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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

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

Deciding to Vaccinate Your Child

1.15 to read

I was recently doing a 4 year old well-child check up. This little girl was the youngest in a family of 4 girls with the oldest daughter being 18.

Through the many years of taking care of this family of girls, I have come upon new issues and changes that have occurred in pediatrics.  There have also been and will continue to be, different parental concerns. 

When this child was born, there was still a lot of discussion about immunization safety and parental concerns surrounding vaccines and autism. Although all of her older siblings had been immunized on schedule, without any issues at all, when the “baby” was born her mother and I had many discussions about giving this little girl her vaccines. 

The mother told me that she was now “hanging out with younger parents and they had made her concerned about vaccines, specifically as they related to autism.”  

Well, after much discussion and hand wringing on the mother’s part, the little girl was vaccinated on schedule just as her siblings had been. In fact, the father brought the daughter for her 1 year old vaccines (which include the MMR) just because the mother was anxious.  The dad and I had a bit of a chuckle about this, but nevertheless the child received her MMR without problems. 

So, fast forward to the 4 year old check up. This little girl is quite precocious and worldly as well, being the youngest in the family. She has always been exceptionally verbal, and doesn’t mind telling you exactly what she has on her mind. (sometimes with words she may have picked up from her older siblings!). Birth order, a daily dose for a later date! 

At the end of the check up, as it became time to discuss vaccines, I turned to the mother and said, “ Sally, is going to get her immunizations today including her MMR”.  Are you still concerned about giving her vaccines as surely you don’t think that Sally is autistic?” 

As the mother was getting ready to speak, little Sally quickly interrupted in her usual loud voice and said, “ Dr. Sue I am to artistic, I drew those pictures for you!” 

Enough said, ice broken, subject over and vaccines all given on time and without a problem. 

Parenting

Mumps Reach 10 Year High; Hitting Colleges and Kids Hard

1:45

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, http://www.cbsnews.com/news/mumps-cases-10-year-high-college-outbreaks-vaccination/

https://www.cdc.gov/mumps/

Daily Dose

Latest Flu News

Dr. SUe discusses the latest news about seasonal flu and H1N1It seems like a while since I have discussed one of the favorite topics this fall, swine flu (novel H1N1).  Now that there is less swine flu in the U.S., actually less than 14 states are reporting widespread flu (the latest update will be released today), there is less hysteria and at the same time less concern for prevention.  

Influenza, and particularly swine flu, is always difficult to predict when and where it will occur, but one thing that seems certain, there will be more flu in the U.S. in the New Year, as flu typically lasts in some parts of the country until May.  Many infectious disease experts worry that swine flu (novel H1N1) will peak again as it has in some parts of the southern hemisphere.  If this turns out to be the case, there are many more people who will become ill. If the current statistics are correct, and 1 out of 6 Americans has already had swine flu, that still leaves MILLIONS more who are at risk of becoming ill. Unfortunately, with illness we will also see deaths, and the swine flu seems to be infecting a younger population and therefore there are more pediatric deaths being reported. All of this is important, as the only way to try and prevent disease is through vaccination.  When novel H1N1 vaccine was first shipped to my pediatric office in October, we could not keep up with the phone calls or provide enough vaccine for those that wanted it.  Remember it is recommended for all children from 6 months – 24 years of age.  That is really my entire practice. It is also recommended for parents and caregivers who have infants under 6 months of age, as these young babies cannot be vaccinated against flu.  But, what I have seen happening, is that now that novel H1N1 is not rampant in our area, the desire for vaccine is also waning.  Human nature is quite interesting, we want what we cannot have, and once the “Frenzy” passes, the desire also wanes. I know this right now from my own Christmas shopping,  as I am desperate to find a “marshmallow gun”.  I am sure that once the “game” of locating one is over, or Christmas arrives, I too will not feel like I “need” a marshmallow gun. There will be something else to replace the gun. This should not be the case with flu vaccines. Do not be complacent and forget to get your swine flu vaccine (or your seasonal flu for that matter).  The swine flu vaccine is safe, and post marketing surveillance continues and has not shown any problems with the vaccine in terms of safety. The latest recall was not due to safety, but rather to concern that the lots of vaccine that were recalled may provide less immunity than expected. In other words, it wont’ hurt you, but it may not provide as much protection as a good vaccine should. Those lots have already been pulled and those infants will be getting a second dose of swine flu vaccine any way, and that should boost their antibody level. Give your children a Christmas present and get their flu vaccines. We may not know which flu is coming, but just like Santa comes each year, we know that flu will too. Who wants to be home sick for a week, hospitalized, or even worse, have someone in your own family become a statistic.   Just because you have been lucky enough never to have had the flu before, does not mean that you are immune.  Don’t test it, get the vaccine and remember children under 10 years need to get a second dose of vaccine to provide optimum immunity and protection. That's your daily dose.  Heave a wonderful weekend!

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

Protecting Your New Bundle of Joy

When I see newborns in my office this fall I am already thinking into the winter season ahead.

As I see new parents in my office this fall, bringing in that most precious newborn for their first pediatric visit, I am already thinking into the winter season ahead. Infants born during fall and winter are exposed to more upper respiratory viruses and flu in their first six months of life. Infants under six months of age are at more risk of complications from viruses like RSV and flu. Unfortunately, infants under six months cannot receive flu vaccine.

But a recent study showed that mothers who received a flu vaccine during pregnancy reduced influenza illness in their newborns. That study is important in reminding pregnant mothers of the importance of receiving flu vaccine during their pregnancy. Unfortunately, in my practice, I do not see this information being given to pregnant mothers while they are in for their OB visits. It is also important that new parents are vaccinated against whooping cough with a newer vaccine which is given to adults called a TDaP. If you are pregnant or thinking about becoming pregnant this winter discuss these vaccines with your obstetrician. If they do not have the vaccines in their office, your local health department has them. The best way to protect that new bundle of joy is by immunizing those around them. This would also apply to grandparents, aunts, uncles and cousins. Spread the word about flu vaccine and TDaP and not the germs. That's your daily dose, we'll chat tomorrow!

Daily Dose

Flu is Here!

1.15 to read

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

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!

 

 

 

  

 

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