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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

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. 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

Why 'Herd Immunity' Does Not Work

With all of the recent anxiety surrounding Swine Flu and the possibility of epidemics, lets be pro active in protecting all of us from diseases that we can prevent with the current immunizations that are available.There is an article in the June issue of the journal Pediatrics, which looked at whether parental refusal of pertussis vaccination could be associated with increased risk of pertussis infection in those unimmunized children. The study was conducted between the years 1996 - 2007 and looked at case controlled studies which compared a child with documented pertussis (whooping cough) to 4 other randomly selected children who did not develop pertussis. This study is important as many parents believe that if they choose not to vaccinate their child, that their child is protected by herd immunity (in other words, by all of the rest of us that are immunized).

In this case the study showed that 11% of all pertussis cases in this pediatric population were attributed to parental vaccine refusal. This study is important for several reasons. It is one of the first to document that herd immunity does not seem to completely protect unvaccinated children from pertussis. Children of parents who refuse pertussis immunizations are at high risk for pertussis infection relative to vaccinated children. One would assume, but further studies need to be done, that similar results would be found if you looked at diseases like measles, or H. flu meningitis. Herd immunity is important to the general health and well being of all of us, but it is not 100% at any time and risk of disease is still there. As we see increases in whooping cough in many communities across the country the need to educate parents about the importance of vaccines is paramount. Parents need to be protected too and we should all have a TdaP as an adult to provide pertussis protection for ourselves, as well as for those infants around us who are too young to be immunized. With all of the recent anxiety surrounding Swine Flu (H1N1) and the possibility of epidemics, lets be pro active in protecting all of us from diseases that we can prevent with the current immunizations that are available. That's your daily dose, we'll chat again tomorrow.

Your Baby

Infant Ear Infections Declining


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

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

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

"This is what we anticipated," she said.

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

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

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

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

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

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

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

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

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

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

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

Some symptoms to watch for are:

·      Tugging at the ear

·      Fever

·      Crying more than usual

·      Irritability

·      Child becomes more upset when lying down

·      Difficulty sleeping

·      Diminished appetite

·      Vomiting

·      Diarrhea

·      Pus or fluid draining from ear

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

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

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

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

Story source: Amy Norton,

Daily Dose

A News Alert for a Preventable Disease

There was a news release in the past several day alerting physicians to five cases of invasive H. Flu bacterial infections in children under the age of five in Minnesota during 2008. The reason this is significant is that this is a vaccine preventable infection. In other words, children are vaccinated against this bacterial infection beginning at two months of age. This is also a series of vaccines with infants receiving a series and a booster dose during toddler years.

There are several issues regarding this newsworthy information of an infection that was dramatically reduced after vaccination began in the early 90s. Number one, there has been a shortage of H. Flu (HIB) vaccine for the past year and infants are receiving the initial series, but doctors are withholding the booster dose in order to ensure adequate vaccine supplies for infants. At the present, it does not seem as if this is affecting vaccine efficacy but the Centers for Disease Control and Prevention (CDC) and state heath departments are watching for changes in rates of H. Flu disease which might indicate that the bacteria is having a resurgence as vaccines are delayed. Secondly, in looking at the five cases in Minnesota (the last time there were this many cases was more than 10 years ago), three of the children had not received HIB vaccine as their parent's refused vaccinations for their children. Of these three children, ranging in age from seven months to five years, all had invasive disease such as meningitis and pneumonia, and unfortunately one child died. I was a much younger pediatrician when I used to see these infections and yes, I too saw children die, or have long-term consequences such a being deaf or mentally retarded due to H. Flu infections. The HIB vaccine changed this and I have not seen a case in over 15 years, which is about the time the vaccine was released. This is a lesson in how vaccines work, not only for the vaccinated child, but also for the "herd" around them. Make sure your child has received this very important vaccine, so that we will not see more articles about increasing H. flu infections and preventable deaths. That's your daily dose, we'll chat again tomorrow.

Daily Dose

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

National Infant Immunization Week

I cannot think of a more appropriate time to discuss the importance of vaccinating newborns (and all children).This week, April 26 - May 2, is National Infant Immunization Week. I cannot think of a more appropriate time to discuss the importance of vaccinating newborns (and all children), while we are in the midst of a possible public health pandemic for which no vaccine is available. Vaccines have been one of the greatest public health achievements of the last decade. Vaccines have prevented countless deaths and morbidity from diseases that parents used to worry about their children catching.

Polio in the 50's, measles, mumps and rubella that accounted for not only disease in children but congenital birth defects in children who had been exposed to rubella in utero. After that came advancements in the prevention of meningitis (from several different bacteria) that not only caused death but complications of deafness and developmental delay in those children who were fortunately saved. If you are a young parent, you have no memory of these diseases, as you too had been vaccinated by your parents, who at that time were anxious to vaccinate their children to prevent these dreaded diseases. You don't remember children in iron lungs or leg braces, or houses with signs reading "quarantined" when an entire family developed measles, or those phone calls in the middle of the night with an infant with fever, a stiff neck and meningitis. The memories are distant, but in reality all too close, as these diseases have not been eradicated. They still cause disease in many countries and are only a plane ride away from re-entering the United States. We are a very mobile society and exposures to these diseases may happen at any time. We saw this phenomena this last year with measles, which was brought into this country by a child who had not been immunized, after vacationing in Switzerland. We have seen mumps outbreaks again brought in from Europe when a child came to the U.S. for camp. We are currently seeing several cases of H. Flu meningitis and death in young children who had not been immunized to these diseases due to parental concerns with vaccines. There have been numerous studies done and reported in medical journals worldwide that show no link between vaccines and autism. And that same science shows that we must keep up high immunization rates to ensure that the "herd" (the entire population) stays healthy. Children who are not vaccinated have been fortunate to benefit from herd immunity; in other words, they are at less risk because most children and adults are immunized. But if the herd gets smaller and those not vaccinated becomes larger, the tides may turn and these diseases may "rear their angry heads" and cause outbreaks again. Begin your child's immunizations on schedule at their two, four and six month visits. Go to the American Academy of Pediatrics Web site and read and listen to sound advice on vaccines. Your best protection against disease is vaccination. That's your daily dose, we'll chat again tomorrow.

Daily Dose

In The News: Vaccine Safety

Vaccine safety in the headlines this week.There have been several articles in the news recently related to vaccines and concerns over their safety.

In the last several days the special master appointed by the United States Court of Federal Claims ruled that “the theory of vaccine–related causation and autism is scientifically unsupportable”.   The special “vaccine court” rejected the plaintiff’s theory linking thimerosal, a preservative previously used in vaccines, with the development of autism spectrum disorders in children. In a previous case before the court in 2009, the court also discounted parent’s claims that the MMR vaccine and thimerasol caused the development of autism.  These rulings continue to refute a connection between childhood vaccines and autism. It should be noted that thimerasol is no longer used in vaccines, and despite this autism incidence has risen.  The argument that the MMR vaccine alone could cause autism has also been refuted and last month the Lancet officially retracted the Wakefield paper from 1998 that started the idea that vaccines and autism are somehow related. Earlier this month, the United States Supreme Court announced that it will hear a case in which a family argues that there should be legal recourse beyond the administrative process set up by the National Childhood Vaccine Injury Act (a law passed in 1986 to protect vaccine manufacturers from costly lawsuits). This family sued over a DPT (diphtheria, pertussis, and tetanus) shot, as a cause of their daughter’s seizure disorder. This case has been in the courts for over 15 years and the family has been denied compensation because they have been unable to prove “causation” between the vaccine and their child’s seizures. This is a pivotal case for both drug companies who want to clarify the legal issues surrounding vaccines, and parents who still believe that vaccines have caused injury to their children. Despite the literature and science surrounding vaccine safety,  a survey in the March issue of Pediatrics still show that fears may linger among parents regarding vaccines and safety.  In the study, 90 percent of parents with young children agreed that vaccines protected children from disease, but 25 percent continued to think that vaccines might cause autism. I continue to hear concerns from parents, but hopefully with logic, science and now the courts behind vaccines, parents will choose vaccines to protect their children and we will not see outbreaks of vaccine preventable diseases in this country. That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

Another Case for Vaccinating Your Child

The American Academy of Pediatrics issued an alert last week that identified several more cases of invasive HIB disease in Pennsylvania and two deaths. One of the deaths occurred in an unimmunized child. Several months ago there were five cases of HIB disease in Minnesota, again resulting in one death, also in an unimmunized child. All of the cases involved unvaccinated or under-vaccinated children.

Prior to routine vaccination against HIB (H. flu) disease, which began in 1988, about 20,000 children developed infections each year, and 12,000 cases of HIB meningitis were diagnosed, with about five percent of children dying. Over the last 20 years the rates of HIB disease have decreased exponentially and deaths were no longer reported. The vaccine was a tremendous victory in preventing childhood meningitis and other serious infections. Over the last several years with parental anxiety related to vaccines, the number of unvaccinated children has been on the rise, especially in "pockets" throughout the country. At the same time, there has been a HIB vaccine shortage since December of 2007, which may have also resulted in children not completing their primary series at 2, 4, and 6 months of age. These two factors may have led to the cases of HIB disease and doctors are worried that we may see a recurrence of HIB disease and deaths. The community as a whole is often protected due to "herd immunity" and the herd must be immunized to provide maximum protection for everyone. This underscores the importance in vaccinating your children. If your child has missed any of their primary vaccine series, now is the time to update them. HIB disease is serious and unfortunately may be on the rise again. This is a vaccine preventable disease. That's your daily dose, we'll chat again soon.


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Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!


Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!

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