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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.


Mumps Reach 10 Year High; Hitting Colleges and Kids Hard


Mumps are making a comeback, particularly on college campuses and in daycare centers.

A recent U.S. Centers for Disease Control and Prevention report shows that mumps are at a 10-year high. As of November, 45 states and the District of Columbia had reported a total of 2,879 mumps infections — more than double the mumps cases reported in 2015.

Mumps is a contagious disease caused by a virus. Common symptoms can include swollen glands in front of and below the ear or under the jaw, pain with opening and closing the jaw, fever, fatigue and malaise, headache and earache.

Currently, college campuses are taking the brunt of the mumps outbreak.

Dr. Michael Grosso, medical director and CMO of Huntington Hospital/Northwell Health, said close quarters such as dormitory living, can make it easier to pick up the virus.

“It’s spread through respiratory secretions, coughing, sneezing, close contact and sharing the same cups and utensils,” Grosso told CBS News.

Some colleges, such as The University of Missouri’s Columbia, are asking students to restrict their social activities and to make sure they get immunized. Typically, two doses of vaccine are recommended by the American Academy of Pediatrics and the CDC, but the school is asking students to get a third measles-mumps-rubella (MMR) vaccine “based on discussions with public health officials and consistent with guidance from The Centers for Disease Control and Prevention.”

College students aren’t the only ones being hit hard by mumps; younger children are also experiencing a rise in reported cases. More parents have opted-out of getting their children the MMR vaccine - putting non-immunized children at a higher risk.

Daycare centers are similar to college dormitories in that they provide an environment where a virus can be easily spread.

While most mumps cases are mild, albeit, uncomfortable, others can be more serious.

“Most individuals recover uneventfully from mumps, however as many as 10 percent of males who get mumps will get an inflammation of the testes which can lead to permanent sterility,” Grosso said.

The brain can also be affected. About 1 percent of people who come down with the mumps get serious brain infections and can experience meningitis, encephalitis and deafness associated with a brain infection.

“That small risk was behind the original impetus to create a vaccine,” Grosso said.

 Physicians are urging students to get the immunizations and to practice good hygiene. Simple steps such as covering your cough or sneeze, washing your hands with soap and water or using an alcohol-based hand sanitizer, avoiding sharing food, drinks, cups or utensils can help prevent the spread of viruses.

Vaccines are still the most effective way to lower your risk of getting the mumps.  No vaccine is a 100 percent protective, Grosso notes, but it can help you avoid the risk of serious illness and lifelong health issues.

“Receiving two doses of mumps vaccines is said to confer about an 88 percent reduction in risk of getting mumps if you’re exposed,” said Grosso. A third dose may increase those odds.

The American Academy of Pediatrics recommends the first dose of MMR vaccine should be administered between 12 and 15 months of age, and the second dose between 4 to 6 years of age.

Grosso emphasizes that parents need to get their children vaccinated early.

“Being immunized late is better than not being immunized ever. But being immunized late is not nearly as good as being immunized on time,” Grosso said.

Story sources: Mary Brophy Marcus,

Daily Dose

HPV Vaccine for Boys

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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

Flu is Here!

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Somehow I knew that flu would finally arrive! I kept telling my patients that during my 27 years of practice, I could not remember having a year go by that there was not some sort of flu season.  I thought maybe this was going to be the year, but as you know with many things in life, “never say never.” Guess what, flu season seems to have arrived in the U.S., albeit quietly. 

The CDC is reporting that for the last 2 weeks flu activity in the country has picked up and that about 15% of tests at different surveillance sites around the country are positive for influenza. So....don’t you feel good that you have gotten your flu vaccine? 

Despite it being a relatively “quiet” flu season, the good news is that the influenza strains that are being reported are “in” this year’s flu vaccine (in other words it is a good match).  It also appears that the flu strains are not resistant to the antiviral drugs that are typically used, which is a concern during each year’s flu season. 

The flu is typically heralded by fever, body aches  cough, sore throat, fatigue and just feeling terribly for anywhere from 3-10 days. Some years the fever seemed to last for a week, but the few cases I have seen this year the fever is only lasting 2-4 days. That is a good thing as well. 

Fortunately, there have only been 3 pediatric deaths reported for the 2011-2012 flu season. I can only hope that this will continue to be the trend as in several recent years there were over 200 deaths in the pediatric population due to flu. 

So, is it too late to get a flu vaccine? The answer is a very loud NO!  No one can predict how long the flu season will last and whether there will continue to be an increase in flu activity across the country. If you don’t want flu to interfere with March spring breaks, or Easter in early April I would suggest getting vaccinated now. It takes a couple of weeks for the vaccine to work as well, so you need to get it sooner than later to be protected. 

Don’t assume that just because the season is quiet that you can dodge the flu. Remember about airborne illnesses and how easily a cough can spread the flu. 

I am still immunizing my 6 month old patients in hopes of providing them protection this season too.  There is plenty of vaccine available this year so rather than let it “go to waste” as some does every year, let’s take advantage of the late flu season and get vaccinated now!   

I hope you'll join us tomorrow, 2/21 for #KidsDrChat on twitter 9-10:00 p.m. ET!

Daily Dose

Why Some Need Two Swine Flu Vaccines

The title of this should be first…before second. What do I mean by that? It seems easy enough, first always comes before second right?

But this year, in the face of shortages and backorders of both seasonal and novel H1N1 (swine) flu vaccines, we are getting a lot of phone calls from parents who are requesting that their child getting their second flu vaccine. Many are not happy to hear that they will have to wait while others get their first doses. The recommendations are a little different for seasonal flu vaccine, than those for H1N1 (swine flu) vaccine. For all children six months to nine years of age, who are receiving seasonal flu vaccine for the first time, need to receive two doses of vaccine, given a month apart. The first dose of the vaccine primes the immune system in a child, while the second dose provides the longer immunity. After a child has received two doses of seasonal flu vaccine during one season, they will be protected by a single shot/mist during the subsequent flu seasons. That being said, things are not always as clear as they may seem and yes, sometimes things change. So…this year with the emergence of novel H1N1 (swine flu) in spring of 2009, and the need for a separate flu vaccine to protect against novel H1N1, children between six months and 10 years (different than seasonal flu recommendations) and will have to have two immunizations this season for novel H1N1 (swine flu). This is necessary to provide adequate immunity against this new virus. With the shortages at hand children ages six months to 24 years are being prioritized for vaccination along with other high-risk groups. Again, the vaccine is available as both an injection (killed virus) for children ages six months to two years, and also as a nasal mist (live attenuated virus) for children two and up that do not have any underlying health issues. As our office is now receiving regular shipments of novel H1N1 vaccine, we are giving first doses to all who fulfill high-risk criteria. We are not going to be giving second doses to any children until we have provided first doses of swine flu vaccine to all eligible children. This is not a perfect answer, but it will provide the protection to the greatest number of people, and that is what public health is all about. We are all hopeful that as the weeks go by we will see a slow down in cases of “swine flu” and an increase in the production of both seasonal and H1N1 vaccines. There are only four vaccine makers to make vaccine for all of us, and they can only work so fast, while providing safe, effective vaccine. You can’t rush the egg to grow the virus needed to make vaccine (kind of like you can’t rush a pregnancy) there is just time and patience involved. If you have not gotten your children their flu vaccines, now is the time to be checking about the availability of both vaccines from your pediatrician or health department. Put a reminder on your calendar if your children require a second vaccine, which must be at least four weeks from the first vaccine. If the vaccine is not available at that time, be vigilant about keeping up with the news on vaccine availability and checking in with your doctors. It may be 2010 before there is enough vaccine to begin second doses for children who require the two dose series. But at the same time, remember flu season does not usually end until March so vaccinations will be continuing. Here’s hoping flu season next year will be easier for all. Stay healthy and wash the hands! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

HPV & Risky Sexual Behavior

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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

Day Care & Vaccines

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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 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

Summer Vacation & Measles

If you are planning a summer vacation outside the U.S. there are new recommendations to protect your family against measles. It is the time of year when many families start planning for summer travel.  While trying to decide when and where to go, some families may choose international travel.  If you are planning on travelling outside of the United States, and have infants or toddlers, it is important to be aware of some recommendation just published by the CDC.

The CDC has just reported an increase in the number of “imported” measles cases seen in U.S. children 6-23 months of age after having returned from international travel. There were 13 cases of  “imported” measles  (7 cases among children in the 6–23 month age range) reported in the first 2 months of 2011, as compared to a typical 12 month period when there are 3-8 children who acquire measles. Although measles is a rare occurrence in the United States, measles is still endemic in much of the world (don’t just think third world countries, Europe currently has big outbreaks, including popular travel destinations such as France, Germany and England). With that being said, there are also measles cases being reported in different areas of the U.S  (unrelated to international travel. Texas is one of the states that has recently reported 3 cases of measles, which are thought to have been acquired while visiting Orlando, Fla. My colleagues in Texas are “on the lookout” for more new measles cases, as the incubation is up to 21 days post exposure.  These data just reinforce the need to continue to vaccinate all children against MMR (measles, mumps, rubella) as recommended between 12-15 months of age. But, the ACIP (Advisory Committee on Immunization Practices) does recommend earlier MMR vaccination for young children who are travelling outside of the United States. So if you are planning on taking “baby Jack” to see the Eifel Tower, you need to talk with your doctor about MMR vaccine.. In cases of international travel, a MMR vaccine is recommended for all children who are at least 6 months of age. If your child is over 12 months of age and has received their 1st dose of MMR, they should also receive a second MMR separated by at least 28 days from their first vaccine prior to travel if possible. For children who are not traveling outside of the U.S. the recommended schedule for MMR vaccine remains at 12-15 months and then again between 4 -6 years of age. Measles is a highly contagious disease and typically causes fever, a diffuse red rash, cough, and may cause pneumonia and encephalitis and even death.  Of the 7 cases in children between 6 – 23 months reported from Jan. and Feb of this year, 4 required hospitalization for several days, but luckily there were no deaths. As we approach the travelling months, stay tuned for more immunization updates and news.  Always go to to get the latest information as it relates to international travel, as recommendations are updated and change. That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

More Updates on the Swine Flu Vaccine

This week the U.S. Department of Health and Human Services announced that the first doses of H1N1 vaccine will not be available until mid-October and there will be far fewer doses initially than expected.I know everyone is still concerned about H1N1 (swine flu) and I want to keep updating the information as it is available. This week the U.S. Department of Health and Human Services announced that the first doses of H1N1 vaccine will not be available until mid-October and there will be far fewer doses initially than expected. Only about 45 million doses will be available at that time, with another 20 million doses produced weekly, until the 195 million doses that were ordered are completed.

As discussed previously, making a new vaccine is a difficult process, and despite the fact that “swine flu” is easily spreading within communities, it has been more difficult to grow enough “lab virus” for vaccine production. It is due to this that vaccine production is about 50 percent of what was initially expected. I continue to get questions as to how the vaccine will be distributed, how many doses will be needed etc. Most of this information is not yet available and should be forthcoming in the next several weeks as the preliminary trials on vaccine efficacy are completed. It does appear that the “swine flu” vaccine will probably require two shots that are separated by at least three weeks. It also takes several weeks post vaccination to produce antibodies to prevent infection. Unfortunately, you are not immune the minute the needle is inserted! The logistics of providing the immunizations have not been worked out, and different communities may provide vaccine in different ways. Some state and local health departments may provide school based vaccine clinics, but again that decision may vary. With school just around the corner the concern is that the vaccine may be too late to halt outbreaks as “swine flu” has continued to be diagnosed throughout the summer months and will probably become more prevalent within weeks of school resuming. The concern is that school aged children seem to be the most vulnerable, with the median age for infection being 12 – 17 years. The symptoms of “swine flu” resemble those of seasonal influenza and one type of flu does not prevent the other. In other words, this could be a very long flu season with successive illnesses with different influenza viruses. For now the best advice is to get your seasonal (regular) influenza vaccine, which is already available in both injectable and intranasal formulations. This is not a good year to “miss” your seasonal flu vaccine as it is still the best protection there is for “regular flu”. This vaccine is recommended for ALL children between the ages of six months and 18 years. (See previous links for more details about recommendations for others). Remember the seasonal flu vaccine does not prevent H1N1 (swine flu) and vice a versa. This is going to be a long and complicated flu season, so stay tuned for more information. That’s your daily dose, we’ll chat again soon!


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