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Your Child

Vaccines May Reduce the Risk of Strokes in Children

2:00

While strokes are not common in children, the risk of a child having a stroke increases when he or she has a cold or the flu. According to a new study, that child’s risk of having a stroke is reduced when he or she is fully vaccinated.

Based on 700 children across nine countries, researchers linked having had a recent illness like bronchitis, ear infection or "strep throat" to a six-fold rise in stroke risk. Having few or none of the routine childhood vaccinations was tied to a seven-fold rise in risk.

“We’re always trying to raise awareness that childhood stroke happens at all,” said lead author Dr. Heather J. Fullerton of UCSF Benioff Children’s Hospital San Francisco.

Stroke is more common in children who have other health risk factors as well, Fullerton told Reuters Health. Parents of children who have a chronic disease often worry if it is safe for their child to be vaccinated. The results from this study suggest that it is even more important for these families to make sure their child is current on all their vaccines.

Parents should also know infection prevention measures like hand washing and vaccines can help prevent stroke as well, Fullerton said.

From birth to age 19 years, the rate of strokes among youth in the U.S. is about five per 100,000 children. Up to 40 percent of kids who have a stroke will die from it, according to the American Stroke Association.

Fullerton and her coauthors used medical records and parental interviews for 355 children under age 18 who experienced a stroke and compared them to records and parental interviews for 354 children without stroke.

Half of the children with stroke were age seven or older.

In the stroke group, 18 percent of the children had contracted some kind of infection in the week before the stroke occurred, while three percent of children in the comparison group had an infection in the week before the study interview.

Stroke risk was only increased for a one-week period during infection.

 Infections a month earlier were not tied to stroke risk, according to the results in Neurology.

Infections, not cold medicines, were responsible for the strokes according to the analysis in this study.

“When you have an infection, the body mounts immune response,” which manifests as fever, aches and blood that clots more easily, Fullerton said.

In stroke, a blood clot blocks blood flow to the brain.

“One can speculate that changes in the body as a result of infection may tip the balance in a child already at higher risk for stroke,” said Dr. Jose Biller, chair of neurology at the Loyola University Chicago Stritch School of Medicine, who coauthored an editorial in the same issue of the journal.

“Parents should not be alarmed if their child has a cold that this will lead to stroke,” Biller told Reuters Health.

But it is important that parents be encouraged to continue with infection prevention procedures including regular pediatric vaccines, Biller said.

“Most physicians will agree that vaccines are among the safest medical products, they are rigorously tested and monitored,” he said. “They prevent thousands of illnesses and deaths in the U.S. each year.”

Infants with stroke generally present with seizures, while older infants and school age kids with stroke will have similar symptoms to an adult, including weakness on one side of the body, Fullerton said.

Kidshealth.org list these symptoms of stroke in a child.

Symptoms of stroke in an infant are:

·      Seizures in one area of the body, such as an arm or a leg.

·      Problems eating.

·      Trouble breathing or pauses in breathing (apnea).

·      Early preference for use of one hand over the other.

·      Developmental delays, such as rolling over and crawling later than usual.

Symptoms of stroke in kids and teens are:

·      Seizures.

·      Headaches, possibly with vomiting.

·      Sudden paralysis or weakness on one side of the body.

·      Language or speech delays or changes, such as slurring.

·      Trouble swallowing.

·      Vision problems, such as blurred or double vision.

·      Tendency to not use one of the arms or hands.

·      Tightness or restricted movement in the arms and legs.

·      Difficulty with schoolwork.

·      Memory loss.

·      Sudden mood or behavioral changes.

If your child experiences any of these symptoms, see a doctor right away, or call 911. Treatment for stroke can be given to reduce the severity, but needs to be administered as soon as possible.

Sources: Kathryn Doyle, http://www.reuters.com/article/2015/09/30/us-health-stroke-child-infections-idUSKCN0RU2O320150930

http://kidshealth.org/parent/medical/brain/strokes.html#

 

 

Daily Dose

Why Doctors Fire Patients

1.30 to read

There was an article in the WSJ entitled “more doctors dismissing patients who refuse vaccines for their children”.  It was interesting to me as I too now only accept new patients who are going to vaccinate their children. This was not an easy decision on my part, and prior to the decision I had several families who refused vaccines completely, and another group that followed “an alternative” vaccine schedule. Even so, I was never comfortable with their decision and it always gave me pause and sleepless nights when their children would get sick. 

During the height of the debate over vaccine safety and the possible link to autism it seemed like much of my day was spent “debunking” vaccine myths. I spent a great deal of time discussing the reasons behind the AAP/ACIP (American Academy of Pediatrics and the Advisory Committee on Immunization Practices) recommended vaccine schedule and also explaining how vaccinations had saved lives, actually millions of lives. 

As more and more data was gathered, and the Wakefield papers were discredited, it became apparent that there was not a link between vaccines and autism. The arguments about thimerasol in vaccines were also moot as thimerasol is no longer the preservative used in vaccines (except for flu vaccine). With all of this being said I decided to take a stand and vaccinate all of my new patients, according to AAP guidelines. 

I discuss this decision with families even before their child is born. I tell them that it is important to pick a pediatrician that shares their beliefs as the  doctor patient relationship is a long one in pediatrics. (hopefully cradle to college)  It is analogous to dating; why would you pick a date on a match site if you held opposite beliefs to begin with?  

The same goes with picking a pediatrician, you need to start off the relationship on common ground. Even if there may be some other disagreements on subjects down the road, I think you need to begin the relationship holding similar beliefs. 

I have practiced long enough that I remember doing spinal taps in my office and treating children with meningitis or bacterial sepsis. There were long nights spent in the ICU with families and unfortunately a few patients died, while other survived but are deaf or have other residual effects from their disease.  It was devastating to me and I can’t even imagine for those families. I also bet that those families would have given anything to have a meningitis vaccine or a chickenpox vaccine for their now deceased children. 

I understand that every parent has to make their own decision for their children. At the same time I believe that it is also “my practice” and I get to choose how I practice pediatrics. With that being said, my parents choose to vaccinate their children and we happily start off the parenting/doctoring partnership together.  I also sleep better at night not worrying that their child will contract a vaccine preventable disease. 

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Exercise Patience During Swine Flu Season

I imagine that you may be getting tired of reading my blogs on swine flu, and I can assure you, we are all (pediatricians that is) tired of talking about it too. But, from the phone calls that our office is being inundated with, there are still more questions and concerns about the H1N1 (swine) flu.

Fortunately, in our part of the country it seems that we have started to see fewer “flu-like” illnesses and the waiting rooms at our office are not quite as crowded. That may not be the same in other areas of the country as now 46 states report widespread flu activity. Even though we seem to be seeing fewer cases of presumed H1N1 flu in our area, we do not know, and no one knows, if this virus is going to quietly fade away, or if we will see a second wave of H1N1 later this year and into 2010.  Unless you can truly predict the future, we will all just have to wait and see. With that being said, the H1N1 vaccine is becoming more widely available and there are prioritized groups that should begin getting vaccinated. There are two types of H1N1 vaccine, just like the seasonal flu vaccine. There is an injectable “killed” vaccine and there is a live-attenuated nasal vaccine (similar to seasonal Flu-mist nasal spray). Children between six months and two years of age should receive the injectable flu vaccine. This injectable vaccine should also be given to pregnant women and to children ages two to 24 years who have underlying chronic medical conditions that prevent them from taking the nasal flu mist (refer to http://www.cdc.gov/ to see the list of those conditions) for those children between the ages of two to 24 years who are otherwise healthy, the injectable or nasal H1N1 vaccine may be given (it is approved for use up to 50 years of age). The other targeted group to receive the H1N1 vaccine is parents, siblings and caregivers of infants under six months of age. Again, the majority of those may receive the nasal vaccine and injectable may be used when appropriate for older individuals. In our office the most current problem comes with trying to prioritize groups that receive the first doses of vaccine and to explain to others that they too will get the vaccine once the vaccine supply increases, as it should in the next several weeks. This is a true lesson in patience, and in taking turns, just like we teach our own children. Those with the most risk should get the first doses of vaccines. Don’t you agree? There is just not a way to vaccinate 100 million people in a day. Lastly, the Centers For Disease Control and Prevention in a news conference yesterday, reiterated that antivirals like Tamiflu, should be given to children who are at higher risk for complications. Tamiflu should not be given “routinely” to those patients who are above the age of two years, and who do not to appear to be extremely ill. It does not need to be given to all household contacts. For most, the illness is self-limited and may be treated with rest, fever control, hydration and TLC (tender loving care, for the younger set that looks at me like, “what does that mean?”). In all cases your doctor needs to see any child who seems to be having respiratory distress, is not taking fluids, or seems to be getting worse rather than better after several days. So, continue to wash your hands, cover your mouths and get your vaccines, as they are available. We have a long way to go this flu season and besides coughing into your elbow. I hope PATIENCE may be the other lesson everyone learns during the fall and winter this year. That’s your daily dose, we’ll chat again soon.

Daily Dose

Back to School Vaccines

1:30 to read

August is here and that means back to school across the country. When I think of kids heading back to school I also think about their immunization history.  I want to make sure that everyone is up to date on their vaccines, because what better place to be exposed to disease and germs than in a school full of children!

 

Vaccines continue to save lives…and vaccines are one of the greatest medical achievements in history. But, despite the continued data on the safety and efficacy of vaccines there are those who prefer to “ignore” the data and either “decline to vaccinate” their children or want to vaccinate with an “alternative vaccine schedule”.  

 

Most recently, I was a guest in a Facebook Live segment discussing back to school vaccines and I was amazed at some of the comments that were posted after the segment. It seems that there are many people who are reading “fake news” to make decisions about vaccines and their children and they are a vocal group. 

 

There are also those who will continue to believe discredited physicians who wrote “fake” articles which have been retracted and resulted in a doctor having his license taken away. But,  this one “former doctor” has caused so much parental anxiety that I find myself discussing the safety of the MMR vaccine on a regular basis. I am always ready to discuss vaccines, their safety and efficacy with my patients, but I also rely on science and data and not anecdote to make a point.

 

Vaccine preventable diseases are just that….preventable but not eradicated!  This means that although the latest generation of parents may have never had the disease or even seen the disease, these diseases are still present.  Measles, meningitis, polio, mumps are still circulating around the world and may “drop in “ to visit our country at any time. This is evident in the recent measles outbreak in an unvaccinated population in Wisconsin and prior to that a measles outbreak in CA several years ago.  We currently have mumps in Texas and are on the look out for more cases.

 

The Advisory Committee on Immunization Practices (ACIP) publishes the immunization schedules based on a plethora of science and input by some of the smartest minds in immunology, microbiology, infectious disease and medicine.  The vaccines that are recommended are given in a certain order and at certain intervals because they have been well studied to show that this is how the vaccines “work” and protect.  It is not arbitrary as some parents seem to think and want to do a “cafeteria plan” of vaccines when they “want” to give them. That really makes no sense…how do you know that your “plan” actually protects your child?  In my own experience this also leads to a lot of confusion in what has or has not been given and in some cases missed vaccines due to the wrong intervals between vaccines or age limits for vaccines.

 

Lastly, when parents “choose” not to vaccinate their child they are not only putting their own child at risk (they tell me it is a personal choice), but they are also putting others around them at risk of getting sick from a vaccine preventable disease. Does that seem fair??  Should we all immunize our own children so that their unvaccinated children are protected?  The word “selfish” comes to mind…as I am now immunizing my own grandchildren and don’t want them “hanging out” with un-immunized children.

I am happy to point anyone to online science and websites with reliable information on vaccines. Just let me know….

Daily Dose

Measles Cases Rising

1.00 to read

The CDC just reported 222 measles cases in the United States during the year 2011. That is a 15 year high and more than triple the number of measles cases typically reported in the United States. Fortunately there were no deaths reported from the measles, although about half of those who developed the measles required hospitalization.

The majority of the cases of measles seen in this country may be a result of foreign travel. Europe has had a serious outbreak of measles with more than 37,000 cases being reported. France, Italy, and Spain are having serious problems with outbreaks. These countries are also those frequently travelled by American tourists.

Of the 222 cases of measles seen last year in the U.S., 200 of the cases could be traced to importation from another country. That means that the case was either acquired when the person was travelling abroad, or that a foreign visitor brought the disease with them when they travelled to the U.S. Diseases like measles, although rare in our country, have not been eradicated. 

With worldwide travel now so common, the disease can easily be imported back into the U.S. Communicable diseases are just a plane ride away.  Measles is acquired via respiratory exposure and you may even be exposed after the infected person has already left the room (or airport lounge, or plane). 

The majority of measles cases in this country were seen in unvaccinated people, many of whom had “declined vaccination”. The measles vaccine is given as the MMR vaccine (mumps, measles, rubella) which is  routinely recommended to be given at 1 year of age, with a booster dose given between the ages of 4 -6 years.

With the huge increase in measles in Europe this brings to mind summer travel . If you or any of your family is planning a trip abroad make sure that you have immunized your children. For those taking a baby to Europe ( or other areas with measles outbreaks as well) check with your pediatrician about giving an early dose of MMR (prior to 1st birthday) and then receiving MMR again on the regular schedule once your child is older.

Some of the measles cases reported in the United States occurred after the Super Bowl in January and were also traced to foreign importation.  The upcoming 2012 Olympics is another venue where people from all over the world will be congregating.   Exposure to communicable diseases is always of concern with events like the Olympics and returning with measles rather than Olympic memories is not what anyone wants!!   This is National Infant Immunization Week and World Immunization Week as well, so what better time to get your children’s immunizations up to date.

That’s your daily dose for today.  We’ll chat again tomorrow.

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Your Child

Getting Ready for a New School Year!

2:00

As summer break begins to wind down, preparations for a new school year are gearing up.  Whether it’s the first day of school for your little one or your teen’s first year of college, making the transition from vacation to a daily schedule requires some pre-planning.

Typically, the most difficult changeover for everyone is getting used to a regulated bedtime routine. Getting enough sleep will help family members handle the switch better. I know that’s much easier said than done, but it's worth the effort. Now is a good time to start preparing for a new school year schedule.

As pediatrician, Dr. Sue Hubbard, has said previously in her kidsdr.com Daily Dose article, a couple of weeks before the start of a new school year is when families should start getting used to a new schedule.

“In order to try and minimize grouchy and tired children (and parents too) during those first days of school, going to bed on time will be a necessity. Working on re-adjusting betimes now will also make the transition from summer schedule to school schedule a little easier. If your children have been staying up later than usual, try pushing the bedtime back by 15 minutes each night and gradually shifting the bedtime to the “normal” hour. At the same time, especially for older children, you will need to awaken them a little earlier each day to re-set their clocks for early morning awakening,” Hubbard noted.

Another important detail to take care of before school begins is making sure your child is current on all immunizations. Each state has its own requirements and exemptions. In Texas for instance:

K-12 grades are required to have - the Tetanus/ Diphtheria/ Pertussis (Tdap) vaccine, Measles, Mumps and Rubella (MMR) vaccine, the Polio vaccine, Hepatitis B vaccine, and the varicella vaccine. K through 6th grade are also required to get the Hepatitis A vaccine and 7th through 12 grades, a meningococcal vaccine.

Also highly recommended, but not a state law requirement, is the Human Papillomavirus Vaccination (HPV) for boys and girls.

You can find out exactly what your state’s school immunization program is by logging onto http://www.cdc.gov/vaccines/imz-managers/awardee-imz-websites.html and clicking on your state.

And lets not forget our college bound students! Universities have their own policies, but these vaccines and booster shots are highly recommended by physicians and most universities: Meningococcal conjugate vaccine (MenACWY), Tdap, HPV vaccine and the seasonal flu vaccine. Be sure to check with your child’s school to see what specific vaccines are required or suggested.

The first day of school for kindergarteners and / or first-graders can be unsettling for kids and parents. Here are a few ways you can help your child face the uncertainty:

·      Remind your child that there are probably a lot of students who are uneasy about the first day of school. This may be at any age. Teachers know that students are nervous and will make an extra effort to make sure everyone feels as comfortable as possible.

·      Point out the positive aspects of starting school.  She'll see old friends and meet new ones. Refresh her positive memories about previous years, when she may have returned home after the first day with high spirits because she had a good time.

·      Find another child in the neighborhood with whom your student can walk to school or ride on the bus.

·      If it is a new school for your child, attend any available orientations and take an opportunity to tour the school with your child before the first day.

·      If you feel it is needed, drive your child (or walk with him or her) to school and pick them up on the first day.

Nutrition is an important factor in children doing well in school. During the summer break kids often get off schedule with their eating habits. Start the early morning routine at least a week before school actually starts so that everyone has a chance to get used to having and preparing breakfast early.

Studies have shown that children who eat healthy, balanced breakfasts and lunches are more alert throughout the school day and earn higher grades than those who have an unhealthy diet. 

Back-to-school- shopping, new schedule arrangements, homework time and space, immunizations, after-school sports and activities – they’re all part of a new school year.

One way to help keep everybody on track is with a calendar that is placed where everyone can see it and update it.

Here’s to a new school year that is full of learning, exciting experiences and good grades!

Source: http://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Back-to-School-Tips.aspx

 

Daily Dose

Vaccine Safety

The MMR (measles, mumps and rubella) vaccine and Varivax (chickenpox) vaccine have both been licensed and recommended for many years. These vaccines are typically given to children between the ages of 12-15 months, and then again between 4-5 years.

In 2005, a new vaccine was released which combined MMR and Varivax  (MMRV) which reduced the number of needle sticks a child would receive from their routine immunizations. Vaccine safety is always a paramount concern and even after a vaccine is FDA approved there continues to be “post licensing” monitoring of the vaccine, looking for any reported adverse events. After the release of MMRV in 2005, there were noted to be an increase in the number of febrile seizures occurring within 10 days of receiving the combination vaccine.  As a result, the use of this combination vaccine was suspended in 2008 and then resumed in early 2010. A study released in the July issue of Pediatrics now looks at the vaccine safety data that was accumulated on MMRV post licensure,  and analyzed data on over 459,000 children who had been vaccinated between 2000 and 2008. In the retrospective study, 83,000 children received MMRV and 376,000 with separate MMR and Varivax vaccines. The study found that children between the ages of 12–23 months have about double the risk of developing a febrile seizure 10 days after receiving MMRV than those children that received separate MMR and Varicella vaccines. MMRV vaccination was associated with an estimated 4.3 additional seizures per 10,000 doses during the 7–10 days post vaccine. As discussed in previous blogs, febrile seizures are fairly common and are typically harmless to a child, but cause a lot of anxiety and fear for parents.  (my own son had a febrile seizure as a toddler).  The American Academy of Pediatrics endorses the use of single or combination vaccine for MMR and Varivax. The fact that there may be a greater likelihood (albeit small) for a child to develop a febrile seizure post MMRV vaccination needs to be discussed with parents as there is not going to be a “right” answer as to vaccine preference. Some parents would prefer minimize needle sticks and would opt to receive MMRV, while others would prefer to have MMR and Varivax given separately to minimize any risk of  an adverse event. Due to the fact that the increased seizure risk was seen in children between 12-23 months, one might advocate to use the separate vaccines for the initial series and the combination vaccine in the older child (who would probably vote to get one less STICK). Protecting against measles, mumps, rubella and chickenpox is the most important issue at hand.  Discuss the pros and cons of the combination vaccine with your own doctor, but be reassured that vaccines are continually being monitored for safety as well as efficacy. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue.

Daily Dose

Thimerosal In Flu Vaccines

Confusion about thimerosal in flu vaccinesI received an email from a reader who “had a problem with my statement about vaccines being thimerosal free”.  Since 2001 all vaccines given to children under the age of 6 are thimerosal free, with the exception of the influenza vaccine.

She is correct in pointing out that influenza vaccines may contain a minimal amount of thimerosal (a mercury based preservative), but influenza vaccines are also available thimerasol free.  The LAIV (live nasal vaccine/flumist), is also thimerasol free and is available for use in children 2 and older.

Although injectable influenza vaccines may contain a minimal amount of thimerosal, the amount is negligible and is deemed safe by both the FDA and the CDC. Infants are not receiving a series of vaccines containing thimerasol, and at most would receive 2 influenza vaccines after they are 6 months of age during the first season that they are vaccinated, and subsequently would receive one dose per year thereafter.  There are also thimerasol free influenza vaccines available (this year both seasonal and “swine flu” vaccines) for use. By the time a child is 2 years of age, they would at most have received 3 doses of an influenza vaccine that had  0.01% thimerasol or less which would be between <1 mcg – 25 mcg/0.5ml vaccine dose. (Do you know how much mercury is in the fish you eat or other products you consume daily?)  After the age of 2 parents may choose to have their child immunized for influenza with the LAIV nasal vaccine that is also thimerasol free. As with many things in life one must weigh the risk benefit ratio, in this case of giving a vaccine that contains minimal thimerasol. In my opinion the science has quite eloquently proven that there is not a link between the preservative thimerasol and autism. With that being said,  I also believe that the risk of an infant developing flu and having complications from their infection, far outweighs any hypothetical or anecdotal concern about thimerasol. As I have said before, we know what does not cause autism and it was not thimerasol in vaccines. In fact the rate of diagnosis of autism has gone up, rather than down, since thimerasol was removed from vaccines. We need to continue to devote research dollars to finding the cause of autism. In the meantime, I stand corrected and wanted to give all of you more detailed information about thimerasol and influenza vaccines. That's your daily dose.  We'll chat again tomorrow! Send your question to Dr. Sue! (click here)

Your Child

HPV Vaccine: More Effective Than Thought

1:45

A study out of New Mexico finds that the vaccine against human papillomavirus (HPV) infection, which doctors believe causes most cases of cervical cancer, could be much more effective than previously thought.

"After eight years of vaccination, the reduction in the incidence of cervical neoplasia [abnormal growth of cells], including pre-cancers, have been reduced approximately 50 percent. This is greater than what was expected -- that's pretty exciting," said lead researcher Cosette Wheeler. She is a professor of pathology and obstetrics and gynecology at the University of New Mexico, in Albuquerque.

Researchers also found that one or two doses of the vaccine may provide as much protection as the recommended three.

"Right now, the recommendation is three doses for girls and boys before the 13th birthday, so that you are protected before you become exposed," Wheeler explained.

"People thought that three doses of vaccine were necessary, but there's a lot of people who are getting one and two doses, and people are getting protection from one or two doses," she said.

Another benefit is that the vaccines protect against more types of HPV than they were designed to do, noted Wheeler.

Other studies have pointed to the effectiveness of the vaccine, but this is the first study to show declines in precancerous lesions across a large population.

This study even took into account changes in Pap test screening over the last 10 years.

In 2009, the American College of Obstetrics and Gynecology said most women under 21 do not need Pap test screening and recommended longer times between screening. In 2012, the U.S. Preventive Services Task Force said women, regardless of age, do not need to get screened more than every three years, Wheeler said.

If these changes were not taken into account, the effect of the vaccine would appear even greater than it already is, because it would assume that more women were being screened than actually were, she said.

"Parents and doctors should pay attention. These vaccines are highly efficacious," Wheeler said.

Cervical cancer can take decades to develop so it’s important to protect children before they become sexually active.

The Centers for Disease Control and Prevention (CDC) recommends that the HPV vaccine be given to vaccine is preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. The HPV vaccine also produces a more robust immune response during the preteen years. Finally, older teens are less likely to get heath check-ups than preteens. If your teen hasn't gotten the vaccine yet, talk to their doctor or nurse about getting it for them as soon as possible.

For the study, Wheeler and colleagues collected data on young women tested for cervical cancer with Pap tests from 2007 to 2014, who were part of the New Mexico HPV Pap Registry. New Mexico should be considered representative of the whole country, Wheeler said.

One expert said the findings make the case for HPV vaccination even stronger.

"These data highlight and provide even more evidence as to the efficacy of the vaccine in preventing HPV infections and related diseases," said Fred Wyand, a spokesman for the American Sexual Health Association/National Cervical Cancer Coalition.

Wyand suggests that one way to increase HPV vaccination rates is for health providers to stress the importance of the vaccine to parents.

Another way is to “normalize” the vaccine.

"Rather than treat it as something exotic, it should just be offered as part of the routine adolescent vaccine program," Wyand said.

The report was published online Sept. 29 in the journal JAMA Oncology.

Story sources: Steven Reinberg, http://www.webmd.com/sexual-conditions/hpv-genital-warts/news/20160929/hpv-vaccine-more-effective-than-thought-study#1

http://www.cdc.gov/hpv/parents/vaccine.html

 

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When should you get your flu shot?

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