[linked to an Article by Jenny McCarthy]  The “One Poke per Visit” or “One Shot Rule” for Vaccines.   Sounds reasonable.  


Jennifer McCarthy states in this article:  


“I am not “anti-vaccine.” This is not a change in my stance nor is it a new position that I have recently adopted. For years, I have repeatedly stated that I am, in fact, “pro-vaccine” and for years I have been wrongly branded as “anti-vaccine.” My beautiful son, Evan, inspired this mother to question the “one size fits all” philosophy of the recommended vaccine schedule. I embarked on this quest not only for myself and my family, but for countless parents who shared my desire for knowledge that could lead to options and alternate schedules, but never to eliminate the vaccines. . . . I believe in the importance of a vaccine program and I believe parents have the right to choose one poke per visit. I’ve never told anyone to not vaccinate.” 

Source: chicago.suntimes.com

Jenny McCarthy can successfully "backtrack" all of her criticisms about childhood vaccinations with this logic.  Her reasons or explanation for the strongly worded versions of her criticisms posted several months ago about vaccinating children seem reasonable.    


In her article she explains her criticisms as follows:    




Blatantly inaccurate blog posts about my position have been accepted as truth by the public at large as well as media outlets (legitimate and otherwise), who have taken those false stories and repeatedly turned them into headlines. What happened to critical thinking? What happened to asking questions because every child is different?   


For my child, I asked for a schedule that would allow one shot per visit instead of the multiple shots they were and still are giving infants.   


[End Quote]


In a review I drew up ten years ago about immunizations for a Medicaid Program working at 95-96% success if providing complete shots, one of the major causes I uncovered for overimmunizing and underimmunizing children was the use of combinations, and how much they varied in their rates of administration.    


Was this a supply problem? I asked the team.  Perhaps.  Shortages two years before had caused a more than 25% reduction in normal year to year immunization series completions for children less than 2 years of age.   


The availability of combinations certainly lessens the number of injections a kid has to receive significantly.  The administration of three or four, or even five different single shots per visit to kids seems to be bordering on torture.  McCarthy complained about six, and probably not all on the same body part.   


McCarthy continues    




“People have the misconception that we want to eliminate vaccines,” I told Time Magazine science editor Jeffrey Kluger in 2009. “Please understand that we are not an anti-vaccine group. We are demanding safe vaccines. We want to reduce the schedule and reduce the toxins.”   


This is what I believe:   


I believe in the importance of a vaccine program and I believe parents have the right to choose one poke per visit. I’ve never told anyone to not vaccinate. Should a child with the flu receive six vaccines in one doctor visit? Should a child with a compromised immune system be treated the same way as a robust, healthy child? Shouldn’t a child with a family history of vaccine reactions have a different plan? Or at least the right to ask questions?   


[End Quote]   



So, let’s do the math here – – –    


There are 49 vaccinations required by the age of 6   (http://www.nvic.org/CMSTemplates/NVIC/pdf/49-Doses-PosterB.pdf&nbsp😉   


36 between the ages of 0 and 2.   


13 between the ages of 2 and 6.      


36 vaccinations/24 months, or 1.5/month, 3 every two months, on the average.  Ideally, the first 12 month’s worth of visits are at least every two months, if not monthly the first quarter of life.  Including day zero or one as a vaccination day as well (for HepB), we have the possibility of 7 visits to given the bulk of these vaccines.  That leaves a 15, 18 and perhaps 21 month visit, leading up the the end date of 24 months visit, totaling somewhere between 10 and 12 visits total for 36 shots.  (The page linked to has one less visit for year 1, and no real visit counts implied up to 18 months, but the same range given above, minus 1).     


the explanation McCarthy gives seems reasonable.  But if you look at the combos required, there are just a few ways to produce the combinations needed to make fewer shots.  The calendar is too complex for between shot periods.  Based on the way the immunizations are sequenced, assuming traditional combos where they can be applied, the sequence for completion before two years of age is as follows (in numbers of shots).


1-8-7-8-1-10-1 (36) types of immunizations administered as:  

1 + 4 + 3 + 5 + 1 + 5 + 1 (20) injections.


(again, see http://www.nvic.org/CMSTemplates/NVIC/pdf/49-Doses-PosterB.pdf


This logic, by the way, doesn’t take into account the 2, 3 and 4 vaccination combos out there (i.e. DTaP, MMR, the rare duplexes for the latter, a new 4some or two being tested).   


The diversity or the product line is why we over-administer some more than others.  The fact that some immunizations need 1, 2, 3, 4, 5 or even 6 administrations to meet the requirements (18 if you add the 12 influenzas requied for 7-18 years of age), only adds to what you may find, if you are searching for reasons to complain.


The point is, there is limit to the math skills required to determine if and how you are going to abide by recommendations. I guess the real question here is ‘what value do you assign to your kid’s life?’  These problems exist because of the value we assign to them.   (And I admit, I wonder how many kids, if any, get the total numbers of flu shots recommended by the time they reach 18).  


Parental responsibility is the issue here.  If the kid had to take an epilepsy medication in some unique cycle, you would probably do it, right?  A kid with diabetes needs that medicine when he/she needs it, not when some calendar says he/she should take it.  A kid with asthma doesn’t wait until it’s too late (I hope).  A kid in need of regular visit because he/she is unhealthy–wait, that’s also required for healthy kids as well–kids in need of well visits must attend to them for the same line of reason.  


So imagine what Jenny McCarthy was telling us did happen, that there were people who abided by the rule of one shot per visit.  How many visits would that require.  


The math above says a minimum of 20 shots are needed with the combos available, or 20 visits in two years.  That’s a little less than one per month.  12 visits the first year to be sure you meet the expectations, 8 the following year.  Maybe with the first two months turned into frequent biweekly visits, to lower the pressure even more.


At 20 visits, $10-20 copay each, that $200/year.  Not too bad, if you can afford it.  On Medicaid, this could be a totally different problem to resolve.  


So, let’s try no co-pay per well visit.  Now you’re demanding much more physicians’ office time, maybe even doubling it per year per patient for pediatrics and newborn specialists, or kids with chronic diseases so young in life.  This is just for 20 visits total.  If you miss one, you narrow the time frame significantly about how and where to make up for that loss.  If you skip it again, your chances drop further for completing the series on time.  If you skip a third visit, even in the second year, you have little to no chance of recovery.


Now let exchange this for what if you skipped some visits, never fully vaccinated your child, and he/she was taken ill.  How much would that event cost you? your insurance agency?


It not only costs you the cost of treatment and hospitalization for the illness, but also the possibility of post-infection consequences, changes in cognition, hearing, onset of epilepsy due to febrile seizures, potential for later life autoimmune and re-exacerbation consequences.


In 2011, a cost of $799,000 was assigned to a 2008 measles outbreak (14 cases, 363 suspected), involving the care of 7 people, in two hospitals.  (http://www.modernhealthcare.com/article/20131130/MAGAZINE/311309983


The cost of having your child cared for if and when you mess up with an immunization isn’t cheap.  Can you or your insurance agency afford the bill?   (Celebrity status not included.)  


In a very recent study it was shown that vaccinations save us $13.5B in direct medical care costs (Zhou, F., et al. (2014). Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009. Pediatrics, 133(4):577-585).




REFERENCES and other resources:


Is the Anti-Vaccination Movement to Blame for Disneyland’s Measles Outbreak?  By Jennifer Swann | Takepart.com.  January 11, 2015 3:56 PM.  Takepart.com.  http://news.yahoo.com/anti-vaccination-movement-blame-disneyland-measles-outbreak-205657288.html


For more on costs and immunizable disease outbreaks, see


Parker, A. A., Staggs, W., Dayan, G. H., Ortega-Sánchez, I. R., Rota, P. A., Lowe, L., … & LeBaron, C. W. (2006). Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States. New England Journal of Medicine, 355(5), 447-455.



Sugerman, D. E., Barskey, A. E., Delea, M. G., Ortega-Sanchez, I. R., Bi, D., Ralston, K. J., … & LeBaron, C. W. (2010). Measles outbreak in a highly vaccinated population, San Diego, 2008: role of the intentionally undervaccinated. Pediatrics, 125(4), 747-755. 

http://pediatrics.aappublications.org/content/early/2010/03/22/peds.2009-1653.short  (more than $10,000 per case, 750/day for quarantine.)


Zhou F, Shefer A, Wenger J, et al. Economic evaluation of
the routine childhood immunization program in the United
States, 2009. Pediatrics. 2014;133(4):577-585.



Mona Patel, MPH; Laura Pabst, MPH; Sajal Chattopadhyay, PhD; David Hopkins, MD, MPH; Holly Groom, MPH; Stuart Myerburg, JD; Jennifer Murphy Morgan, MSPH; and the Community Preventive Services Task Force.  Economic Review of Immunization Information Systems to Increase Vaccination Rates: A Community Guide Systematic Review.  



The Value of Vaccines in Disease Prevention




See on Scoop.itEpisurveillance