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Daily Dose

Acetaminophen & Vaccines

1:30 to read

A recent article in Lancet was quite thought provoking as it studied the common practice of giving infants a dose of acetaminophen (Tylenol) with their routine immunizations.

Many parents and some pediatricians routinely dose their infants with acetaminophen prior to receiving their vaccines at two, four and six months of age. In the study of 459 infants from 10 different centers in the Czech Republic, patients were randomized to either receive three doses of acetaminophen every six to eight hours at the time of vaccination or no acetaminophen. The researchers then looked at both the reduction of febrile reactions post vaccination and at antibody titers among the two groups. Interestingly, there were both some expected and some not so expected results. Not surprisingly, the group that received acetaminophen had a lower incidence of fever post immunization. Of those that received acetaminophen 94 out of 226 (42 percent) developed a fever, compared to 154 out of 233 (66 percent) in the non-treated group after their primary immunization series. After booster vaccination 64 out of 178 (36 percent) in the treated group and 100 out of 172 (58 percent) developed fever. So the widespread perception by both many parents and doctors that routine acetaminophen use with vaccination does reduce the incidence of fever was supported.

The most interesting result of this study was the vaccine antibody response in the acetaminophen treated group. Surprisingly, antibody responses to several of the routinely administered vaccines (including tetanus, diphtheria, h. flu, and pneumococcal serotypes) were lower in the group who received routine acetaminophen. This was also seen after booster doses of the same vaccines between 15 to 18 months of age. The hypothesis is that acetaminophen may reduce the inflammatory response and that this may also induce less of an immune response. So, it would seem prudent to no longer encourage routine use of acetaminophen with vaccines unless a baby develops significant fever, or is at risk for fever and febrile seizures. As a parent you are always trying to “protect” you child, and this would include any pain or fever that might develop with vaccination. Now we have science to show how this may actually provide less protection, against disease. Thought provoking!

That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Politics & Vaccines

1:30 to read

As we head into another election cycle, I bet many of you watched the recent GOP debates (23.1 million viewers).  I too was watching and listening, but I must say my ears perked up when I heard several of the candidates discuss the issue of childhood vaccines.  Suddenly I was hearing politicians or political “wanna bees” discussing whether or not children should receive vaccines?  I held my breath as I heard several of the candidates, some of whom are even physicians who presumably understand science, discuss vaccine safety, alternative vaccine schedules and the relationship of vaccines to autism.

I truly was aghast to hear Donald Trump discuss his anecdote of a child who purportedly had their vaccines and suddenly “became autistic” (which is a diagnosis made over time). Then there was Dr. Ben Carson, a pediatric neurosurgeon who stated  “we are probably giving way too many vaccines in too short a period of time”.  Had he forgotten children with meningitis?  As I sat in front of the TV and groaned I heard Dr. Rand Paul add, “vaccines are one of the greatest medical discoveries of all time, but even if science doesn’t doesn’t say bunching them up is a problem, you ought to be able to spread vaccines out a little bit”. Has he done a study to show that alternative schedules work?

Many of their statements were based on “faulty logic”, and had “no scientific basis” and some were entirely anecdotal. Numerous studies from around the world have proven that there is no link between vaccines and autism. Vaccines have only gotten safer and are essential for public health.  Stick to the facts…were the fact checkers watching?  Where was the rebuttal?

As a pediatrician who discusses vaccines with patients on a daily basis I must say I was horrified by these statements.  If politicians want to weigh in on childhood vaccines then it is incumbent upon them to be “briefed” and up to speed about the science behind the childhood vaccine schedule and vaccine safety.   While they are learning about foreign policy, economic decision making and the recent issues surrounding global immigration ( all of which seem to be more of a political policy issue than childhood vaccines) maybe they need a crash course in public health.  Misinformation about vaccines from those who have a national television audience is unacceptable. Having a child “go un-immunized”  due to statements that were made during  the GOP debate, has the potential to harm many children. Just look at the recent measles outbreak….these are serious issues. 

The president of the AAP quickly released a statement endorsing the childhood vaccination schedule, the importance of vaccines and vaccine safety. Many pediatricians as well as other physicians have also re-iterated the importance of vaccines being given according to the vaccine schedule. As Dr. Remley stated, “what is best for children is to be fully immunized”. plain and simple. I am hopeful that the 23 million debate watchers heard her message.

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

 

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

Jimmy Kimmel's Vaccine Points

1:30 to read

The measles outbreak continues (156 cases in the U.S.) and more and more people are speaking up about vaccinations. In fact, Jimmy Kimmel did a great stand up discussing the importance of vaccinating children. He made several valid points, including the fact that many parents “trust” Facebook posts over doctor’ science and recommendations to vaccinate children.  He also mentioned the fact that there are people who believe Jenny McCarthy’s views on vaccine safety over science.

So, Jimmy Kimmel makes a good point...if you don’t trust your doctor to vaccinate you child (who has gone to school for at least 11 years to become a board certified pediatrician), why would you trust them to stitch up your head, or treat your other maladies. I guess it is a bit of a double edged sword.

But the measles outbreak points to the fact that when you choose not to vaccinate your child, you are not only putting your own child at risk, but you put other children who may be too young to get the vaccine (my grand-daughter included), or be immunocompromised at risk.

If your child does not get vaccinated and develops tetanus after stepping on a dirty nail...you are not putting any one else at risk of getting tetanus. But,  are you then going to take your child to the same doctors who recommended that you vaccinate them and you will now rely on them to save your child’s life. There is a lot of irony when thinking about that terrible scenario.

My granddaughter just had her 6 month vaccines, including the first half of her flu vaccine. She ran a fever that night and her worried parents called me. She was fussy, uncomfortable and deprived her parents of some sleep, but after receiving some acetaminophen and TLC from her parents she was back to her happy self in 24 hours.  A much faster recovery than from meningitis, rotavirus, tetanus, flu or polio, all of which could also be deadly.

She will be getting her booster flu in a month and her MMR (mumps, measles, rubella) the minute she turns one.  In the meantime, I am depending on everyone else to immunize their own children against measles to protect her.

Daily Dose

Why Vaccinate Your Child?

1:15 to read

Getting your child immunized against mumps, measles and rubella (MMR) may provide even more protection than previously thought. An interesting article was just published in the journal Science pointing out yet another reason to get your children vaccinated.  

While measles is still uncommon in the United States (but there have been over 170 cases this year), there are over 140,000 deaths around the world every year due to this disease. Studies have shown that once you have the measles you are more susceptible to other infections for up to 2 years.  But, in countries where most measles cases occur the researchers found that the children who had received the measles vaccine had a reduced death rate for up to 5 years, which suggests that the vaccine somehow provides protection against other illnesses.

A medical student at Emory University (bet he is going to be a great doctor) working with others from around the world found that the measles virus might cause “immunological amnesia”. It seems that the measles virus kills a large number of memory cells, which are white cells that prevent subsequent infections by the same disease. After the measles the body’s immune system somehow “forgets” to remember diseases  it has already beaten, which would then put you at increased risk of being susceptible to diseases you shouldn’t be vulnerable to.

While more research is necessary this secondary protection may be yet another reason to get vaccinated!! Good science continues to show us the value of vaccines....this study was funded in part by the Melinda and Bill Gates foundation which is doing incredible work around the world on vaccines and eradicating vaccine preventable diseases.  For this I am a grateful doctor.

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.

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