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Daily Dose

National Infant Immunization Week

I cannot think of a more appropriate time to discuss the importance of vaccinating newborns (and all children).This week, April 26 - May 2, is National Infant Immunization Week. I cannot think of a more appropriate time to discuss the importance of vaccinating newborns (and all children), while we are in the midst of a possible public health pandemic for which no vaccine is available. Vaccines have been one of the greatest public health achievements of the last decade. Vaccines have prevented countless deaths and morbidity from diseases that parents used to worry about their children catching.

Polio in the 50's, measles, mumps and rubella that accounted for not only disease in children but congenital birth defects in children who had been exposed to rubella in utero. After that came advancements in the prevention of meningitis (from several different bacteria) that not only caused death but complications of deafness and developmental delay in those children who were fortunately saved. If you are a young parent, you have no memory of these diseases, as you too had been vaccinated by your parents, who at that time were anxious to vaccinate their children to prevent these dreaded diseases. You don't remember children in iron lungs or leg braces, or houses with signs reading "quarantined" when an entire family developed measles, or those phone calls in the middle of the night with an infant with fever, a stiff neck and meningitis. The memories are distant, but in reality all too close, as these diseases have not been eradicated. They still cause disease in many countries and are only a plane ride away from re-entering the United States. We are a very mobile society and exposures to these diseases may happen at any time. We saw this phenomena this last year with measles, which was brought into this country by a child who had not been immunized, after vacationing in Switzerland. We have seen mumps outbreaks again brought in from Europe when a child came to the U.S. for camp. We are currently seeing several cases of H. Flu meningitis and death in young children who had not been immunized to these diseases due to parental concerns with vaccines. There have been numerous studies done and reported in medical journals worldwide that show no link between vaccines and autism. And that same science shows that we must keep up high immunization rates to ensure that the "herd" (the entire population) stays healthy. Children who are not vaccinated have been fortunate to benefit from herd immunity; in other words, they are at less risk because most children and adults are immunized. But if the herd gets smaller and those not vaccinated becomes larger, the tides may turn and these diseases may "rear their angry heads" and cause outbreaks again. Begin your child's immunizations on schedule at their two, four and six month visits. Go to the American Academy of Pediatrics Web site and read and listen to sound advice on vaccines. Your best protection against disease is vaccination. That's your daily dose, we'll chat again tomorrow.

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

Medical Decisions at Age 18


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? 

Your Teen

Study: 1 in 4 Girls Received HPV Vaccine

A new government study shows that one in four teenage girls have received the new HPV vaccine. The vaccine protects against strains of the virus that cause about 70 percent of cervical cancers. The study done by the Centers for Disease Control and Prevention covered children ages 13 to 17 years old. The recommended age that girls get the shots is 11 to 12 if possible, before they become sexually active. The vaccine is a three-shot series that costs about $375, although many health insurers now cover it.

Merck, the maker of the Gardasil vaccine, said they were pleased with the vaccination rate.

Daily Dose

Measles Outbreak

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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

Another Case for Vaccinating Your Child

The American Academy of Pediatrics issued an alert last week that identified several more cases of invasive HIB disease in Pennsylvania and two deaths. One of the deaths occurred in an unimmunized child. Several months ago there were five cases of HIB disease in Minnesota, again resulting in one death, also in an unimmunized child. All of the cases involved unvaccinated or under-vaccinated children.

Prior to routine vaccination against HIB (H. flu) disease, which began in 1988, about 20,000 children developed infections each year, and 12,000 cases of HIB meningitis were diagnosed, with about five percent of children dying. Over the last 20 years the rates of HIB disease have decreased exponentially and deaths were no longer reported. The vaccine was a tremendous victory in preventing childhood meningitis and other serious infections. Over the last several years with parental anxiety related to vaccines, the number of unvaccinated children has been on the rise, especially in "pockets" throughout the country. At the same time, there has been a HIB vaccine shortage since December of 2007, which may have also resulted in children not completing their primary series at 2, 4, and 6 months of age. These two factors may have led to the cases of HIB disease and doctors are worried that we may see a recurrence of HIB disease and deaths. The community as a whole is often protected due to "herd immunity" and the herd must be immunized to provide maximum protection for everyone. This underscores the importance in vaccinating your children. If your child has missed any of their primary vaccine series, now is the time to update them. HIB disease is serious and unfortunately may be on the rise again. This is a vaccine preventable disease. That's your daily dose, we'll chat again soon.

Daily Dose

Update All Immunizations

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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

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.

Daily Dose

Measles Outbreak

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The Dallas County Health department has recently notified me that there have been 2 cases of measles in the Dallas area (June 2013) and there have been 9 new cases reported in Ft. Worth as well. Because of this, all doctors in our area have been asked to be vigilant about vaccinating as well as considering a measles diagnosis when the presenting symptoms are compatible. Measles is a viral illness that causes fever, runny nose, cough, conjunctivitis and a whole body red rash. People with measles are sick, and there may be associated complications including pneumonia, ear infections, encephalitis and even death.  

Unfortunately, DFW is not the only area with measles. The United States has already had 129 cases of measles this year (as compared to only 54 cases in 2012).  There have been “pockets” of measles reported in New York city (58 cases) and in North Carolina as well. 

Most of the cases of measles in the United States have been “imported” by those who have travelled outside of the country and upon their return developed measles.  Measles, like some other illnesses, has not been eradicated in many parts of the world. Jet travel allows diseases to be easily imported from all around the globe - just a plane ride can expose hundreds of people who then can go on to expose even more.  The European Union alone has reported 8,500 cases of measles in the past 12 months. 

Vaccines are the mainstay for infectious disease prevention. Children receive a MMR (mumps, measles, rubella) vaccine at ages 1 year and 4 years. While very effective, 2-5% of people do not respond to the first dose of vaccine and require the “booster” dose to be immune.  99% of those who receive 2 doses of vaccine are immune.  Children under the age of 1 year, and children and  adults who have not been immunized (and have not had the disease) are at the greatest risk for developing measles.  

Measles is highly contagious (the virus is spread by respiratory droplets)  and has an incubation period of 7-18 days.   Those with measles are contagious from 4 days before they develop the rash (typically when they are diagnosed) and up to 4 days after the rash has resolved.  A lengthy period of time.

So...with everyone getting ready for school, what better time to make sure your child HAS BEEN IMMUNIZED.  And. if you are traveling outside of the country with your child who is under the age of 1 year, check with your doctor and ask about giving an early measles vaccine.  The measles outbreak may continue to spread unless your child is vaccinated.






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