This Tuesday evening, I’m joining Seth Mnookin at Town Hall in Seattle to discuss vaccines, modern parenthood, and (mis)information about vaccinations online. Although you may know Seth Mnookin secondary to his crucial role in the Boston Marathon Bombings story this past week, at his other day job he’s the co-director of the graduate program in science writing at MIT. He’ll be here in Seattle because he is also the author of a powerful book, Panic Virus, that details the history of vaccine hesitancy in the US.
A True Story of Medicine, Science, and Fear.
Although the book sits on the nonfiction shelf, it reads like a thriller. Think Contagion meets John le Carre´. I’m not exaggerating here: when I first read the book 2 years ago, I pulled a near-all-nighter because I couldn’t put it down. I don’t think that’s because I’m a pediatrician, I believe I couldn’t put it down because I’m a mom.
I met Seth nearly 2 years ago and he signed my scribbled-in copy of his extraordinary book. Panic Virus changed my understanding of vaccine hesitancy. There are parts of the book that caused my stomach to drop and certainly parts of the book that made me worry. Read full post »
This is a guest blog from Karen Ernst. Karen is the mother of three boys and a military wife. She sometimes teaches English and enjoys advocating for and working with children. She is the co-leader of Voices for Vaccines and one of the founders of the Minnesota Childhood Immunization Coalition.
The preschool class party was one of the last hurrahs for my then five year old. The entire family attended, including our ten-day old newborn, whose only interest was nursing. His lack of other interests turned out to be good fortune because another mother-son duo at the party were contagious with chicken pox and began showing symptoms the day after the party. Had the mother held my newborn or the child played with him, the results could have been fatal for our son.
Having immunized my older child, who played with his contagious friend, I was relieved that no one in our home contracted chicken pox and no one passed it on to our new baby.
While I was angry when the mother revealed that she’d purposely left her son unvaccinated against chicken pox, I felt proud that I had chosen well, I had protected both my children, and I had understood and agreed with what public health officials had proposed: that children need the varicella vaccine. I had both done what I was supposed to, and nothing bad happened. So that’s the end of the story, right?
Today a Seattle mom advertised on an online parenting community that both of her children had chickenpox and then invited (non-vaccinated) children over for exposure. That’s the invite from 1:19pm today.
It turns out people are still having chickenpox parties.
Part of this makes my head spin. I just don’t get it, despite having had many families in my practice decline or hesitate or delay the chickenpox shot. I don’t think parents know what virus they are dealing with. After I posted this invitation on Twitter, I had physicians all over the country sharing stories (some included below).
Chickenpox can cause serious infection complications and rarely it can be lethal. Before the vaccine was approved and put into use in 1995, hundreds of children and adults died in this country every year from chickenpox and thousands were hospitalized. Although most young children get chickenpox and recover (only left with pox or scars) some children develop life-threatening secondary infections. Some children develop severe pneumonia (1 in 1000 children), some develop brain infections, and some children develop flesh-eating bacterial infections in their scabs that can even be fatal.
After I saw the pox party invite this afternoon I became slightly enraged. I mean, there are NUMEROUS children and adults in our community immunosuppressed and/or on chemo that could develop life-ending complications if exposed to varicella. And some families are intentionally exposing their children to a potentially harmful infection. After 2 doses of the chickenpox shot (varicella) 99% of patients are immune to chickenpox. Although some children can get chicken pox once vaccinated, they typically only have a few pox and do not develop severe side effects or die.
The pox party just shows me how much work we have to do to build trust in vaccines and vaccine-safety. My boys have both had 2 doses of the varicella vaccine. I’m thrilled they are protected and unlikely to ever get chickenpox or spread it to a community member who could be more at risk. They likely won’t get shingles, either.
Chickenpox Facts & Stats:
Varicella shots hurt upon injection (children tell me it really stings). We give the shot twice, once at 1 year of age and once at 4 years of age. The shot can commonly cause arm soreness and lowgrade fever. In less than 5% of children, a small rash develops, often around the site of the shot. That’s a good sign the immune system is being triggered to fight off future infections. The rash that can develop after the shot is not contagious. Read full post »
Since 2005, teen immunizations have been recommended at the 11 year-old well child check-up but rates of teens who keep up to date on their shots lag. In an ideal community, 90% of us would be up to date on shots to prevent disease spread most effectively. Back in 2007, teen recommendations were expanded to include HPV vaccine for girls. In 2011, both boys and girls were recommended to get HPV shots. Although the majority of teens get the Tdap shot (tetanus and whooping cough booster) only around 1/3 of teen girls are up-to-date on their HPV shot when most recently surveyed.
HPV (human papillomavirus shot, requires 3 doses over 6 months)
A Pediatrics Study on teen shots revealed that parents may not get their teen shots due to concerns about safety or not understanding the shot was recommended. Not all shots are required by schools; I think some families tend to experience that as an endorsement for the shot being less important. In the survey conducted between 2008-2010, researchers sought to understand trends and rationale for lagging shots: Read full post »
New immunization recommendations come out every February. They’re released to assist parents and clinicians in keeping all children up to date and protected from life-threatening infections. The update reflects new science and discoveries, while improving the schedule of vaccines due to outbreaks of infection or improved understandings of how to protect children better amidst a potential resurgence.
This is relevant to every parent: every year the rules for what-children-need-which-shots-when can change. Just when we think all of our children are “up to date,” new science evolves that potentially changes their immunization status. For example, read about new information published this year for the Tdap shot–how & why our children’s immunity fades.
We have to do our best to avoid making false promises to children about “not needing a shot” when they go in to see the doctor. Just when we do, we find our child is due for a necessary booster or missed vaccine. Commonly, children are missing the last shot in a series of immunizations (for example, to protect children and teens from HPV, they need 3 total shots or children haven’t had the second chicken pox shot). In my opinion, the promises broken break trust with our children and amp fear around going to the doctor. Much of the anguish around shots is the anticipation of them. So an update…
2013 Immunization Recommendations And Reminders:
This 2013 immunization recommendations have been simplified into one chart for all children from birth to age 18 (used to be 2 charts). It details the timing for shots and the necessary intervals between doses for all children. The detailed footnote section explains rationale for all the rules. In my opinion the 2013 schedule is easier to read and easier to understand.
Tdap for every pregnant woman, every pregnancy: the biggest change to the schedule is the recommendation that all pregnant women get a Tdap shot (protecting against tetanus-diphtheria-pertussis or “whooping cough”) in the 2nd half of each and every pregnancy. This recommendation was made due to surges in whooping cough infections, epidemics, and a 50-year high in positive cases. Because whooping cough is most risky to newborns we want pregnant women protected. Ninety percent of those who die from whooping cough are infants. The strategy to vaccinate during every pregnancy takes into count how quickly protection from the vaccine fades after we get it. And the reality the vaccine isn’t 100% effective. About 80% of those who get it are protected. The best way to protect us all is to have all children and adults up to date on their Tdap. Read full post »
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 »
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