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Daily Dose

Hurricanes & Your Health

1:30 to read

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).  

 

 

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

Anti-Vaccine Movement

1.30 to read

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.

Your Child

2 Doses of Chickenpox Vaccine Almost 100 Percent Effective

2:00

Chickenpox is one of the most common childhood illnesses. It is a viral infection caused by the Varicella zoster virus and produces a painful, itchy rash with small, fluid-filled blisters.

It occurs most often in early spring and late winter and is highly contagious. Typically, chickenpox occurs in kids between 6 and 10 years of age.

A new study shows that among schoolchildren, two doses of the chickenpox vaccine is more effective than one.

Giving the first dose at age 1 and the second dose at ages 4 to 6 is nearly 100 percent effective in preventing the once common childhood disease, researchers have found.

"A second dose of varicella [chickenpox] vaccine provides school-aged children with better protection against the chickenpox virus, compared to one dose alone or no vaccination," said lead researcher Dana Perella, of the Philadelphia Department of Public Health.

Two doses of the vaccine protected against the moderate to severe chickenpox infections that can lead to complications and hospitalizations, she said.

Before routine chickenpox vaccination began in 1995, virtually all children were infected at some point, sometimes with serious complications. About 11,000 children were hospitalized each year for chickenpox, and 100 died annually from the disease, according to the CDC.

One-dose vaccination greatly reduced incidence of chickenpox, but outbreaks continued to be reported in schools where many kids had been vaccinated. That led the CDC in 2006 to recommend a second vaccine dose.

To evaluate effectiveness of the double- dose regimen, Perella and colleagues collected data on 125 children with chickenpox in Philadelphia and northern Los Angeles and compared them with 408 kids who had not had the disease.

They found that two doses of the vaccine was slightly more than 97 percent effective in protecting kids from chickenpox.

"With improved protection provided by two-dose varicella vaccination compared with one-dose only, continued decreases in the occurrence of chickenpox, including more severe infections and hospitalizations, are expected as more children routinely receive dose two between the ages of 4 and 6 years," Perella said.

For children with weakened immune systems that cannot take the vaccine, having their classmates and playmates protected by the vaccine helps protect them against the viral infection.

School vaccine requirements should include two-dose varicella vaccination, Perella said.

"In addition, 'catch-up' varicella vaccination is also important," she said. This applies to anyone over 6 who haven’t had a second vaccine dose, especially if they could be exposed to chickenpox or shingles - a painful condition in older people caused by reactivation of the chickenpox virus, she said.

Most healthy children who get chickenpox do not have serious complications from the illness. But there are cases when chickenpox has caused hospitalization, serious complications and even death.

A child may be at greater risk for complications if he or she:

·      Has a weakened immune system

·      Is under 1 year of age

·      Suffers from eczema

·      Takes a medication called salicylate

·      Was born prematurely

The report was published online March 14 and will appear in the April print issue of the journal Pediatrics.

Story sources: Steven Reinberg, http://www.webmd.com/children/news/20160314/two-dose-chickenpox-shot-gets-the-job-done-study-shows

http://www.parents.com/health/vaccines/chicken-pox/chickenpox-facts/

Your Baby

Tdap Vaccine Protects Mother and Newborn

1:45

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

MMR Vaccine Changes Are Coming

There is always a lot of news about vaccines, especially this year with the need for two different flu vaccines to provide protection against both seasonal influenza and novel H1N1 (swine flu). But another newsworthy story involves the vaccines to prevent measles, mumps and rubella (MMR).

The MMR II vaccine is typically give given to infants at their 12 month check up. It has been given for over 30 years, and as a result, the incidence of these diseases has decreased dramatically since that time. But in recent years there had been “concern” by some that the MMR vaccine was one of the “causes” of autism. Due to this “unfounded and unsubstantiated” concern, some parents had opted not to give their children MMR vaccine, while others had decided to spread out the doses by giving individual components of the vaccine. In other words, the parents, and some doctors, gave mumps, measles, and rubella vaccine as individual vaccines separated by weeks to months. This decision puts more children at risk for acquiring these diseases that have not been eradicated, especially in other parts of the world and can be imported into the U.S. by international travel. Such was the case in 2006 when there was a mumps outbreak in the U.S. and in 2008 there was a measles outbreak across this country. In the measles outbreak, the first case was imported to California by an unvaccinated child who had been in Switzerland and acquired the measles virus and become ill upon his return to the U.S. This is again an example that the re-emergence of these diseases is always a threat in unvaccinated or partially vaccinated children. Due to the fact that there were different vaccines available, some being MMR combination and other single disease vaccines there was even more concern that children would not be adequately vaccinated, and that there could be widespread disease in this country. Merck had been the only distributor of single component vaccines, which had always been difficult to obtain. It seemed that there were often shortages of either the measles, the mumps or the rubella single dose vaccines, which again just delayed vaccination. After many meetings with both the American Academy of Pediatrics, the Centers for Disease Control and Prevention and the Committee on Infectious Diseases, Merck has announced that it will no longer produce single antigen component measles, mumps or rubella vaccines. Studies have confirmed that combination vaccines like MMR are not only safe, but are an important way to improve overall vaccine compliance and results in higher vaccine coverage. With the decision by Merck to stop producing single antigen vaccines, the MMR vaccine will become the only vaccine available for use and will help clear the “muddy” waters surrounding single antigen vaccine. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Deciding to Vaccinate Your Child

1.15 to read

I was recently doing a 4 year old well-child check up. This little girl was the youngest in a family of 4 girls with the oldest daughter being 18.

Through the many years of taking care of this family of girls, I have come upon new issues and changes that have occurred in pediatrics.  There have also been and will continue to be, different parental concerns. 

When this child was born, there was still a lot of discussion about immunization safety and parental concerns surrounding vaccines and autism. Although all of her older siblings had been immunized on schedule, without any issues at all, when the “baby” was born her mother and I had many discussions about giving this little girl her vaccines. 

The mother told me that she was now “hanging out with younger parents and they had made her concerned about vaccines, specifically as they related to autism.”  

Well, after much discussion and hand wringing on the mother’s part, the little girl was vaccinated on schedule just as her siblings had been. In fact, the father brought the daughter for her 1 year old vaccines (which include the MMR) just because the mother was anxious.  The dad and I had a bit of a chuckle about this, but nevertheless the child received her MMR without problems. 

So, fast forward to the 4 year old check up. This little girl is quite precocious and worldly as well, being the youngest in the family. She has always been exceptionally verbal, and doesn’t mind telling you exactly what she has on her mind. (sometimes with words she may have picked up from her older siblings!). Birth order, a daily dose for a later date! 

At the end of the check up, as it became time to discuss vaccines, I turned to the mother and said, “ Sally, is going to get her immunizations today including her MMR”.  Are you still concerned about giving her vaccines as surely you don’t think that Sally is autistic?” 

As the mother was getting ready to speak, little Sally quickly interrupted in her usual loud voice and said, “ Dr. Sue I am to artistic, I drew those pictures for you!” 

Enough said, ice broken, subject over and vaccines all given on time and without a problem. 

Daily Dose

HPV & Risky Sexual Behavior

1.30 to read

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.

Daily Dose

Let's Talk Flu Vaccines

2.00 to read

It's hard to believe, but fall virus season is just around the corner and the time is now to start thinking about the upcoming flu season. Some areas of the country continue to experience 100+ degrees which makes it hard to believe it’s time to talk about flu! Not the actual virus (just yet) but flu vaccines!  Flu vaccines are being shipped and should be in your doctor’s office at any time. We received ours last week and have already started giving vaccines to patients.

As in previous years, all people aged six months and older need to be vaccinated. This year’s vaccine contains three strains of influenza virus and they are identical to last year’s vaccine strains. Even though the vaccines are identical, it does not mean that you can skip the flu vaccine this year.  Sorry! Because the protection from the flu wanes over the year, it is necessary to get re-vaccinated every year. Why? You just don’t know how much antibody you have left! For children who are six months to age eight years of age, AND who have NEVER been vaccinated, the recommendation continues to be that they should receive two doses of vaccine which are given at least four weeks apart. If your child received at least one dose of flu vaccine in 2010-2011, they will only need one dose of the 2011-2012 vaccine. The recommendation for pregnant women to be vaccinated also continues. There has been some good recent data that babies who were born to mothers who had received flu vaccine had a 45-48% LESS chance of being hospitalized with the flu than babies born to unvaccinated mothers. So, the take home message is that your baby, even in utero, is getting antibody protection from the mother. We have known this about other diseases and now there is evidence of influenza protection too. Time to think/pray/chant for cooler weather, which means that “flu viruses” will be happy to return from vacation….start getting your vaccine now! That’s your daily dose for today.  We’ll chat again tomorrow.

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