The start of a new year is a time to reflect upon the past. There have been many vaccine-notable stories that made headlines in 2019. Here are three that you may have missed.

No. 1: The Centers for Disease Control and Prevention published the case of a 6-year-old unvaccinated boy in Oregon who cut his forehead while playing outside.

Less than a week later, he had jaw clenching, involuntary muscle spasms and difficulty breathing. Doernbecher Children’s Hospital diagnosed him with tetanus. The boy required loads of medications, a tracheostomy and mechanical ventilation for a month.

He also received antibodies against tetanus and a tetanus vaccine. After 57 days, he was discharged. His parents refused his second dose of tetanus vaccine and all other recommended vaccines.

The boy’s medical bills were over $800,000. The cost of protecting him from infancy with the DTaP vaccine (tetanus, diphtheria, whooping cough) would have been about $150.

No. 2: Several news organizations reported that Russian trolls and bots have stirred up anti-vaccine sentiments among United States citizens. For readers unfamiliar with the terms, troll is the term for an individual whose online behavior creates controversy to cause trouble.

Social bots are autonomous programs that attempt to influence public opinion and discussions by posting and reposting certain message themes. There’s clear evidence that Russia and other countries are creating sham profiles and posting misinformation about vaccines. Investigations reveal many of the online “personal” stories about illnesses and deaths following vaccination are bogus.

Foreign attempts to manipulate the American public have been successful. Many parents shy away from vaccinating their children when they’re aware of even the slightest amount of controversy. Americans would be wise not to fall prey.

No. 3: New California laws crack down on vaccine medical exemption abuse. In the aftermath of the Disneyland measles outbreak, California eliminated personal belief vaccination exemptions in 2015.

Joining the ranks of Mississippi and West Virginia, California became the third state allowing exemptions only for medical reasons. The law had its intended effect — the proportion of kindergarten students with all of the required vaccines rose by the thousands.

Predictably, the number of medical exemptions tripled as parents shopped for doctors who readily sign medical waivers. After enactment of the law, some health professionals began advertising waivers online.

Surgeons, cardiologists, dermatologists and other physicians who typically play no role in vaccinating children, started signing waivers. There are cases of physicians charging exuberant fees for temporary waivers and requiring additional payments for renewal.

The new laws empower the California Department of Public Health to make the final decision whether the doctor’s medical exemption is legitimate based on Centers for Disease Control and Prevention guidelines.

Triggers for review of exemptions include attendance at a school that doesn’t report their vaccination rates or has a rate less than 95 percent, and the waiver was written by a physician who has written more than five exemptions in a year.

In light of its falling vaccination rates, Texas could learn much from California.

Vaccine Smarts is written by Sealy Institute for Vaccine Sciences faculty members Drs. Megan Berman, an associate professor of internal medicine, and Richard Rupp, a professor of pediatrics at the University of Texas Medical Branch. For questions about vaccines, email

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