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Back-To-School Immunizations

2:30

Is your child up-to-date on his or her immunizations for the new school year?

Each state has its own set of immunization requirements, but there are a few that are found in nearly all states. Make sure you know which are required for your child’s school.

The typical list includes:

DTaP (Diphtheria, Tetanus, Pertussis)

·      Most children have five dosages by the time they start school, including one after their fourth birthday

·      Remember that children also need a tetanus booster when they are around 11 to 12 years old

·      The Tdap vaccine (Boostrix or Adacel) is recommended for teens and adults to protect them from pertussis in 2006 and replaces the previous Td vaccine that only worked against tetanus and diphtheria

MMR (Measles, Mumps, Rubella)

·      Two doses of MMR are usually required by school entry. In the past, the second dose was given when a child was either 4 to 6 years old or 12 years old. Now, it is usually given earlier, but some older children may not have gotten two doses yet.

·      Having two doses of MMR is important in this age of measles outbreaks.

IVP (Polio)

·      Most children have four or five dosages by the time they start school, including one after their fourth birthday.

Varivax (Varicella, or the Chickenpox vaccine)

·      Your older child will need the chickenpox shot if he has not already had chickenpox in the past. Most toddlers young receive it when they are 12 to 18 months old. Although younger children used to be given just one dose, it is now required that kids get a chickenpox booster shot when they are 4 to 6 years old. Older kids should get their booster at their next well child visit or as soon as they can so that they don't get chickenpox.

Hepatitis B

·      A series of three shots that is now started in infancy. Older children are usually caught up by 12 years of age if they haven't received this vaccine yet.

Hepatitis A

·      A set of two shots for children over 12 months years of age. All infants and toddlers are now getting this shot as a part of the routine childhood immunization schedule, but there is currently no plan for routine catch-up immunization of all unimmunized 2- to 18-year-old children, unless they live in a high-risk area with an existing hepatitis A immunization program or if the kids are themselves high risk. Kids are high risk for example, if they travel to developing countries, abuse drugs, have clotting-factor disorders, or chronic liver disease, etc.

·      Hepatitis A vaccine is required to attend preschool in many parts of the United States.

Hib

·      While required for school entry, children do not usually receive this shot after they are five years of age, so children who have missed this shot don't usually need to get caught up before school starts if they are older than 5 years old.

Prevnar

·      A vaccine that can help to prevent infections by the pneumococcal bacteria, which is a common cause of blood infections, meningitis and ear infections in children.

·      Prevnar is typically given between the ages of two months and five years, and isn't approved for older kids, so your older child wouldn't need this shot if he didn't get it when he was younger. It is often required to attend preschool though.

·      A newer version of Prevnar, which can provide coverage against 13 strains of the pneumococcal bacteria, is approved and replaces the older version (Prevnar 7) in 2010, which means that many older children in preschool may need another dose of Prevnar 13, even if they finished the Prevnar 7 series.

·      Another version of this vaccine is available for certain older high-risk children though, including kids with immune system problems, although that wouldn't be required for school.

Meningococcal vaccine

·      Menactra and Menveo, the newest versions of the meningococcal vaccine, is now recommended for children who are 11 to 12 years old, with a booster dose when they are 15 to 18 years old.

The American Academy of Pediatrics (AAP) recommends that all school age children stay up-to-date on all their immunizations.

As well as the vaccines recommended above, AAP includes a few others in its 2016 list. They include:

Influenza

·      Administer influenza vaccine annually to all children beginning at age 6 months. For most healthy, non-pregnant persons aged 2 through 49 years, either LAIV or IIV may be used. However, LAIV should NOT be administered to some persons, including 1) persons who have experienced severe allergic reactions to LAIV, any of its components, or to a previous dose of any other influenza vaccine; 2) children 2 through 17 years receiving aspirin or aspirin-containing products; 3) persons who are allergic to eggs; 4) pregnant women; 5) immunosuppressed persons; 6) children 2 through 4 years of age with asthma or who had wheezing in the past 12 months; or 7) persons who have taken influenza antiviral medications in the previous 48 hours.

Human papillomavirus (HPV)

·      Administer a 3-dose series of HPV vaccine on a schedule of 0, 1-2, and 6 months to all adolescents aged 11 through 12 years. 9vHPV, 4vHPV or 2vHPV may be used for females, and only 9vHPV or 4vHPV may be used for males.

·      The vaccine series may be started at age 9 years,

·      Administer the second dose 1 to 2 months after the first dose (minimum interval of 4 weeks), administer the third dose 16 weeks after the second dose (minimum interval of 12 weeks) and 24 weeks after the first dose.

·      Administer HPV vaccine beginning at age 9 years to children and youth with any history of sexual abuse or assault who have not initiated or completed the 3-dose series.

Many states have added an “opt out” choice for parents on some vaccines but not all. For the health and safety of all children, the AAP recommends that parents follow each state’s immunizations requirements and not opt out unless there is a medical necessity.

Story sources: Vincent Iannelli, MD, https://www.verywell.com/school-immunization-requirements-2633240

http://redbook.solutions.aap.org/selfserve/ssPage.aspx?SelfServeContentId=Immunization_Schedules

 

 

Daily Dose

Why Doctors Fire Patients

1.30 to read

There was an article in the WSJ entitled “more doctors dismissing patients who refuse vaccines for their children”.  It was interesting to me as I too now only accept new patients who are going to vaccinate their children. This was not an easy decision on my part, and prior to the decision I had several families who refused vaccines completely, and another group that followed “an alternative” vaccine schedule. Even so, I was never comfortable with their decision and it always gave me pause and sleepless nights when their children would get sick. 

During the height of the debate over vaccine safety and the possible link to autism it seemed like much of my day was spent “debunking” vaccine myths. I spent a great deal of time discussing the reasons behind the AAP/ACIP (American Academy of Pediatrics and the Advisory Committee on Immunization Practices) recommended vaccine schedule and also explaining how vaccinations had saved lives, actually millions of lives. 

As more and more data was gathered, and the Wakefield papers were discredited, it became apparent that there was not a link between vaccines and autism. The arguments about thimerasol in vaccines were also moot as thimerasol is no longer the preservative used in vaccines (except for flu vaccine). With all of this being said I decided to take a stand and vaccinate all of my new patients, according to AAP guidelines. 

I discuss this decision with families even before their child is born. I tell them that it is important to pick a pediatrician that shares their beliefs as the  doctor patient relationship is a long one in pediatrics. (hopefully cradle to college)  It is analogous to dating; why would you pick a date on a match site if you held opposite beliefs to begin with?  

The same goes with picking a pediatrician, you need to start off the relationship on common ground. Even if there may be some other disagreements on subjects down the road, I think you need to begin the relationship holding similar beliefs. 

I have practiced long enough that I remember doing spinal taps in my office and treating children with meningitis or bacterial sepsis. There were long nights spent in the ICU with families and unfortunately a few patients died, while other survived but are deaf or have other residual effects from their disease.  It was devastating to me and I can’t even imagine for those families. I also bet that those families would have given anything to have a meningitis vaccine or a chickenpox vaccine for their now deceased children. 

I understand that every parent has to make their own decision for their children. At the same time I believe that it is also “my practice” and I get to choose how I practice pediatrics. With that being said, my parents choose to vaccinate their children and we happily start off the parenting/doctoring partnership together.  I also sleep better at night not worrying that their child will contract a vaccine preventable disease. 

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Why Doctors Fire Patients

1.30 to read

There was an article in the WSJ entitled “more doctors dismissing patients who refuse vaccines for their children”.  It was interesting to me as I too now only accept new patients who are going to vaccinate their children. This was not an easy decision on my part, and prior to the decision I had several families who refused vaccines completely, and another group that followed “an alternative” vaccine schedule. Even so, I was never comfortable with their decision and it always gave me pause and sleepless nights when their children would get sick. 

During the height of the debate over vaccine safety and the possible link to autism it seemed like much of my day was spent “debunking” vaccine myths. I spent a great deal of time discussing the reasons behind the AAP/ACIP (American Academy of Pediatrics and the Advisory Committee on Immunization Practices) recommended vaccine schedule and also explaining how vaccinations had saved lives, actually millions of lives. 

As more and more data was gathered, and the Wakefield papers were discredited, it became apparent that there was not a link between vaccines and autism. The arguments about thimerasol in vaccines were also moot as thimerasol is no longer the preservative used in vaccines (except for flu vaccine). With all of this being said I decided to take a stand and vaccinate all of my new patients, according to AAP guidelines. 

I discuss this decision with families even before their child is born. I tell them that it is important to pick a pediatrician that shares their beliefs as the  doctor patient relationship is a long one in pediatrics. (hopefully cradle to college)  It is analogous to dating; why would you pick a date on a match site if you held opposite beliefs to begin with?  

The same goes with picking a pediatrician, you need to start off the relationship on common ground. Even if there may be some other disagreements on subjects down the road, I think you need to begin the relationship holding similar beliefs. 

I have practiced long enough that I remember doing spinal taps in my office and treating children with meningitis or bacterial sepsis. There were long nights spent in the ICU with families and unfortunately a few patients died, while other survived but are deaf or have other residual effects from their disease.  It was devastating to me and I can’t even imagine for those families. I also bet that those families would have given anything to have a meningitis vaccine or a chickenpox vaccine for their now deceased children. 

I understand that every parent has to make their own decision for their children. At the same time I believe that it is also “my practice” and I get to choose how I practice pediatrics. With that being said, my parents choose to vaccinate their children and we happily start off the parenting/doctoring partnership together.  I also sleep better at night not worrying that their child will contract a vaccine preventable disease. 

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Can a Little Cough Ease the Pain of a Shot?

A study that was published in an ssue of Pediatrics caught my eye online. The title “Cough trick may reduce pain of routine immunizations” seemed relevant to my practice so I decided to preview the study a little early.A study that was published in an issue of Pediatrics caught my eye . The title “Cough trick may reduce pain of routine immunizations” seemed relevant to my practice so I decided to preview the study a little early.

The study was performed at The University of Nebraska and involved 68 children (small sample size) and they were all receiving vaccines at either the pre-kindergarten visit (age four to five years) or at the 11 to12-year-old visit when routine immunizations are again given. In this study the children were all instructed to COUGH while getting their vaccines and then the children as well as their parents and nurses were surveyed to see how painful the procedure seemed. For the kids they used visual scales (pictures of painful faces) to demonstrate degree of pain. There have been numerous studies done in previous years looking at methods to reduce pain during simple office visits for immunizations. Strategies from the use of topical anesthetics (EMLA cream), to sucking on sucrose dipped nipples for babies, to blowing bubbles to distract patients have all been used. In many of these cases the cost or time involved in these strategies was prohibitive for routine use in a busy office or clinic setting But, in this study, the time and cost was NONE as the children were taught to give one BIG cough prior to the injection and then coughed again at the time of injection. What a wonderful discovery! Easy, efficient and no training necessary for staff. In this study it wasn’t clear that it helped all children, and interestingly it seemed to be more effective in certain racial groups than others? In the meantime, while the academic and research docs are at work, I am going to try this approach in my own office I hate the four to five-year-old shots almost as much as the children and parents and have watched my own children scream and yell while getting all of those vaccines. Not fun for anyone. If that screaming, yelling and anxiety can be even slightly diminished by a cough or two, why not? It seems so easy. (I still think a lollipop at the end is helpful too). I guess we could all do a study on the “combo technique” of a cough followed by sugar and see what results we all get. Maybe get it published in Pediatrics next year? So, if you are headed to the doctor in the near future, and you know that it is time for immunizations, why not try “coaching” your child on the “cough trick” and see what you think. If your doctor isn’t aware of this study let them know it will be published in the next few weeks, but you can read it on line now. That’s your daily dose, we’ll chat again tomorrow. Send your question of comment to Dr. Sue!

Daily Dose

Which Shots Do I Need When Traveling?

Dr. Sue answers a teen's question about updated immunization she needs if traveling to a foreign country.Dear Dr. Sue: I read your article on MMR vaccine recently (mumps, measles, rubella). I read the information related to infants, travel and the MMR vaccine but I wondered if I need to get an extra MMR? I am a high school student traveling to Peru this summer. Thanks! –Kristin Hi Kristin: great question! There are many teens and college kids (like you) who may be travelingto a foreign country this summer.  Here are the recommendations. If you are over 4 years of age and have had 2 doses of MMR, you are good to go for travel. Most children/teens have received the first dose of MMR vaccine after their 1st birthday (12-15 months) and then again between 4-6 years of age. If the two doses of vaccine have been given, you are protected. A good place to begin looking to see if you need any vaccine updates when you are planning an overseas trip is www.cdc.gov.   Click on the travel link. There you will find maps of the continents and you can click on the country you are visiting and go from there. If there are outbreaks of disease in the area you are planning to visit, this site has the most recent information.  Try to look several months before your trip in order that you have time to get any vaccines that might be necessary. Keep checking as your trip approaches too. Kristin, have a great trip, send us some pictures! If you have a question for Dr. Sue click here.

Daily Dose

Pertussis Cases Continue to Rise

Pertussis cases on the rise around the country with 10 deaths in California.I have been reading a lot about the pertussis outbreak that has been hitting California, where there are now over 8,000 cases of pertussis, and 10 infants who have died from whooping cough.  But pertussis is not only affecting those in California, the number of pertussis cases are on the rise across the country.

The CDC reported that there were over 17,000 pertussis cases in 2009, and when the 2010 numbers are tallied the number will most likely be higher. Pertussis is also probably under-reported so there are quite likely many more cases than the numbers show, and many cases of pertussis that may be missed as a diagnosis. With that being said it is important to re-iterate the need for both infants, children, adolescents and adults to get their pertussis immunizations. Whooping cough is an infectious disease and the best way to prevent disease is by vaccinating.  What we all forget is that infants are not immunized until 6 – 8 weeks of age, and that one immunization against pertussis does not provide immunity. The reason that the DTaP vaccine is given at 2, 4 and 6 months of age is to confer adequate immunity after 3 doses, and that immune response is boosted again between 15- 18 months of age. As young parents have their new baby immunized, they sometimes feel that their child is “protected” immediately, and that is not really the case.  It takes several doses of vaccine to confer adequate antibody and while a baby is building their own antibody the best way to protect them is by immunizing the older population. This is called passive immunity, which protects a newborn infant by preventing disease in those people who are around the new baby. Whether that is a grandparent, aunt, uncle, nephew, niece, or any of the numerous family members and friends that welcome a newborn, the pertussis (whooping cough vaccine) that is given to the general population protects the newborn baby. The Tdap vaccine that is recommended for use in individuals from the age of 10–64 is the vaccine that is now in the news. So many adults “forget” that immunizations do not stop after you leave the pediatrician’s office.  Adults continue to need vaccines to protect themselves from diseases, including whooping cough. It is amazing that many of my own friends cannot “remember” the last time they  had a shot, which likely means that they have not received the newer Tdap, which protects you from tetanus, diphtheria and pertussis. Doctors need to spread the word that adults also need immunizations, because that terrible persistent cough that you thought might never go away, could indeed, unknowingly be a case of pertussis, which might infect a newborn infant. Just today the Advisory Committee on Immunization Practice (ACIP) recommended that the Tdap vaccine be given to even older individuals, who may come into contact with newborn infants. That means that seniors who are 65 or older are also encouraged to get vaccinated with a newer Tdap if they will be in close contact with infants under the age of 1 year. While the country is seeing outbreaks we must become aggressive in keeping the pediatric population up to date on their vaccines, but in this case the vector may be the grandparent who long ago lost their immunity to whooping cough. I can’t think of a better baby gift, so go get your Tdap and protect that precious newborn. P.S.  A flu shot is important too, so get a “twofer” now. That’s your daily dose for today.  We’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

National Flu Immunization Week

This week is National Influenza Immunization week, so I thought it would be a good time to remind everyone about the need to continue to get vaccinated for both seasonal and H1N1 flu.

We were all fortunate that flu did not “rear its angry head” over the holidays (flu is currently widespread in only several states) and therefore it seems that many people have become “complacent” (verbiage from CDC) about getting vaccinated. The one thing that we doctors know for sure is that flu comes every winter, so we don’t think 2010 will be any different. The difference will be whether it is H1N1 having another resurgence, or will it be seasonal influenza or both? Seeing that none of us has that proverbial crystal ball, I would continue to recommend vaccinations against both. It seems there are many people who wanted to be vaccinated against H1N1 (swine flu) while there was a vaccine shortage, and the lines were long and there were restrictions being placed on who could get vaccinated. Now there is a plethora of vaccine and it is available for all comers. Suddenly, interest wanes, just like the Zhu Zhu pet after the holidays. It is especially important that infants and children continue to be vaccinated as well as the adolescent and young adult population. As you can recall from previous posts, this population seems to have a higher than expected rate of complications and deaths than has been seen with seasonal flu. There have even been recent reports of more pediatric deaths from H1N1, despite the fact that the disease seems to be waning for now. As I continue to see infants who have turned six months of age for their routine check-ups I am giving them their first doses of both seasonal and H1N1 flu vaccine. I am also reminding parents that they will need to bring their infants back in four weeks to receive their second doses. My hope is that we will have plenty of vaccine available to continue to immunize into early spring. The H1N1 vaccine availability does not seem to be problematic at this point, but the seasonal flu vaccine used for children between six months and two years is in short supply. In any event, one dose of vaccine is preferable to none. I have been telling the parents to call us in month and come in and we will give their children second doses of what we have available. Remember too that all children under the age of 10 require two doses of H1N1 vaccine; so many children should be due to get their second doses of vaccine if they were vaccinated in the fall. Take advantage of the availability of H1N1 vaccine and get you and your family vaccinated. The vaccine is the same whether you get it at your doctor’s office, at the health department or at your local pharmacy or grocery store. The continued post marketing surveillance has not shown any problem with side effects or safety related to the H1N1 vaccine. The more people that are vaccinated the better chance we have of preventing widespread disease. Pick up the phone and call your pediatrician this week! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Another Reason Why It's Important to Vaccinate Your Child

I was in the office yesterday on a busy pre-holiday Monday. I went into an examining room late in the afternoon to see a two-year-old who looked “pretty sick”. I was in the office yesterday on a busy pre-holiday Monday. I went into an examining room late in the afternoon to see a two-year-old who looked “pretty sick”. 

Her mother told me that her daughter had developed a fever and a swollen eye over the last 8 hours and that “she had never seen her this sick.” She thought that her daughter had had a mosquito bite the week before and that maybe that was why her eyelid and the area beneath her eye was swollen and red. But the bite had gone away days ago, and now she had a fever. I glanced at her chart and had one of those “ah-ha” moments when I realized that the little girl had never been immunized. Not one vaccine, never!! This made me put on my thinking cap from days gone by. It used to be a fairly common occurrence to see a child in the one- to three-year-old age range in the office with a swollen eyelid and area around the eye, who also had a fever and looked ill. The infection is called peri-orbital cellulitis (an infection of the soft tissue surrounding the eye), and is typically caused by a bacteria named Haemophilus Influenza (H. Flu). This bacteria was renowned for causing meningitis, epiglottitis, periorbital cellulitis and blood infections. A vaccine was developed in the late 80’s (our office participated in the clinical trials) and since that time when children began routinely receiving HIB vaccine it had become quite uncommon to see infections due to this bacteria. But today, I was reminded of the risk of developing diseases that could be prevented with vaccines. The mother was very concerned and kept asking me how her daughter might have “gotten sick with this bacteria?” Just because there is an immunization, does not mean that the bacteria is no longer lurking in our nasal passages, on surfaces and all sorts of places. We often forget that kids may still get sick with these illnesses that we “had forgotten” about. I had to return to my first days of practice to remember that I wanted to get a blood culture on her to make sure that the bacteria had not invaded her blood stream, and to watch her in the office as we got her fever down and looked at her lab results. I was trying to decide if she needed to be admitted or could be treated as an outpatient. Thankfully, after lowering her temperature and getting back her lab work, she looked a little better. She was treated with an injection (ouch) of a broad-spectrum antibiotic and will be seen again in the morning to make sure her eye has improved and that she is also feeling better. In the meantime the reality of vaccine preventable diseases is still on my mind. Why would a parent not want to prevent any illness in their child that they possibly could? The reality that these infections may still occur became too close today. I think these parents may be re-thinking vaccines. If they are not, I am thankful that the frequency of these infections is rare, as the majority of my patients are immunized and will continue to be!! We have not eradicated these diseases; they have just been prevented by immunizations. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Why Vaccinate Your Child?

1:15 to read

Getting your child immunized against mumps, measles and rubella (MMR) may provide even more protection than previously thought. An interesting article was just published in the journal Science pointing out yet another reason to get your children vaccinated.  

While measles is still uncommon in the United States (but there have been over 170 cases this year), there are over 140,000 deaths around the world every year due to this disease. Studies have shown that once you have the measles you are more susceptible to other infections for up to 2 years.  But, in countries where most measles cases occur the researchers found that the children who had received the measles vaccine had a reduced death rate for up to 5 years, which suggests that the vaccine somehow provides protection against other illnesses.

A medical student at Emory University (bet he is going to be a great doctor) working with others from around the world found that the measles virus might cause “immunological amnesia”. It seems that the measles virus kills a large number of memory cells, which are white cells that prevent subsequent infections by the same disease. After the measles the body’s immune system somehow “forgets” to remember diseases  it has already beaten, which would then put you at increased risk of being susceptible to diseases you shouldn’t be vulnerable to.

While more research is necessary this secondary protection may be yet another reason to get vaccinated!! Good science continues to show us the value of vaccines....this study was funded in part by the Melinda and Bill Gates foundation which is doing incredible work around the world on vaccines and eradicating vaccine preventable diseases.  For this I am a grateful doctor.

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DR SUE'S DAILY DOSE

If your child snores, is this a sign of something more serious?

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