News of a whooping cough death in the Seattle area rang out yesterday. By afternoon, many of my patients in clinic had heard the news. Although the epidemic levels of whooping cough have gradually faded since a peak of cases here in May, the risk is still very real.
Newborn babies are at particularly elevated risk for serious complications from pertussis (whooping cough) infections. Unlike older children and adults who often have cough & coughing fits with vomiting, babies can have severe respiratory distress, pauses in breathing, or even stop breathing. Rarely it can be deadly.
Infants are most likely to catch whooping cough from a parent. We have to cocoon newborns everywhere: surround them with people who are vaccinated and less likely to spread whooping cough infection.
This tragic death serves up a reminder for we pediatricians, family docs, and clinicians everywhere to maintain our efforts and amp up our passion to keep babies surrounded by immunized family and friends. We can’t let up.
Are You Up To Date On Your Whooping Cough Shots?
More than anything, we need to ensure family members (mothers, fathers, grandparents, and siblings) all are up-to-date on their whooping cough shot. The shot is imperfect (meaning not everyone who gets the shot is always immune — most estimates find that 80% of us who get the shot are protected) and we know some of our immunity to whooping cough can fade year after year. So the more people immunized the less likely we are to have whooping cough in our community. Read full post »
In 2006, I entered pediatric practice. It was the same year that the Advisory Commission on Immunization Practice (ACIP) recommended to start giving 11 year-old girls the Human Papilloma Virus (HPV) vaccine. Therefore, I’ve really never practiced pediatrics (outside of my training) without the ability to offer up immunization and protection against HPV virus; I’ve been discussing this for about 6 years. We now give HPV shots to both boys and girls because it’s so common–about 50% of all adults who are sexually active will get one form of HPV in their lifetime.
HPV virus can come into our body and do no harm. But it also can come into our bodies and cause vaginal, penis, anal and oral/throat warts. Other strains of HPV also cause changes in the cervix that can lead to cervical cancer and can rarely lead to penile cancer and/or tongue/throat cancer. Teens and adults can get HPV from oral, vaginal, or anal sex. Condoms don’t provide 100% protection from getting it.
GREAT NEWS: Being protected (by the HPV shot) doesn’t trigger risky sexual behaviors in teens.
Nice to have an immunization to protect against the potential development of such disfiguring, embarrassing, and uncomfortable lesions. And what a windfall to have a vaccine that prevents cancer. I often say to my patients, “If my grandmother only knew that I’d see the day where we could prevent cancer.” I mean it—if she only could have seen the day (she died in the late 1980’s).
The reality is though, parents to teenage girls have consistently been hesitant in getting the HPV vaccine in my office. Over the 6 years hesitancy around getting HPV vaccine has lessened, but many of my patients’ parents have told me they don’t want their girls or boys to feel that getting the shots is a green light for sexual activity. And many have worried that having their girls immunized will make them more likely to engage in earlier sexual activity. Read full post »
This is part deux to an earlier video/post describing the global effort to reduce flu & reasons why we need one every year. Infants and children under age 5 are at higher risk for serious complications from influenza infection. Influenza (“the flu”) is an illness that strikes during the late fall and early winter annually in our country. Great thing is, there is a global effort to coordinate knowledge to reduce the consequences of severe infections. Each year a new flu shot is released to protect us. All children need a flu shot. The reason? It’s estimated that somewhere between 10-40% of all children, each year, get influenza. Sometimes it’s a mild upper respiratory infection, but sometimes it can cause severe lung infections and even death. Each year hundreds of children die in our country from flu even though it is a vaccine-preventable illness. I hear lots of myths and rumors about the flu shot in clinic (more than any other vaccine). Check out my friend Dr Claire McCarthy’s post on de-bunking the myths.
Of those children who are seriously ill and hospitalized, somewhere between 1/3 to 1/2 can be children with no underlying medical issues. Healthy children get the flu, too. If your child has underlying neurologic problems, wheezing or asthma, or diabetes they are also considered higher risk for severe infection.
It takes a well-immunized community to reduce the spread of influenza. And our children, swapping spit and snot at school, are one of our most precious groups to protect.
Which Flu Vaccine And How Many to Get?
Infants 6 months of age and up can get flu shot. Most infants will need two doses, separated by 1 month, while all children over age 9 years need only one dose. If you have a young child (<9 years) and they have never had the flu shot before, they will need two doses. Ask your child’s doctor how many doses your baby, toddler, or child needs this year. What you need to know about flu.
There are two types of vaccine, the flu shot & the nasal spray. Both protect against the same virus strains. Check out www.flu.gov. Here’s a quick explanation: Read full post »
We need a flu shot annually because influenza virus changes structure and shape as it moves around the globe each year. The strains that cause human disease are different from one year to the next, so we update and add to our protection annually by getting a shot or nasal flu spray. Children, especially those under age 5, are at higher risk for severe disease from influenza. In children and adults, influenza can cause a mild illness, but unfortunately, sometimes it can cause severe or even life-threatening complications. Children may have a more difficult time fighting off influenza partly because they don’t have years of exposure to other strains of flu and no real immunity built up. Therefore all children are considered a priority group for flu shots. Pregnant women, families with infants at home, and those with underlying medical problems like asthma, diabetes, or neurologic problems really need to get them, too.
It takes a well-orchestrated, worldwide effort to help predict which strains come to our country and which 3 strains are included in the annual flu shot or flu nasal spray here in The United States. The video explains more.
A study published today in The New England Journal of Medicine evaluated the duration of protection against whooping cough after children get the DTaP shot. Researchers wanted to find out how long the shot lasts. DTaP shots are given to infants, toddlers, and kindergarteners (schedule below) to protect them from three infections (Diptheria, Tetanus, and Pertussis –whooping cough). After these childhood vaccines, we give a “booster” shot at age 11. Because we know that many babies who get whooping cough are infected by teens and adults, all teens and adults are now recommended to get a Tdap shot to protect themselves and those vulnerable against whooping cough.
As researchers seek to understand the recent epidemics of whooping cough in the US, they have found more and more that the causes of these epidemics are multifactorial. Not only is it unvaccinated populations that allow epidemics, it may be waning immunity from shots given previously and waning immunity to natural infection, as well. Previously, it’s been estimated that our immunity to whooping cough wanes anywhere between 4 and 20 years after we get whooping cough, and that it may wane 4 to 12 years after the shot.
A little history: back in the 1990’s we switched from using the “whole cell pertussis” shot to using a vaccine that is “acellular.” Some health officials have had concerns that this “acellular vaccine” may not protect children as long. Although it does a great job protecting infants and toddlers, it may not last as long as previous immunizations. Some have wondered how long the kindergarten shot protects our children…
Physicians at Kaiser Permanente reviewed information about children in California during the 2010 whooping cough outbreak. What they found may have significant effects on how to protect our children going forward: Read full post »
Vaccine hesitancy comes in all flavors. It’s not always concerns about safety that causes children, teens, and parents to hesitate or even refuse vaccines. Sometimes it’s about pain. Or simply discomfort. Or anxiety. It’s perfectly natural, of course, to have a fear of needles. It’s rare that a child enjoys the pain of an injection (although those kids, even at young ages, are out there).
Sometimes the fear and anxiety of needles really can manifest itself as a sincere phobia. In those cases, the fear is so overwhelming that it changes family decision-making around vaccinations and leaves children unprotected. It can torture parents when they have to scoop their kids up from under the chair. And parents get embarrassed when their child/teen becomes combative with shots. Sometimes they avoid coming back to clinic simply to avoid the conflict. Makes sense in a hectic world.
However recently in clinic I took care of a teen soon after she’d had a terrible experience with Influenza (the “flu”) and it’s changed how I care for my patients. She was an asthmatic, high school student. Because of her asthma, her doctor had recommended a flu shot. Even though doctors recommend flu shots for all children between 6 months of age and 18 years, we work very hard to get high-risk patients protected. Children and teens with asthma are more likely to have a severe pneumonia after contracting Influenza. We worry about children who wheeze and have asthma (even mild asthma) because it can land them in the hospital and/or can cause a life-threatening illness.
Most parents with asthmatic children get flu shots yearly, early in the season. But not all.
When I saw the girl in clinic she was exhausted and stressed, confused and scared. Through the course of her Influenza illness she had missed 2 weeks of school and lost over 15 pounds. She was still coughing a few weeks later. I looked back to the chart note visit prior to her infection where her pediatrician had recommended the flu shot. “She’d declined,” it said.
I’ve just returned from a week in Idaho where I had the privilege to do a series of talks for the Idaho Department of Health (DOH) about using social media to communicate about vaccines. The best part of the week was all of the education I received. I traveled around the state (see those photos!), witnessed the DOH at work, connected with Idaho physicians & politicians & advocates & volunteers, and talked with many Idahoans about changing the understanding of vaccine science. Three times I heard Dr Melinda Wharton from the CDC present on vaccine safety. And more, in a matter of 4 days we talked with a clinician, nurse, or medical assistant from every single office in the state that provides vaccines to children. I mean, that’s a wow–a sincerely networked community circa 2012.
If all states had the opportunity to convene like they do in Idaho we’d really improve understanding, communication, and opportunities in health care surrounding vaccine safety and decision-making.
After arriving home to my boys, I’m compelled to share 3 things I learned in Idaho:
I think it’s essential that we talk about the risks associated with vaccines when we give them–each and every time. Dr Wharton discussed known risks to vaccines and the science to support those risks. She also talked about inferred risks that aren’t backed up with science (autism, for example).
The 2 month-old check up may be harder for parents than it is for babies. Getting the first set of shots is anxiety provoking for we moms and dads; no question that it’s unsettling to allow a medical provider to cause our beautiful, new, healthy baby pain. Research has found that the pain and discomfort associated with shots is one of the primary reasons parents “elect not to perform timely vaccination.”
A study published this week affirms two truths. First, structured soothing may be a great tool for families to control crying after discomfort from shots. A group of pediatricians in Virginia used Dr Harvey Karp’s Happiest Baby on the Block 5S’s technique (shushing, swaddling, side positioning, sucking, and swinging/swaying) as an intervention for crying after the 2 and 4 month shots. The technique has been advertised to parents as a way to soothe and comfort fussy and colicky babies in the first few months of life. The researchers found that compared to a control group with no intervention and a group of babies that received a sugary solution for comfort prior to the shots, the 5S technique helped soothe crying and pain more rapidly. Most babies that were swaddled, shushed, swung, and offered a pacifier for sucking stopped crying within only 45 seconds. Second, the great reality is that most babies stop crying within 1 to 2 minutes of getting injections anyway. The study confirmed that, too! In my experience, only rarely does a baby leave clinic still crying. Some of our anxiety about the discomfort as parents can be relieved–we really need to get the word out this is a short process. It’s rare for a baby to cry for even 3 to 4 minutes after their injections. Read full post »
This week, Washington State declared that whooping cough (pertussis) has reached epidemic levels. Since the beginning of the year, we’ve had more than 600 documented cases in the state, a dramatic increase since last year. The increase puts our new babies at risk.
In clinic I’ve been urging new parents to cocoon their babies. 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.
Whooping cough is a highly infectious respiratory illness spread by sneezing and coughing that can be deadly to young infants. Getting a Tdap shot is the best way to avoid getting whooping cough. Amidst an epidemic, we worry most about newborns because they are most vulnerable to complications and lack vaccine-protection. If every child and adult that surrounds a newborn gets a Tdap shot, the likelihood of the baby getting whooping cough approaches zero.
Most newborns get whooping cough from their family or adults around them. That’s where an email comes to play.
You’re going to have to be fairly Mama-Papa-Bear about this. You’ll have to show some strength to create a very safe home, even when it feels somewhat over-the-top. As I said to a number of families in clinic today, “It only seems entirely over-the-top-nuts until we lose another newborn to pertussis.” Being smart now will save lives.
Make a new rule: no visits with a newborn until all visitors have had the Tdap shot. Even Grandparents.
Write an email to family and friends to explain.
A sample email for you to use/copy/share –written today by a friend of mine–mother to that darling baby girl born last week: Read full post »
Some of my best friends are about to have a baby, the due date only a few weeks away. I’m teary thinking about it as my excitement for her arrival exceeds the speed limit. They asked my opinion this week for getting their extended family immunized in light of the recent Whooping Cough (pertussis) outbreak in our area. I advised them that all teens and adults (including grandparents) need a Tdap shot before they are with the baby. Even pregnant women are getting immunized after 20 weeks gestation to protect their newborns at and after birth.
Ideally, everyone should have the Tdap shot at least 2 weeks before the baby arrives.
My friends advised their parents. But both grandmas were turned away–one here in the US and one abroad. Each were told by a physician that they didn’t need the Tdap shot because they were over 65 years of age.
That physician was wrong. Whooping Cough (pertussis) knows no age. And immunization recommendations for pertussis protection have changed this past year because of rising rates of infection and infant deaths.
The best way to protect a newborn baby from getting Whooping Cough is to cocoon them with family and friends who are immunized against it.
All grandparents, all adults, and all teens need a Tdap shot before holding a newborn baby.
Ask questions, please. And one more thing, can you suggest girl names? My friend is beside herself that they don’t have one picked out…I’ll buy you coffee if you suggest the name she chooses (hint: use a real email)
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.