Vaccines

All Articles in the Category ‘Vaccines’

Pile On The Paperwork: Vaccine Exemption In WA State

I’m happy about a new pile of paperwork coming my way. To be clear, I’ve never said this before. But I’m serious. Instead of stewing controversy, I suspect a new bill around here could open up lines of communication. I’m not living under a rock; I understand that some feel this new bill requiring signatures for vaccine exemption is heavy handed. I wholeheartedly disagree.

Yesterday Governor Gregoire signed a new bill into law that will demand families talk with a health care worker about the risks when exempting from immunizations. It turns out, WA state lags in their vaccination rates compared to national averages. In the last 10 years there has been a doubling in the number of students with exemptions for vaccinations in our schools. The biggest reason may be a convenience factor. The state suggests that 95% of exemptions are not for a medical reason, but one for convenience. Seems like you’d never opt out of immunizations for convenience putting your child or another child at risk. Right? But then think about how nuts your life is, how chaotic it is to raise children, and work, and pay bills and and and….

Imagine this: you’re a busy mom/dad, your child is about to start Kindergarten or 6th grade. The records you have for their immunizations are incomplete. You didn’t keep the book and like me and everyone else, your paper work isn’t filed perfectly. You’re pretty sure your child is “up to date.” You’re standing at registration at the school. You’ve been waiting in line and your left heel hurts. Come to think of it, your head hurts, too. Your daughter just tugged on your pant leg; she’s hungry. Quickly, when you realize you’ve got an incomplete record, you call your daughter’s doctor office while still in line. No one picks up when you call and you’re put in a queue waiting to talk with someone in medical records. You have a choice, would you rather just sign your name, exempting your child from vaccines, or go on a hunt for the records to ensure your child truly is up to date? Sure, the answer for most any parent is clear.

You sign your name. Read full post »

Influenza: Still Time For A Flu Shot


It’s not too late to protect yourself and your family from influenza. Influenza peaks during February and March in the United States. Now is the time to be vigilant in protecting against and preventing the spread, of flu. Washing your hands, staying home from work/school, and covering your cough can be incredible steps. BUT:

The most effective way to prevent influenza is to get vaccinated. If you haven’t had a flu shot, get one this week. Your child can be immunized if over 6 months of age, and remember that many children under age 9 will need a second dose (booster shot). Read about how to determine if your child needs a second dose <—-here.

10 Things To Know About Influenza:

  1. Influenza peaks in February and March in the United States. Look at the CDC data that reflects ongoing influenza activity
  2. Vaccination is the best way to protect you, your family, and your community from the flu.
  3. Children under age 5 are at higher risk from complications from the flu. Children under age 2 are at even higher risk. Children with asthma and with some underlying medical conditions are at high risk as well.
  4. Pregnant women are at exceptionally high risk from influenza and complications from the infection due to changes in their immune, cardiac, and pulmonary (lungs) systems. While pregnant women make up only 1% of the US population, they accounted for 5% of the country’s deaths from H1N1 (Swine flu) in 2009. All pregnant women are recommended to get a flu shot. However we know that only about 30% of moms are immunized at the time of delivery. The bonus of protecting themselves? New research shows how vaccinating pregnant women protects babies. When moms protect themselves by getting flu shot, they also prevent spreading flu to their babies. Babies born to vaccinated moms have a lower risk of flu (and hospitalization) under 6 months of age when they are too young to get the flu vaccine.
  5. The best way to protect a newborn baby from the flu is to have all caregivers (parents, grandparents, nannies) get the flu shot.
  6. People can spread the flu to others before they even now they’re sick. People also spread the infection after they have had it; they can continue to spread flu for 5-7 days in mucus, sneezes, and cough. The best way to protect yourself is to get a flu shot, and second to that: wash you hands, cover your cough, and stay home from school or work when sick with fever and cold symptoms.
  7. Each year 20,000 children under age 5 are hospitalized with flu or complications of the flu. 11 children died from influenza during the week of January 30-Feb 5th in the United states.
  8. Although flu is reported as widespread in 37 states, nearly all areas have circulating flu right now. See the most recent CDC data on influenza around the country.
  9. Overall flu vaccination rates are less than 50% for people under 65 years of age. To best protect our communities, vaccination coverage rates should be about 90%. We’re not there. Immunizing yourself and your family protects those who are too sick (or too young) to get the flu shot and are also at higher risk of complications.
  10. Flu shots for children under age 3 do not have thimerosal. Nasal Flumist doesn’t have thimeroal. Read National Network for Immunization Information (NNii) page on mercury in vaccines. I don’t believe you need to find a thimerosal-free flu shot.

2011 Immunization Schedule Recommendations

This week, Pediatrics published their yearly update to the recommended immunization schedule. Each year, the immunization schedule is reviewed, and when necessary, guidelines are changed to improve protection for children. Changes stem from new studies that provide insight into immunization spacing, infectious disease experts’ analysis of data from new trends in infection, or epidemics, like that from H1N1 or Whooping Cough. All of this data changes our understanding of how and who we need to protect as time unfolds.

Some of the new recommendations announced this week may require your child to get an additional shot when at the office next. Often we think our kids are up to date when they aren’t. We’re often wrong because of changes made to the recommendations or because our child has missed a dose at some point along the way. Or the records at the office aren’t complete…

Recommendations change yearly to define and hone the best practice for preventing infection in children and in our communities at large. The full recommendations are available in Pediatrics with a nice summary in Health Day geared more for parents.

If you have any questions about your child’s immunization status and their protection from infection, contact the physician’s office.

Talk with your child’s physician about these recommendations to clarify rationale and get their take and opinion. And, bring the immunization record with you! Keeping the book has been shown to protect your child and improves the likelihood of accurate records and thus, staying up to date.

The Injustice of Immunization Interviews

When Dr Wakefield interviewed on Good Morning America today, an injustice occurred. For children, I mean. And it occurred inadvertently I suspect. But I believe this injustice happens all the time when it comes to childrens’ health and wellness. What the media covers really changes how we think and feel about protecting and parenting our children. The media’s effort to inform and educate, just like that of physicians and nurses, social workers and ancillary staff, researchers and students, can get lost and misconstrued. ABC worked hard to inform us of the accusations against Dr Andrew Wakefield with a 2 minute introduction by Dr Richard Besser, a pediatrician and medical editor/correspondent. Yet when the interview was over, I was left remembering the myth.

Today I awoke to the boys asking for breakfast. After getting them to the table with a bowl of Life (always strange to offer a cereal named after our existence), I poured milk in my own bowl. Suddenly I realized that I needed to get the recycling and garbage to the curb. I donned my boots and a coat, ready to haul the can and a number of collapsed boxes to the curb. But just as I headed out of the door, the phone rang. It’s when the day went from the typical day (“making” breakfast and moving garbage) to a day steeped in really trying to understand. My mom was calling, she said Andrew Wakefield was about to be on Good Morning America. I hit my personal fast forward button, flew to the curb with the garbage, and got back inside with enough time to hear the complete interview.

Dr Wakefield interviewed on GMA with George Stephanopoulos who later labeled the interview “combative.” Mr Stephanopoulos was given a terribly difficult task: he was interviewing Wakefield on one of the most complex, emotional, and loaded quandaries of the last few decades: vaccine-hesitancy and Wakefields’s purport linking vaccines to autism. When Wakefield failed to deny any allegations and failed to discuss the significant research that refutes his own work, Mr Stephanopoulos had to defend science. Alone. George Stephanopoulos isn’t gaining popularity (read the comments) with the anti-vaccine crowd and even some who doubt what Dr Wakefield claims. Yet ultimately, the 7 minute interview with Stephanopoulos and Wakefield simply stirs the pot. I trust it will have huge viewership. I worry that this is, in part, why it was done. Read full post »

Do You Believe in Vaccines? (Part III: Experience)

Helping families make decisions about their child’s health takes training, expertise, and experience. The training is standardized (medical school, residency, fellowship), and the expertise confirmed by passing board examinations and maintaining yearly CME (continuing med education). But the experience piece is ultimately unique for each physician. With each day in clinical care, patients teach, instruct, and shape how we understand wellness and illness. Through individual experiences with patients, physicians ultimately become who they are in the exam room. In medicine, despite the huge push to standardization everything from centralized phone calls to how much (or little) time we get with patients, individual doctors will fortunately remain unique. As patients, we still get to enjoy our physicians as people helping us through illness and injury.

This week has been intense. Wednesday, I spent the morning as a patient in the care of my incredible doctor. (I’m fine). She’s entirely instructive for me as a patient and as a physician; her bedside manner astounds. I believe she’s just very good at her job, partly because she’s uniquely experienced. I believe her experience being a nurse for many years before becoming a doctor really colors how she provides care–she gets it.

The week has also been intense because of this series. I’ve been thinking about immunizations, reading comments here on the blog, writing, and witnessing my patients’ responses. I’ve received many e-mails. Yesterday, I was at clinic for over 10 hours and like most days, immunizations were a huge part of my day. But I said things I’ve never said before…True synergy between my clinical self (doctor) and my writer self (Mama Doc), this experience is shaping who I am, in and out of the exam room.

Of course, experiences in clinical care (and living on planet earth) shapes how all pediatricians discuss and listen to families when discussing immunizations. Here’s the final segment in my series on asking pediatricians if they “believe” in vaccines. The 20 or so pediatricians who responded, talked about their experiences in representing vaccines. Additional comments are included in part 1 (emotion) and part 2 (evidence).

Experience:

Dr Kronman, a pediatrician and infectious disease fellow:

We don’t see these diseases anymore. I work at a premier tertiary/quarternary care facility for children. I have seen children die of influenza (seasonal, H1N1), pneumococcus, meningococcus, the late sequelae of measles, pertussis; I have seen Hib meningitis, tetanus, severe debilitating outcomes with varicella, cervical cancer caused by HPV, and severe rotavirus. This list goes on. But most people haven’t seen these things anymore. People don’t have to panic about their children in the summer becoming permanently paralyzed from polio, because we don’t see it anymore. And the reason? Vaccines. Read full post »

Do You Believe in Vaccines: (Part II: Evidence)

I asked a group of 33 pediatricians what they would say to the question, “Do you believe in vaccines?” while standing in line for coffee. I asked for their help in thinking about an effective, 2 minute answer.

This is part 2 in a series. For detailed information behind the why, read part I (emotional responses) or watch the video explaining how this came to be. As I said, I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. Part of the reason I started this blog was that in practice, I realized when I told families what I knew and learned in training, they listened. When I told them what I did for my own children and how I felt, they made decisions. Telling my story seemed essential.

(This is going to sound familiar) I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

Today I’ve included responses from pediatricians that mentioned things that I experienced as “evidenced.” But rather than talk to you about numbers, causality, rates of autism, and the absence of thimerisol in all childhood vaccines (except multi-dose flu shots), these comments focus on the evidence that helps physicians discuss immunizations with families. There was a paucity of numbers in the responses from these physicians.

Dr Gayle Smith (@MDPartner), a general pediatrician in Richmond, VA says it best:

I’d say how much I wished pediatricians were better ‘rock stars’ with our message of prevention so we could be more effective in the media limelight.  I’d speak my own willingness to touch the hearts of the families I care for, to carry the bag of fear and worry for them, perhaps lessening their load a bit. Read full post »

Do You Believe In Vaccines? (Part I: Emotion)

I wrote 33 pediatricians an e-mail asking what they would say, while in line for coffee, to the parent of a newborn when asked if they “believed in vaccines.”  I wrote the e-mail not as a gimmick or a way to frame the issue of vaccine hesitancy, but because this happened to me. Rather, this happens to me. Often. When a new father asked me this question while carrying his newborn baby 2 weeks ago, I told him what I thought.  I then ruminated about my response for 24+ hours and wrote a group of colleagues. How do we talk with parents we don’t know, outside of the exam room, to help them understand why we feel so strongly about protecting children with vaccines?

I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. I wanted to hear what these expert pediatricians would say to get a sense of their collective insight. I wanted you to see it, as well.  I want to be really good at my job as a pediatrician when helping families understand the science, the evidence, and the emotion behind raising healthy kids and preventing illness with vaccines.

But I also really want families to understand why pediatricians work so hard to vaccinate children. I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

We are all so similar.

We all want to do what is right for our children.  That’s why everyone is so nuts about this. Simply stated, we all care immensely.

This was confirmed when I wrote docs from all parts of the US. I got over 20 responses.

I’ve arranged these pediatricians’ thoughts based on how I experienced their comments:

  • Emotional
  • Evidenced
  • Experienced

These thoughts are not mutually exclusive; you’ll hear evidence in the emotional comments, experience in the evidenced ones, and emotion in the experienced ones. Today’s post includes responses that felt emotional.

As I said in the video, it isn’t just parents who are emotional about vaccines. Read the comments to that post and you’ll see—some 30+ comments, mostly written by pediatricians, full of energy, data, and emotion. Pediatricians (and scientists/public health experts) are ultimately responsible for improving the way families understand immunizations. So this is weighty.

Emotional:

Most of these doctors wrote me about listening more than about talking.  But here’s some of what they said:

Dr David Hill, a pediatrician in North Carolina wrote:

Boy is this an issue on all of our minds! For me this question has particular poignancy, as we all watched our partner’s (a pediatrician) 22-year-old daughter die of H1N1 last year. To see her face-down on a ventilator, bloated and pale and then to have a parent tell me, as one did last week, ‘Everyone knows the flu vaccine causes just as much disease as it prevents.’

Gulp. His response to that parent’s viewpoint: Read full post »

Two Minutes To Represent Vaccines?

Last Friday I was in line for a coffee and met a newborn baby. Her father asked me if “I believed in vaccines.” I answered him (hint: I do). But then I got to thinking…how could I have done it better? I wrote some friends…

6 Tips For Successful Shot Visits

Getting shots, or the pain and fear associated with them, is one frustrating association children have with seeing their doctor. There are some ways to make this better. Diminishing shot anxiety is a huge goal for parents and pediatricians. If expectations are clear, everyone can leave a visit after shots feeling more successful.

  1. Prepare: Do your best to prepare yourself for a visit where there will be shots. Bring your husband/wife/partner, friend, or relative with you for support. If you act or feel nervous, your child may pick up on this. Even infants pick up on nervous cues. It is well known that parental behavior influences the amount of pain and distress from shots. In one 1995 study, 53% of the variance in child distress during immunizations was accounted for by maternal behavior. Geesh! So, if you’re freaking out, your child may be influenced. A Pediatrics review article in 2007 found that excessive parental reassurance, criticism, or apology seems to increase distress, whereas humor and distraction tend to decrease distress. First shots for new parents are often nerve-wracking. Layer your support and tell your pediatrician you’re nervous so they can provide reassurance and support. Bring a new toy for your child, plan a joke ahead of time. Scripting may truly help.
  2. Distraction: Use distraction whenever possible. Squeeze your child’s hand during shots, sing songs together, blow on your baby’s face, or talk about plans you have later in the day during the injection. Discuss your favorite spots or places you’ve been together. Also, consider the “cough trick.”  A study in Pediatrics out earlier this year found that children (age 4-6 and age 11-13) who were coached to cough during the injection experienced less pain from the shot. Read full post »

Understanding Immunizations

It’s my true fortune that I spend the majority of my days with children–my patients and my own. But as a mom in the year 2010, I find I worry a lot. As a pediatrician, my job is to reassure. My experiences with these divergent, and then entirely interwoven roles, converge at one issue in particular: immunizations.

The reality is, we live in a vaccine-hesitant world. With my patients, my friends, and even my family, I hear many myths about vaccines. I hear truths, too. Mostly, I feel and witness worry. When it comes to getting shots, most everyone wants to know a little more. There’s no doubt that the things we read online and in the paper, or the mutterings we hear on the news and in line at the grocery store, have left us frightened about immunizations. I remember the fearful stories more than the reassuring ones. Don’t you?

Despite this worry, I believe that alongside the challenge of overweight/obesity, hesitancy about shots may be the biggest issues facing children, parents, and pediatricians today. I spend more minutes (hours) per day with vaccine-hesitant families than I ever imagined I would. So this is a part of my every day. But hold on a minute, this is not a post about the “rights” of doctors or vaccines or the “wrongs” of another group. This is a blog post to help illuminate your right to earnest, research-based information regarding immunizations. You need to have compassionate care rooted in scientific evidence; you need to know what science holds. What I mean is, you have a right to really understand why doctors recommend immunizations.

Vaccines are discussed nearly everywhere by nearly everyone. As a parent, be selective about what you read and with whom you discuss these issues. Not everyone at the water cooler has expertise in this area. And not everyone understands the enormity of the issue, let alone the repercussions of their advice. As the wise say, “Don’t believe everything you think,” either. Read full post »