‘vaccination’

All Articles tagged ‘vaccination’

Hepatitis A Outbreak: A Vaccine For That

frozen smoothie berriesThe CDC declared an outbreak of Hepatitis A over the weekend that has affected over 30 people in 5 states. Preliminary information confirms the source of the outbreak stems from organic frozen berries that were sold at Costco stores (including stores in Washington) yet sickened people thus far are in Colorado, New Mexico, Arizona, Nevada, and California. No cases have been reported in Washington to date. The berries: Townsend Farms Organic Anti-Oxidant Blend, a frozen berry and pomegranate seed mix, have now been pulled from shelves and people who purchased these berries from February through May are being contacted.

The amazing thing about this outbreak: there’s been no reported cases of Hep A in children under age 18.

In the United States, Hepatitis A typically spreads through contaminated food handled by someone with the infection. Rates of Hepatitis A infection tops 5,000-10,000 cases annually in the US while they are far higher in the developing world because city water sources can get contaminated (see below). Hepatitis A vaccine is recommended before international travel.

The lack of children with infections from this outbreak is logical and potentially illustrative.

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People Are Dying From The Flu

Screen Shot 2013-01-08 at 12.45.43 PMInfluenza virus causes “the flu.” It’s a crummy cold that spreads easily causing high fever, body aches, runny nose, terrible cough, and rarely it can cause vomiting and diarrhea, too. The flu isn’t the “stomach flu.” It’s deadlier than that. It’s more dangerous for babies and young children, and for the elderly. It’s also particularly dangerous for those with asthma, diabetes, and people with neurologic or immune problems. This post is a bit of a plea: people are dying from the flu and there are ways we can potentially save others’ lives. Click through to read 5 myths about the flu and watch a 3-min interview I did for HLN television yesterday.

The bad news: We’re having a bad flu season. More people have the flu this year than at any time last year. This is early—flu usually peaks in Feb or March. The most dominate strain of flu that’s moving around the US is the strain called H3N2—it’s known to cause more serious disease. As of today, we have over 80% of our states reporting widespread circulating levels of flu. Here in Washington many people have been hospitalized from complications of the flu. Further, in Washington 6 people have died, one of them a child under the age of 12. A healthy 17 year-old died in Minnesota just this week. Flu is not just your “common cold,” it can be far worse. Eighteen children have already died this season. As of November, we didn’t even have 1/2 of our population with a flu shot. The goal to protect us all is 90%.

I’ve never had a family in clinic get influenza illness and then refuse the flu shot the following year.  They come in early and often for their shots. It’s that bad of an illness.

The good news: We have a vaccine for the virus that causes the flu. The flu shot and flumist nasal spray are effective and that H3N2 strain that we’re worried about, it’s in the flu shot and the nasal flu spray this year. It’s not too late to get a flu shot. You’ll be protected against the flu somewhere from 10 day to 14 days after getting it. Go out now and protect yourself and your family. By getting a shot you protect yourself, your children, and all those more vulnerable in our community unable to get the shot (those infants under 6 mo of age, those on chemo, or those with contraindications to the shot).

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Whooping Cough Shot: Does It Last?

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 »

2 Questions For School On Community Immunity?

My phone wasn’t working well today so I stood in line at the “genius” bar this afternoon to resolve the problem. To be clear, that was 2 1/2 hours ago and I’m home with the promise from a very nice genius that it would be activated by the time I reached my home. It didn’t happen and I’m phoneless (a new thing for me) so it’s quiet around here. In lieu of being able to communicate by phone, I’ll share something I learned while waiting for help. It turns out to have shaped my thoughts for the afternoon.

While at the store, I ran into a researcher who works at the interface of vaccine hesitancy and immunization rates. We got to talking about his work, my writing and work in clinic, and what will ultimately help families. I mentioned what I really want is for families to get good information from their pediatricians (online and off) so when they immunize their children, they rest easy knowing that their children are protected. He asked a question, well two questions, that I didn’t have the answer to in my own life. I wonder, do you? Read full post »

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 »

Guest Blog: Dr. Ari Brown on Dr. Oz

Dr Ari Brown, a pediatrician and author (books in photo), was on Dr Oz yesterday. She was asked to join a discussion about autism. Dr Brown is a board-certified developmental pediatrician, a mom to two, and an advocate for science. She is passionate and clear about what she believes. She is speaking all over the country about how to protect children from illness, particularly when making decisions about vaccines. She contributed ideas in my series in late 2010 entitled, “Do You Believe in Vaccines: part I, part II, and part III.” On Dr Oz, she was asked to contribute to a discussion about autism that ultimately focused on fears about vaccines. I worry the discussion wasn’t a representation of most American families and even Autism Speaks refused to join the show.

She’s shared with me a blog post she wrote after being on the show. Many other pediatricians are writing about the show; read Dr Natasha Burgert’s post, too. On the show, Dr Brown sat next to Dr Bob Sears, a pediatrician who deviates from the recommended AAP schedule and had a chance to discuss her take. She sheds light on what we can do as parents to really understand. Thanks, Dr Brown.

I am thankful, Dr Oz, for the opportunity to participate in your autism show. Both the American Academy of Pediatrics and I hoped the show would help educate the public and move the conversation forward.
As a pediatrician who talks with families everyday in my office, I know parents want to know more about both vaccine safety and about autism. I’m also a mom. Like you, I need accurate information to protect my kids as best as I can.
I am concerned that viewers took away a very inaccurate view of vaccines. The most vocal audience members represent a small minority. Most parents of children with autism agree with the scientific evidence and do not believe that vaccines cause autism. 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 »

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 »