hello my name is lisa gable area and i'm the director of the belmont health collaborative as part of the belmont health collaborative we're going to be doing some interviews over the next six months and i'm very pleased to introduce to you mary conant canter who is the director of nursing at belmont public schools and mary and i are going to talk today about vaccines an occupation and i'm  happy you could make it mary thank you thank you for having me and welcome to belmont public i know i'm thrilled to be here so you started this summer i did i started with the beginning of the school here i was a school nurse many years ago and school nurse leader in lowell for many years before going to the department of public health in boston and i decided i wanted to come back to schools and i want to come back working with kids in this opportunity came up and i absolutely thrilled well we're thrilled to have you as well and i'm excited to be able to have this conversation with you because we hear a lot of talk i hear it on the playgrounds i hear concerns from parents you know you read about it in the paper so we're excited to be able to delve into some of the issues and perhaps dispel some myths and and just share some some information and it's just always great to have an expert so i guess my st question just to get right to it is are vaccines safe vaccines a very safe it's important to understand that in order for a vaccine to be licensed here in the united states there's a multi phase process in which the investigation and research into the the safety and the eff of the vaccine that's being proposed takes place long before the vaccine is ever available to be administered to in a child or an adult this process is multi phased it goes over a long period of time and once a vaccine is licensed by the f d a here in the united states that studies not work does not stop ok those people that participate in vaccine trials are continued to be followed and monitored for the efficacy of the vaccine and any potential side effects that were that could possibly have come from receiving those vaccines so this process is is very expensive on the part of the pharmaceutical companies it's very tedious requires a lot of work a lot of research and ensures that our vaccines are in fact safe after the vaccines are licensed here and in the united states as i said that that study by the pharmaceuticals company does not stop but then there are a multitude of of the ways that we continue to monitor vaccines you know vaccines a license by the f d a there is a group called the advisory committee on immunization practices which is associated with the centers for disease control the c d c in atlanta it's a group of fifteen physicians that are chosen to be are elected to be part of this advisory committee and they are experts in the area of vaccines it is their recommendations beyond the licensure that truly guide how we use our vaccines they look at the original day or and they look at any follow up date or associated with the use of these vaccines to ensure that the recommendations are ensuring that everyone is safe the benefits of the vaccines that we are projecting are in fact true and that if there's any changes in the recommendations they're looking at the literature to actually reflect what those changes may need to be here in massachusetts when i worked for the department i was the representative of the vaccine adverse event reporting system which is a national system with the f d a and the c d c it is a system in which it collects data on licensed vaccines when someone thinks that they could have had an adverse event of the been injured are made ill by vaccine these events can be filed by the person receiving the vaccine the parent of the child receiving the maxing the provider the grandmother there are multiple anyone anyone can file of there's every various is investigated for  concerns are you reasons that we should be looking at the vaccines again and how often does when somebody files this how often does it actually go back to the vaccine versus a confounding factor  well you know it's somewhat hard to say how often there are some very specific examples if you are interested in knowing let's say i want to give my child an h p v vaccine the new human  know what the potential side effects of this vaccine is i want to know what people have already reported so you can go to the various web site just type in there's v a ers dot com and you can get the web site you can actually look at the the adverse events reports that have come in on h p v vaccine and you can see you know what percent are you know i soran what percent you know goes the gamut from a red arm to potential injury and death and you can see the occurrence and you can see when they have determined them to be related to the actual vaccine ok so what i hear you saying is st one of the st vaccines that was ever developed is the vaccine against smallpox for two years i was the smallpox nurse from massachusetts i went around the state and talked about that particular disease and i also vaccinated people with smallpox vaccine smallpox vaccine is is smallpox itself was a human disease a lot of our diseases start now animals and then transmitted over into humans it was specifically a human disease and because of the vaccination products process we were actually able to eradicate smallpox i think it was determined in one thousand nine hundred and seventy two so this is a perfect example where the science of understanding how disease itself that the any bodies that are produced by it will actually will actually protect you against the worst disease of smallpox on the most serious disease of smallpox by doing that by understanding that we were able to not just reduce the cases of smallpox and save lives when and at a time when it was killing very many people but we were able to actually eradicate that from the from the from from the e childhood a p we noticed that by the time children hit middle school they were coming down with pertussis and the reason was that the a cellular component of the new vaccine didn't have the jeopardy of immunity that the whole cell gave people so in two thousand and five they licensed t death and we so we went from thousands of cases of pertussis in massachusetts within a short period of time down to just a few one hundred cases by introducing that booster those and it just shows you how by monitoring and collecting the data in following like in the safety studies following and and looking at a minute and whether it's waning or not we have in control are at least reduce the occurrences of these very deadly and dangerous communicable diseases right so so you mentioned boosters do do all of the vaccinations that babies and children get have a booster requirement are just a subset not all a subset yes one thing that's important to understand is there's different types of vaccines we have live vaccines like we're going to ask you about measles mumps and rubella are m m r vaccine the chicken pox vaccine varicella is another example of a lie vaccine and then we have been activated vaccines like the d t p s the polio as those types of vaccines those are it activated for the most part live vaccines require fewer doses and they do not require a booster to ok immunity you get from the set amount of vaccines that are required in that particular series like for entry into kindergarten it's now to women mars to varicella as we have to ensure that all children in schools starting in two thousand and eleven and phasing in was meeting that requirement here in massachusetts so we know that those two doses is going to be sufficient for people to gain anathem unity to last them their lifetime against those disease the the inactivated vaccines we have to watch them more closely t d for example our tetanus you start as a child with d t a p when you go in at the th grade or you're an adolescent they're going to give you a cheat if you haven't had a teed up as an adult you're going to get one at any point in time but once you hit adolescence you get your teeth up every ten years you need to get another booster those people that participated in those safety trials early on are still followed to see if in fact that that immunity is waning at all to date has not shown that it is waning enough to require a booster dose to all those people that were vaccinated early on and like myself back in the ninety's so this is an example that is very you know for the most part if you want an easy answer live vaccines for the most part don't require a booster some inactivate are inactivated vaccine as well a vaccine like influenza which is a vaccine we were recommended to receive every year is a kind of a combination of  things yes it does you know the immunity stays with you but the but the virus itself more of some mutates each year which requires the continual vaccination so there's different reasons you booster require additional doses one should then backs one type that's very clarifying for knew there was a distinction yet alive versus and this is a helpful distinction let's talk a little bit about you said that there's a teeny tiny amount of of the virus in the vaccine but there also some other things in there and then you hear a lot about the and tell me if i'm saying this right that the merest saul was once in vaccines or it isn't any longer can you talk a little bit about that well it still isn't some vaccine and for the most part in the even in the vaccines it's in it's in small very small trace amounts of of salt in order to produce a vaccine you know and then have multiple doses of vaccine in like one bio preservatives needed to be added and that representation of that type of preserved of it was that it was put in a multi dose file so that you could get  a number of doses of vaccine packaged in one bottle which saves money and that someone like myself a nurse could be puncturing that bio and driving up and not you know not damage the vaccine contaminate the back so i'm aerosol is a preservatives that has been removed from vaccines by the c d c and a lot of that came about with the concern original author of some of the papers dr wakefield was actually has been totally well how do we want to say is discredited by as he himself has actually lost his medical packaging and they do not contain by merest saw the exception being the multi dose vials of influenza vaccine which are still available do does contain time aerosol for that very purpose of puncturing several times but we do provide sufficient here in massachusetts we provide all pediatric vaccines for hiv charge i mean no pediatric influenza vaccine free of charge and we purchase individual scenes preparations for those children as well as pregnant women and it is that it is basically just a precaution i'm aerosols only one of many agents that are in vaccines part of the studies that  around vaccines is the study of how do we take this an agenda of this causative agent and put it into a vaccine and have the smallest amount of that an agenda so that we're sure we're not going to cause disease was sure and we're going to get the greatest mileage out of the image and samples that we have but we want to produce enough ameena day so they add what they call agence are other products that help to the body and recognizing the antigen assist in the immune response reduce the amount of actual disease causing agent whether it be live or an act they did in the vaccines so that the risk factor is extremely low and it's those things that when we interview families are we screen children are adults for vaccination we asked very specific questions about any potential life threatening allergies you know eggs around influenza vaccine gelatin meal myosin are around other types of vaccines these things may be added to the vaccine preparation having to do with assisting the body and respond but if somebody does have one of those allergies there is an alternative that seeing many times there can be an alternative vaccine but remember you know there's now cell mediated influenza vaccine so that those people with egg allergy true egg allergy is we're talking an awful lactic meaning a life threatening allergies to to these components is what would what would prevent someone from next from being able to receive it so the people that really cannot be vaccinated due to an allergic response are on life threatening response is very very small you know when you really look into it but the screening process is built to pick up any any any possible concern for the vaccines that we're in a story ok thank you so i have three teenagers question i hear from a lot of parents out there and you touched on it a little earlier is about the h p v vaccine little one so vaccine they seem to understand the need to get their teenage girls vaccinated because of the cervical very but they're wondering about why the boys why it is not recommended for their boys well you know it's a good question it's a very good question and you know i love you know i think we did a little disservice when we st came out with h p v that we associated with sexually transmitted type of diseases one does not need to have actual sex or intercourse in order to get exposed to h p v ok good thing the most intimate skin to skin contact can also spread it so just because you don't think your child is sexually active if they are exploring and anyway they're at risk it's something to keep in mind girls don't girls can get h p v infection from boys the preventing it voice is also protecting your daughter however you need to look at the types of cancers and diseases that are caused by the h p v virus it's not just cervical cancer ok and that's what's really been astounding so it can cause boys so absolutely head and neck cancers anal and penile cancer those are are also associated with h p v there's some concern at this time that the cervical cancer rate could very well be outpaced by the oral pharyngeal cancers caused by h p v by the one point they were projecting as early as two thousand and twenty now that is still just being theorized but the point i'm making is is that if you are thinking h p v is only going to prevent cervical cancer that is not necessarily true so there are clearly better health benefits for boys health benefits of the war other types of cancers you know and that's a wonderful wonderful vaccine when i was with the department of public health and i would speak about immunity and efficacy of vaccines h p v has been the poster child for our just how how accurate and how efficient the science of vaccines can be the immunity that one receives from three doses of h p v vaccine is in many times stronger and more then that if you were exposed to the actual viruses it's you know it's a piece of the shell of the the virus it does not have any of the active disease causing components it just has a piece of the shell and that piece of shell that that's built into this this this vaccine is is so  efficient you know producing immunity that you know greater than ninety nine percent sociate did pipes that it covers in some people so it's very exciting so the other question that comes up surrounding h p v is i' heard parents say well it's fairly new i'm going to wait until my child is sexually active i'm going to wait until they iron out the kinks but what i heard her say earlier is before it even gets to the point of being administered to o to or to the population that would have been addressed the safety absolutely the safety and as i said if you're concerned go to go on to the various web site look at what the side effects are i can tell you right off the bat you know the  majority of side effects are going to be site related meaning sora and part of that is because of the adjutant's that are in that vaccine you know there's a diptheria component to the vaccine and while that's in h painful you know the vaccine itself as said being administered perhaps that's the association with sink a p or feigning i don't i'm not one hundred percent i'm not hearing you say anything neurological or our know any nothing that it add as a said if you want more information can go you can look on the injury protection plan the vaccine injury protection program that is in place just to compensate people not to say that that makes you feel better about giving a vaccine if i'm going to be compensated and i don't mean it once sexual activity occurs it's in within a year or shot window of time that we see the infection being detected in the sexually active college students that were started in such you know if a child is sexually nine is you know you should still go ahead and vaccinate because the likelihood they're infected with all of them is very slim and all in all probability and they will benefit they will benefit from the  s that are in the vaccine that they have not been infected by by that i mean let's say they had six and eleven that they're infected with all the other strains that are covered in the vaccine they will get protection from think the mess it was h p v is not the st cancer prevention vaccine we have hepatitis b was actually the st cancer prevention vaccine have be as associate them has been known to prevent a very serious complication of hepatic carcinoma that vaccine hepatitis b was slow to be picked up and there was a lot of pushback because had the was also thought to be a sexually transmitted disease and it had a lot of stigma to and i h p v is truly a cancer prevention vaccine which we've been waiting to fall as and why would you play russian roulette you know i wouldn't if i had a i had a child in that age group line him up right there i mean that echoes what our pediatrician has said as well so our time is growing short but i did want to touch base on the belmont population because here we are in and we do hear from parents so a question that parents have asked me is there are actually concerns that not all of the children are vaccinated and although if their children are they know they're protected but what about you know what what happens in belmont with regard are there exemptions and you know are those you know are those children posing any risk to our immunosuppressed children or pregnant teachers if you could just talk a little bit short term sions in what happens entering kindergarten well before i interviewed for this i did go online i did look at our coverage rates which anyone can do anyone can go out to the mass of d p h website immunization website and there is a link there where you can actually see the coverage rate of vaccination and in the individual schools in belmont as  stand right now i was very impressed with belmont has extremely high coverage rate and yes there are you know legally we are allowed to filter and who have medical reasons not to be vaccinated or families with specific really liz years believes ken choose to seek an exemption exemptions and belmont are not anywhere near an excess they are right in line with the rest of the state about one percent of all students and there are the whole point of herd immunity on maintaining high coverage rates is to keep the disease out and protect those that for a medical reason are for a specific religious reason cannot be vaccinated your school nurses here know who those people are that are not vaccinated our job if there is a communicable disease is to immediately identify those people and notify them that they could be at risk so they can seek alternative medicine so ninety nine percent of our students are vaccinated and it isn't ninety percentile they are vaccinated yet it sounds like the nursing the people are watching and they are aware  of of what's happening in the different schools and to keep everybody safe right that that i have to know that is a question that around on my watch well mary thank you so much for coming in there's a lot of great information that you were able to to give out to our community and i felt like i learned some distinctions and i appreciate your time and thank you for all that you do for the children of belmont public schools and where we're fortunate to have you thank you very much i'm