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Daily Dose

Measles Outbreak

1.15 to read

With all of the news about the measles (rubeola) in California (51 cases) and New York (25 cases), (we) pediatricians are also on the alert for any measles cases in our areas.  I have written many times about the importance of vaccines, but this latest outbreak of measles is just a reminder of the importance of vaccines and the concept of herd immunity.  

By maintaining high vaccine rates for all children (adults too),  even those who may not have been vaccinated are protected because the “herd”, in otherwords the largest group of children, has received the vaccine.  It typically takes a 90-95% vaccination rate to maintain this herd immunity. Once the vaccination rate drops below this there is more likelihood to see a re-occurrence of a disease. In some areas of the country, where parents may choose to “opt out” of vaccines, the vaccination rates are below 90%. This is a critical situation.

Although measles was pronounced eliminated in the United States in 2000, measles is still widespread worldwide.  With international travel an everyday occurrence it only takes one person to “import” measles into the United States. Measles is a very contagious disease and is spread by respiratory droplets. The virus can remain in a room for up to 2 hours after an infected person has been there!!! Viruses are smart and hardy.  You would never know if you walked into a room or airplane after someone had just left who had measles. Remember, an infected person is contagious even before the measles rash appears.  Measles symptoms may occur up to 3 weeks after exposure. The illness begins like many others with fever, runny nose, cough and red eyes. It takes several days and then the measles rash develops.  By this time many others have likely been exposed. 

There are certain children who cannot receive vaccines due to medical reasons. Those children are protected by all of the others who are vaccinated. Making sure that your own children are vaccinated is paramount.  Measles vaccine, given as the MMR is typically given at the 12-15 month old visit and again between the ages of 4-6 years.  

There has also been a great deal of confusion on social media sites about measles (rubeola) and exanthem subitum (roseola). These are different illnesses and measles IS a vaccine preventable disease, while roseola is not. More to come on roseola....

 

Daily Dose

Protecting Your New Bundle of Joy

When I see newborns in my office this fall I am already thinking into the winter season ahead.

As I see new parents in my office this fall, bringing in that most precious newborn for their first pediatric visit, I am already thinking into the winter season ahead. Infants born during fall and winter are exposed to more upper respiratory viruses and flu in their first six months of life. Infants under six months of age are at more risk of complications from viruses like RSV and flu. Unfortunately, infants under six months cannot receive flu vaccine.

But a recent study showed that mothers who received a flu vaccine during pregnancy reduced influenza illness in their newborns. That study is important in reminding pregnant mothers of the importance of receiving flu vaccine during their pregnancy. Unfortunately, in my practice, I do not see this information being given to pregnant mothers while they are in for their OB visits. It is also important that new parents are vaccinated against whooping cough with a newer vaccine which is given to adults called a TDaP. If you are pregnant or thinking about becoming pregnant this winter discuss these vaccines with your obstetrician. If they do not have the vaccines in their office, your local health department has them. The best way to protect that new bundle of joy is by immunizing those around them. This would also apply to grandparents, aunts, uncles and cousins. Spread the word about flu vaccine and TDaP and not the germs. That's your daily dose, we'll chat tomorrow!

Daily Dose

Update All Immunizations

1.15 to read

August is National Immunization month and what better time than now to make sure your baby, child, tween, teen or even adults are immunized.  With all of the news surrounding pertussis (whooping cough) outbreaks across the country, and now measles in several states, the importance of vaccinating is paramount.

Vaccines have been proven to prevent disease. But in order for vaccines to be effective the majority of the population must be protected.  By vaccinating upwards of 90% of the population the entire “herd” community is protected. When vaccine rates dip below this threshold a disease such as measles or whooping cough can cause illness, not just isolated to one person, but spread to those who have not been immunized or to those who have lapsed immunizations and whose immunity has lessened. This scenario seems to be part of the case for pertussis as the adult population had not been vaccinated against pertussis for many years. It is now evident and recommended that adults as well as children receive a booster dose of pertussis in the form of a TdaP vaccine.  That means ALL adults. 

As summer comes to an end, I know that winter illnesses and busy pediatric offices are just around the corner.  Parents ask me everyday, why does my child get a cold or a cough, or a fever and vomiting?? That is because we do not “yet” have vaccine for the common cold or for norovirus or enterovirus or adenovirus. Those vaccines may be available one day. BUT, we do have vaccines for rotavirus (winter time vomiting and diarrhea),  measles, chickenpox, and FLU!

Great news is that the flu vaccine for 2013-2014 is now quadrivalent, which means that there are 4 strains of flu in the vaccine (2 for flu A and 2 for flu B). This should provide even greater protection.

So, as you are getting all of your kids ready for school and immunized think ahead about flu vaccine as well. It is already arriving in our office and we will be vaccinating all fall in hopes of keeping more illness away this winter.  The best protection against disease continues to be vaccines - spread the word, not the disease. 

Daily Dose

Changes in Flu Immunizations for Children

Flu season is fast approaching and that means it is time to get your flu vaccine. Recently the Centers for Disease Control and Prevention and the American Academy of Pediatrics expanded the recommendation for flu vaccination to include all children ages six months to 18 years.

The previous recommended age group was 6 months to 5 years. "Children under nine years of age who have never received a flu vaccine need to have two doses of vaccine separated by at least four weeks, and all other children receive a single dose," says pediatrician Dr. Sue Hubbard. That means the time is now for you to call and schedule a flu shot with your doctor and your child's pediatrician. Many offices block off certain times during the day in which they have "flu shot clinics." According to Dr. William Schaffner, president-elect of the National Foundation for Infectious Diseases there is an ample supply of the flu vaccine this year. He encourages people to start taking it now as there is no reason to wait. "There are two options for children older than two: the injectable flu vaccine or the live attenuated flumist intranasal vaccine. There are some restrictions to intranasal vaccine (children with asthma, immuno-suppressed children) but for many children the idea of sniffing a vaccine is far better than a SHOT. The upside of the nasal vaccine is also that it seems to be more effective," says Dr. Hubbard. "Either way, start thinking about getting on your doctors schedule to get vaccinated before the winter and influenza hits." Dr. Hubbard also recommends that you teach your child to practice good hand and cough hygiene to help prevent the spread of germs. More Information: The American Academy of Pediatrics More Information: Centers for Disease Control and Prevention

Daily Dose

Medical Decisions at Age 18

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It suddenly seems that I have been in a time warp and so many of my patients who “should still be little” are coming in for a visit while home frm college.  It was hard enough for me to realize that my own children had “grown-up”, but I am now realizing that my own patients are “growing up” as well. With many of them now being 18 years old, they are now also “in charge” of their own health care decisions. This became apparent the other day as I was seeing a long time patient for her 18 year old check up, and I was filling out her college health form as well. 

When I got to her immunizations I realized that she had not had the HPV vaccine series, and I then remembered that her parents had decided not to give her this vaccine. (I had discussed the importance of the HPV vaccine with her mother and father every year for the last 4-5 years). As I started to say, “Oh I forgot you did not get the HPV vaccine”, she chimed in with “now that I am 18 years old I want to get that vaccine.” 

I paused for a few seconds and then she said, “I always thought I should get that vaccine and I listened to you every year, but my Dad just didn’t think I was old enough to get it.”  “Now that I can make that decision, I think it is a good vaccine and something that I want to have.” “Can I get it today, and can I come back at the end of the summer and get the second one before heading off to school?” 

Now I am thrilled that she had been listening to our discussions about HPV and the need to vaccinate, but it also felt a bit weird that she suddenly could make her own decisions about vaccines.  In reality, she could make all sorts of decisions now, even though her parents were actually still the holders of her health insurance benefits and would be until at least she was out of college. 

I thought about asking her to call her parents one last time to see what they thought she should do, but then decided that she wanted the vaccine and at her age needed the vaccine, so she had the legal right to sign off on it herself---lets get the vaccine. 

This is really not about HPV, but rather it is about children becoming adults and getting to make decisions about their own health care.  It is also about having a long-standing relationship with patients and hoping that you can help them make good decisions about taking care of themselves and the need for preventative medicine. 

She got the shot, she signed, she was happy, I was glad she was going to be protected (once the series of 3 was completed).  It was a good day, I just wonder what her parents thought? 

Daily Dose

First Day of Fall

This is the time of year to think about winter and flu, and to begin annual flu vaccinations.This time of year is so invigorating and the weather everywhere is becoming picture perfect. It all makes for a great time to enjoy the outdoors, whether having family dinners on the porch, picnics on the weekend, spending time playing outside and getting exercise as a family.

But for a pediatrician it is also the time of year to think about winter and flu, and to begin annual flu vaccinations. This year it is recommended that all children six months to 18 years receive a flu vaccine. Children under nine years of age who have never received a flu vaccine need to have two doses of vaccine separated by at least four weeks, and all other children receive a single dose. There are two options for children older than two: the injectable flu vaccine or the live attenuated flumist intranasal vaccine. There are some restrictions to intranasal vaccine (children with asthma, immuno-suppressed children) but for many children the idea of sniffing a vaccine is far better than a SHOT. The upside of the nasal vaccine is also that it seems to be more effective. Either way, start thinking about getting on your doctors schedule to get vaccinated before the winter and influenza hits. In the meantime, enjoy fall! That's your daily dose, we'll chat tomorrow!

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.

Daily Dose

Measles Exposure on an Airplane

Public health officials are warning passengers of possible exposure to measles on an airplane. Dr. Sue talks about how infectious diseases are just a plane ride away. I know you have read previous blogs on immunizations.  I have re-iterated many times, that despite the perception of some, many vaccine preventable diseases have not been eradicated from the United States and some may just be a “plane ride away”.

This is now the issue with a recent case of measles that occurred  in an unimmunized woman from New Mexico who was returning from a trip. The woman developed an illness, later confirmed to be measles, as she returned from London and subsequently travelled through no less than 4 different airports in the United States. The issue is that this one traveler, exposed many individuals on multiple airplane flights, as well as in 4 different airports.  As Dr. William Schaffner, an infectious disease specialist at Vanderbilt University stated, “the potential exposure of so many travelers in airport terminals is a cause for concern”. While most Americans have been immunized against measles (with the MMR vaccine), there are still those who remain unimmunized either due to the fact that they are too young, or because they choose not to be vaccinated (as had this woman who developed the “index case” of measles). Children do not receive their MMR vaccine until after their first birthday, and then receive a booster dose of MMR between the ages of 4–6 years. Therefore, a child who is less than 12 months of age, who may be up-to-date on all of their immunizations but is too young for MMR, may have been exposed to measles if they had been sitting within 5 airline rows of the woman who had undiagnosed measles. The same holds true for infants who might have been next to the woman in a security line, or at a Starbucks, or in the newsstand as she passed through these 4 various airports. It is also possibly an exposure for anyone of any age, who has never been immunized against measles, or who has not had the disease (older individuals). All of these exposures would have been accidental and never even noticed unless an exposed person subsequently develops measles. The incubation period for developing measles after an exposure is between 8-12 days, and measles will present with symptoms of fever, cough, runny nose, red eyes, and a body rash. So….here is just another example of the spread of an infectious disease.  This case involves travelers in airports from London, England, to Washington D.C., to Baltimore, to Denver, and ultimately to Albuquerque.  Now we need be alert for any further cases of measles in next several days and weeks.  Remember, measles is a respiratory virus, and it is spread via coughs and sneezes, and the virus may last in the air for up to 2 hours, without any one suspecting they are being exposed. If your child has not been immunized, this is a good reminder, run don’t walk, and get that MMR. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

More Confusion Surrounding Swine Flu Recommendations

There seems to be little consistency about how we are going to handle swine flu this fall and winter.I woke up today for my regular early a.m. exercise, jumped on the treadmill and put on my headphones. I then began channel surfing flipping between various local and national TV stations. On every station there were stories on H1N1 influenza (swine flu), and the symptoms, possibility of vaccine release dates, number of people who might be infected, and the report just released by the President’s task force on pandemic flu.

There were also stories about schools, specifically colleges in our area with cases of “swine flu” already being reported, and school just started yesterday. It is going to be a long winter! The only problem is there seems to be little consistency about how we are going to handle swine flu this fall and winter. Despite specific guidelines outlined by the CDC, it does not seem that there is anyone really in charge. We don’t even have a Surgeon General to weigh in. State and local health departments seem to be offering different advice about testing and treating possible swine flu cases. Colleges are already treating some students with tamiflu when the specific recommendations have been to only treat patients who are extremely ill, have underlying diseases that make them more at risk for complications or that are hospitalized. I have patients in the same family, who attend two different colleges, whose parents received different information from their colleges. One child is on tamiflu while the other is not. No wonder they are confused and so am I. Many of my friends and patients have reported possible exposures to swine flu and some have called their doctors and are being put on tamiflu over the phone. I have continued to reiterate to them that we are all going to have continuous exposures that we are not even aware of as more and more people become ill and you can’t take tamiflu every time you go to the grocery store, school, cleaners, etc. There are also some not so nice side effects from tamiflu, which no one really wants if not necessary. At the same time, I am wondering if I should just start taking tamiflu for the next six months, as I am sure that doctors are being constantly exposed and no one is recommending that doctors take tamiflu either. Maybe it is time to bring out the masks? I am only kidding. So.. amid all of the confusion I guess I will just keep washing my hands and practicing good hand hygiene. Maybe some of these inconsistencies will be resolved before we start seeing large numbers of cases? One can only hope! That’s your daily dose, we’ll chat again tomorrow.

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