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Daily Dose

Recommendations On Who Should Get a Swine Flu Vaccine

I thought it was a good time to re-iterate the recommendations as to who will be prioritized to receive the novel H1N1 (swine flu) vaccine this fall.With more swine flu in the news and the story continuing to evolve I thought it was a good time to re-iterate the ACIP recommendations as to who will be prioritized to receive the novel H1N1 (swine flu) vaccine this fall. The CDC (Centers for Disease Control and Prevention) and ACIP (Advisory Committee on Immunization Practices) are hopeful that a novel H1N1 vaccine will be available by early this fall. They are expecting that when the vaccine becomes initially available (it is currently in clinical trials) there may be a limited supply. The CDC does not expect there to be a shortage of vaccine over the course of the winter but supplies may be limited as production first begins.

There are five key populations that are recommended to receive vaccine when first available:

  • Pregnant women
  • People who live with or care for children younger than six months of age
  • Health care and emergency services personnel
  • Persons between the ages of six months through 24 years of age
  • People from ages 25
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

Booster Shots

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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

Flu Season Continues

Another Monday in the office and Influenza B is here in full force. Seeing all of the kids (and many of their parents) who have succumbed to flu B this season reminded me that the FDA has already recommended that the flu vaccine for next year contain a different B virus strain than this year's vaccine. The Influenza B virus that is circulating in our area right now is not a good match for this year's vaccine. Fortunately, Influenza B is typically not as serious and as lengthy as Influenza A.

It seems that the flu vaccine this year was right on the mark for the Influenza A viruses that we have been seeing and provides good protection against flu A. The flu vaccine that will be made over the next months for distribution next fall will only vary slightly from this year's vaccine. The two Influenza A strains in this year's vaccine will remain the same while the B component will change from type B/Florida to type B/Brisbane, which is the strain that we have been seeing this winter. Determining the viruses to target in flu vaccine is always based on the epidemiology of flu strains that are circulating throughout the world. The strains must be chosen early in the year in order that manufacturers have a long enough time to ensure that vaccine will be available in the six to seven months ahead. Funny to already be discussing flu for 2009 - 2010 when we are still in the thick of the season for the current flu strain. Hopefully the season will soon be winding down. That's your daily dose, we'll chat again tomorrow.

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.

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

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.

Your Teen

Acetaminophen, No Threat To Child's Liver

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With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. Concerns about liver injuries in children who take the common painkiller acetaminophen, sold as Tylenol in the U.S. are unfounded, researchers said on Monday. "None of the 32,000 children in this study were reported to have symptoms of obvious liver disease," said Dr. Eric Lavonas of the Rocky Mountain Poison and Drug Center in Denver. "The only hint of harm we found was some lab abnormalities." With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. "This drug is used so commonly that even a very rare safety concern is a big concern," said Lavonas, whose findings appear in the journal Pediatrics. Some researchers suspect there is a link between long-term use of acetaminophen and the global rise in asthma and allergies, but the evidence is far from clear at this point. For the new report, researchers pooled earlier studies that followed kids who had been given acetaminophen for at least 24 hours. There were no reports of liver injuries leading to symptoms such as stomachache, nausea or vomiting, in the 62 reports they found. Ten kids, or about three in 10,000, had high levels of liver enzymes in their blood, which usually means their livers have been damaged. In most cases, however, those elevations were unrelated to acetaminophen. And even if they were caused by the drug, they don't indicate lasting damage, according to Lavonas. "Acetaminophen is extremely safe for children when given correctly," he said. "Parents should not be afraid to give acetaminophen to their children when they need it, but they should be very careful about giving the right dose." "If you suspect that you have given a child an overdose, call your state's poison center," he added. The Rocky Mountain Poison and Drug Center receives funding from McNeil Consumer Healthcare, the Johnson & Johnson subsidiary that sells Tylenol, but the researchers said the company did not support this study.

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.

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