel advice checklist, and an extensive list of sources of travel information with contact address.

Undetected location. NO YES. As of June 16, 78 cases of measles had been confirmed in the state, 71 were unvaccinated and 65 were Somali-Americans. Around the same time, disgraced former doctor Andrew Wakefield visited Minneapolis, teaming up with anti-vaccine groups to raise concerns that vaccines were the cause of autism, [] [] [] [] despite the fact that multiple studies have shown no connection between the MMR vaccine and autism.

From fall to early , New York State experienced an outbreak of over confirmed measles cases. Many of these cases were attributed to ultra-Orthodox Jewish communities with low vaccination rates in areas within Brooklyn and Rockland County. State Health Commissioner Howard Zucker stated that this was the worst outbreak of measles in his recent memory. In January , Washington state reported an outbreak of at least 73 confirmed cases of measles , most within Clark County , which has a higher rate of vaccination exemptions compared to the rest of the state.

This led state governor Jay Inslee to declare a state of emergency, and the state's congress to introduce legislation to disallow vaccination exemption for personal or philosophical reasons. In , an outbreak of measles occurred in the Welsh city of Swansea. One death was reported. Most cases of pediatric tetanus in the U. Despite this, his parents declined the administration of subsequent tetanus boosters or other vaccinations.

As of September , a measles epidemic was ongoing across Europe, especially Eastern Europe. In Romania, there were about cases of measles, and 34 people—all of whom were unvaccinated—had died of measles. In , doctor Christa Todea-Gross published a free downloadable book online, this book contained misinformation about vaccination from abroad translated into Romanian, which significantly stimulated the growth of the anti-vaccine movement.

By February , however, the stockpile of MMR vaccines was depleted, and doctors were overburdened. Around April, the vaccine stockpile had been restored. By March , the death toll had risen to 62, with 15, cases reported. While some anti-vaccinationists openly deny the improvements vaccination has made to public health, or succumb to conspiracy theories , [] it is much more common to cite concerns about safety.

The overwhelming success of certain vaccinations has made certain diseases rare and consequently this has lead to incorrect heuristic thinking among people who are vaccine hesitant. Various concerns about immunization have been raised. They have been addressed and the concerns are not supported by evidence.

First, some investigators suggest that a medical condition of increasing prevalence or unknown cause is an adverse effect of vaccination. The initial study and subsequent studies by the same group have inadequate methodology—typically a poorly controlled or uncontrolled case series. A premature announcement is made about the alleged adverse effect, resonating with individuals suffering from the condition, and underestimating the potential harm of forgoing vaccination to those whom the vaccine could protect.

Other groups attempt to replicate the initial study but fail to get the same results. Finally, it takes several years to regain public confidence in the vaccine. The idea of a link between vaccines and autism has been extensively investigated and conclusively shown to be false. Nevertheless, the anti-vaccination movement continues to promote myths, conspiracy theories , and misinformation linking the two.

Thiomersal spelled "thimerosal" in the US is an antifungal preservative used in small amounts in some multi-dose vaccines where the same vial is opened and used for multiple patients to prevent contamination of the vaccine. Thiomersal is now absent from all common US and European vaccines, except for some preparations of influenza vaccine.

In the UK, the MMR vaccine was the subject of controversy after the publication in The Lancet of a paper by Andrew Wakefield and others reporting case histories of 12 children mostly with autism spectrum disorders with onset soon after administration of the vaccine. This suggestion was not supported by the paper, and several subsequent peer-reviewed studies have failed to show any association between the vaccine and autism. In , The Sunday Times reported that Wakefield had manipulated patient data and misreported results in his paper, creating the appearance of a link with autism.

A special court convened in the United States to review claims under the National Vaccine Injury Compensation Program ruled on February 12, that parents of autistic children are not entitled to compensation in their contention that certain vaccines caused autism in their children. The concept of vaccine overload is flawed on several levels. Of the 1, children in the study, one quarter of those diagnosed with autism were born between and , when the routine vaccine schedule could contain more than 3, antigens in a single shot of DTP vaccine.

The vaccine schedule in contains several more vaccines, but the number of antigens the child is exposed to by the age of two is Any experiment based on withholding vaccines from children has been considered unethical, [] and observational studies would likely be confounded by differences in the health care-seeking behaviours of under-vaccinated children.

Thus, no study directly comparing rates of autism in vaccinated and unvaccinated children has been done. However, the concept of vaccine overload is biologically implausible, as vaccinated and unvaccinated children have the same immune response to non-vaccine-related infections, and autism is not an immune-mediated disease, so claims that vaccines could cause it by overloading the immune system go against current knowledge of the pathogenesis of autism.

As such, the idea that vaccines cause autism has been effectively dismissed by the weight of current evidence. There is evidence that schizophrenia is associated with prenatal exposure to rubella , influenza , and toxoplasmosis infection. For example, one study found a sevenfold increased risk of schizophrenia when mothers were exposed to influenza in the first trimester of gestation.

This may have public health implications, as strategies for preventing infection include vaccination, simple hygiene, and, in the case of toxoplasmosis, antibiotics. Aluminium compounds are used as immunologic adjuvants to increase the effectiveness of many vaccines. However, recent case-controlled studies have found no specific clinical symptoms in individuals with biopsies showing MMF, and there is no evidence that aluminium-containing vaccines are a serious health risk or justify changes to immunization practice. Vaccine hesitant people have also voiced strong concerns about the presence of formaldehyde in vaccines.

Formaldehyde is used in very small concentrations to inactivate viruses and bacterial toxins used in vaccines. When the U. During the flu pandemic , significant controversy broke out regarding whether the H1N1 flu vaccine was safe in, among other countries, France. Numerous different French groups publicly criticized the vaccine as potentially dangerous. Other safety concerns about vaccines have been promoted on the Internet, in informal meetings, in books, and at symposia. These include hypotheses that vaccination can cause sudden infant death syndrome , epileptic seizures , allergies , multiple sclerosis , and autoimmune diseases such as type 1 diabetes , as well as hypotheses that vaccinations can transmit bovine spongiform encephalopathy , hepatitis C virus , and HIV.

These hypotheses have been investigated, with the conclusion that currently used vaccines meet high safety standards and that criticism of vaccine safety in the popular press is not justified. Furthermore, some vaccines are probably more likely to prevent or modify than cause or exacerbate autoimmune diseases. The act of spacing out vaccinations may actually lead to more stressful stimuli for the child.

In Pakistan, there have been several attacks and deaths among vaccination workers. Several Islamist preachers and militant groups, including some factions of the Taliban , view vaccination as a plot to kill or sterilize Muslims. The clip was taken from a TV show that exposed the baseless rumors. There are several other vaccination myths that contribute to parental concerns and vaccine hesitancy. Many parents are concerned about the safety of vaccination when their child is sick. Another common anti-vaccine myth is that natural infection produces better immune protection against contracting the illness in the future when compared to vaccination.

The idea that the HPV vaccine is linked to increased sexual behavior is not supported by scientific evidence. A review of nearly 1, adolescent girls found no difference in teen pregnancy , incidence of sexually transmitted infection , or contraceptive counseling regardless of whether they received the HPV vaccine or not. Other concerns have been raised about the vaccine schedule recommended by the Advisory Committee on Immunization Practices.

The immunization schedule is designed to protect children against preventable diseases when they are most vulnerable. The practice of delaying or spacing out these vaccinations increases the amount of time the child is susceptible to these illnesses. Effective management of vaccine hesitancy is challenging and optimal strategies for approaching it remain uncertain. Several communication strategies are recommended for use when interacting with vaccine-hesitant parents. These include establishing honest and respectful dialogue; acknowledging the risks of a vaccine but balancing them against the risk of disease; referring parents to reputable sources of vaccine information; and maintaining ongoing conversations with vaccine-hesitant families.

Limited evidence suggests that a more paternalistic or presumptive approach "Your son needs three shots today.

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Parents may be hesitant to have their child vaccinated due to concerns about the pain of vaccination. There are several strategies that can be used to reduce the child's pain. It is unclear whether interventions intended to educate parents about vaccines improve the rate of vaccination. It is recommended that healthcare providers advise parents against performing their own web search queries since many websites on the Internet contain significant misinformation. Vaccine hesitancy is becoming an increasing concern, particularly in industrialized nations. Both high and low socioeconomic status as well as high and low education levels have all been associated with vaccine hesitancy in different populations.

Multiple major medical societies including the Infectious Diseases Society of America , the American Medical Association , and the American Academy of Pediatrics support the elimination of all nonmedical exemptions for childhood vaccines. Compulsory vaccination policies have been controversial as long as they have existed, with opponents of mandatory vaccinations arguing that governments should not infringe on an individual's freedom to make medical decisions for themselves or their children, while proponents of compulsory vaccination cite the well documented public health benefits of vaccination.

Vaccination policy involves complicated ethical issues, as unvaccinated individuals are more likely to contract and spread disease to people with weaker immune systems, such as young children and the elderly, and to other individuals in whom the vaccine has not been effective. However, mandatory vaccination policies raise ethical issues regarding parental rights and informed consent. In the United States, vaccinations are not truly compulsory, but they are typically required in order for children to attend public schools.

Medical ethicist Arthur Caplan argues that children have a right to the best available medical care, including vaccines, regardless of parental feelings toward vaccines, saying "Arguments about medical freedom and choice are at odds with the human and constitutional rights of children. A review of court cases from to found that, of the nine courts that have heard cases regarding whether not vaccinating a child constitutes neglect, seven have held vaccine refusal to be a form of child neglect.

To prevent the spread of disease by unvaccinated individuals, some schools and doctors' surgeries have prohibited unvaccinated children from being enrolled, even where not required by law. Since most religions were started far before vaccinations were invented, scriptures do not specifically address the topic of vaccination.

Some Christian opponents argued, when vaccination was first becoming widespread, that if God had decreed that someone should die of smallpox, it would be a sin to thwart God's will via vaccination. Judaism supports vaccination. However, when the first vaccines were successfully introduced, he stated: "Every parent should have his children vaccinated within the first three months of life.

Failure to do so is tantamount to murder. Even if they live far from the city and have to travel during the great winter cold, they should have the child vaccinated before three months. In the United States, there are currently only three states Mississippi, West Virginia, and California that do not provide exemptions based on religious beliefs. The cell cultures of some viral vaccines, and the virus of the rubella vaccine, [] are derived from tissues taken from therapeutic abortions performed in the s, leading to moral questions.

For example, the principle of double effect , originated by Thomas Aquinas , holds that actions with both good and bad consequences are morally acceptable in specific circumstances, and the question is how this principle applies to vaccination. Many forms of alternative medicine are based on philosophies that oppose vaccination including germ theory denialism and have practitioners who voice their opposition.

As a consequence, the increase in popularity of alternative medicine in the s planted the seed on the modern anti-vaccination movement. Historically, chiropractic strongly opposed vaccination based on its belief that all diseases were traceable to causes in the spine and therefore could not be affected by vaccines. Daniel D. Palmer — , the founder of chiropractic, wrote: "It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison. Although most chiropractic colleges try to teach about vaccination in a manner consistent with scientific evidence, several have faculty who seem to stress negative views.

One of the study's authors proposed the change in attitude to be due to the lack of the previous influence of a "subgroup of some charismatic students who were enrolled at CMCC at the time, students who championed the Palmer postulates that advocated against the use of vaccination". The American Chiropractic Association and the International Chiropractic Association support individual exemptions to compulsory vaccination laws. They had also opposed a bill related to vaccination exemptions.

Several surveys have shown that some practitioners of homeopathy , particularly homeopaths without any medical training, advise patients against vaccination.

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Homeopathic "vaccines" nosodes are ineffective because they do not contain any active ingredients and thus do not stimulate the immune system. They can be dangerous if they take the place of effective treatments. In Canada, the labeling of homeopathic nosodes require the statement: "This product is neither a vaccine nor an alternative to vaccination. Alternative medicine proponents gain from promoting vaccine conspiracy theories through the sale of ineffective and expensive medications, supplements, and procedures such as chelation therapy and hyperbaric oxygen therapy , sold as able to cure the 'damage' caused by vaccines.

Conversely, alternative medicine providers have accused the vaccine industry of misrepresenting the safety and effectiveness of vaccines, covering up and suppressing information, and influencing health policy decisions for financial gain. In addition to low profits and liability risks, manufacturers complained about low prices paid for vaccines by the CDC and other US government agencies.

The United States has a very complex history with compulsory vaccination , particularly in enforcing compulsory vaccinations both domestically and abroad to protect American soldiers during times of war.

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There are hundreds of thousands of examples of soldier deaths that were not the result of combat wounds, but were instead from disease. American soldiers in other countries have spread diseases that ultimately disrupted entire societies and healthcare systems with famine and poverty. As a military police power and as colonizers the United States took a very hands-on approach in administering healthcare particularly vaccinations to natives during the invasion and conquest of these countries.

These soldiers invaded Cuba, Puerto Rico, and the Philippines and connected parts of these countries that had never before been connected due to the countries sparse nature thereby beginning epidemics. Military personnel used Rudyard's Kipling's poem " The White Man's Burden " to explain their imperialistic actions in Cuba, the Philippines, and Puerto Rico and the need for the United States to help the "dark-skinned Barbarians" [] reach modern sanitary standards.

American actions abroad before, during, and after the war emphasized a need for proper sanitation habits especially on behalf of the natives. Natives who refuse to oblige with American health standards and procedures risked fines or imprisonment. If entire villages refused the army's current sanitation policy at any given time they risked being burnt to the ground in order to preserve the health and safety of soldiers from endemic smallpox and yellow fever.

Military personnel in Puerto Rico provided Public Health services that culminated in military orders that mandated vaccinations for children before they were six months old, as well as a general vaccination order. This period began the United States' movement toward an expansion of medical practices that included "tropical medicine" in an attempt to protect the lives of soldiers abroad.


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Confidence in vaccines varies over place and time and among different vaccines. Refusal of the MMR vaccine has increased in 12 European states since The project published a report in assessing vaccine hesitancy among the public in all the 28 EU member states and among general practitioners in ten of them. Younger adults in the survey had less confidence than older people. Most of the GPs did not recommend the seasonal influenza vaccine.

Confidence in the population correlated with confidence among GPs. This is a database of reports of issues associated with vaccines. When used appropriately VAERS is a useful tool for investigation, but since anyone can make a claim and have it entered into the VAERS, by itself it is not a reliable source of information.

From Wikipedia, the free encyclopedia. Unsubstantiated scares regarding immunisation. General information. Alternative medicine Alternative veterinary medicine Quackery Health fraud History of alternative medicine Rise of modern medicine Pseudoscience Antiscience Skepticism Skeptical movement National Center for Complementary and Integrative Health Terminology of alternative medicine. Fringe medicine and science. Conspiracy theories.

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Allopathic medicine Alternative medical systems Mind—body intervention Biologically-based therapy Manipulative methods Energy therapy. Traditional medicine. Adrenal fatigue Aerotoxic syndrome Autistic enterocolitis Candida hypersensitivity Chronic Lyme disease Electromagnetic hypersensitivity Heavy legs Leaky gut syndrome Wilson's temperature syndrome Wind turbine syndrome.

See also: Swansea measles epidemic. Play media. Main article: Vaccines and autism. Main article: Thiomersal and vaccines. Main article: MMR vaccine and autism. Further information: Vaccination policy. Main article: Vaccination and religion. See also: Homeopathy Plus! Further information: Cyberwarfare by Russia.

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Immunization: Childhood and Travel Health, Fourth Edition Immunization: Childhood and Travel Health, Fourth Edition
Immunization: Childhood and Travel Health, Fourth Edition Immunization: Childhood and Travel Health, Fourth Edition
Immunization: Childhood and Travel Health, Fourth Edition Immunization: Childhood and Travel Health, Fourth Edition
Immunization: Childhood and Travel Health, Fourth Edition Immunization: Childhood and Travel Health, Fourth Edition
Immunization: Childhood and Travel Health, Fourth Edition Immunization: Childhood and Travel Health, Fourth Edition
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