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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”.

Your Baby

Tdap Vaccine Protects Mother and Newborn

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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

National Flu Immunization Week

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

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

Daily Dose

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

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

HPV & Risky Sexual Behavior

1.30 to read

I have written many articles on the HPV vaccine and have been a big advocate for giving this vaccine to all adolescents . I let my patients know that I even gave it to all of my sons in their teen and early adult years (off label at the time, as it was not initially approved for males in the U.S.), as I had looked at the European data as to HPV vaccine efficacy in both males and females. 

At any rate, some parents, while proponents of vaccines, did not want to vaccinate their children during their teen years, “for fear that it might promote early sexual behaviors”.  I myself had not been concerned about that issue, as I have seen too many teens who never gave getting a sexually transmitted disease a second thought (though they should), prior to having their first sexual experience. I told parents, “I just wish they were thinking with their brains rather than with hormones and genitalia”. 

My own impression was that by giving the HPV vaccine while re-iterating to teens and young adults the ongoing risks about STI (sexually transmitted infections), we might see more “thinking” before engaging in pre-marital sex. My hope was that by providing information about developing a STI  (including those not covered by the HPV vaccine such as chlamydia, herpes, gonorrhea etc) doctors and parents could also be influential in helping adolescents realize that even with HPV vaccine, “there is no safe sex”. Double win, right?

There is now an article in Pediatrics (February 2014) which confirms that HPV vaccine was not tied to initiation of riskier sexual behavior.  A study done at Cincinnati Children’s Hospital surveyed 339 female adolescents and young adults aged 13- 21 years following HPV vaccination. They also did follow up questionnaires 2 and 6 months post vaccine.  The study showed that giving a young girl HPV vaccine did not lead to the perception that she was protected against STI’s nor did it promote sexual activity. The study did show that the girls that received HPV vaccine understood that it only protected them against HPV related disease and the possibility of developing a HPV-related wart or cancer.

Another finding in the study, was that most girls held appropriate perceptions that there was still a need to practice safe sex even after HPV vaccine, including the use of a condom.

So, if a parent is worried that HPV vaccine may lead their teen to initiate earlier sexual behavior, at least there is one study confirming that there is no association in girls. Further studies including boys should also be undertaken.

Could there be an association between not discussing risky sexual behavior, not giving the HPV vaccine and early initiation of sex?  Food for thought.

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.

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