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Daily Dose

Vaccines During Pregnancy

1:30 to read

August is National Immunization Awareness Month and a great time to discuss childhood vaccines (see previous post), but also a good time to discuss vaccines for adults. Adult vaccines help to protect our children. Specifically, Tdap vaccination during pregnancy.

 

Immunizations may protect a newborn….and this is accomplished by immunizing the mother during her pregnancy. It is routinely recommended that all pregnant women receive the Tdap (tetanus, diphtheria and pertussis)  vaccine at 27-36 weeks’ gestation. The goal of maternal immunization is to provide the newborn infant with “passive protection” from circulating antibodies that cross the placenta. Passive antibodies will provide the newborn some protection from disease, specifically pertussis (whooping cough), prior to the first dose of DTaP given at the 2 month pediatric visit. 

 

A recent study published in Pediatrics looked at the effectiveness of maternal Tdap vaccine on preventing pertussis in newborns.  In the study of over 140,000 infants there were 17 cases of pertussis in infants under 2 months of age, and 16 of those cases were in infants born to unvaccinated mothers. There was only 1 case of whooping cough in the vaccinated group. In other words, maternal Tdap vaccine provided 91.4% effectiveness in preventing pertussis in the first 2 months of an infant’s life. Pretty great odds!!

 

This is important data in that whooping cough has become more and more prevalent in the United States and is especially dangerous in young infants.  By immunizing a pregnant mother these precious newborns are protected.  The study also found that maternal Tdap vaccination during pregnancy reduced an infant’s risk of pertussis by an estimated 69% in the first year of life.  

 

So…the importance of vaccines during pregnancy is well studied and I know my pregnant daughter in law who is now in her last trimester will be getting her Tdap, as will her husband.  

It is equally important that pregnant women receive flu vaccine in their last trimester…and the 2017-2018 vaccines are just arriving.  Studies have found that this maternal antibody also transfers to the baby and is protective for those infants born during flu season who are too young to receive flu vaccine, which is not given prior to 6 months of age. 

Daily Dose

Booster Shots

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Under the heading “kids say the smartest things” comes one of the latest entries!! I was seeing a 4 year old for their check up...this is a great age as most kids are very conversational and engaged and most are over their fear of the doctor.  I think “Doc McStuffins” has helped this out as well. Thank you Doc!

So, if you didn’t know it, 4-5 year olds get immunized before they start kindergarten.  I give 4 year olds their DTaP, IPV, MMR and Varicella vaccine, all in preparation for school.After a wonderful chatty and interactive visit, I always find it hard to now tell this precious child that at the end of the visit they are going to get some “vaccinations”.  Many times, in fact most, the idea of shots does not go over well.

Last week I saw this 4 year old, had a great visit, talked all about school and his soccer team and his new bike and bike helmet, only to end with “you are going to get several shots to keep you healthy”.  Then you wait for the reaction, right?

So, this little boy looked me right in the eye and said, “I get shots to protect and help my immune system!”.  What a smart kid! I think he is going to be an immunologist one day and save the world. I couldn’t be happier that he already understands re-boosting immunity.  

Daily Dose

HPV & Risky Sexual Behavior

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I have written many articles on the HPV vaccine and have been a big advocate for giving this vaccine to all adolescents . I let my patients know that I even gave it to all of my sons in their teen and early adult years (off label at the time, as it was not initially approved for males in the U.S.), as I had looked at the European data as to HPV vaccine efficacy in both males and females. 

At any rate, some parents, while proponents of vaccines, did not want to vaccinate their children during their teen years, “for fear that it might promote early sexual behaviors”.  I myself had not been concerned about that issue, as I have seen too many teens who never gave getting a sexually transmitted disease a second thought (though they should), prior to having their first sexual experience. I told parents, “I just wish they were thinking with their brains rather than with hormones and genitalia”. 

My own impression was that by giving the HPV vaccine while re-iterating to teens and young adults the ongoing risks about STI (sexually transmitted infections), we might see more “thinking” before engaging in pre-marital sex. My hope was that by providing information about developing a STI  (including those not covered by the HPV vaccine such as chlamydia, herpes, gonorrhea etc) doctors and parents could also be influential in helping adolescents realize that even with HPV vaccine, “there is no safe sex”. Double win, right?

There is now an article in Pediatrics (February 2014) which confirms that HPV vaccine was not tied to initiation of riskier sexual behavior.  A study done at Cincinnati Children’s Hospital surveyed 339 female adolescents and young adults aged 13- 21 years following HPV vaccination. They also did follow up questionnaires 2 and 6 months post vaccine.  The study showed that giving a young girl HPV vaccine did not lead to the perception that she was protected against STI’s nor did it promote sexual activity. The study did show that the girls that received HPV vaccine understood that it only protected them against HPV related disease and the possibility of developing a HPV-related wart or cancer.

Another finding in the study, was that most girls held appropriate perceptions that there was still a need to practice safe sex even after HPV vaccine, including the use of a condom.

So, if a parent is worried that HPV vaccine may lead their teen to initiate earlier sexual behavior, at least there is one study confirming that there is no association in girls. Further studies including boys should also be undertaken.

Could there be an association between not discussing risky sexual behavior, not giving the HPV vaccine and early initiation of sex?  Food for thought.

Your Baby

Tdap Vaccine Protects Mother and Newborn

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A new study shows that the Tdap vaccine, (tetanus, diphtheria and pertussis), is safe for pregnant women and their unborn child.

The vaccine does not appear to cause birth defects or any other major health problems for a developing fetus, according to a review of more than 324,000 live births between 2007 and 2013.

"We basically showed there is no association between receiving the Tdap vaccine during pregnancy and these congenital [birth] defects, including microcephaly," said lead researcher Dr. Malini DeSilva. She is a clinical investigator for HealthPartners Institute in Minneapolis.

Controversy over vaccines has caused some pregnant women to worry about possible side effects. The study is part of ongoing efforts to monitor the safety of vaccines, DeSilva said. Her center is part of the Vaccine Safety Datalink, a collaborative project led by the U.S. Centers for Disease Control and Prevention that includes health care organizations across the nation.

Whooping cough (also known as pertussis) is a bacterial infection that gets into your nose and throat. Whooping cough is dangerous in babies, especially ones younger than 6 months old. In severe cases, they may need to go to an ER. Babies with whooping cough may not make the typical whooping sound or even cough, but might gasp for air instead.

Babies can't receive the vaccine that protects against these diseases until they are 2 months old, DeSilva said. Until they do, they have a high risk of contracting whooping cough.

"In between the time they're born and their 2 months' visit, they don't really have any protective antibodies other than what has passed through the placenta," DeSilva said. "There have been some studies that show there is an increased chance of passing these antibodies when the mother gets this vaccine."

The researchers found that maternal Tdap inoculation wasn't significantly associated with increased risk for any major birth defects in vaccinations occurring at less than 14 weeks' gestation, between 27 and 36 weeks' gestation, or during any week of pregnancy.

Dr. Amesh Adalja is a senior associate with the University of Pittsburgh's UPMC Center for Health Security. He said, "This study illustrates the safety of maternal Tdap vaccination and the lack of an association with any birth defects." Adalja was not involved with the new report.

"Vaccination of pregnant women with this vaccine is an important aspect of protecting neonates from pertussis, a potentially fatal condition," Adalja added. "This study should reassure physicians and patients and hopefully increase vaccination rates in pregnancy."

The Tdap vaccine has been recommended for unvaccinated pregnant women since 2010 in California, and since 2011 across the United States, researchers said in background information.

The study was published Nov. 1 in the Journal of the American Medical Association.

Pertussis is very contagious and is particularly dangerous for infants. With the cold season underway, the Tdap vaccine is highly recommended for pregnant women as well as the general public.

Story sources: Dennis Thompson, https://consumer.healthday.com/public-health-information-30/vaccine-news-689/common-vaccine-is-safe-for-mother-baby-in-pregnancy-716379.html

Renee A. Alli, MD, http://www.webmd.com/children/guide/whooping-cough-symptoms-treatment#1

Daily Dose

A News Alert for a Preventable Disease

There was a news release in the past several day alerting physicians to five cases of invasive H. Flu bacterial infections in children under the age of five in Minnesota during 2008. The reason this is significant is that this is a vaccine preventable infection. In other words, children are vaccinated against this bacterial infection beginning at two months of age. This is also a series of vaccines with infants receiving a series and a booster dose during toddler years.

There are several issues regarding this newsworthy information of an infection that was dramatically reduced after vaccination began in the early 90s. Number one, there has been a shortage of H. Flu (HIB) vaccine for the past year and infants are receiving the initial series, but doctors are withholding the booster dose in order to ensure adequate vaccine supplies for infants. At the present, it does not seem as if this is affecting vaccine efficacy but the Centers for Disease Control and Prevention (CDC) and state heath departments are watching for changes in rates of H. Flu disease which might indicate that the bacteria is having a resurgence as vaccines are delayed. Secondly, in looking at the five cases in Minnesota (the last time there were this many cases was more than 10 years ago), three of the children had not received HIB vaccine as their parent's refused vaccinations for their children. Of these three children, ranging in age from seven months to five years, all had invasive disease such as meningitis and pneumonia, and unfortunately one child died. I was a much younger pediatrician when I used to see these infections and yes, I too saw children die, or have long-term consequences such a being deaf or mentally retarded due to H. Flu infections. The HIB vaccine changed this and I have not seen a case in over 15 years, which is about the time the vaccine was released. This is a lesson in how vaccines work, not only for the vaccinated child, but also for the "herd" around them. Make sure your child has received this very important vaccine, so that we will not see more articles about increasing H. flu infections and preventable deaths. That's your daily dose, we'll chat again tomorrow.

Parenting

Mumps Reach 10 Year High; Hitting Colleges and Kids Hard

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Mumps are making a comeback, particularly on college campuses and in daycare centers.

A recent U.S. Centers for Disease Control and Prevention report shows that mumps are at a 10-year high. As of November, 45 states and the District of Columbia had reported a total of 2,879 mumps infections — more than double the mumps cases reported in 2015.

Mumps is a contagious disease caused by a virus. Common symptoms can include swollen glands in front of and below the ear or under the jaw, pain with opening and closing the jaw, fever, fatigue and malaise, headache and earache.

Currently, college campuses are taking the brunt of the mumps outbreak.

Dr. Michael Grosso, medical director and CMO of Huntington Hospital/Northwell Health, said close quarters such as dormitory living, can make it easier to pick up the virus.

“It’s spread through respiratory secretions, coughing, sneezing, close contact and sharing the same cups and utensils,” Grosso told CBS News.

Some colleges, such as The University of Missouri’s Columbia, are asking students to restrict their social activities and to make sure they get immunized. Typically, two doses of vaccine are recommended by the American Academy of Pediatrics and the CDC, but the school is asking students to get a third measles-mumps-rubella (MMR) vaccine “based on discussions with public health officials and consistent with guidance from The Centers for Disease Control and Prevention.”

College students aren’t the only ones being hit hard by mumps; younger children are also experiencing a rise in reported cases. More parents have opted-out of getting their children the MMR vaccine - putting non-immunized children at a higher risk.

Daycare centers are similar to college dormitories in that they provide an environment where a virus can be easily spread.

While most mumps cases are mild, albeit, uncomfortable, others can be more serious.

“Most individuals recover uneventfully from mumps, however as many as 10 percent of males who get mumps will get an inflammation of the testes which can lead to permanent sterility,” Grosso said.

The brain can also be affected. About 1 percent of people who come down with the mumps get serious brain infections and can experience meningitis, encephalitis and deafness associated with a brain infection.

“That small risk was behind the original impetus to create a vaccine,” Grosso said.

 Physicians are urging students to get the immunizations and to practice good hygiene. Simple steps such as covering your cough or sneeze, washing your hands with soap and water or using an alcohol-based hand sanitizer, avoiding sharing food, drinks, cups or utensils can help prevent the spread of viruses.

Vaccines are still the most effective way to lower your risk of getting the mumps.  No vaccine is a 100 percent protective, Grosso notes, but it can help you avoid the risk of serious illness and lifelong health issues.

“Receiving two doses of mumps vaccines is said to confer about an 88 percent reduction in risk of getting mumps if you’re exposed,” said Grosso. A third dose may increase those odds.

The American Academy of Pediatrics recommends the first dose of MMR vaccine should be administered between 12 and 15 months of age, and the second dose between 4 to 6 years of age.

Grosso emphasizes that parents need to get their children vaccinated early.

“Being immunized late is better than not being immunized ever. But being immunized late is not nearly as good as being immunized on time,” Grosso said.

Story sources: Mary Brophy Marcus, http://www.cbsnews.com/news/mumps-cases-10-year-high-college-outbreaks-vaccination/

https://www.cdc.gov/mumps/

Daily Dose

The Flu Vaccine For Moms-To-Be

I have the opportunity to see (not treat) a lot of pregnant women in my practice and they have been asking me my opinion about flu vaccine during pregnancy.

They were inquiring about both seasonal flu vaccine and H1N1 (swine) flu vaccine. The statistics surrounding pregnancy, influenza and secondary infections or other complications have been documented for several years. Retrospective studies done in the late 1990s showed that healthy pregnant women were more likely to have complications from influenza and had higher death rates than expected. This was especially noted in women in the last trimester of their pregnancies. Due to these studies the CDC and ACOG (American College of Obstetrics and Gynecology) recommended that all pregnant women receive seasonal influenza vaccine. Despite these recommendations, more than 50 percent of OB’s recently surveyed do not routinely recommend flu vaccine and do not provide vaccine in their offices. I see many expectant mothers who are totally surprised when I ask them if they have received a flu vaccine from their OB. In fact only 1 in 7 pregnant women are being vaccinated. This may be partially due to the fact that OB’s have not routinely been vaccine providers, as we pediatricians have been, and are now becoming more aware about universal recommendations for flu vaccine in pregnancy and are ordering vaccine for their patients to receive during routine obstetrical visits. Flu vaccine is safe throughout pregnancy. This year is especially significant in that the H1N1 (swine) flu has also caused serious complications and deaths in pregnant women. The data shows that a disproportionate number of the deaths seen from swine flu (about 6 percent) were in pregnant women. Pregnant women are four times more likely to be hospitalized than other flu sufferers. This may be due physiological changes in lung function during pregnancy, as well as to differences in immune function. Regardless of the reasons, pregnancy in and of itself puts a woman at increased risk of serious complications, hospitalization and even death. Pregnancy is typically a time that we see the “the glow of pregnancy”, not complications or even death from having the flu. As an added benefit of vaccination, the antibodies that a pregnant woman will produce after vaccination will then be transported across the placenta to help protect the newborn. Passive transport of maternal antibodies may be the best protection for a newborn in the first two months of life. This is especially important for those infants being born during the height of the flu season. As you know we cannot give an infant flu vaccine until they are six months of age. With both H1N1 influenza currently circulating throughout the U.S. and seasonal flu yet to come, now is the time to make sure that you are vaccinated, especially if you are pregnant. Lastly, pregnant women should not receive live –attenuated flu vaccine (Flu-mist), but should receive the injectable flu vaccine for both seasonal flu and H1N1. You may receive both flu vaccines on the same day.  It is equally important for the father of the baby to be immunized against both types of flu to minimize the newborn’s risk of exposure as well. The best protection for a newborn is vaccination of those who will be caring for the infant during the flu season!! That’s your daily dose, we’ll chat again soon.

Daily Dose

Anti-Vaccine Movement

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It seems that the “anti-vaccine” movement is still alive and well and has been a hot topic on Twitter and Facebook again. Unfortunately, much of what I have read on these sites seems to be inaccurate and based on a lot of emotion and very little science.  But, emotional posts can be quite persuasive, especially to a new parent who wants to do EVERYTHING for their new child.  I would think that would include protecting them from deadly diseases that have NOT been totally eradicated.

One of the first things you learn during your early medical school days is the mantra that doctors should “first do no harm”.  I have continued my daily pediatric practice with that in mind.....so how could I not vaccinate my precious patients?  Vaccines have been well studied ( and continue to be studied) and absolutely DO protect children (and adults) from numerous diseases....including polio, bacterial meningitis, whooping cough and measles.  Vaccines are also safe.....how many different studies does it take to assure parents of this? 

Choosing to not vaccinate your child unfortunately can “cause harm”.  Do parents not realize that we are all exposed to diseases unknowingly?   I know that there isn’t a parent out there that would purposely expose their child to a disease....especially one that could cause death. But with that being said, the bacteria ( h. flu and pneumococcus) that cause meningitis are often harbored in a person’s nose and are just a sneeze away from an unprotected baby.  When I used to do spinal taps on a regular basis on very ill children, some of whom indeed had bacterial meningitis, every parent would ask, “how did my child get this?”  The answer at that time was, “we don’t know where they were exposed”.  Not a very good answer to give parent’s of a critically ill child, some of whom would die. 

Since the vaccines against meningitis have been released I have not seen a case of H.flu or Pneumococcal meningitis in my practice. I can’t remember the last time I did a spinal tap.  Those are memories I don’t need to experience again.  My office was also involved in the studies for the HIB meningitis vaccine and I saw first hand how labor intensive and difficult vaccine studies are. There were a lot of parents at that time that allowed us to stick their infants for blood samples on (many times, on a regular basis) to prove that the vaccine provided antibody and protection for their baby.  Thank you to all of those parents!

So.... I continue to be alarmed that there are parents (often clustered in certain areas) that want to deny their child vaccines.  I wonder what their baby would say, if they had the chance to choose to get vaccinated. Unfortunately, they don’t.

Daily Dose

Hurricanes & Your Health

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The last week has been a tough one for Texans, and especially for those who live in Houston and along the Texas Gulf Coast.  Having my son, brother and mother all with houses in Houston, I have been watching the “Harvey” situation quite closely. Fortunately, my family is lucky enough not to have flood damage and they have not had to leave Houston.  But, too many other families have suffered flooding and have been forced to evacuate their homes and seek refuge in shelters not only in Houston, but in Dallas where I live as well. 

 

There are many families who are now living in very close quarters where they may be for sometime…as it will take weeks and months if not years to recover from this disaster and to rebuild the homes, schools, churches and businesses that have been either damaged or destroyed. 

 

The necessary relocation of families and children into shelters is also “a perfect storm” for the possibility of the spread of infectious disease. This is an important time in which managing the spread of illness and infection is paramount. What this means is that EVERYONE needs to be up to date on their immunizations to prevent the spread of vaccine preventable diseases. 

 

If you have ever “skipped” a vaccine by choice or missed a vaccine, now is the time to get your child’s vaccines updated. This is not only for those who have had to evacuate, but for everyone, as infectious diseases are spread outside of the shelters and as well.  We pediatricians are working in the shelters to try and make sure that everyone is vaccinated as they arrive, but there are those who are too young to be vaccinated and others who do not have their medical records to ensure accuracy of their vaccines. It is an arduous process.

 

But, for the public health system which will be stretched even more so during the flood recovery, vaccines are one of the most important ways to protect people. It only takes one person who might get mumps, measles or whooping cough to spread it to hundreds of others….all living in close proximity. These people will then also leave their shelter to go to school, church the store or even a temporary job where they may put others at risk, you never know if you might be exposed.

 

Lastly, it is really time to get those flu shots!!! The last thing we need is an early flu season with a large group of un-immunized people…and most doctors have already received shipments of flu vaccine.

 

Please please pray for these families who have lost so much and protect everyone by immunizing your children (and yourself).  

 

 

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DR SUE'S DAILY DOSE

Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?

DR SUE'S DAILY DOSE

Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?

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