Why Vaccine Mandates Won’t Stop Measles In The US

The recent outbreaks of measles have caused a great divide within the ranks of parents with young children over vaccinations. There is an alarming trend in Pediatric offices toward strong-arming parents into vaccinating their children. Some offices are even giving parents who don’t vaccinate their marching orders to find a new Pediatrician. Those who know me will tell you that I’m a strong proponent of vaccinations, and I believe that vaccines are safe and effective. As a world medical traveler, I’ve had all of mine and then some, including the smallpox vaccine I got as a child.

However, I refuse to try and dictate to parents what they will or won’t do with vaccines. A pinch of caring and compassion I think will go further than a pound of forced “persuasion.” I will try to persuade parents through a good patient-physician relationship where they can trust that the vaccine information I present to them is sound and reasonable. I must, and will, however, put this decision in their hands as the parents of children that they love deeply.

No doubt much of the current rancor from vaccine-reluctant parents stemmed from the article published some thirteen or so years ago by Andrew Wakefield in the journal Lancet. His article stated that his research showed a direct relationship between the MMR vaccine and autism. Though the Lancet did recently refute these findings and retract his article, it took them more than a dozen years. The damage that the Lancet sought to correct had already been long done, and the MMR vaccine will probably forever be tainted by that article. As a result of his repudiated research, Andrew Wakefield now resides in the U.S. and no longer practices medicine at all.

The storm of anti-vaccine sentiments however continues. Those with children who are under a year or who cannot receive the MMR for health reasons are calling for ‘non-vaxxers’ to be forced to do so under the guise of public interest and safety. Those who refuse to vaccinate are holding to the rights they see as citizens to choose not to vaccinate. Underlying motives are difficult sometimes to ascertain on both sides. One thing I can say about mandates is that you only have to go so far as the current health care mandate mess to know what can happen. Once a mandate is in place, it is very hard to step back from it. A vaccination mandate would only add to more bad mandate decisions.

There are three groups of children that I think we need to consider here. The children in the first group are those who are ill and cannot receive the MMR vaccination because even an attenuated live virus vaccine poses a serious risk. Their parents want them to be able to attend school or daycare and try to live as normal a life as possible, free from the risk of infection with viruses like measles and such, wherever they go. The children in the second group are those whose parents are wary, even fearful, of the vaccines harming their children, and elect to refuse some or all of the vaccines, or opt for a different vaccine schedule than the current recommendations. The children in the third group are those whose parents are already planning to vaccinate per published recommendations, but the children have not yet been vaccinated for MMR.

Children in the first group who can’t receive vaccinations because of a medical condition are at risk everywhere in society unfortunately. As much as I would like, we cannot protect them everywhere they go. All large public venues are a danger to these medically immuno-incompetent children. I suspect that some 50,000 people a day may pass through many of WalMart’s 24-hour facilities. I tell my parents that I generally consider everything in such large, well-travelled places to be contaminated. I counsel the parents of my immunocompromised patients to be very careful about where they take their children.

Children in the second group, who may receive only a few or no vaccines, are at risk of getting the infections when they are exposed to others who bring in the infections across our borders, or when they travel beyond our borders. Unlike Yellow Fever, where visitors to endemic countries must be vaccinated prior to travel, and who must also present a Yellow Fever vaccination certificate before regaining entry back into the United States, we have no such screening for any other contagious infections. Even Ebola screenings, where death rates are upwards of 70 percent or more, are not properly done before a person reenters from an endemic Ebola area. Simply measuring a temple temperature is not good enough to make any clinical decisions by non-medically qualified airport personnel. I don’t trust these types of devices to make sound medical decisions in my office, and I’m an experienced physician. It has been shown, even among highly intelligent physicians and other healthcare professionals, that self-quarantine does not work either. Physicians and nurses are no better than anyone else who would try to circumvent heath prevention measures at our border. They act as though these barriers are good for everyone else, but do not apply to them.

Children in the third group are those who are in the process of being vaccinated according to schedule but are not yet immunocompetent. With respect to the MMR vaccination and measles, these children, however, are at risk for a period of up to the first year, where they have limited or no immunity. The MMR is not routinely given until on or after the first birthday. This is because the seroconversion rate, which is the measure of vaccine effectiveness, after the one year measles vaccination is around 95 percent or better.

While the solution for the first group lies in exposure prevention on a day to day basis, and for the second group in convincing parents to vaccinate, there is something more I think we can do to help the third group. It may also help to limit the exposure of immuncompromised children more effectively than trying to simply mandate that all children receive the present schedule of vaccines. Children can get the MMR vaccine before their first birthday. They will still be required to get vaccinated according to the regular two-dose schedule at and beyond age one year. It has been demonstrated that 74 percent of children who get MMR vaccine at 6 months do seroconvert and become immune to measles. Over 89 percent of those vaccinated at 8 months have been shown to acquire measles immunity. At 15 months the conversion rate is reportedly 100 percent.

It is already recommended that unvaccinated children as young as 6 months get the MMR prior to travel to endemic areas of the world or during local outbreaks of measles. I am now recommending to parents of my patients that they consider giving their children their first MMR at age 6 months. Currently, here in Georgia, these children will still have to have two more MMRs at or beyond their first birthday for daycares, schools and such that require a completed Georgia form 3231 vaccine certificate for attendance. This will, I think, significantly reduce the susceptible population of young children. It will also indirectly reduce some of the risks to the first group of children who are immunocompromised.

What about immunity to measles in the first 6 months of life then? Because the largest antibody transfer from mother to child occurs at some point prior to delivery, I’m recommending that all women who have low measles, mumps, or rubella titers, have their measles titers measured. If their titers are low, then they should be vaccinated prior to pregnancy. Prenatal transfer of the maternal measles antibody from seropositive mothers to their newborn children can give immunity that may last perhaps up to 4 months of age. Breast feeding does also transfer some maternal antibodies, but I don’t think that the quantitative effect is really known, and it probably cannot be relied upon to provide the protection we want.

Pregnant women or those planning to soon get pregnant within 28 days should first discuss MMR vaccination with their obstetrician. The CDC recommendations against live virus MMR vaccination during pregnancy are also based, according to the AAP Redbook, on theoretical risks of infection to the unborn baby. Women have been unknowingly vaccinated during pregnancy without negative effects to the fetus. Women thinking about becoming pregnant or who are pregnant need to discuss MMR titers and the indications for vaccination with their obstetrician. Determining pre-pregnancy measles titers are a very good idea.

This policy should help to significantly narrow the susceptibility of a significant number of healthy vaccinated children down to about two months. It will indirectly help reduce the risk to immunocompromised children. I will continue to encourage and educate my parents who refuse or want to delay vaccines why I recommend the current vaccine schedule for all children. The problem with forcing these parents to vaccinate seems politically driven rather than well-reasoned. Mandatory vaccination will certainly not stop the entry of measles into our country across the border which seems to be how the virus is getting here. Until we demand verification of an approved MMR vaccination by all citizens and non-citizens coming through customs, and until we fully control illegal entry at our borders, we will continue to be at risk for measles. Mandatory vaccination will gain nothing but the control of one group of people over another. It will further limit the shrinking freedoms for which we as Americans have fought and died.

Those interested in MMR vaccination before the first birthday should call their health care professional’s office and discuss all the particulars of insurance coverage, risks, etc. More information about the current MMR recommendations and the supporting sources for my information are found at PubMed.govthe CDC’s Morbidity and Mortality Weekly Reportthe CDC’s Measles, Mumps, and Rubella (MMR) Vaccine Safety Studiesand the CDC’s Vaccines and Immunizations page on the measles vaccination. I have written a free iTunes ebook for my parents called “The Pediatric Guide for Parents” which has extensive information on the various diseases vaccines protect against and lots of pictures. It may be helpful to parents who remain unconvinced.

Our New MMR Vaccination Policy

As some have seen in the news, there is an alarming trend in Pediatric offices toward strong-arming parents into vaccinating their children and giving them their marching orders to find a new Pediatrician. Those who know me will tell you that I’m a strong proponent of vaccinations. I believe that vaccines are safe and effective. As a world medical traveler, I’ve had all mine and then some, including the smallpox vaccine as a child.

However, I refuse to try and dictate to parents what they will or won’t do with vaccines. A pinch of caring and compasion I think will go further than a pound of forceful ‘persuasion.’ I will try to persuade parents through a good patient-physician relationship where they can trust that the vaccine information I present to them is sound and reasonable. I must and will, however, put this decision in their hands as the parents of children that they love deeply.

There are three groups of children that I think we need to consider here. The children in the first group are those who are ill and cannot receive vaccinations as a result. Their parents want them to be able to attend school and try to live as normal a life as possible free from the risk of infection with viruses like measles and such wherever they go. The children in the second group are those whose parents are wary, even fearful, of the vaccines harming their children, and elect to refuse some or all of the vaccines, or opt for a different vaccine schedule than the current recommendations. The children in the third group are those whose parents are already planning to vaccinate per published recommendations.

Children in the first group who can’t receive vaccinations are at risk everywhere in society unfortunately. Much as I would like, I cannot protect them wherever they are. I sometimes wonder if the same parents who demand that all other children be vaccinated to protect their children, are also careful about taking them out to large venues. For example, I suspect that some 50,000 people a day may pass through WalMart’s 24-hour facilities. I am suspicious that everything that a child could touches in these places puts them at risk of infection. I have no studies to back this up, but that is my suspicion, nonetheless. I care for children with significant immune deficiencies myself, and their parents and I always have the discussion about these risk factors, and I am very aware of the needs of these children.

Children in the second group who may receive only few or no vaccines are at risk of getting the infections when they are exposed to others who bring in the infections across our borders. Unlike Yellow Fever, where visitors to endemic countries must be vaccinated prior to travel, and who must also present a Yellow Fever certificate before regaining entry back into the United States, we have no such screening for any other contagious infections. Even Ebola screenings where death rates are upwards of 70% or more, is not properly done before a person reenters from an endemic Ebola area by simply measuring a temple temperature.

Children in the third group are those who are being vaccinated according to schedule. With respect to the MMR vaccination and measles, these children however are at risk for a period of up to the first year where they have limited or no immunity. The MMR is not routinely given until on or after the first birthday. This is because the seroconversion rate, which is the measure of vaccine effectiveness, after the one year measles vaccination is around 95%.

While the solution for the first group lies in exposure prevention on a day to day basis, and for the second group in convincing parents to vaccinate, there is something more I can do to help the third group, and perhaps very significantly. It may also help to limit the exposure of immuncompromised children more effectively than trying mandate that all children receive the present schedule of vaccines.

Children can get the MMR vaccine before their first birthday. However they will still be required to get vaccinated according to the regular two-dose schedule at and beyond age one year. It has been demonstrated that 74% of children who get MMR at 6 months do seroconvert and become immune to measles. Over 89% of those vaccinated at 8 months have been shown to acquire measles immunity.

It is already recommended that unvaccinated children as young as 6 months get the MMR prior to travel to endemic areas of the world or during local outbreaks of measles. I am now officially recommending that parents of my patients consider giving their children their first MMR at age 6 months. Currently here in Georgia they will still have to have two more MMRs at or beyond their first birthday for entities that require the official form 3231 for attendance. This will, I think, significantly reduce the susceptible population of young children, and indirectly reduce some of the risks to the first group of children, whose parents are particular concerned about exposure.

What about immnity to measles in the first 6 months of life then? Because the largest antibody transfer from mother to child occurs at some point prior to delivery, I’m recommending that all women who have low measles, mumps, or rubella titers, be vaccinated prior to pregnancy. Pregnant women or those planning to soon get pregnant within 28 days should first discuss MMR vaccination with their obstetrician.

The CDC recommendations against live viruse MMR vaccination during pregnancy are also based, according to the AAP Redbook, on theoretical risks of infection to the unborn baby. Women have been unknowingly vaccinated during pregnancy without negative effects. Many physicians caring for expectant mothers are starting to check for the presence of measles antibodies. Women thinking about becoming pregnant or who are pregnant need to discuss MMR vaccination with their obstetrician.

Prenatal transfer a measure of their measles antibdoy to the children of mothers who are measles seropositive, which can last up until perhaps 4 months of age. Breast feeding does transfer some antibodies but I don’t think that the quantitative effect is really known there, and it cannot be relied on in lieu of prenatal seropositivity.

This policy should help significantly to narrow the susceptibility of healthy children who are being vaccinated. The problem with forcing the current vaccination schedule on all children seems politically driven rather than well-reasoned, though I understand the fear behind it. It will certainly not stop the entry of measles into our country across the border which is how the virus is getting here. Until we demand verifcation of an approved MMR vaccination by all citizens and non-citizens coming through customs, and until we fully control illegal entry at our borders, we will continue to be at risk for measles. Mandatory vaccination will gain nothing but the control of one group of people over another, and it will further limit the shrinking freedoms we as Americans have traditional enjoyed and fought and died for.

Those who are interested in MMR vaccination before the first birthday should call our office and discuss all the particulars of insurance coverage, risks, etc. More information about the current MMR recommendations are found at these web sites below to support the data that I have presented.

http://www.ncbi.nlm.nih.gov/pubmed/24837773

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6334a1.htm

http://www.cdc.gov/vaccinesafety/Vaccines/MMR/MMR.html

http://www.cdc.gov/vaccines/vpd-vac/measles/vacc-in-short.htm

Ron Smith, MD, Pediatrics

ronsmithmd.com

Sensibility About Measles Vaccination

History of Vaccines

The first vaccine was aimed at Polio, a virus which can render children and young adults permanently crippled or wheelchair bound or even ventilator dependent. Our experience in America is rife with the images of iron lungs, and even growing up in a small town of 10,000 I knew of an adult who was wheelchair bound from it.

Today, there are only pictures of that terrible past for us. In other countries, such as India, the disease ravages on. Access to the vaccine is the obstacle.

Whooping cough, known to me as a Pediatrician as Pertussis, used to be a rampant childhood illness also. Few of today’s Pediatricians have ever confirmed a case they have treated. It is hard, because the best test still requires a thin metal swab be inserted into the nose all the way to the very back of the nasal cavity. Very carefully the swab is rotated to sweep off some of the cuboidal epithelial cells of the mucous membrane there. Mucous and blood will not do and may cause the test to be falsely negative. Picture trying to do this in a 4 month old baby.

Now the swab has to be carefully rolled on the surface of a fresh, clean glass slide, so that the epithelial cells become adherent to it. The number of cells you get onto the slide is critical to the diagnosis of Pertussis. The bacteria adheres to these cells and the more you get the better. You see the slide must then be air dried and packed in a special cardboard transport package and sent off for testing. At the lab, the slide is treated with a special fluorescent antibody stain which sticks to the bacteria on the epithelial cells. If there are not enough bacteria or the epithelial cells that were collected didn’t have the bacteria attached to them, then there is no fluorescence. Thus a negative fluorescent antibody test for Pertussis, could mean that the test was truly negative, or falsely negative. There are few other tests that offer better results even today.

Measles is a viral infection which produces a rash and high fever. The tell-tale signs of the Koplik spots in the inside of the cheeks is very short lived. In addition to this, there are relatively few cases in the US because the vaccine is so effective. Because there are so many other viruses that causes rashes, what medical professionals call exanthems, most physicians have never seen a true case. I haven’t seen a bonafide case in my thirty-three years of Pediatrics, and if I ever considered the diagnosis, the clinical impression must be confirmed with serologic testing.

Herd Immunity

In the discussions about population immunity, what is referred to as herd immunity, the theory is that at some point if you get enough individuals vaccinated that you can eliminate the existence and spread of the disease. Those individuals who aren’t immune to the disease are then so spread apart by the individuals who are that all become protected. In cases of the original oral Polio vaccine, when you immunized a child, they shed that attenuated virus in their stool, and as a result other chidren and individuals who because infected with it, also could develop immunity.

Not all individuals who are vaccinated become immune to the targeted infectious agent. Developing an immunologic response to an infection is critical here. Vaccines are rated by their effectiveness at producing an immunologic response. I like to see vaccine responder rates of 90% to 92%. Rates of 95% are excellent.

Threats To Effective Herd Immunity And Infection Barriers

I see three threats with varying levels of concern toward the protection of population from diseases for which we vaccinate. Understanding these is very important especially when everyone is throwing in their two cents on how to deal with serious threats of infectious spread at the population level.

If the number of vaccinated individuals in the population drops to some certain level, then you will have more and more non-vaccinated individuals contacting other non-vaccinated individuals. Non-vaccinated individuals would include both those who were too young to produce a reliably adequate immunologic response, such as with measles and children under a year of age, and those individuals who have compromised immune health issues that precludes their vaccination.

It also includes those individuals who could have have gotten an immune response, but didn’t get the vaccine. The recent focus on American citizens who refuse the vaccines for their children however, have overlooked the more significant threat, which is individuals coming to our country unvaccinated. They pose a much bigger threat because by virtue of being outside our society, we have no way to monitor or encourage vaccination, nor do we know that the vaccines they received are ones that are effective, since vaccine manufacturers in other countries are not held to the higher standard generally required here in the United States.

Additionally, there is this thought that once you are vaccinated, that you’re good to go. That is not true however, as anyone sustaining a pentrating wound with a rusty nail would understand after they got a tetanus booster. This is particularly true of Pertussis which I mentioned already.

Not many medical studies really impact what Pediatricians actually recommend in the exam room. About a half dozen years or so ago, however a study came out which really caused me to tack in how I dealt with coughs in children. It turns out that an adult who has a cough that lasts two to three weeks has a 21% chance of actually having Pertussis. This is the prime reason we have to still be so vigilant even with a vaccination effort that has been effective but unable to mostly eradicate this disease. The repository of the bacteria is in the adult population whose childhood immunity has waned. As adults they don’t get as sick as infants, and most actually don’t go to a physician and get treated with the proper antibiotic. The usual antibiotics are all but ineffective agains Pertussis.

This adult repository is the reason that I recommend all parents of newborns that I see to get a Tdap, which is a tetanus vaccine that includes the Pertussis. Many hospitals are now starting to give the vaccine as well to the parents of newborns before they go home. I laud this, but the one problem in ERs and urgent cares is that many of them still give the Td tetanus vaccine which does not contain the Pertussis vaccine component.

Where Pertussis, which is called the Hundred Days Cough for good reason, can easily hide in the adult population by simply being a prolonged cough, Measles symptoms are not so easily undetected. High fever, coryza, and rash usually prompt an exam. Serious sequelae of measles is relatively higher than Pertussis. In the dozen or so cases of whooping cough that I’ve diagnosed in all my years have all responded well and none died. Measles can debilitate and kill.

To bring this all then back to three threats to preventing the spread of these infectious diseases in our country we have to pay close attention. The largest threat to our unvaccinated population of citizens comes from non-citizens who visit here or come illegally. Large amusement parks like Disneyland will promote the mix of those foreign individuals with our population. Similarly large warehouse-sized retail outlets are highly likely to be points of transmission of infectious disease. Personally I caution parents with newborns that Walmart and other large high-traffic stores are possibly a risk. Though I am guessing, I would suspect that many of the retailers might see 10,000 up to mabye even 50,000 people a day vist them. Contagion doesn’t have to be personal contact. I consider all the surfaces in those stores to be infection risk myself.

Clearly the biggest threat is the way our population mixes in normal life now compared with thirty years ago when superstores and large amusement were an rarity.

The second largest threat is from the waning immunity of our population. We are not vigilant enough as individuals toward vaccination as a lifelong thing. We associate vaccination with children.

Now we come the third threat I see from those individuals who are not vaccinated. While our citizens must be vigilant about Pertussis, these individuals can be vectors for disease. Unvaccinated popultions can include citizens of our country who can’t, or choose not to, be vaccinated. Those ‘antivaccine’ individuals actually make up a very small part of this. The problem is the non-citizens who are not vaccinated who visit or come and stay here illegally. The number of these individuals is so very much greater than citizens who choose not to vaccinate, yet I see this mostly ignored in discussions about forcing all citizens in this country to be vaccinated.

When a non-citizen comes to this country they do not have to show immunity to these diseases. Yellow fever is perhaps the exception. If you as a citizen visit certain areas of the world, you will be required to show proof that have been vaccinated upon reentry. This yellow fever certificate is as valuable as your passport. We don’t do this for measles. We don’t do it for Pertussis.

While presently there is a raging anger at those citizens who choose not to vaccinate, there is nothing said about foreign visitors who come to this country, and the conversation is even shunned when we discussed illegal visitors because of the current political correctness that is choking society.

What Should Be Our Priorities

If we are to eliminate the threat of such serious diseases like measles, then we must stop unvaccinated individuals at the border. We already do this for Yellow Fever so this is not novel. We must start admitting that illegal immigration carries more than political and ecomonmic implications. The health implications are the ones that will bring home the serious illness to our children.

We must stop being angry at those citizens who choose not to vaccinate their children. As a Pediatrician I think they should vaccinate and that the vaccines are safe. As a free citizen, however, I cherish the freedom that our country was founded and built on. It is no different than free speech. It is not only the ones who lose their freedom to choose, that lose their freedom. We all lose.

Many years ago in the new wake of the popularity of breastfeeding, I heard of a clinic in the Tulsa area where I trained, that stopped taking new infants whose mothers didn’t breast feed. Is that nonsense any different that medical practices who refuse to take children who aren’t vaccinated?

The most important way to prevent contagion in a medical office is to use appointment scheduling and stay on target with the exam schedule during the day. This prevents the mix of patients in the waiting rooms. Walk-in clinics are notoriously effective at transmitting infectious agents from one patient to another. Urgent cares and ERs are often very crowded, yet we see an alarming percentage of children who get almost routine healthcare there instead of establishing a regular physician relationship to private practitioners.

We stopped using paper on our exam tables long ago. The typical practice is in most practices to simply pull a fresh piece of paper over the exam table rather than actually clean the surfaces with an appropriate disinfectant.

Our policy is that we will try to take care of things that don’t need to be seen without a visit to our office. This makes not only good economic sense for parents, but good contagion prevention for the children we see.

I strive to develop good relationships with all my parents, even those who don’t want to vaccinate. Trying to force them goes against my grain, and will not be effective anyway. Developing a strong physician bond and trust can give parents a reason to decide to vaccinate. It is not that I’m trying to accommodate their decision, but rather give them access to my knowledge so they won’t be led astray by Dr. Google and all his non-medical cohorts. In a nation used to its freedom, there is marked push back when one group focuses on another over traditionally free-choice areas in our lives as though they are the bad guys

Its Just Chickenpox, Right?

I’m always very careful not to lambast parents who choose not to vaccinate. The reason is that I want to persuade rather than force. This is supposed to be a free country and even if I think otherwise about vaccines, I do think we ought to respect the right to choose not to vaccinate.

Be that as it may, this post itself is to give parents who choose not to vaccinate an informed appreciation for the darker side of that choice.

In an article posted here on ABC News’ web site, there is a sad story of a six year old girl who contracted chickenpox, i.e., varicella, and then subsequently developed pneumonia. The storm of both infections was more than she could repel. She passed on in her mother’s arms.

Her mother was reportedly talked out of childhood vaccines that have proven efficacy against those infections by the child’s physician. He apparently told her he was suspicious of the vaccines and that the child should be exposed to the illnesses and develop immunity naturally.

At autopsy, Abby was found to not have a spleen, which predisposed her to fatal infection by encapsulated bacteria in particular. Her asplenia is what happens to children with Sickle Cell Disease where the malformed red cells destroy the spleen over time. We vaccinate those children to Pneumococcus to prevent those fatal kinds of infection.

So often anti vaccine proponents tend to point blame at reactions to vaccines. But the dark side is that not giving vaccines is not the same thing as doing no harm.

Let me repeat that I staunchly support a parents right to refuse medical care, including vaccines, (except of course in the case of child abuse), but it is vitally important to clearly understand that not vaccinating does not equate to no consequences.

If you have further questions about vaccines, come in for an appointment and I’ll be glad to tell you what I know. We will treat you with respect and courtesy and answer your questions honestly.

Warmest regards,

Ron Smith, MD

A Mere Christian

A Mere Christian

What Christians Need To Know About Christianity

Just last week I published a work that some of you might be interested in. I teach Sunday school at my church and have been teaching Mere Christianity by C. S. Lewis. My book is called A Mere Christian and is the culmination of things I’ve learned and taught about what Christians should know about Christianity. If you are a Christian then this book is for you. The website is http://www.amerechristian.com for the book where you can read excerpts and learn more. It is available currently as an ebook on Amazon, Barnes & Noble, and iTunes for iBooks. I hope soon to have an on-demand print copy in Amazon as well.

After-hours Care Recommendations

We strive to always see patients in our office for medical care. It is not only cheaper, but much more efficient. Sometimes however, your child may need treatment when my office is not open. We often are asked our recommendations and so we have put together a list of the best sources of after-hours care in our opinion. This is not to say that in an emergency you should ignore other places to get treatment. Sometimes situations demand other choices. These recommendations are intended to be a helpful list. Please note, all urgent care providers’ hours of operation may change during any holiday.

After-hours pediatric urgent care

CorrectMed
4861 Bill Gardner Parkway
Locust Grove, GA
770-626-5740

  • Hours: Mon-Fri, 8 am-8 pm, last appt @ 7 pm. Sat-Sun, 9 am-6 pm, last @ 6 pm.
  • Does not accept Medicaid or HMO plans
  • Has x-ray capability
  • Will see children 3 months and older

Primary Pediatrics
110 Regency Park Drive
McDonough, GA
770-288-2285

  • Hours: Mon-Fri, 5 pm-10 pm; Sat-Sun, 10 am-9 pm
  • Accepts most insurance plans
  • No x-ray capability

Kids Time Pediatrics
125 Eagles Walk
Stockbridge, GA
678-289-4483

  • Hours: Mon-Fri, 6 pm-9 pm; Sat-Sun, 10 am-5 pm
  • Accepts most insurance plans
  • Not an emergency care facility

Pediatric Emergency Care Facilities

Scottish Rite Children’s Hospital
Atlanta, GA.

This Time

Online For Life has an amazing video created in partnership with John Elefante. I think this tells the argument for life with amazing visual clarity. Thanks to Online For Life for graciously permitting me to link to the music video here. If you think that your situation is too hard, then I would suggest you read our Laura’s ebook story, Forever And A Day For Laura Michelle, available free on iTunes. May I also suggest full screen viewing.

The Relationship Between Homosexual Pedophilia And Homosexuality

This article, primarily written to address Governor Christie’s signing of New Jersey legislation that seeks to bar free speech to minors, has some other information about the association of homosexual abuse of children and their later tendencies to choose homosexuality. I was frankly a little disturbed by some of the quoted points.

http://www.cnsnews.com/commentary/j-matt-barber/gay-lawmaker-christians-we-ll-take-your-children

Measles Outbreak In Non-vaccinated Children Affects 20+

Apparently there is a significant Measles outbreak in a local church body in Newark, Texas. This group of church members is opposed to vaccinations and their children were affected by one of their members who contracted Measles on a trip to Indonesia.

Of note that in my thirty years as a Pediatrician, I’ve never seen a confirmed case of Measles. Confirmation of measles requires formal serologic testing and cannot be adequately concluded based solely on a red rash, despite some of the specific characteristics that are present in the first 24 hours.

http://www.newsmax.com/TheWire/texas-measles-outbreak-sicken/2013/08/27/id/522423