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Daily Dose

Hurricanes & Your Health

1:30 to read

The last week has been a tough one for Texans, and especially for those who live in Houston and along the Texas Gulf Coast.  Having my son, brother and mother all with houses in Houston, I have been watching the “Harvey” situation quite closely. Fortunately, my family is lucky enough not to have flood damage and they have not had to leave Houston.  But, too many other families have suffered flooding and have been forced to evacuate their homes and seek refuge in shelters not only in Houston, but in Dallas where I live as well. 

 

There are many families who are now living in very close quarters where they may be for sometime…as it will take weeks and months if not years to recover from this disaster and to rebuild the homes, schools, churches and businesses that have been either damaged or destroyed. 

 

The necessary relocation of families and children into shelters is also “a perfect storm” for the possibility of the spread of infectious disease. This is an important time in which managing the spread of illness and infection is paramount. What this means is that EVERYONE needs to be up to date on their immunizations to prevent the spread of vaccine preventable diseases. 

 

If you have ever “skipped” a vaccine by choice or missed a vaccine, now is the time to get your child’s vaccines updated. This is not only for those who have had to evacuate, but for everyone, as infectious diseases are spread outside of the shelters and as well.  We pediatricians are working in the shelters to try and make sure that everyone is vaccinated as they arrive, but there are those who are too young to be vaccinated and others who do not have their medical records to ensure accuracy of their vaccines. It is an arduous process.

 

But, for the public health system which will be stretched even more so during the flood recovery, vaccines are one of the most important ways to protect people. It only takes one person who might get mumps, measles or whooping cough to spread it to hundreds of others….all living in close proximity. These people will then also leave their shelter to go to school, church the store or even a temporary job where they may put others at risk, you never know if you might be exposed.

 

Lastly, it is really time to get those flu shots!!! The last thing we need is an early flu season with a large group of un-immunized people…and most doctors have already received shipments of flu vaccine.

 

Please please pray for these families who have lost so much and protect everyone by immunizing your children (and yourself).  

 

 

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. 

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

Day Care & Vaccines

1.30 to read

I heard the weirdest thing from a patient today and wondered if anyone else has had this issue with their day care or school?

I saw a 15 month old patient of mine for his “well baby” checkup and the mother, who is an elementary school teacher, was surprised when I told her that her son needed some immunizations. Now, she has no problems vaccinating her children, but she was concerned as she had “planned” on taking her son to daycare after her visit that morning and had forgotten that he had vaccines at the visit.  I couldn’t figure out what the problem was....but she said that she couldn’t take him back to daycare on the same day that he had his shots! WHAT?

Now this child was getting his 15 month old HIB and DTap “booster” shots (in other words, he had received 3 of these vaccines before) and there was not a history of ANY problems.  The daycare also “required” that her child show proof of his immunizations.....so what was the deal? How is it possible that parents must take off from work on a day that their child sees the pediatrician for a “well child” visit and immunizations and then the child cannot go to daycare?  How are parents supposed to juggle work and “save” days off for when their child is ill and legitimately needs to stay home?

She wanted to get his vaccines, as she really did not have another day that she felt she could take off in the near future and she was already at my office. What a dilemma. So, I grabbed my letterhead, and hand wrote a letter to the daycare explaining that he had just had his check up, was in EXCELLENT health, and that he had received his immunizations according to AAP and ACIP guidelines and could return to school.  Guess what? It didn’t help! The poor mother had to take the rest of the day off from school, get a substitute for her class and go home with her perfectly healthy and fully immunized child. Seems like we penalized her as well as her class for trying to be a good parent.  

I think this is crazy! I’m all for keeping sick children out of day care and school, but for immunizations....go figure. 

Daily Dose

Fight The Flu

1:30 to read

It is National Influenza Immunization Week, and I am hopeful that most everyone reading this has already had their flu vaccine….but if not, it is NOT too late! Just like the after Thanksgiving sales being extended…..your opportunity to be vaccinated has not passed!  Lucky for you, there are still vaccines available. If you act quickly there may be some places having a two for one sale, a coupon for shopping after getting vaccinate or even free vaccines…no excuses, everyone in the family ( over 6 months) may be vaccinated.

All kidding aside, this is an important time to remind people that it is not too late to get your flu vaccine and as of the first week of December there has not been a significant amount of flu in the country. But with that being said, influenza typically circulates December thru February but some years flu may even last into April or May.  But one thing is sure, flu is coming!!

No one is immune from the flu and the best protection is to get a flu vaccine!!  I hear people tell me, “they have never had the flu before so why should I get a vaccine?”, or “ I got sick after I had the flu vaccine, so I am not getting it again”.   Both of those are myths and are just a few of the anecdotes that I hear from patients and their families.

It is recommended that everyone over the age of 6 months receive a flu vaccine as it is the best protection against getting sick from the flu, and by vaccinating everyone we are also protecting those infants under 6 months that cannot yet get a flu vaccine.  Infants have a higher incidence of complications from the flu ( as do children with asthma and other underlying health issues ), and those precious babies born during the late summer and into the winter depend on the community to help keep them healthy. This is especially important for infants and children in day care, as influenza is a respiratory virus that is spread when someone in close proximity has coughed or sneezed. So, check to make sure that everyone in your daycare center is vaccinated, including the parents.

Statistics show that flu vaccination activity drops off after the end of November, but it is never too late to get the vaccine.  Remember,  it does take about two weeks to develop immunity after being vaccinated.  People also tell me, “I think I have already had the flu this year”, but even if you have, you have not had all of the strains of influenza that are in the vaccine and yes…you could get sick again. This years flu vaccine is available as a trivalent vaccine (which contains 2 type A, flu and 1flu B) and a quadrivalent vaccine ( with 2 type A and 2 B strains), and either vaccine is fine….get whatever your doctor, health department, pharmacy, grocery store, or employer has.  Most children over the age of 2 years may also take the live attenuated intranasal flu vaccine ( because how many kids want a shot -right?) and it is a quadrivalent vaccine.

So now is the time to run…not walk to get your flu vaccine!!  Don’t delay, put it on the top of the holiday “to do list”.

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

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

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

Changes in Flu Immunizations for Children

Flu season is fast approaching and that means it is time to get your flu vaccine. Recently the Centers for Disease Control and Prevention and the American Academy of Pediatrics expanded the recommendation for flu vaccination to include all children ages six months to 18 years.

The previous recommended age group was 6 months to 5 years. "Children under nine years of age who have never received a flu vaccine need to have two doses of vaccine separated by at least four weeks, and all other children receive a single dose," says pediatrician Dr. Sue Hubbard. That means the time is now for you to call and schedule a flu shot with your doctor and your child's pediatrician. Many offices block off certain times during the day in which they have "flu shot clinics." According to Dr. William Schaffner, president-elect of the National Foundation for Infectious Diseases there is an ample supply of the flu vaccine this year. He encourages people to start taking it now as there is no reason to wait. "There are two options for children older than two: the injectable flu vaccine or the live attenuated flumist intranasal vaccine. There are some restrictions to intranasal vaccine (children with asthma, immuno-suppressed children) but for many children the idea of sniffing a vaccine is far better than a SHOT. The upside of the nasal vaccine is also that it seems to be more effective," says Dr. Hubbard. "Either way, start thinking about getting on your doctors schedule to get vaccinated before the winter and influenza hits." Dr. Hubbard also recommends that you teach your child to practice good hand and cough hygiene to help prevent the spread of germs. More Information: The American Academy of Pediatrics More Information: Centers for Disease Control and Prevention

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DR SUE'S DAILY DOSE

When should you get your flu shot?

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