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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There are also those who will continue to believe discredited physicians who wrote “fake” articles which have been retracted and resulted in a doctor having his license taken away.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

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

 

Daily Dose

Measles Outbreak

1:30 to read

Entering Disneyland where the sign reads, “The Happiest Place on Earth”, it does not also say, “Beware of Infectious Diseases!”.  But, if you think about it...what better place to contract any infectious disease than Disneyland where many of the visitors are under the age of 12 years....and I know from my own experiences as a parent taking children to Disney...even if not feeling well nothing stops a child at Disney. That means not even a fever.  (Other parents have reported the same thing to me when they went;  fever/tylenol and then off to theme park). 

So, now reports of at least 70 cases (and counting) of measles which children have contracted while visiting Disneyland in December. Not all of the confirmed cases have even been in California with cases are now in Utah, Washington, Colorado and Mexico.  With continued new cases, and our mobile population, unintentional exposures will occur, so unfortunately there are expected to be more cases.

Measles is a VACCINE PREVENTABLE DISEASE!!!  I repeat, you can prevent measles but that means your child needs to receive an MMR at 1 year and again between 4-5 years of age.  About 3/4 of the current new measles cases were unvaccinated, by choice.  Several of the children were too young to receive the vaccine and so they were unprotected for that reason.  Orange County (home of Disneyland) has one of the highest rates of vaccine refusers, and Dr. Bob Sears practices there as well where he admits that “many/most” of his patients refuse some vaccines.  In my humble opinion he has had a big impact with families who are making vaccine choices. Dr. Sears' books are “wishy washy” on this subject and he has proposed an “alternative vaccine schedule” which has not been scientifically proven to work. Dr. Paul Offit a pre-eminent scientist, doctor and vaccine proponent has some good articles discussing his feelings about alternative vaccine schedules. Feel free to check them out. 

Enough of the soap box...but this should be yet another wake up call that many of the diseases younger parents think are “not around” are indeed showing a resurgence.  Measles cases are the highest they have been for over 20 years in the U.S. Pertussis (whooping cough) rates are still on the rise here as well.  Polio continues to be a problem in other parts of the world despite huge efforts in vaccinating and trying to eradicate this disease.

Fortunately, there have been no deaths in the latest measles outbreak but there have been hospitalizations.  Only hoping people go get their children vaccinated as there is no other way to stop this.  It makes so much sense and seems simple. There are so many places to get a vaccine!! 

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.

Your Baby

No Link Between Vaccines and Autism

1.30 to read

A new study slated to appear in the Journal of Pediatrics, says that there is no association between the amount of vaccines a young child receives and autism. Some parents have worried that there may be a link and have opted out of having their child vaccinated or reduced the number of vaccines recommended.

The percentage of children diagnosed with autism spectrum disorder (ASD) has increased by 72% since 2007. Some experts believe that changes in the diagnostic criteria may account for some of the increase as well as better screening tools and rating scales.

According to a statement released from the journal, researchers from the Centers for Disease Control and Prevention and Abt Associates analyzed data from children with and without ASD.

Researchers examined each child's cumulative exposure to antigens, the substances in vaccines that cause the body's immune system to produce antibodies to fight disease, and the maximum number of antigens each child received in a single day of vaccination, the journal's statement said.

The antigen totals were the same for children with and without ASD, researchers found.

Scientists believe genetics play a fundamental role in the risk for a child developing autism (80-90%), but recent studies also suggests that the father’s age at the time of conception may also be a contributor by increasing risks for genetic mistakes in the sperm that could be passed along to offspring.

Parents have worried about a link between vaccines and autism for decades despite the growing body of scientific evidence disproving such an association.

Source: Luciana Lopez, http://www.reuters.com/article/2013/03/29/us-usa-health-autism-idUSBRE92S0GO20130329

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

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

Another Reason Why It's Important to Vaccinate Your Child

I was in the office yesterday on a busy pre-holiday Monday. I went into an examining room late in the afternoon to see a two-year-old who looked “pretty sick”. I was in the office yesterday on a busy pre-holiday Monday. I went into an examining room late in the afternoon to see a two-year-old who looked “pretty sick”. 

Her mother told me that her daughter had developed a fever and a swollen eye over the last 8 hours and that “she had never seen her this sick.” She thought that her daughter had had a mosquito bite the week before and that maybe that was why her eyelid and the area beneath her eye was swollen and red. But the bite had gone away days ago, and now she had a fever. I glanced at her chart and had one of those “ah-ha” moments when I realized that the little girl had never been immunized. Not one vaccine, never!! This made me put on my thinking cap from days gone by. It used to be a fairly common occurrence to see a child in the one- to three-year-old age range in the office with a swollen eyelid and area around the eye, who also had a fever and looked ill. The infection is called peri-orbital cellulitis (an infection of the soft tissue surrounding the eye), and is typically caused by a bacteria named Haemophilus Influenza (H. Flu). This bacteria was renowned for causing meningitis, epiglottitis, periorbital cellulitis and blood infections. A vaccine was developed in the late 80’s (our office participated in the clinical trials) and since that time when children began routinely receiving HIB vaccine it had become quite uncommon to see infections due to this bacteria. But today, I was reminded of the risk of developing diseases that could be prevented with vaccines. The mother was very concerned and kept asking me how her daughter might have “gotten sick with this bacteria?” Just because there is an immunization, does not mean that the bacteria is no longer lurking in our nasal passages, on surfaces and all sorts of places. We often forget that kids may still get sick with these illnesses that we “had forgotten” about. I had to return to my first days of practice to remember that I wanted to get a blood culture on her to make sure that the bacteria had not invaded her blood stream, and to watch her in the office as we got her fever down and looked at her lab results. I was trying to decide if she needed to be admitted or could be treated as an outpatient. Thankfully, after lowering her temperature and getting back her lab work, she looked a little better. She was treated with an injection (ouch) of a broad-spectrum antibiotic and will be seen again in the morning to make sure her eye has improved and that she is also feeling better. In the meantime the reality of vaccine preventable diseases is still on my mind. Why would a parent not want to prevent any illness in their child that they possibly could? The reality that these infections may still occur became too close today. I think these parents may be re-thinking vaccines. If they are not, I am thankful that the frequency of these infections is rare, as the majority of my patients are immunized and will continue to be!! We have not eradicated these diseases; they have just been prevented by immunizations. That’s your daily dose, we’ll chat again tomorrow.

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