Annie’s Dad

17 10 2011

(This testimony was given on behalf of PKIDs to a U.S. House of Representatives’ committee a few years ago. It is so compelling—and, unfortunately, still relevant—that we wanted to share it with you now.)

My name is Dr. Keith Van Zandt, and as a practicing family physician, I appreciate the opportunity to address this committee regarding hepatitis B vaccines. I have degrees from Princeton and Wake Forest Universities, and completed residency training in family medicine here in Washington at Andrews AFB.

Today, however, I am here as a dad. I have five children, two of whom my wife Dede and I adopted from Romania. Our youngest, Adrianna, was nearly four years old when we adopted her from the orphanage, and was found to have chronic active hepatitis B when we performed blood work prior to bringing her home.

She had contracted this from her mother, who died when Annie was nine months old, from the effects of her liver disease as well as tuberculosis. We have been very fortunate to have had some excellent medical care for Annie, but her first year with us was an endless procession of liver biopsies, blood draws and over 150 painful interferon injections I gave to my new daughter at home. Interferon is a form of chemotherapy for hepatitis B that has many side effects and only a 25 to 40% success rate.

We know first-hand the pain and family disruption this completely preventable disease can bring.

You have already heard testimony from some of the world’s leading experts on hepatitis B and its vaccine, and I can add little new information to that. As a family doctor, though, I see patients every day whose lives have been significantly improved by the immunizations we now have available. My forebears in family medicine struggled in the pre-vaccination era with the ravages of horrible diseases that are now of only historical interest.

Preventive immunizations have so changed our world that I am afraid that we no longer remember how horrible some of these diseases were. My family and I have made multiple trips to Romania to work in the orphanages, and unfortunately I have seen the effects of many of these diseases there.

I am certainly aware of the potential for adverse reactions to our current vaccines, but we must maintain the perspective that these reactions are extremely rare. My partners and I in Winston-Salem care for over 40,000 patients, and I can honestly say that in over 20 years of practice we have never seen a serious adverse reaction to any vaccine. I believe that the vast majority of family physicians around the country can say the same. Certainly, I do not wish to minimize the suffering and losses of families who have experienced these problems, but we must remember that immunizations remain the most powerful and cost-effective means of preventing disease in the modern era.

Personally, it still sickens me to know that the disease my daughter has was completely preventable if hepatitis B vaccines had been available to Annie and her mother.

Whereas 90% of adults who contract hepatitis B get better, 90% of children under the age of one go on to have chronic disease, and 15 to 20% of them die prematurely of cirrhosis or liver cancer.

I know first-hand the gut-wrenching feeling of being told your child has a chronic disease that could shorter their life. I know first-hand the worry parents feel when their hepatitis B child falls on the playground, and you don’t know if her bleeding knee or bloody nose will infect her playmates or teachers. I know first-hand the concern for my other children’s health, with a 1 in 20 chance of household spread of hepatitis, and the thankfulness I feel that they have had the availability of successful vaccines. I know first-hand the pain a parent feels for their child as they undergo painful shots and procedures for their chronic disease with no guarantee of cure.

I am not the world’s leading expert on hepatitis B or the hep B vaccine, but I am an expert on delivering the best medical care I can to my patients in Winston-Salem, NC. I am also not the world’s leading expert on parenting children with chronic diseases, but I am the world’s best expert on parenting my five children.

I know professionally that immunizations in general have hugely improved the lives of those patients who have entrusted their medical care to me. I know personally that had the hepatitis B vaccine been available to my daughter, her life and mine would have been drastically different. I am also thankful that my other children have been spared Annie’s suffering by being successfully vaccinated.

Anecdotes of vaccine reactions are very moving, but they are no substitute for good science. Please allow me to continue to provide the best medical care I can with the best system of vaccinations in the world, and allow me to keep my own family safe.

Thank you very much for your time.

Keith Van Zandt, M.D.





Why are Vaccines Mandated?

26 05 2011

Why does the government mandate that millions of children and adolescents receive certain immunizations for school entry?

The more people in a community who are vaccinated, the healthier that community is.  Here is how Dr. Samuel Katz, a renowned vaccine expert and a member of PKIDs’ Medical Advisory Board, explained it before Congress in 1999.

“We know too well that the level of [immunization] protection that we have now established in our children and our communities is a fragile one that depends on what we refer to as community or ‘herd’ immunity.  From the standpoint of effectiveness, modern childhood vaccines are approximately 90 to 95 percent effective.  What that means is that for every 20 children who are vaccinated one or two may not develop a sufficient immune response [or antibodies to fight an infection].

“It cannot be assured that these children will be protected from the virus or bacteria should they encounter it at school, at a playground, at a shopping mall, or at their church daycare.  However, if sufficient numbers of children in a community are immunized, the vaccinated ones protect the unprotected by effectively stopping the chain of transmission in its tracks and drastically lowering the probability that the susceptible child will encounter the bacteria or virus,” said Katz.

Community immunity also helps protect children and adults whose immune systems are compromised or weakened because of another illness or old age.

“As long as the great majority of children receive their vaccines, we will be able to maintain our current level of disease control,” Katz explained.  “However, should the level of community protection drop to the point where the viruses and bacteria travel unimpeded from person-to-person, from school-to-school, and from community-to-community, we instantly return to a past era when epidemics were an accepted part of life.”

America experienced such an outbreak in 1989-91 with the resurgence of measles.  There were 55,622 reported cases mainly in children less than 5 years of age, more than 11,000 hospitalizations and 125 deaths.  States do allow personal exemptions, so parents can choose not to vaccinate their children, but those exemptions carry risk to the child and the public’s health, emphasizing the importance of community immunity.

An article in the Journal of the American Medical Association found that, on average, those children who were exempted from immunizations ran a 35-fold greater risk of contracting measles compared to those who were nonexemptors.

Not only are these children at greater risk of disease, their infections can be the spark that ignites a disease outbreak in a community.

According to Dr. Katz, in the late 1960s and early 1970s, despite the availability of a safe and effective measles vaccine, the United States continued to experience regular epidemics of measles.  Left to individual choice (as opposed to government mandates), only 60 to 70 percent of the community was immunized.

That coverage failed to provide adequate community immunity to prevent an outbreak.

“States without school immunization requirements had incidence rates for measles significantly higher than states with these requirements,” noted Dr. Katz.  “Recognizing these data, other states (not the federal government), quickly adopted similar requirements.  These requirements are supported by the American Academy of Pediatrics.

“The results are striking,” he added.  “Before we had a measles vaccine, an estimated 500,000 cases of measles were reported each year.  In 1998, there were 89 cases of measles in the United States with no measles-associated deaths.  Most counties in the United States were free of measles.  However, we have learned that nearly all of the cases of measles that did occur in the United States were imported from other countries.  This would not have been possible without the “school exclusion” statutes that now exist in every state.  While we hear dramatic stories of exotic diseases that are just a plane ride away, the importation of vaccine preventable diseases into a susceptible population is much more frightening.  Should we allow our community immunity to wane, we will negate all the progress we have made and allow our communities to be at risk from threats that are easily prevented.”

Compulsory vaccination laws in the United States have repeatedly been upheld as a reasonable exercise of the state’s compelling interest even in the absence of an epidemic or a single case.  As the U.S. Supreme Court held in 1905 in the case Jacobson vs. Massachusetts:

“ …in every well-ordered society charged with the duty of conserving the safety of its members, the rights of the individuals in respect of his liberty may at times, under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations as the safety of the general public may demand.”

The Supreme Court makes clear that “the liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint.  There are manifold restraints to which every person is necessarily subject for the common good.   [Liberty] is only freedom from restraint under conditions essential to the equal enjoyment of the same right by others.”

This is one in a series of excerpts from PKIDs’ Infectious Disease Workshop. We hope you find the materials useful – the instructor’s text and activities are all free downloads.

Photo credit: lawtonjm





Sand, Surf, and What?!

25 04 2011

Kids love to dig in the sand and build castles. They’ll work for hours, crafting structures of dizzying heights, sculpting the turrets and drawbridges just so with their hands.

Oh, and getting buried in the sand? Even better.

Turns out, all that digging and getting buried can expose kids to lots of germs.  Researchers found “… evidence of gastrointestinal illnesses, upper respiratory illnesses, rash, eye ailments, earache and infected cuts. Diarrhea and other gastrointestinal illnesses were more common in about 13 percent of people who reported digging in sand, and in about 23 percent of those who reported being buried in sand.”

Just makes your skin crawl, doesn’t it?  Before you give up on the beach, know that there are things we can do to combat the germs.

Tell the kids they can play in the sand, but not to touch their faces with sandy hands, and make sure they clean their hands with soap or sanitizer when they’re done playing.  Also, send them to scrub down in a shower as soon as possible after play.  There’s no guarantee they’ll avoid an infection, but it’ll help.

Kids (and adults) love to swim in pools, lakes, and oceans. We’re usually swimming in urine,  garbage, or who knows what contaminants.  Due to the reality of raw sewage runoff, we could come down with all sorts of infections, including E. coli, after practicing the backstroke.

Blech, but hey, everything carries a risk. There’s no guarantee we’ll get sick or we won’t get sick from swimming.

So go. Swim. Enjoy and shower when you’re done.

Life is too short not to have fun on vaca!

(Photo from dMap Travel Guide)





April: STD Awareness Month

21 04 2011

There are an estimated 19 million new cases of STDs each year in the United States.  That’s too many.  We can significantly cut that number down.

April, the STD Awareness Month, is a time to shine a light on sex and disease.

STDs know no age limits, they can be visible or invisible and, yes, they can even affect our own sons and daughters. STDs also have a serious economic impact, with direct medical costs estimated at $17.0 billion annually  in this country alone.

The majority of STDs are preventable. Just by having a frank discussion with our partners, and using the appropriate protection, we can prevent most sexually transmitted diseases.

These are practical resources to help individuals and parents learn more about STDs and how to deal with current or potential infections:

There is never anything embarrassing about protecting our health. So wrap it up, protect yourself and keep STDs at bay!

(Photo courtesy of Andy54321)





Celebrating Prevention! NIIW 2011

18 04 2011

Protecting babies from infectious diseases is a big deal around here, as evidenced by disease prevention taking up a chunk of space in our mission statement.

National Infant Immunization Week (NIIW), observed April 23-30 this year, is part of a larger global vaccine education initiative with WHO. For the past 17 years in the U.S., the CDC, health departments, and immunization organizations across the country have marked the week as a time to showcase immunization achievements and raise awareness of the need for continued vaccination of babies.

We asked our child immunization friends to share their planned activities, and we did some research of our own to find novel programs to share. To learn about activities in your area, visit the CDC’s NIIW site for details. Here’s a sampling of events coming up for NIIW:

  • Arizona – The Cochise County Health Department is giving free diapers to parents who bring in up-to-date immunization records. Children who need vaccines will also be vaccinated at the event and parents will receive free diapers. Scientific Technologies Corporation is doing a blog series during NIIW and promoting the week on their homepage.
  • Connecticut – The New Britain Immunization Program has collaborated with the New Britain Rock Cats Minor League Baseball Team to give free tickets to stadium visitors who have their children’s immunization records reviewed. The Southwestern Area Health Education Center will honor WIC moms and dads at a Mother’s Day Social where attendees will get education and play CIRTS (Connecticut Immunization Registry and Tracking System) BINGO.
  • Illinois – The Chicago Area Immunization Campaign has partnered with Jewel Osco, a local pharmacy chain, to distribute 15,000 immunization information cards with people’s prescriptions.
  • Nevada – The Northern Nevada Immunization Coalition will host “Give Kids a Boost: Sun Valley Health and Safety Fair” (GKAB Fair) to alleviate the barriers of health care access and transportation.
  • Rhode Island – The Rhode Island Department of Health has partnered with birthing hospitals and childcare centers to have area children to draw pictures inspired by the story “The Flu and You,” by Geri Rhoda, RN. The pictures will be used on placemats designed for use in the maternity wards and will include the infant immunization schedule and information about the importance of vaccinating caregivers with Tdap.
  • Texas – The Hidalgo County Health & Human Services Department will host an event with speakers from Mexico and Texas educating promotoras (health educators in Latino communities) on vaccine preventable diseases, the importance of vaccines, and the Mexico/US immunization schedule. The Immunize Kids! Dallas Area Partnership is reaching out to Hispanic families and women’s centers with education packets and presentations.

Do you have great activities planned for NIIW? Post a comment and tell us about it!

(photo courtesy snorp on Flickr)





Ryan is Hepatitis C+

14 03 2011

(Guest post from Nora, Ryan’s mom.)

courtesy sugar daze

As a little girl, I dreamed of being a wife and mother with a home filled with children. 

When I realized that “prince charming” wasn’t showing, I knew I could still be a mom.  When I set out on the journey alone, I thought it would take forever, however I was a lucky one.  I signed with an adoption agency in June of 2002, and my son was born in August 2002. 

When the agency told me they had a birthmother looking for a single mom, I questioned why? In speaking to the birthmom she said “she had grown up in a household where her parents fought a lot, so her thought was if there was one parent she was ok with that.”  Anyway, it worked out great for me. 

 The agency told me the mother was a drug user and had hepatitis B and C.  I thought “OK so what does that mean?”

I was able to get the birthmom’s medical records as well as my son’s records, once he was born, and have then reviewed.  At birth, my son’s blood was non-reactive to hepatitis C and of course he was given the vaccine for hepatitis B.  OK, non-reactive that’s good right?  Well it really doesn’t mean anything except that the virus is not active as of right now, and we would have to wait until he was 15 months old to run further blood work. 

 When I was asked if I still wanted to adopt him, I thought they were crazy, well of course.  He was my son, it was meant for me to be his mom and my blessing from above.  We plugged along with him over the first year having some issues, having to be withdrawn from the drugs he was born addicted to, having a bout of meningitis, bladder infections, a lot of virus issues etc.  Then the dreaded 15 month time frame was here. 

Ok we went and had the blood work and I just knew in my heart that since I had been told that there was less than a 1% chance that he would have hepatitis C that we would be doing this just to get the all clear.  I remember it was right before Thanksgiving and I was going into the mall to shop when my cell phone rang.  It was Ryan’s pediatrician who was a friend that I had worked with over the years.  I couldn’t believe what I was hearing, his blood work was positive for hepatitis C.  What, say that again?  You have to be wrong, right? 

No, he wasn’t wrong.  He told me to enjoy the holiday and he would see me right after.  Enjoy the holiday, are you kidding me, how would I ever enjoy anything again? 

You see for me the first 15 months of my son’s life was spent dealing with the other issues, and not ever really thinking that we would have to deal with HCV.  I didn’t really know a lot about it and my first thought was “Oh my God, I am going to have to watch my child suffer.” 

Well over the next week I began researching and reading everything I could on hepatitis.  By the time Ryan got in to see the GI specialist, I knew we had to run a genotype screening and viral load blood work.  I was in an attack mode and wanted my baby fixed.  Well I wish it was that easy.  The GI physician here at our local Childrens’ Hospital told me that there was not much info on children dealing with this disease and he would follow Ryan with blood work and ultrasounds every six months, and at age 3 we would treat him. 

WHAT, I wanted something done now.  Of course I realized in my mind that that was not the protocol and that I had to trust the doctors.  That was hard for me, I wanted to be in control over what happened with my son, not this horrible disease that could be eating away at his liver.  How would I allow it to go on for another 2 years before we did anything?  Of course, now I realize the harshness of the treatment, but at that time I just wanted it not to be true.  I prayed that I would be strong for my son and be able to gain as much knowledge as I could about this monster living within his blood and liver.  

(Ryan is finally in treatment.)





Ryan and HCV

7 02 2011

Ryan’s mom Nora talks about Ryan and his daily struggles with the difficulties in treating hepatitis C infection.

Listen now!

Right-click here to download podcast (7.5 mins/3mb)