All Articles tagged ‘immunizations’

Vaccines, Profanity, And Professionalism

Screenshot 2015-02-01 12.30.40You’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.

Read full post »

Cocooning For Measles

2-12 measles cocooningThe 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 »

Measles Outbreak With A Baby At Home

baby-O-e13075541951481Many 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 »

Enraged By 2015 Measles In America

Screenshot 2015-02-01 12.30.40I 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 »

Ouchless Flu Vaccine In 2014-2015

Influenza spray finalIt’s Flu “shot” season but thankfully not every vaccine hurts going in. This year your child may be offered either the “flu shot” or the flu nasal spray vaccine (ouchless!). This year most nurses and docs will encourage young children to get a nasal flu spray over the shot as recent data has found the nasal flu vaccine protects younger children better. Every year the flu vaccine is created to protect against influenza viruses predicted to spread and circulate in North America. We need the shot every year for two main reasons:

  1. Typically, different influenza virus circulate around the world from year to year. Over 100 international centers maintain year-round surveillance to determine and predict which strain will cause human infections. The information is used to forecast the recipe for the vaccine here at home. This year the strains (types) of influenza in the shot and nasal spray are the same as last year (2013-2014).
  2. Protection Fades. When you get a flu vaccine you stimulate the immune system to create protection against the strains of the virus in the vaccine. That immunity (the antibodies that are created) tends to fade and wane in your bloodstream after about 6-12 months. Therefore, even if you got the flu vaccine last year you really want your family to have it again this year so it protects you through the winter influenza season which can continue late into the springtime but tends to peak in February or March.

The flu vaccine contains either three (trivalent) or four (quadrivalent) strains of influenza. There is no official recommendation for one over the other. Flu vaccine is recommended for all children over 6 months of age who have no contraindication to the vaccine.

Worth noting: If the thought of needles deters you from getting the vaccine for your child or your family, Live Attenuated Influenza Vaccine (LAIV), a nasal spray, is a great option for those age 2 to 49 years. In fact, there’s data to suggest the nasal flu vaccine is more effective in protecting children from influenza in young childhood. Recommendations this year include a push to have children between 2 and 8 years of age immunized with the nasal spray whenever possible. If the nasal isn’t available, the shot should be given — no reason to wait.

About 20,000 children younger than 5 years old are hospitalized from flu every year  — form CDC “Which Flu Vaccine Should Children 2 to 8 Years Old Get?”

Information about nasal flu spray from CDC, Healthy Children and my “Debunking 5 Myths about the Flu

Who Can Get The Nasal Flu Vaccine?

Read full post »

The Link Between Vaccines And Optimism

Yesterday morning there was a public Freudian slip. It was perfect. During an interview on the Today Show about “hot button” health issues the team addressed concerns about myths related to the causes of autism. Autism spectrum disorder, now estimated in 1 of 68 children, is a brain condition causing challenges with how children communicate, behave and relate with others. Autism spectrum disorder is thought to be caused by a mix of genetic risk, potentially starting inutero, and potentially influenced by environmental factors. There is so much more research needed to understand causes (for cures). In the past some have pointed to vaccines as a cause of autism although that theory has been debunked, disproven, and refuted again and again. But here’s what happened on the show. The interviewer addressed the topic and said, “We hear a lot about it in the media, that is, vaccines causing optimism….”

Now it was a misspeak, which of course happens to us all, all the time. But it got me thinking, we need to share this real link  like wildfire — the link between vaccines and optimism. We moms, we dads, we pediatricians, we nurses, we family doctors, we community members, we must speak up. Share this incredible fortune, peer-to-peer, the reality that indeed living now in the 21st century that yes, vaccines are linked to optimism.

Read full post »

Something In The Air: It’s Measles

Something is in the air right now. There’s a strange mix of vaccine-preventable illness sweeping the country (measles) and a strange bump in media coverage for celebrities and vocal opponents to tested and recommended vaccine schedules. Part of me thought we might be done with that but pageviews, clicks, and views all sell.

My hope is the coincidence of coverage and outbreaks is just that, a coincidence. But as a mom, pediatrician, author and media reporter, the view from here is unsettling. We can’t prove that mishandled media coverage is changing the way we immunize our children (or at least I haven’t seen the data) and how parents protect them, but there are moments like this it feels it’s possible that trust is simply being eroded with this 24-hour online/TV/print news cycle. Parents might be vulnerable to bad medicine when gowned as good business. A couple of examples:

Two weeks ago Kristin Cavallari (a wife to an NFL player and reality TV star) went on Fox News to discuss her career (and parenting) and ended up discussing her theories on a group of vaccine refusers and autism. Perhaps talking about medical theories is a really good model for accelerating a career? Next up was Huffington Post where she dropped the bomb, “’I’ve read too many books’ to vaccinate my child.” I suspect she’s yet to read mine. Particularly chapter number 57 entitled Measles In America. Read full post »

Pain Is Inevitable But Suffering Is Optional

This is a guest blog from Lisa M. Peters, MN, RN-BC (in the video above). Lisa is mom of two children and a clinical nurse specialist for the Pain Medicine Program at Seattle Children’s Hospital. She holds a clinical faculty appointment in the Department of Family and Child Nursing at the University of Washington School Of Nursing. She is board certified in pain management from the American Nurses Credentialing Center and is a Mayday Pain & Society Fellow. Lisa has a passion for improving the lives of children in pain. I’ve learned so much from her already!


Pain is inevitable; suffering is optional. That’s a key message when I partner with parents who bring their kids in for procedures and hear them recount stories of standing by, feeling helpless, as they watch their kids suffer with pain and distress.

It does not have to be that way.

Parents seldom realize the power they have as advocates and as partners with doctors and nurses in managing, and even preventing, their children’s pain. Could that shot at the doctor’s office really be a different experience? Do a few moments of pain really matter in the long run? If I speak up, will they label me and my kid as “troublemakers”?

As a parent, you can make a big difference in your child’s experience with pain. Knowledge is power.

3 Things To Know About Pain:

Poorly treated pain is harmful, both immediately and long term.
Science continues to teach us about the consequences of poorly treated pain on our bodies and minds. There is evidence that it can change how our bodies process pain signals, especially during critical periods of development in childhood. This can lead to highly sensitive areas of our bodies or a generally louder experience of pain. Memories of painful experiences have been shown to shape how we respond; studies show that 10% of the adult population avoids seeking medical care when needed due to fear of needles. Read full post »

2013-2014 Flu Is Here

Influenza December 2013

Influenza currently has widespread activity here in Washington and fortunately the news media has really picked up the story the last couple of days. I say fortunately, because as we know more about flu in our community, the better we can work to protect our families. There’s no question clinic was full of coughs and colds yesterday!

At of the end of last week, the CDC reported that 25 states in the US have widespread influenza (see above map). In addition, public health officials confirm that H1N1 Influenza A is causing more serious, sometimes deadly disease in young adults. This post is simply a reminder that flu is here in our communities, work, and schools. The best way to reduce the risk of serious influenza infection is still to get a flu shot. Particularly if you’re a middle-aged adult (!!), as young adults are bearing a particular burden of serious disease this season. In fact,there have already been a number of deaths in WA state. Many of the individuals who died were unvaccinated.

This is still true: pregnant women, young children, those over 65 years, and anyone with underlying medical conditions are at higher risk for serious infection from influenza. Read full post »

Simply Not Factual

No-SymbolSimply not factual. That’s really all that needs to be said in response to Michael Edwards’ opinion piece entitled “Vaccine Side Effects and Why You Shouldn’t Vaccinate” published in Organic Lifestyle Magazine last week. This is clearly a non-peer reviewed, non-fact-checked online publication that Mr Edwards edits and owns. Fortunately, the magazine is reported to get about the same amount of traffic as my blog so it’s not exactly the Washington Post…

That being said, Edwards’ piece is so egregious I’m unable to hold my breath. Although I’m no watchdog, the dangerous writing demands physician attention partly because it’s been published amidst a noteworthy week in the world of vaccine misinformation:

  1. A segment aired last week by a local TV station in Las Vegas claimed doctors debating a need for vaccines. The TV station reported false information and misrepresented a chiropractor as a “holistic physician.” There was a noted uproar online, especially when original comments from physicians were, at first, taken down. Here’s more from news watchdog Gary Schwitzer, “Back To School Anti Vaccination Woo.”
  2. Mr. Edwards published false information claiming families shouldn’t vaccinate. More below.
  3. Jenny McCarthy’s credibility erodes further as it’s announced she is now advertising e-cigarettes. A pediatric colleague wrote a blog post entitled, “Jenny McCarthy continues tireless crusade to kill us all.”

Back to the piece in “Organic Lifestyle” though. What is so dangerous is not just Mr. Edwards’ misinformation but the way his article appears to the eye. Mr. Edwards published his vaccine opinion in a structure that misleads a reader to believe it’s based in fact. There are sections with headers, subtitles with supposed historical reference, and a list of resources at the end. All the while Mr Edwards warps truth and paints a picture of a fictitious world—one where those diseases now eradicated (small pox) or nearly so (polio) thanks to vaccines, aren’t.

Small pox has been eradicated by worldwide vaccination and thanks to vaccines married with a remarkable commitment from the Gates Foundation, polio is nearly gone too. Read full post »