The vaccine schedule is the same schedule for boys and for girls. The path to today’s human papilloma virus (HPV) vaccine has not been entirely straightforward for parents as recommendations have changed over time. Know this: the clear and simple message is that HPV vaccine is safe and effective for boys and girls. We know it works best when given earlier in the tween/teen years and we know the immunity it produces in our bodies is durable and lasting. HPV vaccines is an anti-cancer vaccine that works best when given to boys and girls at age 11. For me it’s a no-brainer to recommend this vaccine enthusiastically before children head off to 6th grade.
Earnestly, it’s not a “new” vaccine as pediatricians began giving the vaccine back in 2007 and it’s been given well over 50 million times. In the U.S. we starting giving the vaccine to girls first yet because human papilloma virus can infect boys and girls, men and women, HPV vaccine is also recommended for boys age 11 and older. Uptake by boys has been fast and steady since recommendations included them. Three different HPV vaccines are now available: a 2-HPV strain (protects against the viral strains that cause 70% of cervical cancer) or a 4-HPV strain vaccine (same 2 strains plus two more that protect against HPV strains causing warts) and now a 9-strain vaccine (expansion of strains causing warts), upping the number of different viruses that the vaccine protects teens against. The new options improve protection against HPV viruses that cause genital warts and also HPV viruses that can cause cancers of the cervix, mouth, throat vagina and rarely, the penis.
HPV Vaccine Protecting Teens
Although we haven’t reached vaccination rates of countries like Australia (they vaccinate at school which certainly makes the vaccine convenient) our rates of completed HPV vaccine series are up (see graph below). In Australia where the majority of teens have been immunized they have seen remarkable progress:
A 77% reduction in HPV types responsible for almost 75% of cervical cancer
An almost 50% reduction in the incidence of high-grade cervical abnormalities in Victorian girls under 18 years of age
A 90% reduction in genital warts in heterosexual men and women under 21 years of age.
2. Boys and girls getting the vaccine protect themselves but they also help protect future partners.
If you have a daughter getting ready to head to college this fall, holy moly I’m excited for you. In clinic it’s clear to me that the huge transition from high school to college-age brings great joy but also a remarkable sense of unrest for everyone, too. Vaccines, birth control, and suicide prevention may not top your to-do list while packing the car but there’s no question these are 3 things you can check in on to ensure it’s a better and safer year for your daughter. Not only is a brand new meningitis vaccine available to college-age girls this fall, included here are reminders with ways to support your daughter and her health as she heads off to learn even more…
ONE: Birth Control Options For Your Teen Daughter
1. Amazing Resources To Prevent Unwanted Pregnancy
The CDC confirms that as girls head off to college we know over 40% of them have had sex. And although 4 in 5 of them used a form of birth control the last time they had sex, only about 5% are using the most effective forms to prevent pregnancy. Read full post »
Yesterday California Governor Jerry Brown signed a childhood vaccination bill into law along with a letter stating, “The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases. While it’s true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community.” The hash-tagged, much discussed bill (#SB277) was co-authored and proposed to lawmakers by Dr Richard Pan, a pediatrician and CA state senator in Sacramento. The law, SB 277, establishes one of the toughest mandatory vaccination requirements in the nation for school children and those in child-care centers. As imagined, the process of getting the bill into law was not for the faint of heart. Riding on realities of necessary community immunity unveiled during the 2014-2015 Disney measles outbreak, the idea of mandating vaccines for public health still ignited evocative and divisive bullying campaigns on social media.
Testimony before the state senate was reported to be passionate, evocative, and compelling from both sides. The law passed the senate by a 24 – 14 vote and went to the governor. By signing the bill into law yesterday, Governor Brown acknowledges a tenet in public health and vaccination: vaccines are for individuals, yes, but they also serve to protect others — those especially vulnerable and not. Read full post »
Two new Pediatrics studies are out this week teaching us more about the effectiveness of the whooping cough vaccine. Lots to learn about how we protect babies and reminders here why we’re immunizing moms during EVERY pregnancy:
First, the good news: traditionally we have been trained to tell parents that the first shots we give during infancy aren’t fully protective for infants but rather the beginning of creating immunity against the diseases they prevent. However, a study conducted by researchers at the CDC looked back at cases of infants with pertussis from 1991-2008 and they found evidence that babies who received their whooping cough shot as early as they could, at the age of 6 weeks, were less likely to be hospitalized and/or die from the infection. Wonderful news! The first evidence out there that even that first shot, when given as early as possible, helps protect very young infants who are most at risk from whooping cough. New parents can increase protection, even during outbreaks like we’re having right now, by getting their babies immunized on-time and as early as possible.
The not so good (but important) news: the effectiveness of the Tdap shot given to young teens (explained more below) doesn’t always provide long-lasting protection and wanes significantly in the years after the 11-year-old booster dose is given. New research out found after 1 year, about 70% of teens are still protected from the booster, but by 4 years after the shot only about a 1/3 of them are. More:
There’s a beautiful story of success tucked away in the recent measles outbreak in the United States. Sometimes we forget to talk about it. When measles popped up at Disneyland in December 2014, it made headlines as the public remained thirsty for the media’s support in understanding who was at risk and why. I spoke to dozens of media outlets about the outbreak, under-vaccinated populations, the MMR vaccine, and how to protect those most vulnerable during an outbreak. We all emphasized those at biggest risk: infants too young to be immunized, those who were unvaccinated, or those too ill to be vaccinated. Measles is an illness I would be terrified to get — and I don’t like that people who aren’t protected are at risk for both catching the disease and spreading it. I think the public gets this in new ways although I hate that it takes outbreaks to capture attention and drive this education and understanding.
Measles virus, and the vaccine we have to prevent it, form a unique pair because although measles is wildly infectious and can be life-threatening the immunization is wildly effective and life-saving (>99% of those immunized are protected for life). It is a safe vaccine with minimal side effects. What a fortune and a triumph in prevention medicine. A terrible disease, once thought to be eradicated in the U.S., is swiftly prevented by a vaccine that nearly everyone in the population can get after their 1st birthday.
You’ve likely seen the Jimmy Kimmel “public service announcement” on vaccines. Over 3 1/2 million people have viewed it on Youtube so if you’re not yet one of them you’ll likely add to the tally now. The first 3 minutes of the monologue are spot-on and they’re also very funny. Jimmy takes a stand against the “anti-vaxxers.” He mentions that some parents are more scared of “gluten than small pox” and references the reality that some schools in this country have 20% of students opted out of some vaccines. His monologue is followed by a series of pediatricians voicing profane frustration. Most people think the video is hilarious and many of us fired up about vaccines feel a rush when the safety and trust we have in vaccines gets the spotlight like it does here. Jimmy’s script is brilliantly written and his execution is direct.
Thing is, I didn’t like the video. I was left feeling somewhat uncomfortable and embarrassed for my profession. Immediately I wanted to explain that even though many of us are frustrated with where we are on vaccine hesitancy, we really aren’t interested in offending. We will always work to partner with parents –we won’t mock, swear, or intimidate you. Our goal is to support, protect, and cure children whenever we can and our privileged responsibility is to listen to parental fear and connect families with resources that soothe. This really is why we went to medical school.
It’s exciting when celebrities voice-up and stand to talk about vaccine issues that reflect science. It’s especially exciting when they include practicing physicians. Counseling families who are hesitant or flat-out refuse vaccines is a part of the job for every pediatrician. A study published in the journal Pediatrics this week found 93% of pediatricians had reported they’d been asked by parents to skip or delay vaccines in the last month. The current measles outbreak has changed the tone of these conversations for many of us; I’ve written about my new stance because I’m enraged pockets of measles can even occur in 2015. That being said, even though I really do like to swear like these pediatricians when I’m out of public earshot, I’m unsure the tactic of this PSA will do any good for those parents who hesitate to immunize their children according to the tested and safe schedule.
It seems to me that if parenting is governed by love, pediatrics is governed by respect for that love and for the integrity of children individually.
The measles outbreak continues to spread, with 121 cases now reported in 17 states (CDC data as of February 6th). Many states are getting serious about detailing why exemptions for vaccines exist and looking at ways to better protect the population. This week in the Seattle Times three local pediatricians speak out for removing both personal choice and religious exemptions to protect the public and vulnerable children. And here, Dr Paul Offit writes about religious exemptions asking, “What Would Jesus Do About Measles.”
There’s no question vaccines are having their moment. We are working through tough questions. In the Seattle Times piece, Drs. Diekema, Opel, and Marcuse keenly point out:
We hold dear both freedom of choice and public health.
Finding an optimal balance is clearly of great import. This will take great advocacy and work to help continue to build trust in the MMR vaccine that is safe and highly effective at preventing measles infections.
Though I’ve been lucky enough to avoid seeing measles thus far in my medical education and career, this serious, uber-contagious disease has given some parents and caregivers pause when it comes to putting their unprotected (read: too young to vaccinate) infants in a situation where their health could be compromised. Many mothers have emailed, tweeted and Facebook messaged me asking how they can protect their little ones who haven’t received their vaccinations yet and my simple answer is this: cocooning. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections. Read full post »
Many parents around the U.S. are asking what to do about a possible measles exposure with a baby at home who is too young to be immunized. Should they stay home? Can they travel? Should they cancel that trip to Utah or to Vermont or even to Disney next month? Can they head out to the store without worry? Are they “safe?”
I hate that I can’t completely say they are safe. Measles is wildly contagious and during an outbreak it can spread, especially to older infants who aren’t vaccinated yet. The good news is that risk is low (more than 90% of us won’t get measles because we’re vaccinated so we also won’t spread it to you!). Some parents are also wondering about getting the vaccine before the baby turns 1 year because they’ve heard the recommendation for infants traveling abroad: infants traveling outside the U.S. are recommended to get an MMR (measles, mumps, rubella) shot if they are over 6 months of age (of note, babies who get the shot as an infant also get the usual shot again at 12 months of age). Without travel plans we wait to immunize babies with their first MMR vaccine until they are 12 months of age. Over 95% of babies who get the shot at 12 months of age are protected against measles and over 99% are protected for a lifetime after the 2nd dose (given at least 1 month later). Wow, right?
“This is not going to be the end-all-be-all post on protecting your infant or child from measles'” Dr Matthew Kronman, a pediatric infectious disease expert at Seattle Children’s, reminded me as we chatted today. Advice and guidance for protecting babies and children will change as we learn again how to protect our population from measles infection while unvaccinated pockets of people remain.
The CDC warns that the outbreak could grow (there’s over 100 cases in 14 states as of today) and nationally there’s a palpable dialogue going on between the herd (those immunized) and those not. Politicians are involved — Governor Christie talked today about “choice;” Obama is urging parents to immunize right along side the president of the American Academy of Pediatrics who released another urgent statement. Pediatricians, family docs, nurse practitioners and health workers everywhere are encouraging parents to get shots up-to-date to protect their own children and vulnerable populations (this includes infants). Here’s a bit of evidence and information that can hopefully curb anxiety for parents to babies. I teamed up with Dr Edgar Marcuse, a lifelong scholar with vaccines, former pediatrician at Seattle Children’s and an emeritus professor of pediatrics at University of Washington and Dr Matthew Kronman. Here are 7 tips about infants and families that may help shape your thinking: Read full post »
I wept at the end of the movie I watched last night, The Imitation Game. The reason really was this: it reminded me how we’re just so terrible to each other at times. How much suffering occurs when we don’t think things through. The movie wasn’t about measles or vaccination, but injustices in it pushed me to leave my Sunday morning with my children to share this:
My patience with vaccine hesitancy has pivoted. I’m embarrassed to say it took an outbreak of measles stemming at Disney to move me from impatient and passionate to hands-on-my-hips fired-up and disappointed. Today I feel a bit of outrage that unvaccinated families are not pounding on the door to get their MMR vaccine, even on Superbowl Sunday. In my mind they should be doing so selfishly (for personal protection) and they should be doing so altruistically (for others who really count on them). I expect both from the public.
Read Charlie and the Chocolate Factory author Roald Dahl’s 1988 message about his daughter’s death from measles — insane that it rings true today.
I feel somewhat enraged that many parents with babies in the United States are nervous right now about their infants getting measles. The chance is small but it shouldn’t even be a chance when there is a vaccine that is nearly 100% protective for those milling around these delicious babies. I’m angry because a friend of mine has a child who got measles when she was too young to be immunized. I’m enraged that children who fulfill their “Make A Wish” trip to Disneyland — after a liver transplant or after chemotherapy or after a tumor is cut out of their bone — must feel a little shaky making the choice to go there now. Can you imagine getting a short straw like a liver that didn’t work like it should or a childhood cancer diagnosis and then getting another one (increased measles risk) just when you’re elevated to celebrate your life? Read full post »
Influenza is hitting hard this year thanks to a drifted influenza strain (H3N2) causing a more serious illness and one that is not included in our annual vaccine. Because of the hard hit, public health officials are reminding us to get high-risk patients into see physicians early if they have symptoms of “the flu” or influenza infections. Reason being, those at high-risk for complications may benefit from a prescription anti-viral medicine that can lessen the burden of illness and decrease risk for complications. Over-the-counter medicines you buy don’t fight influenza.
What Is “The Flu” And What Is Influenza
In general, in healthcare we use the term “the flu” when discussing an infection with influenza, a virus that causes widespread body aches, high fever, cough/cold symptoms, headache or even leg aches. Some children vomit with influenza infections as well (incidentally many patients with lab-confirmed influenza that I’ve seen this winter have also been vomiting) although in general influenza infections are upper and lower respiratory infections, and not the “stomach flu.” We worry about influenza as it’s in the list of top ten causes of death in the US and because it can cause severe symptoms, even in children. Infants and young children are at particular risk for serious infections as their bodies and their immune systems haven’t fought off influenza before.
High risk patients:
Children 2 years & younger (their immune system not as robust and not as much “memory” to fight off severe influenza infections).
Adults age 65 year & older (their immune system is aging and not as robust fighting off severe influenza infections).
People with underlying health problems (including asthma) or other lung problems, other chronic health conditions (like diabetes, heart disease).
Pregnant moms or newly postpartum moms.
Those people immunosuppressed.
The Numbers So Far
According to the CDC, widespread influenza activity is being reported in 46 states. The most common strain is that drifted virus H3N2, accounting for over 90% of the more than 5,000 reported influenza-positive tests recorded last week (ending January 10). It’s still too soon to tell whether we’ve reached the peak of flu season, however there are early signs that the virus is lessening in parts of the country. So far, this year the influenza vaccine is estimated to be about 23% effective, clearly not as effective as usual but still providing some protection.
What Over-The-Counter Medicines Can Help With Influenza?
It’s important to remember that over-the-counter (OTC) medications cannot cure “the flu” nor shorten your suffering with symptoms. They’re designed simply to help you get through the illness and should be taken within the proper guidelines. In general children under 4 should not be given OTC cough and cold medicines.
That being said, there are four types of medications that can make getting through the flu a little more bearable. Read full post »
Seattle Children’s provides healthcare for the special needs of children regardless of race, color, creed, national origin, religion, sex (gender), sexual orientation or disability. Financial assistance for medically necessary services is based on family income and hospital resources and is provided to children under age 21 whose primary residence is in Washington, Alaska, Montana or Idaho.