Twitter Facebook RSS Feed Print
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

Your Baby

Infant Ear Infections Declining

2:00

Ear infections in infants are very common and can be quite unsettling for parents. The good news is that ear infections among U.S. babies are declining according to a new study.

Researchers found that 46 percent of babies followed between 2008 and 2014 had a middle ear infection by the time they were 1 year old. While that percentage may seem high, it was lower when compared against U.S. studies from the 1980s and '90s, the researchers added. Back then, around 60 percent of babies had suffered an ear infection by their first birthday, the study authors said.

The decline is not surprising, according to lead researcher Dr. Tasnee Chonmaitree, a professor of pediatrics at the University of Texas Medical Branch, in Galveston.

"This is what we anticipated," she said.

That's in large part because of a vaccine that's been available in recent years: the pneumococcal conjugate vaccine, Chonmaitree said. The pneumococcal conjugate vaccine protects against several strains of pneumococcal bacteria, which can cause serious diseases like pneumonia, meningitis and bloodstream infections.

Those bacteria are also one of the major causes of children's middle ear infections, Chonmaitree said.

She added that flu shots, which are now recommended for children starting at 6 months, could be helping as well. Many times an ear infection will follow a viral infection such as the flu or a cold.

Vaccinations "could very well be one of the drivers" behind the decline in infant ear infections, agreed Dr. Joseph Bernstein, a pediatric otolaryngologist who wasn't involved in the study.

Other factors could be having a positive impact as well, such as rising rates of breast-feeding and a decrease in babies’ exposure to secondhand smoke.

"The data really do suggest that breast-feeding -- particularly exclusive breast-feeding in the first six months of life -- helps lower the risk of ear infections," said Bernstein, who is director of pediatric otolaryngology at the New York Eye and Ear Infirmary of Mount Sinai, in New York City.

There's also the fact that breast-fed babies are less likely to spend time drinking from a bottle while lying down, Bernstein noted. That position can make some infants more vulnerable to ear infections, he said.

The study findings were based on 367 babies followed during their first year of life. By the age of 3 months, 6 percent had been diagnosed with a middle ear infection; by the age of 12 months, that had risen 46 percent, researchers found.

Breast-fed babies had a lower ear infection risk, however. Those who'd been exclusively breast-fed for at least three months were 60 percent less likely to develop an ear infection in their first six months, the study showed.

But whether babies are breast-fed or not, they will benefit from routine vaccinations, Chonmaitree said. "Parents should make sure they're on schedule with the recommended vaccines," she said.

Parents can have a difficult time recognizing an ear infection in an infant or a child to young to tell them that their ear hurts.

Some symptoms to watch for are:

·      Tugging at the ear

·      Fever

·      Crying more than usual

·      Irritability

·      Child becomes more upset when lying down

·      Difficulty sleeping

·      Diminished appetite

·      Vomiting

·      Diarrhea

·      Pus or fluid draining from ear

Treatment for ear infections rarely requires medication, such as antibiotics, except when an infection is severe or in infants. 

According to the American Academy of Pediatrics (AAP), most children with middle ear infections get better without antibiotics, and doctors often recommend pain relievers -- like acetaminophen -- to start. But with babies, Bernstein said, antibiotics are often used right away.

The AAP recommends antibiotics for infants who are 6 months old or younger, and for older babies and toddlers who have moderate to severe ear pain.

The study was published online in the March edition of the journal Pediatrics.

Story source: Amy Norton, http://www.webmd.com/children/news/20160328/infant-ear-infections-becoming-less-common

Daily Dose

Can a Little Cough Ease the Pain of a Shot?

1.30 to read

A study that was published in an issue 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. 

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 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.

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/

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

Vaccine Pain

1.00 to read

I am often reminded of the adage, “this is going to hurt me more than it hurts you” before beginning infant vaccinations. I can remember my own parents saying that to me before a spanking (the preferred discipline of my childhood) and that statement never made any sense to me until I too became a parent. 

As I discuss infant vaccinations with new parents, I somehow know that they are wishing they could “take the needles” for their own child. I really do believe that those first vaccines at 2 months of age “hurt the new parent, more than the infant”. It is an early parenting hurdle to get through those first immunizations and realize that your baby handled the vaccines without much ado and somehow the next set of vaccines at 4 and 6 months are a bit easier. Pain is not anything that a parent wants their child to endure, and if there is any way to mitigate the pain associated with immunizations I am all for it. 

Many parents come to my office prepared with sucrose to let their baby suck on during the immunizations.  I recently read an article in Pediatrics that showed the 5 S’s - swaddling, side/stomach positioning, shushing, swinging and sucking on a pacifier significantly reduced the pain associated with vaccines in 2 and 4 month old infants. In fact the 5S’s worked “substantially better to reduce post vaccination pain than sucrose alone”. 

So, if you are concerned about the pain associated with your infant’s vaccines, come ready to swaddle, shush, swing and let your baby have a pacifier as well. A little tummy time after the immunizations might be good medicine too. 

But more importantly, remember that by vaccinating your baby you are protecting them from disease for their entire childhood and into adolescence (when I am not sure the immunizations are any easier). 

The 5S’s seem like an easy solution for parent and baby, and a lollipop or ice cream cone goes a long way for pain relief in the 4-11 year old set as well. Vaccines are a moment of pain for a lifetime of gain for sure!

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

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

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.

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

Know the warning signs that your teen is depressed.

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.