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Your Toddler

Long-Term Study Confirms Measles Vaccines Safe

1:30

Researchers in a 12-year-study, investigating the safety of two measles-containing vaccines have found them safe and effective.

The study included children between the ages of 12 to 23 months. Some of the children received the MMRV vaccine (measles –mumps-rubella-varicella). The others were administered the MMR + V vaccine (measles, mumps. rubella and varicella), but they received both the MMR and the V vaccines on the same day.

In total, the researchers at the Kaiser Permanente Vaccine Study Center in California looked at almost 125,000 MMRV doses and nearly 600,000 MMR + V doses.

Many parents are still concerned that there may be long-term health issues that are either introduced or triggered by the vaccines. Dr. Nicola Klein, co-director of the vaccine study center, said parents should feel confident in the vaccines’ safety.

"Our findings offer reassurance that adverse outcomes of measles-containing vaccines are extremely rare and unlikely, and that parents of 1-year-old children can choose MMR + V instead of MMRV vaccines to reduce the low risk of fever and febrile seizures," Klein said in a Kaiser Permanente news release.

The vaccines didn't increase children's risk of seven types of neurological, blood or immune system disorders. No other safety concerns were identified with either vaccine, according to the researchers.

Previous studies have suggested that the two vaccines are associated with fever and fever-related (febrile) seizures in one-year-old children. The study confirmed these previous findings. These types of seizures usually happen seven to 10 days after vaccination. The study also found that the MMRV is more likely to cause febrile seizures than MMR + V.

Febrile seizures, which happen during a fever, can be common in toddlers and young children. Although frightening to witness, seizures often don’t cause serious health problems. Having said that, anytime a child has an unexpected seizure, you should seek emergency help just in case.

The researchers emphasized the risks of febrile seizures from the vaccines is small; occurring in less than one of every 1,000 vaccine injections.

"This level of safety monitoring for vaccines can give the public confidence that vaccine surveillance is ongoing and that if a safety problem existed, it would be detected," Klein said in the news release.

The study was published online in the journal Pediatrics.

Source: Robert Preidt, http://www.webmd.com/children/news/20150107/long-term-study-finds-measles-vaccines-safe

Daily Dose

Dispelling The Vaccine and Autism Myth

Dr. Sue discusses the link between vaccines and autism.After interviewing Alison Singer, co-founder of The Autism Science Foundation on the radio show this weekend, I thought it was imperative to re-iterate that The Lancet, a well respected British medical journal (somewhat like our JAMA), retracted the study done in 1998 by Dr. Andrew Wakefield that first suggested a link between the MMR vaccine and autism.

It is extremely rare for a journal to retract an article, which means that the study will no longer be considered an official part of scientific literature. This is just another step towards dispelling the decade long myth that linked the MMR vaccine to the development of autism. If you do recall, Dr. Wakefield’s study was even sited by “noted vaccine expert” Jenny McCarthy when she too took it upon herself to personally link her son’s autism to his vaccines. Hopefully, she has read the latest retraction by The Lancet as it seems that Dr. Wakefield falsified data that was used in his study. Dr. Wakefield and two of his colleagues have also been found by the General Medical Council of the U.K. to have “acted dishonestly and irresponsibly” in conducting their research. It was the longest trial in history for the GMC to conduct and Dr. Wakefield was found to have more than 30 charges against him. Unfortunately, Dr. Wakefield continues to “practice” in an autism clinic outside of Austin, Texas.  How he can legally do that that really escapes me! Why is the medical board in the United States allowing that? This story has been developing since 2004 when 10 of the 13 co-authors of Dr. Wakefield’s paper disavowed the study after a journalist reported that Dr. Wakefield had several conflict of interests as well as had used unethical methods in obtaining data, both of which made the study invalid. Despite that, parental fears as well as sensationalized media reports (back to Jenny McCarthy), caused enough public hysteria to cause parents to “opt out” of the MMR vaccine. Due to decreased immunization rates in UK and other European countries, measles cases have risen to record numbers and there has even been a death in an unvaccinated child secondary to a measles infection. In the first 6 months of 2008, measles cases were reported in the U.S. having been “imported” by un-immunized children who unknowingly acquired measles while vacationing in Europe, and subsequently infected other un-immunized children.  Fortunately, that “mini-epidemic” did not continue to spread as had been feared, but never the less there were over 130 cases of measles in the U.S. that year, higher than reported for decades. Measles outbreaks continue to be problematic in other countries as well, and should be on the radar screen for anyone who is traveling outside of the United States. The scientific evidence dispelling the link between vaccines and autism is compelling. The scientific community has never been able to replicate Dr. Wakefield’s results (now known to be falsified) and millions of research dollars have been spent to “undo” the damage and anti-vaccine sentiment which started with the Wakefield article. We now need to re-focus the research dollars on finding the causes of autism. Scientists have made recent breakthroughs on the genetic link to autism and will continue to try to understand how genes may be involved in development of autism. These are vital areas for funding research, rather than continued pre-occupation by some to discredit the science behind life saving vaccines. Bottom line, get your child vaccinated, read good science and pray that more vaccines are developed to prevent disease. It is a matter of life and death. That's your daily dose. We'll chat again tomorrow! The Autism Science Foundation

Daily Dose

Pertussis Cases Continue to Rise

Pertussis cases on the rise around the country with 10 deaths in California.I have been reading a lot about the pertussis outbreak that has been hitting California, where there are now over 8,000 cases of pertussis, and 10 infants who have died from whooping cough.  But pertussis is not only affecting those in California, the number of pertussis cases are on the rise across the country.

The CDC reported that there were over 17,000 pertussis cases in 2009, and when the 2010 numbers are tallied the number will most likely be higher. Pertussis is also probably under-reported so there are quite likely many more cases than the numbers show, and many cases of pertussis that may be missed as a diagnosis. With that being said it is important to re-iterate the need for both infants, children, adolescents and adults to get their pertussis immunizations. Whooping cough is an infectious disease and the best way to prevent disease is by vaccinating.  What we all forget is that infants are not immunized until 6 – 8 weeks of age, and that one immunization against pertussis does not provide immunity. The reason that the DTaP vaccine is given at 2, 4 and 6 months of age is to confer adequate immunity after 3 doses, and that immune response is boosted again between 15- 18 months of age. As young parents have their new baby immunized, they sometimes feel that their child is “protected” immediately, and that is not really the case.  It takes several doses of vaccine to confer adequate antibody and while a baby is building their own antibody the best way to protect them is by immunizing the older population. This is called passive immunity, which protects a newborn infant by preventing disease in those people who are around the new baby. Whether that is a grandparent, aunt, uncle, nephew, niece, or any of the numerous family members and friends that welcome a newborn, the pertussis (whooping cough vaccine) that is given to the general population protects the newborn baby. The Tdap vaccine that is recommended for use in individuals from the age of 10–64 is the vaccine that is now in the news. So many adults “forget” that immunizations do not stop after you leave the pediatrician’s office.  Adults continue to need vaccines to protect themselves from diseases, including whooping cough. It is amazing that many of my own friends cannot “remember” the last time they  had a shot, which likely means that they have not received the newer Tdap, which protects you from tetanus, diphtheria and pertussis. Doctors need to spread the word that adults also need immunizations, because that terrible persistent cough that you thought might never go away, could indeed, unknowingly be a case of pertussis, which might infect a newborn infant. Just today the Advisory Committee on Immunization Practice (ACIP) recommended that the Tdap vaccine be given to even older individuals, who may come into contact with newborn infants. That means that seniors who are 65 or older are also encouraged to get vaccinated with a newer Tdap if they will be in close contact with infants under the age of 1 year. While the country is seeing outbreaks we must become aggressive in keeping the pediatric population up to date on their vaccines, but in this case the vector may be the grandparent who long ago lost their immunity to whooping cough. I can’t think of a better baby gift, so go get your Tdap and protect that precious newborn. P.S.  A flu shot is important too, so get a “twofer” now. That’s your daily dose for today.  We’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Your Child

Getting Ready for a New School Year!

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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

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

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

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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

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.

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No tech summer: enjoy the outdoors!

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