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Daily Dose

Vaccines During Pregnancy

1:30 to read

August is National Immunization Awareness Month and a great time to discuss childhood vaccines (see previous post), but also a good time to discuss vaccines for adults. Adult vaccines help to protect our children. Specifically, Tdap vaccination during pregnancy.

 

Immunizations may protect a newborn….and this is accomplished by immunizing the mother during her pregnancy. It is routinely recommended that all pregnant women receive the Tdap (tetanus, diphtheria and pertussis)  vaccine at 27-36 weeks’ gestation. The goal of maternal immunization is to provide the newborn infant with “passive protection” from circulating antibodies that cross the placenta. Passive antibodies will provide the newborn some protection from disease, specifically pertussis (whooping cough), prior to the first dose of DTaP given at the 2 month pediatric visit. 

 

A recent study published in Pediatrics looked at the effectiveness of maternal Tdap vaccine on preventing pertussis in newborns.  In the study of over 140,000 infants there were 17 cases of pertussis in infants under 2 months of age, and 16 of those cases were in infants born to unvaccinated mothers. There was only 1 case of whooping cough in the vaccinated group. In other words, maternal Tdap vaccine provided 91.4% effectiveness in preventing pertussis in the first 2 months of an infant’s life. Pretty great odds!!

 

This is important data in that whooping cough has become more and more prevalent in the United States and is especially dangerous in young infants.  By immunizing a pregnant mother these precious newborns are protected.  The study also found that maternal Tdap vaccination during pregnancy reduced an infant’s risk of pertussis by an estimated 69% in the first year of life.  

 

So…the importance of vaccines during pregnancy is well studied and I know my pregnant daughter in law who is now in her last trimester will be getting her Tdap, as will her husband.  

It is equally important that pregnant women receive flu vaccine in their last trimester…and the 2017-2018 vaccines are just arriving.  Studies have found that this maternal antibody also transfers to the baby and is protective for those infants born during flu season who are too young to receive flu vaccine, which is not given prior to 6 months of age. 

Daily Dose

Science & Vaccines

1:30 to read

August is National Immunization Awareness Month and it seems appropriate that while heading to NYC for business I managed to watch the in flight movie “The Immortal Life of Henrietta Lacks”.  I had read the book years ago and I have recommended it to many, as it is such a great “read” about an incredible woman who unknowingly changed medicine and science. The movie was produced by Harpo Productions and Oprah Winfrey stars….that alone is enough to get you hooked!

 

The story is sad but true. Unfortunately in the 1950’s we did not have laws to protect patient rights…but Henrietta’s life and her story changed all of ours.  Why?  Because the cells that doctors at Johns Hopkins took from her during her treatment for cervical cancer were ultimately used to grow more cells…which would be used over and over again in developing vaccines and so many other medical break throughs!!!  It is incredible that these cells which are named HeLa cells (after the initials of her first and last name) literally changed the world of medicine. I know not everyone knew her story when studying HeLa cells…but I am hopeful more and more remember her due to this excellent book and now HBO movie. 

 

I was amazed by this story which demonstrates the science (albeit from unfortunate circumstances) that enabled scientists to begin to develop vaccines.  I continue to be amazed at those who “don’t believe in vaccines”. Just as Henrietta’s HeLa cells have changed our medical and scientific world, so have vaccines.  During Henrietta’s life the United States was in a state of panic as  countless children and adults came down with polio and many died or were paralyzed.  But after HeLa cells were found to propagate, the cell cultures were used to meet the needs of researchers working on the development of a polio vaccine. A HeLa factory was opened at theTuskegee Institute to manufacture HeLa cells.  This cell line was ultimately instrumental in  testing the vaccine and demonstrating the development of antibodies against polio. Subsequently, Dr. Jonas Salk’s vaccine was approved and given to children and the polio epidemic was stopped in the United States.

 

Pure, eloquent science - which reduced disease and save lives. The panic against polio subsided…but we are now “too complacent” about infectious disease. We even take vaccines for granted, while some choose not to be protected by a vaccine??  Hundreds and hundreds of researchers have come and gone since the first HeLa cells were used…but Henrietta’s legacy and her “gift” to science remain.  We all need to know more about the woman from whom those precious cells had come….and say thank you.

 

Talk to your doctor and make sure your children are protected!

 

 

 

  

 

Daily Dose

HPV Is An Equal Opportunity Virus

Human Papilloma Virus (HPV) is the most common sexually transmitted infection in the United States and most genital warts (condyloma accuminata) are caused by HPV.

In 2006 a vaccine (Gardasil) was approved for girls and women aged nine to 26 to prevent cervical, vulvar and vaginal cancers caused by HPV 16 and 18, as well as genital warts caused by HPV types 6 and 11. This vaccine has been shown to be quite efficacious in preventing these conditions, especially when given before adolescents and young adults become sexually active. When looking at national statistics among teens regarding their sexual activity and first intercourse, over 60 percent of teenage girls had intercourse before graduating from high school and the percentage just continues to rise during college. Among those girls, in one study up to 50 percent may be exposed to HPV by their partner after their sexual debut. Not all of those exposed to HPV will go on to develop warts or cancer, as many people can clear this viral infection on their own. The difficulty is, we don’t know who can clear the virus and who will go on to become infected. Obviously, girls and boys pass this virus to one another, and it is not through intercourse alone. Genital to genital contact as well as oral and anal sex may cause transmission of this virus. In my practice, I have many adolescent girls who test positive for HPV on pap smears, as well as both girls and boys who have genital warts. Prevention is the key. Ideally that is through education and abstinence, but as any parent knows, kids make mistakes, and some are more serious than others. Most of the patients in my practice begin taking their HPV (Gardasil) vaccine series between 11 and 13 years of age and upon completion of their three dose series are well protected. I personally have not seen any complications from the vaccine, besides complaints of pain with the injection and sore arms (most of my patients complain with ALL shots anyway). When the vaccine was released there were many questions as to why it was not offered to boys too. It would seem like that would be appropriate? It was in fact given in other parts of the world to boys and young men. I even vaccinated my three sons (completely off label from FDA recommendations) as I felt it would protect them and their partners one day. Of course they complained, and said they “were guinea pigs”. Well, validation came this week when the FDA approved the use of Gardasil to prevent genital warts due to HPV types 6 and 11. The vaccine was approved for use in boys ages 9 – 26, in the same 3 dose series as girls. Each year, about 2 out of every 1,000 men in the U.S. are newly diagnosed with genital warts. I recently saw a 24-year-old male with a wart on his penis, and he could not believe that it was a genital wart. Something about penis and wart just did not connect for him, how could that be a genital wart, I must be confused? Again, education and prevention is the key. The studies in men showed that Gardasil was nearly 90 percent effective in preventing genital warts caused by HPV types 6 and 11. So talk to you doctor at your next checkup with your sons and ask about HPV prevention in boys. HPV is an equal opportunity virus and now we can equally protect both girls and boys. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

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Daily Dose

HPV Vaccine

1:30 to read

I recently read an interesting article in JAMA in which a study was done suggesting that “HPV vaccine does not lead to risky behaviors in teen girls”. This seemed to be a timely study as Merck has just recently received FDA approval for their new Gardasil vaccine which will now protect against 9 serotypes of HPV (human papilloma virus) which causes the majority of cervical cancer ( as well as other genital cancers) and genital warts.

Since the vaccines against HPV were released in this country about 8-9 years ago, the uptake of the vaccine among tween/teen girls and boys has been less than hoped for.  Like many vaccines, there were those parents who were “worried or skeptical” about giving their children a new vaccine - despite the fact that it is the first vaccine against a virus that was known to cause cancer..actually a great deal of cancers.  The CDC reports that about 57% of preteen/teen girls have received one dose of HPV vaccine, while only 35% of boys in the same age group. The completion rate for completing all 3 vaccines is only 37% for girls and 14% for boys. 

But while many parents believe in the benefit of the vaccine a common concern has been, “giving the vaccine to a pre-teen may lead girls to engage in sexual activity at younger ages”.  In my personal experience I have not found that to be at all true. In fact, educating these tweens and teens about the risk of infection and cancer is “scary enough” for some to be even more wary.  I am pretty direct with this group as they get into their true teen years and are experimenting in all sorts of ways...not only sexually. I truly do not think that a vaccine does “promotes” becoming sexually active....hormones do a good job in that area. 

So, the study looked at 21,000 vaccinated girls who were matched with more than 186,000 non vaccinated girls. Researchers then compared rates of sexually transmitted infections (STI) including herpes, chlamydia, gonorrhea, syphilis and HIV. They found that the “rate of STI’s overall were equal among the vaccinated and unvaccinated groups”, which suggests that the HPV vaccine does not impact sexual behaviors. 

With an even more protective HPV vaccine now available I encourage you to read the literature and talk to your own doctor about getting your adolescent vaccinated.  The vaccine is protective but does not treat HPV if you have already been exposed....there will be 14 million new cases of HPV in the U.S. this year...and that statistic is not one you want your adolescent to be among.

Daily Dose

Rotarix Vaccine Temporarily Suspended

The FDA suspends Glaxo Rotarix vaccine I received the CDC Health Alert yesterday afternoon notifying physicians to “temporarily suspend the usage of GlaxoSmithKline (GSK) Rotarix (rotavirus) vaccine. Rotarix was licensed for use in 2008 to prevent rotavirus disease, which typically causes fever, vomiting and diarrhea in infants and young children.

Prior to this Merck’s vaccine RotaTeq had been licensed for us in 2006. Both of these vaccines are given orally. Both RotaTeq and Rotarix were found to prevent serious rotavirus illness and hospitalizations for dehydration. The GSK product, Rotarix, which is a “live attenuated” vaccine, has been found to contain DNA from porcine circovirus type 1 (PCV 1). PCV 1 virus is not known to multiply in human cells or to cause illness.  According to the FDA, “all available evidence indicates that there had been no increased risk to patients who have received this vaccine”.  The GSK vaccine, Rotarix, is made in a different manner than the Merck vaccine RotaTeq.  Preliminary studies by the FDA on RotaTeq vaccine have not shown the presence of PCV 1 DNA. Preliminary data reported to the FDA  by GSK related to PCV 1 being in the vaccine seems to suggest that it has been present since the early stages of the vaccine’s development.  Studies on Rotarix, both before and after the approval of the vaccine, have shown it to be extremely safe and no unusual adverse events have been reported.  At the same time, the vaccines that have been given are presumed to be effective. In the interim, while futher studies are being completed, it is recommended that children continue to receive RotaTeq vaccine.  The FDA plans to convene an advisory committee to look into how the DNA components came to be present in this vaccine. They are also going to look into the use of new techniques for identifying viruses in vaccines.  After this meeting, the FDA will make further recommendations about the use of rotavirus vaccines in the United States. This recall was limited to the United States, and children in other areas or the world are continuing to receive Rotarix, as the available evidence suggests that the benefits of the vaccine outweigh the risks, especially in areas where rotavirus disease causes severe disease and even deaths. I would not be alarmed if my baby had received this vaccine as it does not cause disease in animals or humans.  I would also complete my child’s vaccine series with the Merck product which is available.  We will all have to stay tuned for further details,  but this should also make parents aware that the safety of vaccines continues to be monitored, even after they have been approved. That's your daily dose for today.  We'll chat again tomorrow! Send Dr. Sue your question now!

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.

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

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.

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.

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DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

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