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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

Recommendations On Who Should Get a Swine Flu Vaccine

I thought it was a good time to re-iterate the recommendations as to who will be prioritized to receive the novel H1N1 (swine flu) vaccine this fall.With more swine flu in the news and the story continuing to evolve I thought it was a good time to re-iterate the ACIP recommendations as to who will be prioritized to receive the novel H1N1 (swine flu) vaccine this fall. The CDC (Centers for Disease Control and Prevention) and ACIP (Advisory Committee on Immunization Practices) are hopeful that a novel H1N1 vaccine will be available by early this fall. They are expecting that when the vaccine becomes initially available (it is currently in clinical trials) there may be a limited supply. The CDC does not expect there to be a shortage of vaccine over the course of the winter but supplies may be limited as production first begins.

There are five key populations that are recommended to receive vaccine when first available:

  • Pregnant women
  • People who live with or care for children younger than six months of age
  • Health care and emergency services personnel
  • Persons between the ages of six months through 24 years of age
  • People from ages 25
Daily Dose

Why 'Herd Immunity' Does Not Work

With all of the recent anxiety surrounding Swine Flu and the possibility of epidemics, lets be pro active in protecting all of us from diseases that we can prevent with the current immunizations that are available.There is an article in the June issue of the journal Pediatrics, which looked at whether parental refusal of pertussis vaccination could be associated with increased risk of pertussis infection in those unimmunized children. The study was conducted between the years 1996 - 2007 and looked at case controlled studies which compared a child with documented pertussis (whooping cough) to 4 other randomly selected children who did not develop pertussis. This study is important as many parents believe that if they choose not to vaccinate their child, that their child is protected by herd immunity (in other words, by all of the rest of us that are immunized).

In this case the study showed that 11% of all pertussis cases in this pediatric population were attributed to parental vaccine refusal. This study is important for several reasons. It is one of the first to document that herd immunity does not seem to completely protect unvaccinated children from pertussis. Children of parents who refuse pertussis immunizations are at high risk for pertussis infection relative to vaccinated children. One would assume, but further studies need to be done, that similar results would be found if you looked at diseases like measles, or H. flu meningitis. Herd immunity is important to the general health and well being of all of us, but it is not 100% at any time and risk of disease is still there. As we see increases in whooping cough in many communities across the country the need to educate parents about the importance of vaccines is paramount. Parents need to be protected too and we should all have a TdaP as an adult to provide pertussis protection for ourselves, as well as for those infants around us who are too young to be immunized. With all of the recent anxiety surrounding Swine Flu (H1N1) and the possibility of epidemics, lets be pro active in protecting all of us from diseases that we can prevent with the current immunizations that are available. That's your daily dose, we'll chat again tomorrow.

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

1.30

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.

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