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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

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

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.

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

Update: Back-to-School Vaccines

Which vaccines do your kids need as they head back to school? Dr. Sue fills you in. With only a few days or weeks to go (for some) before school resumes, it's important to know August happens to be National Immunization Month.  For every age child that is getting ready for school there are, immunizations that are necessary and for any child who has missed or lapsed immunizations it is a good time to update and “catch-up”.

Children entering kindergarten (ages 4-6) will need to have had a  DTaP (diphtheria, tetanus and acellular pertussis), an IPV (inactivated polio), MMR (mumps, measles, rubella) and Varivax (chickenpox) vaccines.  (These are all booster doses). It has also been recommended that children over the age of 1 year (who have completed their 4 dose Prevnar series with Prenvar 7) and who are under the age of 6, receive a booster dose of the newer Prevnar 13 . (see previous blog from Spring 2010). For those children between the ages of 11-12 years there are also booster doses (for older children and adults too) of the tetanus, diphtheria and pertussis vaccine (TdaP) as well as the meningococcal vaccine.  These shots are typically given before entering 7th grade. If your child is over the age of 11 years and has not yet received the meningococcal vaccine I would go ahead and get it, even if they are still in later elementary school and it may not be “required”.  (The names of the vaccine are Menactra or Menveo). This vaccine prevents a devastating form of meningitis and bacterial blood infection that often leads to a rather rapid death in the adolescent and young adult age group. There is also the recommendation that all adolescents who “missed” receiving a meningococcal meningitis vaccine during their high school years receive a dose prior to entering college. In fact, in the state of Texas, this is the first year that ALL college freshmen must show proof of immunization prior to moving into their dormitory.  This is due to the fact that meningococcal meningitis has a higher attack rate for adolescents and young adults, especially those living in close living quarters, such as a dormitory. Once you get the vaccine it takes awhile for your body to develop antibodies and therefore immunity, so college students who get vaccinated once arriving at school, will also have to wait 10 days before they are allowed to move into their dorm.  If you son or daughter is heading to college in the next several weeks, go get the vaccine now, so that you will have a 10 day window to show proof of vaccination. With outbreaks of pertussis on the west coast, and actually clusters throughout the United States, this is a good time to reiterate that all adults should have a tetanus, pertussis and diphtheria vaccine too!! That means every 8–10 years and you want to make sure you have gotten the vaccine containing acellular pertussis, which prevents the adult population from spreading whooping cough to infants who have not yet been immunized or who are just getting their own 3 dose series. Even adults need to continue getting vaccinated and the TdaP vaccine is recommended for adults until 65 years of age. What can you expect from me over the next few weeks? Updates about flu vaccine once again. How time flies! That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Your Child

Back-To-School Immunizations

2:30

Is your child up-to-date on his or her immunizations for the new school year?

Each state has its own set of immunization requirements, but there are a few that are found in nearly all states. Make sure you know which are required for your child’s school.

The typical list includes:

DTaP (Diphtheria, Tetanus, Pertussis)

·      Most children have five dosages by the time they start school, including one after their fourth birthday

·      Remember that children also need a tetanus booster when they are around 11 to 12 years old

·      The Tdap vaccine (Boostrix or Adacel) is recommended for teens and adults to protect them from pertussis in 2006 and replaces the previous Td vaccine that only worked against tetanus and diphtheria

MMR (Measles, Mumps, Rubella)

·      Two doses of MMR are usually required by school entry. In the past, the second dose was given when a child was either 4 to 6 years old or 12 years old. Now, it is usually given earlier, but some older children may not have gotten two doses yet.

·      Having two doses of MMR is important in this age of measles outbreaks.

IVP (Polio)

·      Most children have four or five dosages by the time they start school, including one after their fourth birthday.

Varivax (Varicella, or the Chickenpox vaccine)

·      Your older child will need the chickenpox shot if he has not already had chickenpox in the past. Most toddlers young receive it when they are 12 to 18 months old. Although younger children used to be given just one dose, it is now required that kids get a chickenpox booster shot when they are 4 to 6 years old. Older kids should get their booster at their next well child visit or as soon as they can so that they don't get chickenpox.

Hepatitis B

·      A series of three shots that is now started in infancy. Older children are usually caught up by 12 years of age if they haven't received this vaccine yet.

Hepatitis A

·      A set of two shots for children over 12 months years of age. All infants and toddlers are now getting this shot as a part of the routine childhood immunization schedule, but there is currently no plan for routine catch-up immunization of all unimmunized 2- to 18-year-old children, unless they live in a high-risk area with an existing hepatitis A immunization program or if the kids are themselves high risk. Kids are high risk for example, if they travel to developing countries, abuse drugs, have clotting-factor disorders, or chronic liver disease, etc.

·      Hepatitis A vaccine is required to attend preschool in many parts of the United States.

Hib

·      While required for school entry, children do not usually receive this shot after they are five years of age, so children who have missed this shot don't usually need to get caught up before school starts if they are older than 5 years old.

Prevnar

·      A vaccine that can help to prevent infections by the pneumococcal bacteria, which is a common cause of blood infections, meningitis and ear infections in children.

·      Prevnar is typically given between the ages of two months and five years, and isn't approved for older kids, so your older child wouldn't need this shot if he didn't get it when he was younger. It is often required to attend preschool though.

·      A newer version of Prevnar, which can provide coverage against 13 strains of the pneumococcal bacteria, is approved and replaces the older version (Prevnar 7) in 2010, which means that many older children in preschool may need another dose of Prevnar 13, even if they finished the Prevnar 7 series.

·      Another version of this vaccine is available for certain older high-risk children though, including kids with immune system problems, although that wouldn't be required for school.

Meningococcal vaccine

·      Menactra and Menveo, the newest versions of the meningococcal vaccine, is now recommended for children who are 11 to 12 years old, with a booster dose when they are 15 to 18 years old.

The American Academy of Pediatrics (AAP) recommends that all school age children stay up-to-date on all their immunizations.

As well as the vaccines recommended above, AAP includes a few others in its 2016 list. They include:

Influenza

·      Administer influenza vaccine annually to all children beginning at age 6 months. For most healthy, non-pregnant persons aged 2 through 49 years, either LAIV or IIV may be used. However, LAIV should NOT be administered to some persons, including 1) persons who have experienced severe allergic reactions to LAIV, any of its components, or to a previous dose of any other influenza vaccine; 2) children 2 through 17 years receiving aspirin or aspirin-containing products; 3) persons who are allergic to eggs; 4) pregnant women; 5) immunosuppressed persons; 6) children 2 through 4 years of age with asthma or who had wheezing in the past 12 months; or 7) persons who have taken influenza antiviral medications in the previous 48 hours.

Human papillomavirus (HPV)

·      Administer a 3-dose series of HPV vaccine on a schedule of 0, 1-2, and 6 months to all adolescents aged 11 through 12 years. 9vHPV, 4vHPV or 2vHPV may be used for females, and only 9vHPV or 4vHPV may be used for males.

·      The vaccine series may be started at age 9 years,

·      Administer the second dose 1 to 2 months after the first dose (minimum interval of 4 weeks), administer the third dose 16 weeks after the second dose (minimum interval of 12 weeks) and 24 weeks after the first dose.

·      Administer HPV vaccine beginning at age 9 years to children and youth with any history of sexual abuse or assault who have not initiated or completed the 3-dose series.

Many states have added an “opt out” choice for parents on some vaccines but not all. For the health and safety of all children, the AAP recommends that parents follow each state’s immunizations requirements and not opt out unless there is a medical necessity.

Story sources: Vincent Iannelli, MD, https://www.verywell.com/school-immunization-requirements-2633240

http://redbook.solutions.aap.org/selfserve/ssPage.aspx?SelfServeContentId=Immunization_Schedules

 

 

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

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)

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