‘vaccines’

All Articles tagged ‘vaccines’

Measles At The Super Bowl

Like the makings of a Hollywood movie, I learned this week that there were an estimated 200,000 people in Super Bowl Village this past weekend in Indiana. Amongst them on February 4th, was one (or maybe two) child with infectious measles. Fortunately, the child didn’t attend the game. Yet, measles is highly contagious. The period of infectivity starts before symptoms in some cases and usually 4-5 days before the typical rash, when many think they have just a bad cold. Measles is spread by the respiratory droplets infected people share when breathing, coughing, or sneezing. And the virus can survive for about 2 hours on surfaces or in the air after a person leaves the room. Measles has a wild history and although most children/adults do well after recovering from the illness, measles can result in severe complications like pneumonia or encephalitis. Fortunately, the majority of those in attendance last weekend who may have walked by or been near the infected person were protected by the measles vaccine.

The incubation period (the time it takes to get sick after being exposed) is about 10 days with measles. So if unprotected people contracted measles last weekend, they may get sick this weekend or early next week. Hopefully, we’ll hear of no one.

Measles spreads easily. There are reports of measles infecting every single unvaccinated person at a picnic. The public health department, even here in Seattle, sent an advisory email last night with instructions for what we doctors should do if we suspect measles in someone who was in Indiana last weekend.

But this is a global thing not just a US national sport thing. Starting in 2009, the number of cases of measles rose sharply in Europe. In 2010 for example, there were over 30,000 cases of confirmed, reported measles and in 2011 (through October), there were over 25,000 cases, with over 14,000 cases in France alone. Fifty percent of those with reported measles were children, less than 14 years of age. Immunization rates for measles have declined in Europe and public health officials point to waning vaccination as one reason for the surge. Read full post »

An App For That?

Stop what you’re doing to read this The New England Journal of Medicine perspective by Dr Doug Diekema. It’s about vaccines, opportunities for health, and physician obligation. Written for physicians, it also speaks loudly to parents and includes a few very essential points. The whole time I read the article, my thoughts kept leaping to our imminent opportunities. Today, in 2012, we can harness the tools of social media and technology to solve many of these problems. It’s time. HPV vaccine? Varicella vaccine? Remember your yearly flu shot?  I really think there could an app for that.

Let me explain.

Dr Diekema opens describing a scene very typical in Seattle.

Recently, the mother of a young child confessed to me that she didn’t know any parents who were following the recommended immunization schedule for their children. She said that when she told her pediatrician she’d like to follow an alternative schedule, the physician had simply acquiesced, leading her to assume that the recommended schedule had no advantage over the one she suggested.

Yes, the physician obliged her desired schedule for many reasons, I suspect: time restraints/desiring a partnership/a hope for future opportunities to provide education and update immunizations for the child. In a state (Washington) that leads the nation in vaccine exemptions, we encounter patients daily who prefer a delayed or personal schedule. I’ve written about parents and alternative schedules and physicians’ conditional comfort with alternative vaccine schedules. But when Dr Diekema mentions this family, he highlights what many pediatricians and family physicians realize: families may be clustered together in vaccine-hesitancy. Friends of friends instruct each about vaccine schedules and share beliefs about safety. We know that 40% of parents who use an alternative schedule create it themselves.

Family members persuade my patients not to get immunized. Even in the midst of a pertussis outbreak in the county in which I practice, grandparents and relatives of newborns refuse the Tdap vaccine. My patients are bombarded with advice and naysayers. Who we love (friends and family) and who we trust (friends and family) certainly affect what we do. My patients get confused. And most of health (care) conversations happen outside the exam room. Therefore, hesitancy clusters in neighborhoods naturally and poses regional risk. What if we had real time information about our schools? About our neighborhood? What if Google mapped our rates of protection from vaccinations? What if we had a smart phone app that provided us yearly data on school immunization/exemption rates when we selected a kindergarten? Why not an app for that? Read full post »

Pediatricians’ Conditional Comfort With Alternative Vaccine Schedules

I had coffee with Dr Doug Opel last week to discuss his study about pediatricians and alternative vaccine schedules that published today. I learned a lot while we spoke. There is great wisdom in what he said (below in the interview & on video) that extends far past what he learned in the study.

Dr Opel is one of those genuinely authentic, kind people. The kind of person you meet and wonder, gosh if only I could be a fly on the wall when he’s making decisions for his kids or decisions for his life or decisions for his patients–I’d be so much better off. Not just because I’d see the answer, but because I’d have a front row seat while he asked the questions. He’s just remarkably thoughtful so there is no wonder this study illuminated some helpful observations.

Dr Opel and his colleagues conducted a survey of WA State pediatricians to find out how often they were being asked about alternative vaccine schedules and how doctors felt about it. Seventy-seven percent of pediatricians reported they are regularly being asked to use an alternative vaccine schedule. And in general, the majority of pediatricians (61%) are comfortable with alternative schedules but only for particular vaccines. Meaning that although pediatricians are okay with parents’ request to delay some vaccines (Hepatitis B vaccine or Polio) they are not comfortable waiting on others (DTaP, Hib, or PCV). The reason, Dr Opel suggests, is that pediatricians are unwilling to leave kids unprotected for potentially devastating diseases that still circulate in our communities.

In this interview, Dr Opel lends insight to the culture of concern about vaccine safety, how the changing health care environment has shaped how we ask questions in the exam room, and how the concern about autism and vaccines is simply emblematic of concerns about vaccine safety in general. Read full post »

Pediatricians Who Refuse Families Who Don’t Immunize

I just responded to a New York Times “Armchair Ethicist” chat about pediatricians who refuse patients who don’t fully immunize. I realized my comment on their site belongs here on the blog. (my comment is number 79 but also copied below).

What do you think about pediatricians who refuse patients who don’t follow the AAP schedule? Do you disagree with me? Would you be more comfortable seeing a pediatrician who refused those families who chose not to immunize to protect your children? Have you, or someone you know, ever been kicked out of a pediatrician’s practice?

I’m a pediatrician (w a master’s degree in bioethics) and mother to 2. I will always keep my practice open to vaccine-hesitant families. However, the waiting room risk (unimmunized kids & risk to vulnerable populations–ie infants, those too young for vaccines, and immunocompromised children) is a good one and the only compelling reason to close to patients who refuse immunizations in my opinion.

But it’s not a good enough reason for me to send families away who have questions and hesitations about the AAP/CDC schedule. All children deserve a pediatrician versed in immunization benefit/risk & deserve an expert in conversation w their parents to foster insight & understanding. Frankly, if waiting room risk is the concern, there are ways to create separate waiting rooms for kids “up to date” and kids who are not.

Great thing is, only about 10% of families use alternative vaccine schedules. In a recent Pediatrics article, only 2% of families who used alternative schedules refused all vaccine altogether. So although this is a large issue in pediatrics and parenting, the majority of families do vaccinate on time or nearly on time. I don’t want to lose sight of that.

I practice in WA State. We lead the nation in exemptions for vaccines (over 10% of kids w exemptions vs only 2% nationally) and have recently put into place a law that requires families to consult with a health care provider prior to an exemption. It was designed to avoid exemptions out of convenience. This hopefully opens up the opportunities for discussions with parents & pediatricians!

We all want the same thing: healthy children, healthy communities. Fostering conversation and diminishing a context of “war” or opposition about immunizations is an important step. In my experience, most parents end up immunizing their children over time even when they start out as refusers. The group of full refusers is fairly small. So allowing all kids into my practice feels like a great opportunity.

What Is The Tdap Shot? Seattle Mama Doc 101

Tdap is a shot necessary for all adults and children starting at age 11 that protects against infections caused by Tetanus, Diptheria, and Pertussis (Whooping Cough). Because of increasing reports of Whooping Cough and increased infant deaths in the last 2 years, we are working hard to protect infants, children, adolescents and adults from Whooping Cough (caused by Pertussis). Most importantly we want to protect our newborn babies from being exposed or contracting whooping cough. Whooping cough is most dangerous and most devastating (occasionally fatal) for newborn babies (under 2 months of age) and infants under the age of 6 months. If you are around a newborn baby it’s essential you’ve had a Tdap shot at least once as an adult. Watch the video for more.

Keep in mind, even fully vaccinated adults can get pertussis. If you are caring for infants or young children, check with your health care provider about what’s best for your situation.

What is Whooping Cough & How is it Treated (Link)?

WHEN TO CALL THE PEDIATRICIAN: Pertussis infection starts out acting like a cold. You should consider the possibility of whooping cough if the following conditions are present:

  • The child is a very young infant who has not been fully immunized and/or has had exposure to someone with a chronic cough or the disease.
  • The child’s cough becomes more severe and frequent, or her lips and fingertips become dark or blue.
  • She becomes exhausted after coughing episodes, eats poorly, vomits after coughing, and/or looks “sick.”

How To Protect Your Family From Whooping Cough

  • The best way to prevent Pertussis (Whooping Cough) is to get vaccinated.
  • Children 7 to 10 years old who did not have their full DTP/DTaP series (2,4,6, and 15 months shots) need a Tdap shot.
  • Children with either an unknown or incomplete shot record/history before age 7 years of age need a Tdap shot.
  • All adolescents with an up-to-date record need the Tdap shot at the 11 year old well child check-up/visit.
  • Anyone over age 11 who has not previously received Tdap – when indicated.
  • There’s no minimum interval between Td and Tdap vaccines. Meaning, if you for some reason had a Td (“tetanus booster”) in the last few years, you still need a Tdap now to protect against whooping cough(Pertussis). No 5-10 year interval is required between the shot.
  • Vaccine protection for pertussis, tetanus and diphtheria fades with time, so adults need a booster shot. Experts recommend adults receive a Td booster every 10 years and substitute a Tdap vaccine for one of the boosters.
  • Getting vaccinated with Tdap is especially important for adults who are around infants – new parents, grandparents, babysitters, nannies, and health care providers.

AAP Policy Statement on Using Tdap to prevent Pertussis

CDC: Protecting your family from whooping cough (Pertussis)

It’s Time For A Flu Shot

Why To Get A Flu Shot (Cliff Notes):

Influenza causes more hospitalizations than any other vaccine-preventable illness. It’s not just kids at risk for complications (asthmatics, diabetics, children with complex heart disease or immune problems) that die from the flu. Nearly 1/2 the children who died in this last year in the US were well, healthy children. PREVENT influenza, get a flu shot for all the members of your family. Although the flu vaccine dose is the same as last year, it’s recommended we all get a dose this season. For children who didn’t have a dose last year under the age of 9: they need 2 doses this year, separated by 1 month.

Links worth reviewing:

10 Things To Know About Influenza

www.flu.gov

Seasonal Influenza 2011-2012 from the AAP

Summary describing CDC data on complications and deaths from Influenza this past year

Flu Information from Seattle Childrens

ERRATA: I said that 46% of all children who died between Aug 2010 and Aug 2011 were healthy kids. The correct number is even higher: 49% of the 115 children who died in the US were healthy children without significant flu risks. My apologies.

HPV Vaccine Safety

The current conversation about HPV vaccine is a perfect example that anecdotes about health are powerful. My belief: anecdotes with evidence can be more powerful.

I am going to write a series of blog posts about HPV virus and HPV vaccine. Please tell me what you want to know. What questions do you have about HPV vaccine safety? What concerns do you have about HPV virus in girls and boys, women and men? What can I clarify? I plan to write stories from my own practice, interview adolescent medicine experts, and talk with pediatric vaccine researchers. Who else should I talk to?

In clinic, I recommend HPV vaccine to girls at their 11-year visit. I talk about the shot yearly thereafter with girls and their parents if they haven’t completed the series. Boys can also get HPV vaccine (HPV4) to prevent genital warts. One of the most challenging parts of protecting girls (and boys) from HPV virus is completing all 3 shots in the series. In Washington State for example, over 69% of our girls have received the first HPV shot, but only 45% have completed all three.

For starters, here is a link from the CDC summarizing questions about HPV vaccine safety: HPV Vaccine Safety

And here’s a statement from the AAP about HPV vaccine in the news:

The American Academy of Pediatrics would like to correct false statements made in the Republican presidential campaign that HPV vaccine is dangerous and can cause mental retardation. There is absolutely no scientific validity to this statement. Since the vaccine has been introduced, more than 35 million doses have been administered, and it has an excellent safety record.

The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians all recommend that girls receive HPV vaccine around age 11 or 12. That’s because this is the age at which the vaccine produces the best immune response in the body, and because it’s important to protect girls well before the onset of sexual activity. In the U.S., about 6 million people, including teens, become infected with HPV each year, and 4,000 women die from cervical cancer. This is a life-saving vaccine that can protect girls from cervical cancer.

Varicella Vaccine: It Works

I don’t diagnose Chickenpox often. I’ve seen patients with Chickenpox only a handful of times since I started medical school in 1998. Auspiciously, there simply haven’t been many children to serve as my teachers. Varicella virus causes Chickenpox and there’s a vaccine for that. So, like Smallpox or Polio, I’ve been forced to learn a lot about Chickenpox in textbooks. My strongest professor in the Chickenpox department is my own memory; I had Varicella between the age of 5 and 6 years. It was the one week of my childhood where I remember being really babied– my mom gave me a small gift or craft every day while I was home from school. I got to watch TV on the couch. I must have looked pretty awful…But it wasn’t so bad and I was lucky. I was a healthy 5 year old girl who had a case of chicken pox that was “run of the mill”: lots of spots, lots of itching, a week of fever and feeling crummy. Then poof, I scabbed over and got better. The only remaining trace (besides the virus that may live in my nerves) is the scar on my L forehead. You seen it?

The big trouble with Chickenpox is you can’t predict which child will have a serious complication (a brain infection, an overgrowth of flesh eating bacteria in the sores, or a life-threatening pneumonia).

While I was finishing up college, the Varicella vaccination was introduced into the United States. At that time, over 150 people died every year from Chickenpox and over 11,000 people were hospitalized annually. This created a huge economic toll (from missed work to health care costs).

So my apparent lack of clinical opportunity with Chickenpox reflects reality. A study published this week found that over the last 12 years there has been a 97% reduction in deaths from Chickenpox in children and adolescents younger than 20 years of age. There’s been an 88% reduction of Chickenpox deaths over all (kids plus adults). These are staggering statistics. Read full post »

Speak Up, Share Your Values About The Vaccine Schedule

Ever wonder how the CDC makes the vaccine schedule? For example, how they decide when to start a dosing series (at birth versus a year of age versus age 11) or why pediatricians and other clinicians recommend the number of shots that we do?

Ever want to let them know your thoughts about how the schedule feels to you and what values you feel should contribute to changes?

This is your moment. For real. 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 »