Twitter Facebook RSS Feed Print
Daily Dose

HPV Vaccine for Boys

1.45 to read

There has been plenty of chatter among parents surrounding by the current recommendations by the ACIP (Advisory Committee on Immunization Practices) who recently voted to “recommend the routine use of the human papillomavirus quadrivalent vaccine (HPV 4) in boys aged 11 to 12 years.” This is important news for our children. 

This committee had previously discussed the use of HPV 4 in males.  In 2009, the ACIP provided guidance stating the vaccine “could be” used in males 9–26 years of age, but did not state “it should be routinely recommended.”

The waters are no longer muddy: vaccinate both boys and girls.

HPV is the number one sexually transmitted disease in the United States and data shows that up to 50% of sexually active people will acquire HPV at some point in their lives.

Not everyone who gets HPV (a virus) can clear the infection and some individuals will go on to develop precancerous and cancerous lesions.

I’ve had many parents ask “why should I vaccinate my child when they are only 11 years old?”  Of course YOUR child is not having sex at this age, some may not have even had THE TALK yet!

Unfortunately, there are kids having sex before they are ready and this includes children as young as 11 years (or even younger).  In order for the vaccine to be most effective it must be given before your child is exposed to the virus. Therefore the recommendation is to give it at 11-12 years, although it is also approved to be used in children as young as 9 years if warranted. The vaccine does not treat disease, and it only prevents disease if you are vaccinated.  

HPV is sexually transmitted and by immunizing both girls and boys the back and forth of this virus may be prevented. Until the vaccination rates are higher for both sexes there will not be a significant change in the rates of cervical cancer or genital warts.

With this latest recommendation one can hope that both boys and girls will be protected prior to their exposure later in life.  And yes, it is a three shot series so make sure you complete all three.

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

Daily Dose

Anti-Vaccine Movement

1.30 to read

It seems that the “anti-vaccine” movement is still alive and well and has been a hot topic on Twitter and Facebook again. Unfortunately, much of what I have read on these sites seems to be inaccurate and based on a lot of emotion and very little science.  But, emotional posts can be quite persuasive, especially to a new parent who wants to do EVERYTHING for their new child.  I would think that would include protecting them from deadly diseases that have NOT been totally eradicated.

One of the first things you learn during your early medical school days is the mantra that doctors should “first do no harm”.  I have continued my daily pediatric practice with that in mind.....so how could I not vaccinate my precious patients?  Vaccines have been well studied ( and continue to be studied) and absolutely DO protect children (and adults) from numerous diseases....including polio, bacterial meningitis, whooping cough and measles.  Vaccines are also safe.....how many different studies does it take to assure parents of this? 

Choosing to not vaccinate your child unfortunately can “cause harm”.  Do parents not realize that we are all exposed to diseases unknowingly?   I know that there isn’t a parent out there that would purposely expose their child to a disease....especially one that could cause death. But with that being said, the bacteria ( h. flu and pneumococcus) that cause meningitis are often harbored in a person’s nose and are just a sneeze away from an unprotected baby.  When I used to do spinal taps on a regular basis on very ill children, some of whom indeed had bacterial meningitis, every parent would ask, “how did my child get this?”  The answer at that time was, “we don’t know where they were exposed”.  Not a very good answer to give parent’s of a critically ill child, some of whom would die. 

Since the vaccines against meningitis have been released I have not seen a case of H.flu or Pneumococcal meningitis in my practice. I can’t remember the last time I did a spinal tap.  Those are memories I don’t need to experience again.  My office was also involved in the studies for the HIB meningitis vaccine and I saw first hand how labor intensive and difficult vaccine studies are. There were a lot of parents at that time that allowed us to stick their infants for blood samples on (many times, on a regular basis) to prove that the vaccine provided antibody and protection for their baby.  Thank you to all of those parents!

So.... I continue to be alarmed that there are parents (often clustered in certain areas) that want to deny their child vaccines.  I wonder what their baby would say, if they had the chance to choose to get vaccinated. Unfortunately, they don’t.

Daily Dose

Whooping Cough Epidemic!

1.30 to read

For the first time in many years, being a pediatrician in Dallas means that I am seeing children with pertussis (whooping cough). That is due to the fact that Dallas-Ft. Worth is in the midst of a whooping cough epidemic, the worst in over 20 years. But pertussis is not just a problem in the DFW area, the entire country continues to see rising pertussis cases.  

The CDC reported that in 2012 the U.S. had more whooping cough cases reported( >41,000) than since 1955. There are currently 16 states, including Texas reporting higher pertussis rates than last year. In 2012 there were 18 reported deaths in the U.S.  due to whooping cough.  Sadly, there have already been more than 2,000 cases of whooping cough reported in Texas this year,  and there have been 6 deaths in infants and children.    

Unfortunately, one reason for increasing pertussis cases seems to be that some parents are choosing to either not vaccinate their children, or to vaccinate them on an “alternative” vaccine schedule.  A study just published shows that unvaccinated or under-vaccinated children between the ages of 3 months and 36 months of age are at greatest risk for getting whooping cough. The study from The Institute for Health Research at Kaiser Permanente Colorado stated that “children who had not received the  recommended 3 or 4 doses of DTaP (diptheria, tetanus, pertussis vaccine) were about 18-28 times more likely to have had pertussis than children who were fully vaccinated”. 

These children are not only at risk for getting ill from pertussis themselves,  they also pose a public health risk for others as they spread the bacteria (bordetella pertussis) with their coughs. This is especially true for innocent infants under the age of 2 months who have not even started their DTaP vaccines. The recommended schedule for DTaP is 2,4,and 6 months of age with a 4th dose between 15-18 months of age.  

What we doctors do know is that vaccines are safe, effective and save lives. They are given on a schedule for a reason.  We also know that when too many children “opt out”, or rather their parents choose not to vaccinate them, we see increase in disease numbers. This is not only true in this country with pertussis, but with measles as well. Measles cases in the United States are also at their highest in years.

The other group of people who need to be immunized are teens and adults. Many adults incorrectly think that they “don’t get more shots”.  But, adults need “booster” shots as well as children. This is especially true with the TdaP (adult version of the pertussis vaccine). While this vaccine is safer than the older whooping cough vaccines, it doesn’t seem be as effective at providing long term immunity. This too may account for increased whooping cough rates in teens and adults.  Research is looking at giving the TdaP more often as well as the possibility of a more effective vaccine.

The bottom line? Everyone needs to be up to date with their vaccines. Don’t depend on others to get vaccinated to protect you either, not everyone “plays by the rules”.  Help protect those innocent babies under 2 months of age. In the meantime, try to limit your baby’s exposure to crowds until they have started their vaccines. 

Daily Dose

MMR Vaccine Update

vaccine, virus, health, parenting

Although there is more and more data to confirm that childhood vaccines are safe, and DO NOT cause autism….there  continues to be some parental concern surrounding the timing of a child’s vaccines.  The majority (read as all of my patients) receive their vaccines according to the CDC guidelines…and for the most part my patients realize the importance of vaccines and how many lives have been saved as more vaccines are given to children today than 25 years ago.  

But, when it comes time for the MMR (measles, mumps, rubella) vaccine, there are still a few parents who express concerns and some who would “like” to defer the vaccine to a later date when their child is “older”….typically after their child reaches the age of 18-24 months. Concerns are not only about safety, but also about efficacy of the vaccine at a younger age.   There have been several recent studies that should help to allay fears and actually reassure parents that giving the vaccine at 12 months of age is preferable and may have even have fewer side effects, if any, than when given when the child is older.

A study from Finland (which uses the same MMR vaccine)  looked at whether the antibody response (protection) from the MMR vaccine was any different when given at 12 months vs 18 months of age.  This study showed that the antibody response and protection from the MMR vaccine was similar when given at 12 months vs 18 months. Good news for giving it younger and protecting the child earlier.

Another study looked at the risk of febrile seizures after the MMR vaccine. This study reported that the risk of a seizure was more than 6 times higher during the 7 - 10 day interval after the MMR vaccine among children who were 16-23 months, as compared to those who were 12 -15 months.  So..in fact, delaying the vaccine actually put a child at more risk for a seizure than if given earlier.

These studies point to the win-win in giving the MMR vaccine to children at their 1 year old well child visit.  Not only does it provide earlier protection against measles, mumps and rubella ( a new outbreak of measles in the Amish community in Ohio was just reported), the chance of your child having any adverse effects are actually even lower. 

But remember, while this study showed “twice the risk” for delaying the vaccine…it is still a VERY LOW number, out of 10,000 kids there may be 4 extra febrile seizures.  While that number may seem insignificant,  when your child is one of the 4 to have a seizure it is significant. This is coming from a mother whose child had a febrile seizure (unrelated to vaccines) and who is a pediatrician.  It was even frightening for me to watch my child have a febrile seizure and I knew what was happening. While most febrile seizures only last 1-2 minutes he of course decided to have a prolonged seizure, (always doctor's kids). I am happy to report that he is of course totally fine and never had another febrile seizure…as most children “outgrow” febrile seizures during the pre-school years. 

Bottom line,  with these studies in hand…you should feel reassured that immunizing at 12 months is  preferable, safe and prevents serious illnesses.  

Daily Dose

Booster Shots

1:00 to read

Under the heading “kids say the smartest things” comes one of the latest entries!! I was seeing a 4 year old for their check up...this is a great age as most kids are very conversational and engaged and most are over their fear of the doctor.  I think “Doc McStuffins” has helped this out as well. Thank you Doc!

So, if you didn’t know it, 4-5 year olds get immunized before they start kindergarten.  I give 4 year olds their DTaP, IPV, MMR and Varicella vaccine, all in preparation for school.After a wonderful chatty and interactive visit, I always find it hard to now tell this precious child that at the end of the visit they are going to get some “vaccinations”.  Many times, in fact most, the idea of shots does not go over well.

Last week I saw this 4 year old, had a great visit, talked all about school and his soccer team and his new bike and bike helmet, only to end with “you are going to get several shots to keep you healthy”.  Then you wait for the reaction, right?

So, this little boy looked me right in the eye and said, “I get shots to protect and help my immune system!”.  What a smart kid! I think he is going to be an immunologist one day and save the world. I couldn’t be happier that he already understands re-boosting immunity.  

Daily Dose

Flu Season Continues

Another Monday in the office and Influenza B is here in full force. Seeing all of the kids (and many of their parents) who have succumbed to flu B this season reminded me that the FDA has already recommended that the flu vaccine for next year contain a different B virus strain than this year's vaccine. The Influenza B virus that is circulating in our area right now is not a good match for this year's vaccine. Fortunately, Influenza B is typically not as serious and as lengthy as Influenza A.

It seems that the flu vaccine this year was right on the mark for the Influenza A viruses that we have been seeing and provides good protection against flu A. The flu vaccine that will be made over the next months for distribution next fall will only vary slightly from this year's vaccine. The two Influenza A strains in this year's vaccine will remain the same while the B component will change from type B/Florida to type B/Brisbane, which is the strain that we have been seeing this winter. Determining the viruses to target in flu vaccine is always based on the epidemiology of flu strains that are circulating throughout the world. The strains must be chosen early in the year in order that manufacturers have a long enough time to ensure that vaccine will be available in the six to seven months ahead. Funny to already be discussing flu for 2009 - 2010 when we are still in the thick of the season for the current flu strain. Hopefully the season will soon be winding down. That's your daily dose, we'll chat again tomorrow.

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

Daily Dose

MMR Vaccine Changes Are Coming

There is always a lot of news about vaccines, especially this year with the need for two different flu vaccines to provide protection against both seasonal influenza and novel H1N1 (swine flu). But another newsworthy story involves the vaccines to prevent measles, mumps and rubella (MMR).

The MMR II vaccine is typically give given to infants at their 12 month check up. It has been given for over 30 years, and as a result, the incidence of these diseases has decreased dramatically since that time. But in recent years there had been “concern” by some that the MMR vaccine was one of the “causes” of autism. Due to this “unfounded and unsubstantiated” concern, some parents had opted not to give their children MMR vaccine, while others had decided to spread out the doses by giving individual components of the vaccine. In other words, the parents, and some doctors, gave mumps, measles, and rubella vaccine as individual vaccines separated by weeks to months. This decision puts more children at risk for acquiring these diseases that have not been eradicated, especially in other parts of the world and can be imported into the U.S. by international travel. Such was the case in 2006 when there was a mumps outbreak in the U.S. and in 2008 there was a measles outbreak across this country. In the measles outbreak, the first case was imported to California by an unvaccinated child who had been in Switzerland and acquired the measles virus and become ill upon his return to the U.S. This is again an example that the re-emergence of these diseases is always a threat in unvaccinated or partially vaccinated children. Due to the fact that there were different vaccines available, some being MMR combination and other single disease vaccines there was even more concern that children would not be adequately vaccinated, and that there could be widespread disease in this country. Merck had been the only distributor of single component vaccines, which had always been difficult to obtain. It seemed that there were often shortages of either the measles, the mumps or the rubella single dose vaccines, which again just delayed vaccination. After many meetings with both the American Academy of Pediatrics, the Centers for Disease Control and Prevention and the Committee on Infectious Diseases, Merck has announced that it will no longer produce single antigen component measles, mumps or rubella vaccines. Studies have confirmed that combination vaccines like MMR are not only safe, but are an important way to improve overall vaccine compliance and results in higher vaccine coverage. With the decision by Merck to stop producing single antigen vaccines, the MMR vaccine will become the only vaccine available for use and will help clear the “muddy” waters surrounding single antigen vaccine. That’s your daily dose, we’ll chat again tomorrow.

Your Teen

Acetaminophen, No Threat To Child's Liver

2.00 to read

With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. Concerns about liver injuries in children who take the common painkiller acetaminophen, sold as Tylenol in the U.S. are unfounded, researchers said on Monday. "None of the 32,000 children in this study were reported to have symptoms of obvious liver disease," said Dr. Eric Lavonas of the Rocky Mountain Poison and Drug Center in Denver. "The only hint of harm we found was some lab abnormalities." With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. "This drug is used so commonly that even a very rare safety concern is a big concern," said Lavonas, whose findings appear in the journal Pediatrics. Some researchers suspect there is a link between long-term use of acetaminophen and the global rise in asthma and allergies, but the evidence is far from clear at this point. For the new report, researchers pooled earlier studies that followed kids who had been given acetaminophen for at least 24 hours. There were no reports of liver injuries leading to symptoms such as stomachache, nausea or vomiting, in the 62 reports they found. Ten kids, or about three in 10,000, had high levels of liver enzymes in their blood, which usually means their livers have been damaged. In most cases, however, those elevations were unrelated to acetaminophen. And even if they were caused by the drug, they don't indicate lasting damage, according to Lavonas. "Acetaminophen is extremely safe for children when given correctly," he said. "Parents should not be afraid to give acetaminophen to their children when they need it, but they should be very careful about giving the right dose." "If you suspect that you have given a child an overdose, call your state's poison center," he added. The Rocky Mountain Poison and Drug Center receives funding from McNeil Consumer Healthcare, the Johnson & Johnson subsidiary that sells Tylenol, but the researchers said the company did not support this study.

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

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

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.