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​Selected Media Coverage & Op-Eds


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  When it Comes to the Coronavirus Outbreak, there are Clear Lessons from SARS and Ebola
We are once again faced with the outbreak of an emerging pathogen with potentially global implications. We don’t know how bad it will get. But there is no excuse for not getting ready for the worst. We already know the consequences of inaction.

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How physicians can fight misinformation about vaccines
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Today, patients’ concerns about vaccinations fall along a spectrum, with some refusing all vaccines while others are more hesitant about specific immunizations like the MMR vaccine or receiving several vaccines at once.
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As vaccines have eradicated illnesses, some patients no longer view these diseases as threats. They may believe that real or perceived adverse events from vaccinations are a bigger threat than the illnesses themselves, says Saad Omer, MBBS, MPH, Ph.D., director of the Yale Institute for Global Health in New Haven, Conn., and a vaccination researcher.

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We’re finally studying how to combat the anti-vax movement, but the methods may surprise you​

Despite anti-vax movements being nearly as old as the first vaccine, there hasn’t been much research at all on how to convince parents to vaccinate. Public health officials have learned some lessons from their own efforts to increase vaccination rates, but that’s not the same thing as truly understanding what works and what doesn’t.
“There’s a little bit of a Dunning-Kruger effect going on where knowing a little bit about it means we think we know a lot more than we do,” says Saad Omer, an epidemiologist and vaccinologist at Emory University who regularly serves on advisory boards for vaccine-preventable diseases. “People don’t feel entitled to talk about the microbiology of a virus without having enough experience, but anyone with an advanced degree feels entitled to talk about vaccine acceptance.” In other words, doctors and virologists shouldn't talk about vaccination efforts as if they're experts on how to persuade uncertain parents. What we need instead, he explains, is to demand the same rigor in studying the social science side of vaccine hesitancy as we do for every other area of science. Only by actually studying the issue will we figure out how to increase vaccination rates. “We’ll have to have evidence-based approaches to dealing with this,” Omer says. “This is not amateur hour.”

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"Bußgelder wirken gut, um Impfquoten zu erhöhen"
Gesundheitsminister Jens Spahn will eine Masern-Impfpflicht. Der Mediziner Saad Omer forscht dazu seit Jahrzehnten. Er sagt: Die Forderungen gehen nicht weit genug.

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Students And Staff At LA Universities
Quarantined Over  
                   Measles Fears


Rachel Martin speaks with Saad Omer, an infectious disease expert at Emory University, about the quarantine at California schools after a student contracted measles.

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Unaware he had measles, a man traveled from N.Y. to Michigan, infecting 39 people

Officials said the risk remains high for those who are unvaccinated or under-vaccinated and who travel to communities here or abroad where measles cases are raging.
Gaps in vaccination coverage have led to a 20-year high in measles cases in Europe. Major outbreaks also are taking place in parts of the Middle East, Southeast Asia and Japan. More than 1,200 people have died in Madagascar. With spring break and summer vacations approaching, travelers visiting European countries with outbreaks, such as France and Italy, have a much higher chance of bringing infections back to “islands or pockets of vulnerability,” said Saad Omer, an infectious disease expert at Emory University.
“Measles is a very unforgiving disease,” he said. “Even if most people are vaccinated, that number may not be high enough.”

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90 New Cases of Measles Reported in U.S. as Outbreak Continues Record Pace

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The W.H.O. said that every region of the world was experiencing outbreaks, both in poor countries with low vaccination rates such as the Democratic Republic of Congo and wealthier countries like the United States and Israel, where the agency said the disease had spread among unvaccinated communities.
“This is a very unforgiving disease,” said Dr. Saad Omer, a researcher at the Emory Vaccine Center in Atlanta who studies immunization coverage and disease incidence. The illness killed close to 110,000 people worldwide in 2017, according to the W.H.O.

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New York City vaccination order shines spotlight on insular Jewish community
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Public health experts warn that the city’s use of emergency power, while reasonable, could further alienate the ultra-Orthodox who already isolate themselves from greater society.
“When an outbreak is concentrated in a specific group, there is a risk of outsiders stigmatizing that group,” said Saad Omer, an infectious-disease expert at Emory University who researches public health and immunization. “This risk is exacerbated when a public health emergency is declared.”

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How Easy Are Vaccine Exemptions? Take A Look At The Oregon Model

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It’s clear why parents are overwhelmingly choosing the online option, said Dr. Saad Omer, a vaccine and infectious-disease expert at Emory University in Atlanta: convenience.
Omer and other public health officials find this trend worrisome, because kids who remain unvaccinated can catch — and spread — dangerous diseases such as measles, posing a risk to themselves and the wider community.

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Hanging with the anti-vaxxers

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​What’s happened since California let fewer families reject vaccines
A California law that aims to limit the number of people who can refuse vaccines has led to a slight improvement in kindergartners’ vaccination rate in recent years, according to a new study in Health Affairs. But the law was not as effective in private schools, and did little to break up localized clusters of children who opted out of vaccines.

It’s these local clusters of vaccinations that put a specific community or school at the greatest risk, according to the study, which linked large measles outbreaks across the United States to “declining population vaccination and to voluntary abstention from measles vaccine.” 

“All disease transmission is local, just like politics,” said Saad Omer, a professor in global health and epidemiology at Emory University in Atlanta and one of the study authors. He added that national and state monitoring is not enough to effectively monitor infectious disease; more needs to be done on the local and county level.

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Why small groups of vaccine refusers can make large groups of people sick

Infectious diseases such as chickenpox and measles — once a rite of passage for American children — have been made uncommon because of vaccines. However, in recent years, an increasing number of parents are refusing vaccines, resulting in outbreaks.

The overall vaccination rate in the United States is still high, fortunately, despite this worrisome trend. For example, according to the Centers for Disease Control and Prevention, more than 90 percent of 19- to 35-month-old American children are adequately vaccinated against measles and chickenpox. Why, then, do we continue to see outbreaks of diseases preventable in the United States?
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One reason is the epidemiological phenomenon of clustering of susceptible individuals — which happens when a group of unvaccinated individuals in a specific area grows large enough to render protection from overall high immunization rates less effective.


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Tdap vaccine given to pregnant women did not increase risk of autism in children, study says

By giving the Tdap vaccine to pregnant women, doctors hope to protect babies during those first few months — when they are unvaccinated and most vulnerable to disease.
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Saad Omer, a professor of global health, epidemiology and pediatrics at Emory University, said the study was comprehensive and well-designed.
The results, he said, are “not surprising” but “very reassuring.”

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Kids in these U.S. hot spots at higher risk because parents opt out of vaccinations

Saad Omer, a professor of global health, epidemiology and pediatrics at Emory University, said the analysis provides a deeper understanding of where pockets of vulnerability exist. “We may have known about hot spots, but this is a little more systematic look,” he said.
The analysis also shows a direct correlation between exemption rates and vaccination rates for the measles, mumps and rubella (MMR) vaccine and suggests other issues, such as access, are less of a factor in influencing vaccine coverage, according to Omer. Overall, the study found that states with more nonmedical exemptions had lower MMR vaccination rates. In contrast, the three states that have banned nonmedical exemptions — Mississippi, California and West Virginia — show the highest MMR vaccine uptake and lowest incidence of vaccine-preventable diseases.

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Opting out of vaccines leaves these US 'hot spots' most vulnerable for outbreaks

The new study is a "good contribution" to the field, said Saad B. Omer, a professor of global health and epidemiology & pediatrics at Emory University. 
Omer, who was not involved in the research, said one strength of the work is that the researchers conducted an in-depth analysis of individual states with nonmedical exemptions, which had never been done.
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Omer's own research has shown that states with philosophical exemptions had both higher rates of refusal and higher rates of disease; his study focused on rates of whooping cough. "Clusters of refusal overlap clusters of outbreaks," he said.

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Failure to vaccinate is likely driver of U.S. measles outbreaks, report says

​A common scenario is this: A family leaves the country on vacation and one child gets infected and develops measles upon returning to the United States. “Then the child goes to a play group with other kids who are unvaccinated, and those kids catch measles,” said Saad Omer, a professor of global health, epidemiology and pediatrics at Emory University.

Omer, who was not involved in the analysis, said the data illustrate the increasing number of  “pockets of vulnerability” in the United States. Cases typically occur in such communities as well as in metropolitan areas or those with major ports of entry. During the 15-year period studied, the largest number of cases were in California (380), New York (250), Ohio (396) and Washington state (102).

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The moral differences between pro- and anti-vaccine parents

“Parents with the most concerns about vaccinating their children were twice as likely to have a high score for those clean, pure, wholesome themes as well as support of themes of individual liberty, compared to parents with the fewest concerns,” said Avnika Amin, a doctoral student in epidemiology at Emory University, and one of the study's authors.

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How Anti-Vaccine Activists Harmed Minnesota's Somali-American Community
“If there is a lesson in this unfolding tragedy, it is that public health authorities and practitioners need to work hard to build trust and resilience among minority communities targeted by vaccine skeptics,” writes Omer. 

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Measles is back because states give parents too many ways to avoid vaccines
Between 2014 and 2014, Omer and his colleagues found a sharp 23 percent decline in the conditional admission rate between 2014 and 2015. So even with the rise in medical exemptions, the overall vaccine exemption rate still went down thanks to the decline in conditional vaccine entry to schools. 
Omer told Vox, “I’m not discounting eliminating nonmedical exemptions. It’s a reasonable option. But it may not resolve all issues.” That’s why California — which has seen 55 measles cases so far this year — is now cracking down on bogus medical exemptions, too

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If Anyone Tells You to Get a “Detox” Remedy for Vaccines, Run
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But the public health experts I spoke to said these seemingly evenhanded statements belie a very real threat. They worry that the claim that people need to “detox” after vaccines could undermine public trust in immunizations. “It’s just sad,” says Saad Omer, an epidemiologist who studies vaccine hesitancy at the Emory Vaccine Center. “They’re trying to make money off parental worry, and they’re adding to this environment of fear.”

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The World Health Organization Needs to Put Human Behavior at the Center of Its Initiatives

One underlying theme is the relevance of human behavior to many, if not all, of these threats. For some global health threats, the connection is obvious: non-communicable diseases and their associated behavioral risk factors (i.e. smoking or poor diet), or the reluctance of some parents to vaccinate their children and over-prescription and over-demand of antibiotics—a reason for emergence of antibiotic resistance—have clear behavioral connotations. For many others, the link is less obvious but equally important. For example, human behavior is largely at the center of global climate change and will be at the core of any substantial response to it. Similarly, HIV prevention, avoiding dengue carrying mosquitos, shoring up primary care delivery, and responding to Ebola and influenza outbreaks require modifying or working with human behavior.   


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As measles cases spread, the tinder for more outbreaks is growing

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Dr. Saad Omer has been worrying about the growing number of measles-susceptible people in this country for a while. In 2016 he and colleagues from Emory University published a study estimating the number of children and teenagers who are unprotected against measles.
Using data from 2008 to 2013, they calculated that 12.5% of children and adolescents were not protected against measles, with the biggest portion being children 3 and younger. At the time they submitted their study for publication, in June 2015, they estimated that 8.7 million children aged 17 and younger were vulnerable to the virus.
Omer’s study estimated that in 2013 alone, 4.5% of teens aged 13 to 17 had not received a single dose of measles-containing vaccine, years after they should have received both doses. That’s more than 940,000 children who are now young adults.
The authors were concerned their study would appear alarmist, so they “cushioned” their message a bit,” Omer admitted. But to them, the future the data foretold was clear.
“We predicted that if we don’t change the trajectory we’ll start seeing larger and more frequent outbreaks. And this is exactly what we are seeing,” he said.

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It’s Terrifyingly Easy to Get Measles Vaccine Exemptions
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​Evidence shows, however, that making it more difficult to obtain vaccine exemptions can reduce the rates of those who opt out. 

“The ease of exemption is a big predictor,” said Omer, who has been named the inaugural director of the Yale Institute for Global Health, starting in July. 
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He favors counseling by a health care provider as one good way to strengthen requirements. That not only makes it harder to get exemptions, but also puts parents in touch with “the most trusted source” of information, Omer said. 
In Washington state, overall vaccine exemption rates fell by about 40% after passage of a 2011 law that required a health care provider’s signature on exemption forms, according to a 2018 study by Omer.

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Measles was eliminated. But we can’t be sure it’ll stay that way
Are these recent measles cases and outbreaks truly sporadic, or are we on the verge of the return of widespread measles? While recent measles outbreaks have been contained, the frequency and size of these outbreaks is alarming. A return of widespread measles is not inevitable, but to be sure we prevent it, we need to address vaccine refusal directly.

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Understand the values behind people’s vaccine fears
We found a link between vaccine hesitancy and values of purity and liberty, which is especially informative given that many “traditional” pro-vaccine arguments focus on other values: fairness and protecting oneself and others from harm. Perhaps, if we incorporate these additional values into pro-vaccine messages, they’ll resonate more with hesitant parents and be more effective at convincing people to get vaccinated.

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​The anti-vaccine movement's influence may be waning
Lead study author Saad Omer, a professor in global health, epidemiology, and pediatrics at Emory, said the data make him cautiously optimistic. While the overall vaccine exemption rate grew between 2011 and 2013, Omer said, it plateaued after that. And he suspects vaccine coverage may soon get even better. 
During the study period, there were important legislative advances in vaccine policy, which went into effect after the study ended. In July of 2016, Vermont banished its philosophical exemptions, and California also did away with all nonmedical exemptions.

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California Shows The Rest Of The Country How To Boost Kindergarten Vaccination Rates
“You have this tinder that can start a fire,” Saad Omer of Emory University in Atlanta told BuzzFeed News, referring to the risk posed by local pockets of unvaccinated children. His research has shown that, for both measles and pertussis, outbreaks are associated with clusters of unvaccinated children.

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Don’t Let Vaccines Go the Way of Climate Change: Be careful how you call out our vaccine-skeptic president. This is one fight we can’t afford to politicize.
Increased politicization of the vaccination issue would be deadly, because it could spawn new anti-vaccination converts and further insulate the debate from scientific research, potentially lowering immunization rates and increasing the risk of disease.

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The Vaccine Debate

@sallykohn and Dr. Saad Omer @EmoryVaccineCtr weigh in on "the vaccine debate" @CNN http://t.co/LuLeZQ6m9G

— Carol Costello (@CarolCNN) February 3, 2015

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Flu Shot Tied to Healthy Pregnancy  

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Dr. Omer and his colleagues looked at the electronic medical records of 3,327 pregnant women between April 2009 and April 2010. The study, published in the journal Clinical Infectious Diseases, found that the infants born to vaccinated mothers had a 37 percent lower likelihood of being premature, and they also weighed more at birth than babies born to unvaccinated women.

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Why statin users should still get the flu shot, even if cholesterol drugs make it less effective
But older people are also much more likely to take statins. And two new studies, including one from my research group, suggest that people who take these cholesterol-lowering drugs have a lower response to the flu vaccine compared to those who don’t take them.​

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Public Health Risk Seen as Parents Reject Vaccines

While nationwide over 90 percent of children old enough to receive vaccines get them, the number of exemptions worries many health officials and experts. They say that vaccines have saved countless lives, and that personal-belief exemptions are potentially dangerous and bad public policy because they are not based on sound science.
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“If you have clusters of exemptions, you increase the risk of exposing everyone in the community,” said Dr. Omer, who has extensively studied disease outbreaks and vaccines.

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How to Handle the Vaccine Skeptics
ATLANTA — The alarming number of measles cases — a record 644 last year, and 102 last month, the most since the disease was declared eliminated in the United States in 2000 — has focused scrutiny on parents who refuse vaccinations for their children.

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15 Myths About Anti-Vaxxers, Debunked​

“It’s never a good idea to humiliate individual parents because it never changes anyone’s minds,” said Saad Omer, an associate professor of global health, epidemiology and pediatrics at Emory University School of Public Health and Emory Vaccine Center.

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Talking to Vaccine Resisters

Saad Omer at the Emory Vaccine Center has conducted studies on how schools, health-care providers, and state-level legislation effect vaccine uptake.

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Stricter Mandate, More Education Lifts
California Child Vaccination Rates


The researchers found that the increase in vaccination rates reduced the chances that unvaccinated students would come into contact with each other, an easy way for measles to spread. The chance that two unvaccinated students would come into contact with each other at school fell to 4.56% in 2017, down from 26.02% in 2014, according to the study.
Clusters with high rates of students without up-to-date vaccinations also decreased substantially in Central and Southern California but continued to remain high in Northern California, the study found.
Yet the study also found the rate of kindergartners in California without up-to-date vaccinations rose slightly from 2016 to 2017, as the numbers of medical exemptions, students not subjected to immunization requirements and students overdue for vaccinations increased.
“Unintended effects such as this need to be carefully evaluated,” said Cassandra Pingali, a former epidemiology graduate student at Emory University and now a research fellow at the Centers for Disease Control and Prevention, who is the first author on the study. “Policy makers should consider such consequences when creating new legislation.”

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Measles outbreak: How doctors can change anti-vaccine mind

​Vaccine safety and effectiveness have been studied for decades, but research on how to talk about vaccines, and how to increase vaccine acceptance, is still in its infancy. In the midst of the measles spread in the U.S., doctors and public health workers are learning on the fly what works, and what doesn’t, when it comes to communicating with vaccine-hesitant parents and communities.

“These outbreaks are showing us that we’re behind the curve” when it comes to vaccine communication research, said Washington Department of Health secretary John Wiesman. “There’s no reason people should be getting sick from vaccine preventable diseases.” And the little that is known has yet to “scale up,” or spread to every single doctor’s office and local public health department, said epidemiologist Dr. Saad Omer, a vaccine and infectious-disease expert at Emory University in Atlanta. “We have no coherent program for vaccine communication,” said Omer.

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Percentage of young U.S. children who don’t receive any vaccines has quadrupled since 2001
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All but a handful of states allow parents to opt their children out of school immunization requirements for nonmedical reasons, with exemptions for religious or philosophical beliefs.

The overall percentage of children with an exemption was low, 2.2 percent. But the report noted “this was the third consecutive school year that a slight increase was observed.” The report does not provide a breakdown, but the majority of exemptions are nonmedical, according to data reported by the states.

Saad Omer, a professor of global health, epidemiology and pediatrics at Emory University, said that an analysis he and colleagues conducted a few years ago found the rate of increase in nonmedical exemptions had appeared to stabilize by the 2015-2016 school year after many years of increase.

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Anti-vaccine activists are playing with fire in Minnesota
But the major public health success of the elimination of measles is under threat.  The concern that localized outbreaks like the one in Minnesota can morph into large, national-level events is not far-fetched.

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​Third dose of mumps vaccine could help stop outbreaks, researchers say

The research, published in the New England Journal of Medicine and based on analysis of data from a large mumps outbreak at the University of Iowa in 2015-2016, showed that getting a third dose of MMR vaccine cut the risk of contracting the mumps by 78 percent.
“The thing that this study particularly adds is that a third dose may have a role — at least in outbreak control — for mumps,” said Dr. Saad Omer, a professor of epidemiology and pediatrics at Emory University. Omer, whose work focuses on vaccinations, was not involved in the new study, which was published Wednesday.

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I was skeptical that the anti-vaccine movement was gaining traction. Not anymore.
“Even a modest decrease in [vaccine coverage] rates could be enough to cause future outbreaks,” wrote Saad Omer, a leading vaccine researcher at Emory University, in a Washington Post opinion piece.​

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​Measles No Longer Lives In The Americas -- Though It Still Visits
“This is a very big deal,” said Saad Omer, PhD, a professor of global health, epidemiology and pediatrics at Emory University School of Public Health and Emory Vaccine Center. “It’s significant because measles is a big killer that impacts real life and predisposes babies to other diseases.”

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Resurgence of Measles, Pertussis Fueled by Vaccine Refusals
In the study, led by Saad Omer of Emory University, Atlanta, researchers searched the medical literature for all reports of measles outbreaks in the United States from January 2000 through November 2015. They did a similar search for pertussis outbreaks since 1977, when cases of this disease reached their lowest point in the U.S.

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​Safety of Flu and Pertussis Vaccines in Pregnancy Assessed
“This is a somewhat comprehensive meta-analysis,” said senior author Saad Omer, an associate professor of global health at Emory University. “The findings were not really surprising but they were reassuring in that all the bigger and higher quality studies, with a lower chance of randomness in the results, pointed in the same direction.” 

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The Measles Outbreak Coming Near You

By wiping out many common and deadly diseases, and thus the fear they induce, vaccination can be its own worst enemy. However, we cannot afford to remain reactive. Seminal work in 2012 by Saad B. Omer, an epidemiologist at Emory University, has demonstrated that making it more difficult to obtain exemptions—say, by requiring physician consultation, education or annual renewals—reduces the rate of exemptions. “The balance of convenience should tip in the favor of vaccinations as opposed to vaccine exemptions,” he told me.

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Most Doctors Give In to Requests by Parents to Alter Vaccine Schedules

​“Unfortunately, we don’t have a solid evidence base in terms of how to communicate to patients about vaccines,” said Saad Omer, an epidemiologist at Emory University. “A lot of approaches are wisdom-based, not evidence-based.”

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Vaccines' Benefits Trump Concerns, Experts Say


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Undermining Confidence in Immunization Could Damage "Herd Immunity."
 ​Success of immunization programs in the United States should not be taken for granted. It took decades of hard work by doctors, the Centers for Disease Control and Prevention and state and local health departments to get vaccination rates to where they are today — over 90 percent for vaccines against polio, hepatitis B, chickenpox, measles, mumps and rubella.

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When It's Hard To Get A Vaccine Exemption, More Kids Get Shots


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August 19, 2016  

Parents' Attitudes on     Opting Out of HPV                                Vaccine
Trying to impose mandates without broad public support can backfire, says Saad Omer, a professor of global health, epidemiology and pediatrics at Emory University Schools of Public Health & Medicine whose research focuses on state exemptions for vaccines required for school. "We're living with the legacy of going for a mandate a little too early," he says. Getting a particular vaccine needs to be a social norm before a law requires it, he adds.

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Statins May Dampen Response to Flu Vaccine

...The lead author on the second study, Saad B. Omer, an associate professor at the Emory Vaccine Center in Atlanta, said that nothing in these studies should lead to immediate changes in practice.

​“Even with the diminishing effect, flu vaccines remain the most effective tool to prevent influenza, including in the elderly,” he said. “They’re not perfect, but nobody should skip their flu vaccine.”

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California Vaccination Bill SB 277 Clears Senate -- And Will Save Taxpayer Money If It Becomes Law

​Research by Saad Omer, an associate professor of global health and epidemiology at Emory University, has shown that states with religious and personal belief exemptions have had higher rates of exemptions and greater incidence of pertussis (whooping cough). 

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Washington State Makes It Harder to Opt Out of Immunizations

...despite efforts to educate the public on the risks of forgoing immunization, more parents are choosing not to have their children vaccinated, especially in states that make it easy to opt out, according to a study published on Thursday in The New England Journal of Medicine.

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Swine Flu Shots Revive a Debate About Vaccines

One of the things they are focusing on now is immunization and pregnancy,” said Saad B. Omer, assistant professor of global health at Rollins School of Public Health at Emory University, “and their perceptions of the vaccine in use of pregnant women. It is not a benign perception in this case, and could have serious impacts, because pregnant women have high risk of complication if they get the swine flu.”

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Vaccine Issue Arises at Republican Debate, to Doctors' Dismay

​“I was thinking: There’s a reason why we have a schedule,” said Dr. Saad Omer, an infectious diseases expert at Emory University in Georgia. He watched the beginning of the debate, then stopped to do work, but ran back in to turn it on again when some vaccine expert friends started posting on Facebook about the back-and-forth on the stage.

“I had hoped was there would have been a stronger endorsement of the schedule,” he said. “It’s not one person’s opinion. It’s not even just the government’s opinion. It’s based on very broad scientific advice.”

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 In Pandemic Study, Health Workers Stay Home

Researchers at the Johns Hopkins Bloomberg School of Public Health in Baltimore and Ben Gurion University of
the Negev in Israel surveyed 308 public health workers in Maryland and found 46.2% said they would be unlikely
to report for work during a pandemic. Less than a third believe they would play an important role in the health agency during a local outbreak.

The results may not hold true for health departments in big cities or other regions, says co-author Saad Omer.

The idea that so many public health workers may not show up for work is "a little unsettling," Omer says, but "you
can't blame the public health workforce," which after a series of events from the anthrax attacks to Hurricane Katrina, is being asked to take on new roles.

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Fear of Vaccines Spurs Outbreaks, Study Says

Too many abstainers can put a town at risk, wrote Dr. Saad Omer, of Emory University in Atlanta, the lead author in the report...
"People need to recognize that in the case of infectious diseases, what other people do impacts my child," Dr. Omer said in an interview.  "If they live in a community that has a cluster of refusers, their risk of getting a vaccine-preventable disease goes up, just by virtue of who they play with."

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Clinicians Must Persuade Parents To Vaccinate Kids

Pediatricians have varying responses to parents who refuse to vaccine their children, according to a 2005 survey of members of the American Academy of Pediatrics.
A large minority (40%) said they would not treat children from families that refused all vaccines, and 28% said they would not treat youngsters whose parents declined some vaccines.

This approach is inappropriate, Dr. Omer argued.

"The American Academy of Pediatrics' Committee on Bioethics advises against this and recommends that clinicians address vaccine refusal by respectfully listening to parental concerns and discussing the risks of nonvaccination," he and his colleagues wrote.

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Docs Can Sway Parents' Attitudes to Vaccination

Vaccine refusal is a growing phenomenon, as indicated by the proportion of children exempted from school immunization requirements for non-medical reasons, explain Dr. Saad B. Omer, at Emory University in Atlanta and his associates. Between 1991 and 2004, exemption rates rose from less than 1 percent to more than 2.5 percent in states that allow exemptions for philosophical or personal beliefs.

However, Omer's team reports, "Parents who reported that decisions were influenced by their child's health care provider were almost twice as likely to consider vaccines safe as parents who said their decisions were not influenced by the provider."

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Doc Knows Best About Jabs

Parents who are hesitant about having their children vaccinated should listen to their healthcare provider.
Doctors can play a critical role by explaining the benefits and addressing concerns about risks, researchers report in New England Journal of Medicine. Vaccine refusal is a growing phenomenon, as indicated by the proportion of children exempted from school immunization requirements for non-medical reasons, say Dr Saad B. Omer and his associates at Emory University in Atlanta.

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When Moms Get Flu Shot, Babies Benefit Too:  Study

Dr. Saad Omer of Emory University in Atlanta and colleagues looked at 6,410 births between June of 2004 and September of 2006, checking to see how many babies were premature or small for gestational age.
When flu was the most widespread, vaccinated moms had an 80 percent lower risk than unvaccinated mothers of having a premature baby, Omer said. The risk of having a baby that was small for gestational age was 70 percent lower for vaccinated mothers.

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Nevirapine for breastfeeding infants: benefit of 6-week course still evident after one year

Use of six weeks of extended-dose nevirapine compared to single-dose nevirapine accounted for a 62%
reduction in infant mortality and a
46% reduction of HIV transmission or death in breastfed, HIV-exposed infants, according to the final 12-month analysis of the SWEN study.

Saad B. Omer and colleagues reported the final analysis of the Six Week Extended Dose Nevirapine (SWEN) randomised controlled trials in the advance online edition of AIDS.
These results confirm earlier reported analyses of six-week and six-month endpoints of the three SWEN
trials.

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Low vaccination rates in some schools raise outbreak risks

"Whenever the community risk goes up, everyone tends to get affected, including people who are vaccinated," said Saad Omer, an Emory University scientist who researches unvaccinated clusters. "Even the best vaccines are not perfect."
Clusters of unvaccinated people are, Omer said, like patches of dry grass that, with a single match, can start a wildfire that will burn not only dry material, but sometimes wet as well. The match could be a student who returns from a trip abroad with measles or a train commuter with whooping cough.

"I don't want to exaggerate the problem. It is not that we are going to have the same rates of measles that we had in the pre-vaccination era any time soon," Omer said. "But the community risk of outbreak goes up, depending on what is happening in your community and in your school. That is why parents should be concerned, even if they do the right thing and get their kid vaccinated."

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Parents Delaying, Skipping Recommended Vaccines

Parents who skip or delay vaccines typically cite safety concerns, researchers said, including the now debunked idea of a link between vaccines and autism.
What they miss is the risk of the disease they aren't vaccinating against, said Saad Omer, an infectious diseases researcher at Emory University in Atlanta.

"Parents often have this perception that it's a benign choice, whether to vaccinate or not," Omer, who was not involved in the new research, told Reuters Health.
He said parents who refuse vaccines tend to cluster together in certain areas -- increasing the risk of a local disease outbreak, even in kids who have been vaccinated.

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Can You Teach New Docs Old Tricks?

Younger primary care providers are more likely than their older counterparts to believe that vaccines do more harm than good, according to an abstract here at the Infectious Diseases Society of America 49th Annual Meeting by Saad Omer, MBBS, MPH, PhD, assistant professor of global health, epidemiology, and pediatrics at Emory University in Atlanta, Georgia, and colleagues.

Dr. Omer said that for parents, safety-related issues are the most important. "The medical profession and the public health community have focused on messages to the general community in terms of vaccine safety....I think there should be some more emphasis on efficacy," he said.

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School Vaccines:  More Students Skip Required Shots in 8 States

A rising number of parents in more than half of states are opting out of school shots for their kids. And in eight states, more than 1 in 20 public school kindergartners do not get all the vaccines required for attendance, an Associated Press analysis found.That has health officials worried about possible new outbreaks of diseases that were all but stamped out.

"Vaccine refusers tend to cluster," said Saad Omer, an Emory University epidemiologist who has done extensive research on the issue.

Parents who let their kids skip some vaccines put others at risk, health officials say. Because no vaccine is completely effective, if an outbreak begins in an unvaccinated group of children, a vaccinated child may still be at some risk of getting sick.

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The Panic Virus:  The True Story Behind the Vaccine-Autism Controversy.
By Seth Mnookin

 "There has never been strong or reasonable scientific evidence to point to a link between thimerosal and autism," says Saad Omer, a vaccine specialist who teaches global disease epidemiology at the Johns Hopkins Bloomberg School of Public Health.  "Even the people who advocated removing [thimerosal from vaccines], the Public Health Service, when they did that, they were not talking about autism."

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Vaccination Exemptions Put Kids at Risk

"The appropriate use of medical exemptions is important to maintaining sufficient herd immunity to protect those who should not be vaccinated due to medical contra-indications," said lead researcher Dr. Saad B. Omer. "Medical providers, parents, school officials, and state health officials are responsible for ensuring that medical exemptions are actually medically indicated."

In an accompanying editorial, Daniel A Salmon and Dr. Neal Halsey, of the Johns Hopkins Bloomberg School of Public Health, said the findings should prompt action from those responsible for implementing and enforcing school immunization requirements at the state and local levels.

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Non-Medical Vaccination Opt-Outs on the Rise

An increasing number of parents are getting state approval to allow their children to opt out of school-mandated vaccinations for non-medical reasons, according to a new analysis published Wednesday.

Dr. Saad Omer, author of the correspondence published in the New England Journal of Medicine, warned that this trend is leaving large populations of children at risk for developing potentially deadly illnesses that haven't been seen in the United States in many years.

"Rates of exemption are substantially higher today than several years ago," said Omer, assistant professor of global health, epidemiology and pediatrics at Emory University in Atlanta. "Previously, rates were only rising in states with easy exemption policies, but now they are even rising in states that make it more difficult."

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Frequent Review Needed For Medical Exemptions to School Immunizations

Saad B. Omer, MBBS, MPH, PhD, of Emory University Schools of Public Health and Medicine in Atlanta, and colleagues said medical exemption rates should be monitored and continuously evaluated to ensure that medical exemptions to school-entry immunizations are not granted solely because they are easier to obtain than other types of exemptions.

“Judicious use of the medical exemption option helps ensure that individual children and the broader community can benefit from high immunization coverage,” the researchers wrote.

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Girls May Not Have Riskier Sex After HPV Vaccination

Girls who had been vaccinated against human papillomavirus (HPV) weren't more likely to get other sexually transmitted infections or to become pregnant, in a new study from Georgia.

"Some parents have expressed it as a concern," said Saad Omer, an infectious diseases and vaccine researcher from Emory University in Atlanta who worked on the study.

"Parents can be reassured at least based on the evidence that young girls who receive HPV vaccines did not show increased signs (of) clinical outcomes of sexual activity," he told Reuters Health.

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What Jenny McCarthy and The Taliban Have In Common

In the summer of 2011, another noxious ingredient was added to the swirling milieu of conspiracy over vaccinations. Shortly after the killing of Osama bin Laden, it was revealed that the CIA had been running a fake vaccination campaign to acquire genetic material from members of the Bin Laden compound.

"The credibility of health care workers involved in polio eradication seems to have taken a hit due to this episode" said Saad Bin Omer, an associate professor at Emory University with expertise in vaccine refusals both in Pakistan and the United States. The systematic countrywide massacre of hapless vaccinators morbidly underscores his point.

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2010 California Whooping Cough Outbreak Linked to Vaccine-Averse Parents

"We live in a free society, but infectious diseases are different from other phenomenon. Someone else's behavior can affect my child or loved one, or me," study author Dr. Saad Omer, an associate professor of global health, epidemiology and pediatrics at Emory University's Vaccine Center in Atlanta, said to HealthDay.

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Legend has it...:  Panel Aims to Debunk the Myth of Harmful Vaccines


Karachi:  Pakistan has the highest global burden of childhood diseases and mortality and therefore, needs to
utilise all the tools available to combat them, especially the most effective one — vaccines.

These views were shared by Emory University associate professor of global health, epidemiology and paediatrics Dr Saad B Omer, while he was speaking at a panel discussion at the Aga Khan University (AKU), ...

Dr Omer provided concrete statistical data to negate the theories about vaccines causing more harm than good to children.

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My Interview With  A Pediatrician Who Thinks Vaccines Are "Messing With Nature"

For a reality check, I call up some outside experts, including Alanna Levine, a pediatrician in Orangeburg, New York, and a spokeswoman for the American Academy of Pediatrics, to ask what they thought of this boutique approach to immunizations. "My blood is boiling right now," Levine replies. "I think that policy is dangerous. I think it puts children at risk when they are most vulnerable."

Saad Omer, a professor of public health and vaccine expert at Emory University, holds a similar view. "There is a reason why we give vaccines to young children," he says. "That's because the risk of disease is higher for certain age groups. You want to give vaccines as early as possible to protect the child. If you delay, you are leaving the most vulnerable period for the child open."

Omer adds that he considers it very risky to vaccinate only against diseases that are prevalent in a particular community. "Most practices don't have a community surveillance system," he says. "They don't know whom these kids interact with or where they will travel. Infectious diseases are by nature infectious, so it's not just individual behavior that matters. It's everyone's vaccinations."

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Spreading The Message About Vaccine Compliance

What parents aren’t hearing enough, says RSPH researcher Saad Omer, is that pregnant women and their babies need vaccines so that both stay healthy.

"When you start talking about childhood vaccines with parents after their babies are born, it is already too late," he says. "Young parents are more receptive when they are pregnant. There are already lots of messages that are targeted to them during pregnancy, such as breastfeeding and safety. We need to add mother and child vaccinations to that."

"Vaccinating pregnant women is especially important in developing countries," he says. "Here in the United States, premature babies go to the NICU. In many parts of developing countries, there is no NICU. Worldwide, 1 million deaths are associated with preterm births."

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Meet the Anti-Vaccination Pediatrician Catering to California's Rich, New Age-y Parents

Butler spoke to Saad Omer, a professor of public health at Emory University, about the dangers of this one-shot-per-visit strategy. He worried that the incredibly elaborate scheduling of all these shots would mean that kids would skip some necessary ones, since "the parents have to take more time off to bring the child to get the vaccines," creating more opportunities for parents to miss appointments.

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Amish Parents Mirror Wider Concerns Over Vaccines

Of 359 households that responded to the survey, 85 percent said that at
least some of their children had received at least one vaccine.
Forty-nine families refused all vaccines for their children, mostly because
they worried the vaccines could cause harm and were not worth the risk.

Saad Omer, an assistant professor at Emory University who was not involved in the study, said he was not surprised by the results.
Most parents' decisions about immunizations are based upon perceptions of how common and dangerous a disease is, Omer said, and perceptions of how safe and effective a vaccine is.

"There is a reason why the rates of vaccine-preventable diseases are low," he said, "and that's because of the vaccines."

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Health Check,
15/06/2009


In the UK some parents are still refusing to have their children vaccinated against measles, mumps and rubella after a false scare linked the MMR vaccine with autism.
There is no evidence of a link.

Dr Saad Omer –who’s an Assistant
Professor of Public Health at Emory
University in the US – says that policy makers need to be careful if they change the rules in the UK – as there could be a backlash against vaccination.

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Growing Outbreaks of Whooping Cough Raise Health Fears

Growing outbreaks of whooping cough
including a California epidemic that has killed six babies — are worrying public health officials who fear that sporadic vaccination practices may be contributing to dangerous
cases of the preventable disease.
"I'm saddened, but I can't truly say I'm
surprised," said Dr. Saad B. Omer,"....We know and we have known for a while that we have these gaps in protection at
the local level."

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Rising Public Health Risk Seen as More Parents Reject Vaccines

Children who are not vaccinated are unnecessarily susceptible to serious illnesses, they say, but also present a danger to children who have had their shots — the measles vaccine, for instance, is only 95 percent effective — and to those children too young to receive certain vaccines.

“If you have clusters of exemptions, you increase the risk of exposing everyone in the community,” said Dr. Omer, who has extensively studied disease outbreaks and vaccines.

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How Can H1N1 Vaccine Be Optimally Distributed?

Reporting in the journal Science on Friday, an epidemiologist-mathematician team says it has developed a mathematical model of influenza transmission that analyses the best strategy for distributing vaccines among different age groups in a way that would minimize the spread of the virus.

The broader point regarding the usefulness of quantitative models for making decisions on public health is valid, says Saad B. Omer, professor of global health and epidemiology at Emory University in Atlanta. But it might not be very relevant for India because the model uses European data and makes assumptions about how people intermingle; this mixing pattern could vary in India.

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Lessons learned: Risk of serious flu-related sickness far outpaces risk of injectable vaccine in pregnant women

“Health care providers will play a key role in women’s decisions about whether or not to be vaccinated against H1N1,” said study senior investigator Saad Omer, of Emory University. “There is substantial evidence that vaccination is not only safe for pregnant women but that it is critical for protecting women and their infants against serious complications from the flu. Physicians and other providers should talk about risks and benefits with their patients and help alleviate any unfounded fears.”

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Flu Vaccine During Pregnancy May Help Reduce the Risk of Premature Birth

"Influenza vaccine has been administered for decades to pregnant women and has a strong safety record. In this paper, for the first time, we document a protective effect of the vaccine on the fetus and the newborn."
Omer says this research only shows an association between influenza vaccination and reduced risk of prematurity, but does not demonstrate a causal link.

He says studies in other populations, particularly randomized controlled trials, are needed to confirm their results.

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More Parents Say No to Vaccines

Despite the uptick in cases of vaccine-preventable disease like measles and whooping cough, some parents remain deeply suspicious of vaccines – and will likely stay that way.

California is one of 20 states allowing philosophical exemptions to vaccines for schoolchildren, as a distinction from religious or medical exemptions. While overall the number of unvaccinated children in California is low, clusters of exemptions create pockets of vulnerability, said Dr. Saad Omer, an infectious disease epidemiologist at Emory University.

“These kids are not spread evenly, and it increases the risk at the local level,” he said.

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Parents Distrust, Delay Vaccines, Survey Finds

"When you increase coverage of vaccines, the rates of those diseases start going down," said Dr. Saad Omer, an assistant professor of Global Health, Epidemiology and Pediatrics at Emory University.

So fewer people can remember seeing someone with the disease, and "at the same time, people start hearing more about the real or perceived vaccine adverse events," Omer said.

This creates an environment where parents are more likely to fear the vaccine more than the disease.

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Studies Dig Into Physicians' Views on Vaccine Issues

In the first study, Saad Omer, PhD, MPH, MBBS, assistant professor of global health, epidemiology, and pediatrics at Emory University in Atlanta, and his colleagues wondered if a "cohort effect" found in parents who grew up in an age when they did not encounter vaccine-preventable diseases plays any role in the vaccine beliefs of healthcare providers.

"What we wanted to see is, can the effect be seen in physicians, as well? For providers who have seen a case of whooping cough or treated meningitis, that experience is a little more visceral," Omer said.

They found that younger doctors were more likely to believe that immunizations do more harm than good. Also, the more recent graduates were 15% less likely to believe vaccines were effective, compared with older ones.

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Once Common Diseases Slipping Past Younger Doctors

As rates of now-preventable diseases have plummeted with the success of
vaccines, infectious-disease experts worry that doctors no longer have the experience to diagnose them and that many parents now fear the vaccines more than the diseases. Younger doctors, according to a recent study, don't take vaccines as seriously as their older colleagues.

"We're losing the memory of these diseases, and that is a problem," said the study's author, Saad Omer, an infectious-disease epidemiologist at Emory University's Vaccine Center.

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Vaccine Exemption Bills Often Introduced but Rarely Passed

Researchers identified 36 bills that were introduced in 18 state legislatures between 2009 and 2012 to change school immunization requirements. Most of those bills aimed to allow more parents the ability to refuse vaccinations for their children.

About 86 percent of the bills sought to expand access to exemptions while the remaining bills sought to restrict exemptions.  None of the bills attempting to expand access to vaccine exemptions passed into law, but Washington, California and Vermont each passed laws to restrict exemptions.

"Concerted efforts by individual clinicians and professional associations can benefit the legislative process by emphasizing public health considerations and the use of science in developing public policy," Omer wrote.

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School Vaccine Opt-Outs Rise in Private Schools Increases Risk of Disease Outbreak, Physicians Say

Parents who send their children to private schools in California are much more likely to opt out of immunizations than their public school counterparts, an Associated Press analysis has found, and not even the recent re-emergence of whooping cough has halted the downward trajectory of vaccinations among these students.

Saad Omer, a professor of global health at Emory University in Atlanta who has studied vaccine refusal in private schools, surmised more private school parents are wealthy and have the time to spread five shots over a series of years and stay home should their child get an illness like chickenpox. Neal Halsey, a professor of pediatric infectious diseases at the Johns Hopkins University, said parents who choose private schools are likely to be more skeptical of state requirements and recommendations.

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Washington State Makes It Harder to Opt Out of Immunizations

Dr. Omer’s study categorizes state exemption policies on a scale from easy to difficult. The easiest rules require parents only to fill out a standardized form, which often involves merely checking a box. More stringent policies require parents to write a letter, detailing precisely why they believe their children should be exempt. “These laws have an impact,” he said. “The idea is to nudge the balance of convenience away from getting exemptions.”

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Extra MMR Vaccine Helped Prevent Mumps In Outbreak

Giving kids and teens in a New York community a third dose of the measles, mumps, rubella (MMR) vaccine likely helped halt a mumps outbreak in late 2009 and early 2010, according to a new report from the Centers for Disease Control and Prevention.

"The vaccine is so safe and the evidence is very reasonable now," Omer, who wasn't involved in the new study, told Reuters Health. "I think (a third vaccine) should be on the list of first-line options for decent-sized outbreaks."

Mumps outbreaks are most common in crowded settings such as college dorms and prisons, he added. So the recent outbreak in religious schools "is not all that unique."

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Close To Half of Kids Late Receiving Vaccines:  Study

Researchers said that trend is cause for concern because if enough kids skip their vaccines, whole schools or communities may be at higher risk for preventable infections such as whooping cough and measles.

"When that happens, it can create this critical mass of susceptible individuals," said Saad Omer, from the Emory Vaccine Center in Atlanta.

"For some vaccinated kids, their risk of getting the disease also goes up," Omer, who wasn't involved in the new study, told Reuters Health.

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In Texas and Beyond, Hot Spots for Vaccine Refusers Alarm Officials

An outbreak of measles among unimmunized members of a Texas megachurch is fueling new health worries about pockets of vaccine-wary parents -- just as more than 50 million public school kids head back to class across the nation.

“The rate of change has sort of accelerated,” said Dr. Saad Omer, an infectious disease epidemiologist at Emory University in Atlanta who studies clusters of vaccine exemptions in public schools.

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Vaccination Opt-outs Found to Contribute to Whooping Cough Outbreaks in Kids

The research found significant overlaps of areas with high numbers of whooping cough cases and areas where more parents had sought legal exemptions to opt out vaccinating their children.

“The strength of our approach was not just to find out the clustering of cases but also the statistical significance of the clustering overlap,” says senior author Saad Omer, an associate professor at Emory University School of Medicine’s Vaccine Center. “This tells us whether the clustering is by chance or not.” Neither the clusters nor their overlapping was by chance.

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How Many People Aren't Vaccinating Their Kids in Your State?

In a 2012 study of vaccine exemption policies across the country, a team of researchers led by Saad Omer, a professor of public health at Emory University, found that of the 20 states that allowed personal-belief exemptions for enrollment in a public school or child care program, less than a third made it "difficult" to do so...

In the nine "easy" states identified in the study, the rules required only signing a form. Indeed, Omer suspects that some parents sign vaccine exemption forms not because they actually hold anti-vaccine beliefs, but simply because it's easier than juggling the doctors' appointments, missed work, and other inconveniences of getting kids vaccinated.

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Two Countries, One Deadly Disease

“We haven’t seen the drastic drops in coverage that the U.K. saw, and I believe this is at least partially due to immunization laws,” says Saad Omer, associate professor of global health at Emory University.

He says people outside the U.S. often see these laws as “draconian” because they misunderstand how they work.
“In reality, these laws change the balance of convenience from non-vaccination to vaccination,” Omer says. “The basis of these laws is in the police powers of the state, predating the Constitution. States can compel people to do a few things that are in the overall interest of society, and these have provided a buffer against drastic drops in coverage.”

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Fewer California Parents Refuse To Vaccinate Children

California has long been criticized for making it too easy for parents to avoid immunizing their children. Before, all a parent had to do was sign a slip of paper at the school office.

The new immunization law signed by Gov. Jerry Brown requires all parents who sought the exemption to first speak with a healthcare provider. But in his signing statement, Brown allowed parents to seek a religious exemption without seeing a medical professional.

"That was a bit of a disappointment," said Saad Omer, associate professor in the Rollins School of Public Health at Emory University. But he added that the new data show promise that the immunization law is working.

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Measles Outbreak:  Doctors See Tighter 'Philosophical' Vaccine Exemption as Fix

At least 20 states, including California, currently permit such broad “personal belief” vaccination exemption for parents, many of whom are skeptical of mainstream science. The findings of a 2012 study led by infectious disease epidemiologist Saad Omer show that legislation narrowing parents’ exemption options could help bring down the opt-out rates.

“What we showed was that there was an association between rates of exemptions and the ease of obtaining an exemption,” Omer, an associate professor of global health, epidemiology and pediatrics at Emory University, told the Guardian. “The more difficult it is to obtain an exemption, the lower the rate of exemption, and the lower the rate of disease.”

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Vaccine Experts:  It's Time To 'Nudge' Hesitant Parents

“The public mood may be able to pass these laws now, but the concern is when this current dies down,” said Dr. Saad B. Omer, a professor of global health and epidemiology at Emory University, who has studied so-called “hot spots” of vaccine resistance, including several in Washington state.

“My fear is that in the long run, it may end up backfiring,” Omer added. Instead, it might be better to “nudge” parents into compliance rather than penalizing them.

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The Problem of Nonmedical Exemptions From School Vaccine Mandates is Getting Worse

An increasing number of parents are getting state approval to allow their children to opt out of school-mandated vaccinations for non-medical reasons, according to a new analysis published Wednesday.

Omer’s results were not the least bit unexpected, but the reason for him to do the study is (1) to determine whether “common wisdom” about vaccine exemptions is correct (it turns out that it is) and (2) to quantify the effect, which is what Omer et al tried to do. Common sense and an understanding of human nature tell us that if something’s easy to get more people will take it and that if something’s harder to get fewer people will take it.

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States Target Anti-Vaccine Parents Amid Measles Outbreak

Some health experts don’t recommend a full ban on philosophical exemptions. In an op-ed today in the New York Times, Saad B. Omer, an Emory University epidemiologist, said laws should simply make it more difficult to get exemptions -- obtaining documents in person instead of online, requiring forms to be notarized, filing for a renewal of the exemption each year.

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2013 Young Investigator Award:  Saad B. Omer, MBBS, PhD, MPH

Dr Saad Omer is a young investigator with a record of major accomplishments in pediatric infectious disease research. He has worked on studies in Guatemala, Ethiopia, India, Pakistan, Uganda, Bangladesh, South Africa, and the United States. Dr Omer’s research portfolio includes clinical trials to estimate efficacy and/or immunogenicity of influenza, polio, measles, and pneumococcal vaccines; studies on the impact of spatial clustering of vaccine refusers and clinical trials conducted in Ethiopia, India, and Uganda to evaluate drug regimens to reduce mother-to-child transmission of human immunodeficiency virus in Africa. His work has informed and has been cited by many national and international guidelines, as well.

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Parents Who Shun Vaccines Tend To Cluster, Boosting Children's Risk

...some choose immunization schedules that defy science or refuse to vaccinate altogether.

​If these parents were distributed randomly, their decisions would be less likely to harm others, especially babies too young for vaccination. But parents who use personal belief exemptions to avoid school vaccination requirements often live in the same communities, studies have found.

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Disneyland Measles Outbreak Reminds Us Of An Important Point About Vaccination

​The battle has moved to state legislatures, where lawmakers have sought to make it easier for parents to obtain exemptions from vaccination requirements. However, all 31 bills introduced from 2009 to 2012 that would have loosened the exemption process were defeated, said Saad B. Omer, an infectious disease epidemiologist at Emory University who studies vaccine refusal. Three out of five bills that sought to tighten the requirement passed, he said.

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Measles Cases Linked to Disneyland Rise, and Debate Over Vaccinations Intensifies

However, all 31 bills introduced from 2009 to 2012 that would have loosened the exemption process were defeated, said Saad B. Omer, an infectious disease epidemiologist at Emory University who studies vaccines.

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Experts Concerned About Vaccination Backlash

Around the world, vaccination rates are dropping, and the unthinkable is happening:
children are dying from childhood
diseases like measles and pertussis.
This fall in immunisation has
coincided with an increasingly vocal
anti-vaccination movement.

However ludicrous some of the anti-
vaccination messages might seem to
scientists, it is hard to deny that they
do hold some traction with the public.
“As the rate of illness goes down, and people
mostly encounter real or perceived
vaccine associated adverse events
(instead of disease), there is a change
in mental calculus in terms of benefit versus risk of vaccines”, says Omer.

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Flu Shot May Prevent Pre-Term Births

According to the report in
PLOS Medicine, the odds of a premature birth during the eight-week period of widespread influenza activity were around 70 per cent lower for
vaccinated mothers compared to mothers who did not
receive the influenza vaccine.

"Our finding suggests that influenza vaccination may be a
potential tool for reducing adverse birth outcomes, particularly prematurity," says Omer.

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MD's Should Better Explain Vaccine Refusal Risks:  NEJM

Omer and his colleagues review evidence from several states that finds that in communities where the incidence of vaccine refusal has increased, the children are at substantially higher risk for infectious diseases, such as measles and whooping cough.

Even children whose parents did not refuse vaccination -- those who are too young to be vaccinated, can't be vaccinated for medical reasons, or whose immune systems do not respond sufficiently to vaccination -- are put at risk because "herd immunity" normally protects those children.

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Faith Lets Some Kids Skip Shots

Regardless of the reason, the ranks of parents exercising non-medical exemptions to vaccination are growing, public health officials say. Although the number remains small and involves an estimated 2 to 3 percent of the approximately 3 million children who start kindergarten annually, the trend alarms some experts.  This refusal, scientists say, threatens a cornerstone of public health.

"Many states are making personal-belief exemptions easier," said Saad B. Omer, a vaccine researcher at the Johns Hopkins Bloomberg School of Public Health. "Filing for an exemption should at least be a function of conviction, not laziness."

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Why Vaccine Compliance Matters

An outbreak of measles in the state of Washington last year sickened 19 children. Of those
who fell ill, 18 had something in common—they were not vaccinated.

“Vaccine-preventable diseases such as measles, influenza, and pertussis often start among persons who forego
vaccinations, spread rapidly within unvaccinated populations, and also spread to other sub-populations,” says
Omer, assistant professor of global health in the RSPH and an affiliate faculty member of the Emory Vaccine Center.

“Everyone benefits from vaccines."

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Health Officials to Consider Tightening Vaccine Exemptions

California’s vaccine exemption system is among the easiest in the country, said Dr. Saad Omer, of the Emory Vaccine Center at Emory University in Atlanta, who has compared exemptions around the country. California law requires only that a parent sign a form called a personal belief affidavit – also known as a personal belief exemption – stating that immunizations are contrary to his or her beliefs.

Omer found that in states where getting an exemption is easy, such as in California, the rate of whooping cough was at least 50 percent higher than in states that made it more difficult for parents to opt out.

“It’s not just an abstract legal requirement,” Omer said. “It has an impact on disease rates.”

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Flu Shot May Lower Odds for Preemie Delivery

U.S. researchers looked at data on nearly 4,200 births between June 2004 and September 2006 in the state of Georgia. About 15 percent of the women received a flu shot during pregnancy.
Pregnant women who received the vaccine and who gave birth during the assumed flu season (from October through May) were 40 percent less likely to have a baby born prematurely, that is, before 37 weeks' gestation, the study found.
"The effect is significant during the flu period, and it goes up along with the intensity of flu circulation," said lead study author Saad B. Omer, an assistant professor of global health, epidemiology and pediatrics at Emory University Schools of Public Health & Medicine.

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San Diego County Has Highest Growth in Vaccine Exemption

San Diego County saw a higher increase than any other county in the state last year in the number of incoming kindergartners who received philosophical exemptions from state vaccine requirements, according to a review by the Watchdog Institute.

The review found that half of the kindergartners who received exemptions are enrolled in only 10% of the schools. Saad Omer -- an infectious diseases epidemiologist at Emory University -- said the clusters of exemptions could increase the risk of spreading vaccine-preventable diseases at the local level.

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Younger Docs Less Sold on the Value of Vaccines

In a cross-sectional survey of 551 healthcare providers, more recent graduates were less likely to think that vaccines were efficacious, according to Saad Omer, MBBS, PhD, of Emory University in Atlanta.

In one way, Omer said, the finding may be a result of the very success of vaccination programs. "With such a low burden of disease, the efficacy and real or perceived side effects of vaccines may be the most significant factors contributing to vaccination behaviors," he and Mergler argued.

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Recent Medical Graduates More Doubtful of Vaccines vs. Older Counterparts

“As cohorts of parents who have not experienced vaccine-preventable diseases come of childbearing age, their support of vaccines may be less than a cohort of parents who grew up directly experiencing the high rates of vaccine-preventable diseases,” Saad B. Omer, MBBS, MPH, PhD, assistant professor at Emory University, said during the press conference.

“Our findings should be further investigated and replicated in other studies, with a potential policy implication of improved vaccine-related medical curricula and training,” Omer said.

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Deadly Choices:  How the Anti-Vaccine Movement Threatens Us All.
By Paul A. Offit, M.D.


"In 2006, Saad Omer and his colleagues, also from the Johns Hopkins School of Public Health, examined the impact of philosophical exemptions. Between 1991 and 2004, the number of unvaccinated children in states with exemptions more than doubled.  Children in states with easy-to-obtain exemptions (granted by the simple signing of a form) were almost twice as likely to suffer outbreaks of whooping cough."

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More Oregon Kids on "Alternative" Vaccine Schedules

Delaying or avoiding shots through alternative schedules have known risks -- such as increasing the amount of time babies are susceptible to certain disease -- but no known benefits, according to the authors from the Oregon Health Authority and the U.S. Centers for Disease Control and Prevention (CDC), who published their study in the journal Pediatrics on Monday.
"The findings are not surprising, but they're troubling," said Dr. Saad Omer, an assistant professor at Emory University in Atlanta.
Omer, who was not involved with the new study, said past research showed that some parents reported plans to not follow the recommended vaccine schedule. These numbers, he said, show those parents acted on those plans.

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More Kids Opting Out of School-Required Vaccinations:  Study

The number of parents who opted out of school-required vaccines for their children because of non-medical reasons, such as religious or philosophical beliefs, increased between 2005 and 2011, according to U.S. researchers.

During this period, the rates of non-medical exemptions were higher in the states with easy opt-out policies, such as California and Maryland, and in those states that allowed philosophical, instead of only religious, exemptions.

"The more relaxed these requirements are, as we and others have shown, the easier it is to get an exemption, the higher the rates of exemptions," said Saad Omer, an infectious disease epidemiologist at Emory University in Atlanta, and lead study author.
"It is common sense to me that it should not be easier to file for an exemption than it is to get your kid vaccinated," Omer said.

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Increasing Vaccine Compliance for School Immunizations

"Since school immunization requirements play a major role in controlling vaccine-preventable diseases in the United States, studies like this underscore the need for states to examine their current exemption policies," says lead author Saad B. Omer, assistant professor of global health, epidemiology and pediatrics, Emory's Rollins School of Public Health and Emory University School of Medicine.

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How To Get More Parents To Vaccinate Their Kids

Researchers led by Emory University's Saad Omer found that from the school years 2005-2006 to 2010-2011, parents have taken advantage of nonmedical exemptions at not only an increased but also an accelerated rate. So far, resulting holes in vaccination coverage in the U.S. have enabled whooping cough and measles to make comebacks.

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US States Make Opting Out of Vaccinations Harder

To increase vaccination rates, law-makers want to make it harder to get an exemption than it is to get a vaccination.

This idea is backed by studies linking the existence of personal-belief exemptions, and the ease of getting them, to reduced vaccination rates and increased incidence of disease.

Research by Saad Omer, an epidemiologist at the Emory Vaccine Center in Atlanta, Georgia, points out similar abuses: he and his colleagues have found that medical exemptions are up to six times more common in states that have lax medical-exemption requirements or don't allow philosophical exemptions.

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Flu Shots Offer Poor Protection to Seniors

"We're well aware that influenza vaccines, in particular, work less effectively as you get older," said Joseph Bresee, a medical epidemiologist at the CDC.

Still, the CDC estimates shouldn't dissuade physicians from suggesting seniors get vaccinated, said Saad B. Omer, a public-health assistant professor at Emory University who researches flu-shot efficacy. "The doctor's advice should not
change," Dr. Omer said.

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Perspective:  The Risk of Measles in Religious Communities

“Unvaccinated people tend to cluster geographically and these clusters are often associated with disease outbreaks. There are several such areas in the U.S. and outside the US,” says Dr Saad Omer, Associate Professor Global Health, Epidemiology, and Pediatrics at Emory University.

Dr. Omer also says boosting vaccine confidence requires a multifaceted approach. “Maintaining public confidence in vaccines by conducting robust vaccine safety surveillance, enabling healthcare providers to effectively communicate with parents regarding vaccines, and effective messaging to parents that focuses not only on whether or not a specific adverse event is associated with vaccination but also discuss the risks of non-vaccination.”

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Vaccination Exemptions Still on States' Legislative Agendas

In California, a bill signed into law in 2012 allows parents to send their children to public school without vaccinations after they submit a form signed by a health professional affirming that they had been informed about the risks and benefits of immunization.

Requirements that children going to school receive certain vaccinations “have played an important role in maintaining high immunization coverage in the United States,” the researchers, led by Saad Omer of Emory University, wrote.

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Public Health:  An Injection of Trust

The refusal numbers are low — just 2% for 2010–2011, according to the CDC — but epidemiologist Saad Omer of Emory University in Atlanta, Georgia, has observed a disconcerting rise. “The rate of refusal has gone up, and even the rate of change compared to previous years has accelerated,” he says.

Omer found that non-medical exemption rates were 2.3 times higher in states with easy requirements than in those with steeper administrative barriers. “If you make it easier for a parent who is hesitant and on the fence to claim an exemption, it looks like they will,” he says.

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Hundreds of Georgia Schools May be Vulnerable to Disease Outbreaks

Unvaccinated children aren’t the only ones at risk, experts say. So, too, are others who come into contact with students—like infants or grandparents. Even vaccinated children can become ill since some vaccines don’t always fully protect against disease.

“Even if you do the right thing and get your child vaccinated with a vaccine with 80-percent efficacy, there’s a 1 in 5 chance that your child could still get infected,” said Saad Omer, an associate professor in Emory University’s Rollins School of Public Health.

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A Way Out of The Vaccine Wars

People who are told that their dearly held beliefs are stupid and selfish tend to withdraw from the conversation while continuing to do whatever they did before.

“If you insult people or you disrespect people, you can harden their perspective,” says Saad Omer, a professor of global health and epidemiology at Emory University’s Rollins School of Public Health.

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More States Are Letting Parents Refuse To Vaccinate Their Kids

According to a 2012 study led by Saad Omer, a professor of global health and epidemiology at Emory University, allowing PBEs leads to fewer kids getting vaccinated. Opt-out rates in states with PBEs are more than double those in states with religious exemptions alone.

These vaccination gaps result in higher rates of diseases like measles and whooping cough, especially in states where PBEs are easily obtained.
"We do know that states that have philosophical exemptions tend to have not only high rates of exemption but also high rates of disease," Omer says.

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Yes.  The CDC Childhood Immunizations Schedule is Safe.  For Reals

The spoiler: this is big, big, big news. This is the first time the IOM has reviewed the entire current childhood vaccination schedule and given it a thumbs up for safety. If you’re a parent, this news either tells you what you already knew, or it should significantly reassure you if you had concerns about the safety of the schedule.

The IOM is truly the gold standard in assessing medical questions based on the current research.  In this report, the IOM took up study of the CDC vaccination schedule because there has been concern in some circles that kids get too many shots too soon.


They also spoke to leading epidemiologists in the field of vaccine research, such as Dr. Jason Glanz at Kaiser Permanente Colorado and Dr. Saad Omer at Emory (University) Vaccine Center.

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More Parents Opting Out of Vaccines In Some States, Emory Study Finds

“The reason we are concerned about this is because people who seek exemptions tend to cluster in certain communities,” says Omer. 
In other words, group mentality sometimes takes over.  And that changes the equation, Omer says. 
For example, a vaccine that’s 90% effective can prevent an outbreak even if it fails 10% of the time.  That’s because other children are vaccinated.
But if a good number of children aren’t vaccinated, it makes the likelihood of an outbreak greater.
“That means that all of us have a stake in maintaining high vaccine coverage, not just at the national and state level, but also at the local and school level,” says Omer.

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