Vaccintations and severe hypospadias, and adult immunizations
I have to get on my soapbox for a moment.
I’ve been quiet on the vaccine topic. And to be clear up front, this article isn’t about which side of the vaccine debate I’m on or what I believe to be right. It’s about my decision with my son and why I made it – and a few interesting changes on the horizon with adult immunizations.
As a mom I believe to each their own. I believe the decisions we make for our children are, for the most part, ours to make. We know our children best and know what works and doesn’t work for them. I am not here to argue for or against vaccines, about the “herd” or about what I believe to be right or wrong regarding vaccination policy. What I am here to argue against is how the 2014-2015 outbreak of measles linked to Disneyland has become a culture war over vaccinations. While this war is nothing new and has been controversial since the 1800’s, with the availability of social media, it’s never been so in-our-face as it is now.
The community and media outlets, including the CDC, are placing pretty heated blame exclusively on parents choosing not to vaccinate their children. But we’re not just talking about children. Most of the Disneyland cases are adults older than 20. Vaccination levels of adults, representing the other half of the population, are not on track with national targets.
Yesterday news came out that my state of Oregon is pushing to become the third in the nation to remove vaccine exemptions, requiring all infants and children to follow the CDC-recommended schedule. Because I’m a research geek, I followed the stream of national news all day, including the hundreds of comments pitted back and forth from each side. If the goal is to convince another to vaccinate or not, is social gang banging the best way to go about it? I just saw the following on Facebook: Jimmy Kimmel Got a Bunch of Actual Doctors to Tell Off Anti-Vaccinators. They use loads of f-bombs targeted exclusively at parents. Perfect.
Regarding vaccinations and severe hypospadias, my third child was born with penoscrotal hypospadias.
Variations of hypospadias range from mild to severe. With glandular hypospadias, the meatus is on the dorsal surface of the glans. With Coronal, the meatus is at or just below the coronal margin, with distal the meatus is on the distal third of the penile shaft, with penoscrotal, the kind my son was born with, the meatus is at the base of the shaft, in front of the scrotum. With scrotal the meatus is on the scrotum or between the genital swellings, and with perineal hypospadias the meatus is below the scrotum or genital swellings. There’s another variant, megameatus intact prepuce, which usually isn’t detected until circumcision, if parents choose that direction.
Hypospadias, especially the more severe forms, can be part of congenital syndromes such as Opitz syndrome, Smith-Lemli-Opitz syndrome, Wolf-Hirschhorn syndrome, Denys-Drash syndrome and Hand-Foot-Genital syndrome. Hypospadias is also a manifestation in some single gene traits affecting sex differentiation, for example, the X linked partial androgen insensitivity syndrome (this is what the doctors thought was the culprit with my son), and the recessive 5-alpha-reductase deficiency. These syndromes are characterized by severe hypospadias and often association with other malformations such as cryptorchidism, bifid scrotum and penoscrotal transposition. More severe forms of hypospadias and other genital defects are also linked to autism – the hot button of the antivaxx crowd. There have been recent studies identifying increased risk for neurodevelopmental disorders in patients with hypospadias, as well as an increased risk for autism spectrum disorders in their brothers, suggesting a common familial (genetic and/or environmental) liability.  Butwicka A. et al. Hypospadias and increased risk for neurodevelopmental disorders. Journal of Child Psychology and Psychiatry. 2014. July 22. doi: 10.1111/jcpp.12290.
Hypospadias becomes complex because it’s unknown the exact genetic and/or combination of environmental factors that cause it. For me, as a mother, this put my child born with penoscrotal hypospadias in a medical exemption, since there was really no telling in his infancy if there were any sensitivities or insensitivities that contributed to his congenital condition. We have no known hypospadias on either side of our families. My personal belief on this one is that as mamas to babies born with severe hypospadias, from penoscrotal to perineal, we’ve probably had enough medical complications and worry to last a lifetime. Considering the potential for increased risk of autism spectrum or other sensitivities to environmental toxins that could contribute to hypospadias, I’ve decided against the CDC-recommended vaccination schedule for my son born with penoscrotal hypospadias, and instead I nurture and protect his immune system with essential oils, homeopathy and homeoprophylaxis. I also keep him home from daycare or other community care centers.
Now, what about adult immunizations?
This is really a post of its own, however since this blog is about hypopsadias and not vaccinations, I’m sneaking it in here out of pure timing and interest. I believe regardless of what side or camp you belong to, this one’s a doosey.
The US Health and Human Services published a 46 page draft proposal on February 5, 2015 in the Federal Register regarding more mandated vaccines for adults. Of special targets were pregnant females, employer-enforced adult vaccinations and stipulations for faith-based groups. There is an open public comment period that ends March 9, 2015 (seven days from the writing of this article), for the community to register their comments or objections. Electronic responses are preferred and may be addressed to Rebecca.Fish@hhs.gov.
According to the HHS’s National Vaccine Plan (NVP), “While the NVP provides a vision for improving protection from vaccine-preventable diseases across the lifespan, vaccination coverage levels among adults are not on track to meet Healthy People 2020 targets. The National Vaccine Advisory Committee and numerous stakeholder groups have emphasized the need for focused attention on adult vaccines and vaccination.” The NAIP [National Adult Immunization Plan] is a five-year national plan. As a national plan, it will require engagement from a wide range of stakeholders to achieve its full vision. The plan emphasizes collaboration and prioritization of efforts that will have the greatest impact. The NAIP also aims to leverage the unique opportunity presented by the implementation of the Affordable Care Act.”
According to the draft proposal, the following vaccines will likely at some point be mandated for adults: pneumococcal vaccine, influenza vaccine (the report discuss rollouts of mandated influenza and others for health care workers), pertussis, hepatitis B, herpes zoster and measles (MMR). It also states:
With the aging of the U.S. population, the public health impact of vaccine-preventable diseases and their complications in adults is likely to grow. The diminishing function of the aging immune system reduces the immune response to vaccination and underscores the need to develop more products for older adults. In addition, NVAC provides forward-looking analyses to identify barriers and challenges to research and development of new vaccines specifically for pregnant women. [Pg.10]
Here’s another scary tidbit: By 2020, the plan seeks for 100% of all pharmacists administering vaccines. [Pg.29] In the draft’s base year of 2012, only 45 percent of adults received a provider-recommended flu shot; whereas by 2020, the plan calls for 90 percent compliance. Flu vaccines don’t fare very high in efficacy ratings or safety for children or older adults.
There is a lot in the Draft National Adult Immunization Plan. There is also a lot at stake regarding goals for adult vaccinations that needs to be considered from all angles. I believe regardless of which camp we’re in, do we want our teenagers on a compulsory HPV schedule through their twenties? Do we want 90% of the population required to receive the flu shot each year? What about our aging parents or grandparents? The NVAC provides ‘One of the five goals of the NVP is to develop new and improved vaccines [Pg. 24] for provider and employer compliance.’ What happens when the same way we require health insurance in the US or pay a fine, we require a vaccine schedule at the CDC’s election or pay a fine? I don’t know about you, but that scares the bejeebers out of me.