Hot Shots

Equal rights for young men – Boys may get HPV vaccine

Several years after approving the HPV vaccine for girls for the prevention of cervical cancer (and genital warts), and a couple after giving a lukewarm recommendation for boys, the Advisory Committee on Immunization Practices has made a recommendation for boys and young men to get the vaccine.  

This is an important step, because some insurers do not pay for this vaccine for young men, even though they cover it for young women. Once the Center for Disease Control and Prevention (CDC) accepts this recommendation and publishes it officially (a 2 to 3 month process), insurance companies will be required to cover it as they do routine immunizations.

Here in Texas, we have been lucky because our state had the foresight to expand the federal Vaccines for Children program to include vaccination of “underinsured” individuals. So, many boys with otherwise good medical insurance, but not covering them this vaccine were able to get it through publicly funded programs. Budget cutting in Texas and elsewhere may soon make this option unavailable.

The discrepancy came primarily because the initial indicated use for the vaccine was to prevent cervical cancer. Although males and females have an equal burden of human papilloma virus infection, or HPV, and despite the fact that males help to spread the infection to females, males of course don’t have a cervix! They are just as prone to genital warts, however, and many physicians were in favor of immunizing them long before the vaccine was shown to have other benefits – the prevention of penile, anal and oral cancers among them.

Now the issue will be convincing parents and youth to be vaccinated. Immunization rates for HPV vaccine continue to lag behind the rates for other vaccines, mostly because of unfounded fears of serious side effects, and parental belief that their children are not at risk for this infection. 

 

Reliable Information Sources - Vaccines and Health Issues

We all have a tendency to listen to and believe tales of woe, and to pass them along pretty much uncensored. Furthermore, the Internet has provided a wide audience for rumors, as well as a source of both reliable and unreliable information.  The question is – how do we know what or whom to believe?

Recently, Michelle Bachmann’s comments about HPV vaccine have received widespread coverage.

If a claim is outrageous, be skeptical. There is nothing that causes a 12 year old to become “retarded” within a week; much less a vaccine that causes mental retardation.  Even head injuries, encephalitis and stroke can cause selective losses of ability, not instantaneous retardation.

Watch this story about a child who contracted HIB epiglottis because his parents chose not to vaccninate him based on unreliable information and fear of vaccinations.

If you think a health claim or any other claim is too good or too bad to be true, you should investigate further. Many scams and outrageous email rumors are debunked on snopes.com, and there are great sources of reliable information one the web.

Be aware that individuals with chronic health conditions are targeted by opportunists.  If there are few legitimate options for treatment of an illness, then worthless “cures” are even more likely to be marketed. Copper bracelets have never been shown to benefit chronic arthritis, for example. If you have a chronic health concern, beware of getting your information off of a website offering a cure for sale.

General search engines such as Google and Yahoo only match search terms and provide the lists of websites that include those terms – whether or not the information is accurate.  Being high in the listing does not necessarily mean that the information is more accurate, or that the site is the best one out there. Medical information changes often as new studies are published and it is a good idea to check more than one place for information.

Start with a trustworthy source, especially one which can link you to other reliable sources. Examples are the Centers for Disease Control and Prevention, the National Library of Medicine’s Medline Plus, the National Institutes of Health, the World Health Organization, as well as professional organizations such as the American Academy of Pediatrics, medical schools, and disease-specific organizations such as Parents of Kids with Infectious Diseases.

Websites should make clear who is responsible for the site and have a way to contact the information provider. Just because a website claims to be a “National Information Center” does not mean that it is government sponsored, or even nationally recognized by experts in the field as a reliable source of information.  Credentials are difficult to verify on the Internet, and an expert in one field may not be an expert in another, particularly in medical issues. Look for sponsoring organizations that allow their name and website links to be associated with the website.

Good websites will not have information slanted in favor of a site sponsor or funding source, particularly information that favors an advertised product or service. If there is a “lawyer referral” tab prominently displayed, then consider that the claim may be promoted because someone is trying to make money off of it.

Finally, look for facts and not for opinion. Beware of research quoted out of context and claims unsupported by research. 

Everyone should do their best to be an informed consumer of healthcare services.  Ask your doctor for leads on the best websites and information for your health concerns!

For more information on evaluating information on the internet, check the National Network for Immunization Information.

 

Flu Vaccine – Choices for 2011

Do you hate getting your annual flu shot? This year, you have more choices to be protected from the flu, including a new “mini-shot” that feels more like a mosquito bite than a shot.

The new vaccine is called “intradermal” because it barely goes into the skin – instead of into the muscle below – and has a short needle. While the vaccine works the same as the usual flu shot, the dosage is much less. 

For those of you who are still worried about preservatives in vaccines (needlessly, I might add), it is preservative free. This new version of the vaccine is approved for adults ages 18 through 65, including pregnant women.

If you are 65 or over, you may want to consider getting the “high-dose” vaccine that came out last year. This vaccine has four times as much vaccine antigen, the protein we respond to that makes us become immune. Older individuals have the poorest response to the usual flu vaccine and the high-dose vaccine has been shown to produce a higher level of immune response. 

When we get vaccinated, we know that a sore arm is a possible result. This is because our body’s immune response to the vaccine takes place in the muscle and can make it slightly swollen, warm or tender.
 
With the intradermal vaccine, the reaction – like the vaccine – is in the skin. You can expect a bit of local reaction at the site of the vaccination, most commonly a red itchy bump. The high-dose vaccine causes the same type of sore arm as the usual vaccine, but because it has more antigens, the likelihood of a local reaction is higher than with the usual dose of vaccine.

Nasal flu vaccine and regular flu shots are still available. Nasal vaccine is only for healthy individuals ages 2 through 49, while the regular flu shot, which comes both in multi-dose vials and in preservative-free versions, can be given to anyone age 6 months and older.

This year’s flu vaccine protects against the same strains as last year’s vaccine, but since immunity declines over time, you should get a vaccine this year even if you were vaccinated last year. Children under age 8 usually need two doses of vaccine when there are new strains, or if they haven’t received two doses in a previous year. If they received a dose last year, they will only need one dose of vaccine this year.

Vaccine is available now, so make time to come in and get vaccinated! Schedule an appointment with Kelsey-Seybold by calling 713-442-0000 or on MyKelseyOnline. 

Higher Insurance Premiums for Vaccine Refusers? NPR Discusses

 

This was a very interesting show on NPR today!  

It pondered the question of whether vaccine refusers should have to pay higher insurance premiums or if there are other responses that would be appropriate, since their refusal can end up costing insurers and the public health institutions money to treat and contain preventable infections such as measles.  

Give it a listen!

For more thoughts on this subject, visit BigThink.com. 

 

Get Vaccinated - Back to School 2011!

In the heat of the summer, it is hard to think of back-to-school doctor’s visits and shots, but now is the best time to come in – before the August rush!

Sports physicals and immunization updates need to be done before the fall term starts, or the late summer practices begin.

Elementary School
Of course, new kindergarteners need boosters for most of their baby shots before they start school. Of particular importance is the second dose of measles, mumps and rubella (MMR) vaccine, because there have been more cases of measles in the United States this year than any year since the early ‘90s when we had our last measles epidemic in Houston. 

Most measles are imported from outside the U.S., but there has been ongoing transmission in places like Florida. Don’t bring measles home as your vacation souvenir!

Other vaccines given at age 4 to 6 include Varicella (V) vaccine, diphtheria, tetanus, pertussis, and polio. Combination vaccines exist, so the number of shots is fewer than the number of vaccines! In late August, influenza vaccine will likely also be available, and should be given as soon as your doctor’s office has it.  

Children younger than 9 years old who have not had flu vaccine will need two doses, spaced one month apart. Catch-up immunizations for other vaccines and vaccines for children with certain health problems may also be offered.

Middle School
Entering middle schoolers in Texas need to show proof of having received two doses of MMR and varicella vaccines, as well as a booster for tetanus, diphtheria and pertussis (Tdap), and a meningococcal meningitis vaccine. They should also get the flu vaccine as soon as it comes out and the human papillomavirus (HPV) vaccine to prevent certain types of cancer, though these vaccines aren’t required for school entry.  

High School and College
A booster dose of the meningitis vaccine is now recommended at age 16 for adolescents who received a dose at age 11 or 12, and at least one dose of the vaccine is required for college entry in Texas, regardless of the student’s age.

College
College students should also make sure they have had two doses of the MMR, and a tetanus booster if it has been 10 years since their last one. They should get the Tdap version if they have never had it. If it hasn’t been given earlier, it is a great time for students entering high school or college to reconsider the HPV vaccine and to make sure that all three doses have been received.

Immunizations are one of the most significant things you can do to ensure a long, healthy life for your kids. Make sure they are kept up-to-date not only with required vaccines, but with other recommended vaccines. 

School entry requirements generally lag behind recent recommendations. Newly available vaccines and new recommendations for old vaccines come out often, and everyone should check to see if they are due for vaccines at every doctor’s visit.

Take Precautions before Traveling for Business Abroad

Do you travel frequently for business?

Do you often travel internationally, sometimes at short notice?  Perhaps you are setting up a branch office in China or your company is expanding into new markets.

You should consider having a travel medicine consultation and getting vaccines that may be recommended or required for possible future trips. If you often travel on short notice, you should consider “loading up” on the vaccines you might need for future trips.

Many travel vaccines need several doses or should be given a few weeks prior to the trip to be most effective. If your upcoming trip poses no risk for yellow fever, for example, but you are planning on a big trip to Africa next year for vacation, share that information with your physician or travel clinic nurse, and plan ahead.

Your activities and hobbies may increase your risk of certain infections. Spelunkers should get rabies vaccine because of exposure to bats in caves, but so should joggers traveling to parts of the world where canine rabies is sill common, such as China. 

Rabies kills over 50,000 people a year in the developing world and jogging increases your chance of dog bites. Your main trip may be to a large city, but if you think you might visit rural areas for recreation, additional preventive measures and vaccines may be needed, especially for infections transmitted by mosquitoes. 

The most common cause of injury in travelers abroad is motor vehicle accidents. While no vaccine prevents these injuries and deaths, seatbelts and helmets do! The developing world poses the highest risk of death from car accidents.

There are many reasons for this, including more inexperienced, “first-generation” drivers, narrow and crowded roadways which are less well maintained, less enforcement of driving standards, poor road lighting at night, multiple-use roads (wagons and foot traffic as well as cars and motorcycles and bicycles), and less-developed emergency services.

Wear your seatbelt and use a helmet on motorcycles and avoid travel at night whenever possible.

 

Bringing Baby Home for a Visit

I’ve recently seen several families who want to take their newborn out of the country for a visit with relatives abroad, or who are relocating soon. Many of these families are unaware of the risks that the trip abroad travel may pose for the baby and themselves.

Newborns have some protection from illness that is extended from mom through breastfeeding. Travel, however, poses additional risks for the baby.

In general, it isn’t wise to take your newborn on an airplane flight until they are over 2-3 weeks old. This is because some serious heart defects don’t develop murmurs or symptoms until that age – and the baby may need oxygen at high altitude.

It is best to avoid air travel until at least the first set of shots has been given, usually at 2 months, but as early as 6 weeks of life if necessary. This is because travel involves exposure to hundreds possibly thousands of individuals in airplanes and terminals.

Infants will be exposed to more colds, respiratory infections and public changing tables. These could potentially include whooping cough, rotavirus diarrhea and pneumococcal bacteria, all of which are preventable by vaccines given at the 2 month check-up. Even measles has been transmitted in airport terminals in the United States in recent years.

Travel abroad poses additional risks and most travel vaccines can’t be given to young infants. If your family lives in a country with measles, for example, it may be best to postpone the trip home until after the child is old enough for measles vaccine – usually given at 12 months, but possible to give as early as 6 months of age. Surprisingly, measles is now common in much of Europe, especially England.

The meningitis vaccine can now be offered as young as 9 months old if your travel is to the “Meningitis Belt” of Africa, or you plan to go on pilgrimage to Mecca. Other vaccines (yellow fever, hepatitis A, typhoid, Japanese encephalitis, etc.) may be recommended depending on your child’s age and your travel plans.

Before you make travel plans, check with your pediatrician for advice on the safest time for your baby to travel.

On Measles and Traveling Abroad: Get Vaccinated Before You Go

Measles has been in the news a lot this week in Houston, as an 11-month-old infant in Houston and two adults in Tarrant County were infected in the Orlando area returned to Texas with the illness.
 
Florida, Massachusetts and Minnesota have ongoing measles infections as a result of imported cases from other countries, and within the past few years, this scenario has played out in California as well. 

Measles, a disease once eradicated in Europe and most of the developed world, has made a resurgence in England and elsewhere due to unwarranted fear about vaccinations.

Countries and continents where there had been no measles cases for years (other than imported cases) are now experiencing ongoing transmission among citizens with no foreign travel. It could happen here as well.  

Every community has pockets of unimmunized individuals who either lack access to basic immunizations for financial and social reasons, or who refuse vaccinations due to unproven and non-scientific beliefs about vaccine ingredients or side-effects. 

A community has to be about 90 percent immunized for measles to prevent ongoing transmission and provide “herd immunity,” meaning that it is unlikely an infected person will pass the disease on to others because most people exposed are immunized.  

Measles is contagious. The virus can remain in the air for hours after an infected person has been in a room and those with infection are contagious for several days before they break out in the classic rash. 

About 90 percent of unimmunized individuals will catch measles if exposed. Anyone born after 1957 is recommended to have two lifetime doses of the measles, mumps and rubella (MMR) vaccine, and children as young as 6 months can be immunized if travel abroad is planned.

Those at highest risk of importing measles into the United States are immigrants and first-generation descendents of immigrants who go home to their native country to visit friends and relatives without updating their vaccines for travel. 

They are also most likely to become ill with typhoid fever or malaria on their trip, because they have lost the resistance that was built up from years of exposure, and are less likely to take precautions against food, drink and mosquito exposure. 

Casual tourists to Mexico and Switzerland have also imported measles cases into the United States, however. One case was even caught by a child in the terminal of an international airport, although the country he visited had no cases.

Anyone traveling out of the U.S. should check the Centers for Disease Control and Prevention website for information on disease risks in their foreign travel destinations. 

Are we giving too many vaccines too soon?

There are many more vaccines offered to infants now than when I went into practice. But despite the increase in the total of vaccines given, the number of “foreign proteins” (or antigens) in all of the vaccines given today that the child is exposed to is fewer in the vaccines we used prior to 1985.
 
This reduction in antigens is because vaccines have improved dramatically in the past few decades and components that aren’t necessary to develop immunity have been eliminated.
 
Infants are exposed to more germs and antigens at birth (as well as with the introduction of new foods, ear infections or strep throat) than with vaccines.
 
The immune system of an infant is designed to deal with foreign proteins. It is not foreign proteins that can overwhelm an infant’s immune system, but infections with diseases such as pneumococcal meningitis.  

Vaccines are produced by taking the germs that cause serious illness, and modifying them to render them harmless by killing them or weakening them. Some vaccines, such as hepatitis B, are not even made from the virus, but are copies of the viral capsule, mimicking the real deal.
 
It is your child’s natural process of developing immunity and their competent immune system that makes vaccines effective. The very studies that prove that immunity is produced by a vaccine also prove that the child’s immune system is not overwhelmed by that vaccine. 

Combination vaccines are proven to produce immunity that is not inferior to that produced by individual vaccines, and the vaccination schedule itself has been studied to show that giving the recommended vaccines simultaneously will produce good immunity. Again, the presence of good immunity is proof that the immune system has not been overwhelmed.

What about the stress of getting multiple shots at one visit? Well, when we are stressed, we produce specific hormones that can be measured in our blood and there are scales of infant discomfort that have been validated.  

Pediatricians as well as parents were concerned when the number of vaccinations recommended for infants began to increase because it is no fun for the doctor or for the nurse to have to give multiple shots at one visit, and combination vaccines were not immediately available.  

Several studies have shown that getting one shot is, as parents and doctors know, very stressful for children. Interestingly, however, the stress of getting five isn’t any different than getting one – both are equally strong stressors. Spreading out the shots just puts you and your child through more episodes of distress and leaves him or her vulnerable to infection longer.

How many of you insist on bicycle helmets for our children when they start to ride? We can see that they are most vulnerable to falls and injury when they are young and inexperienced. Unfortunately, infants and young children are more vulnerable to those catastrophic infections that are vaccine preventable. 

Delaying vaccinations delays effective protection, and puts your baby’s life and health at risk.  

Babies and Vaccines

I have 13 years of general Pediatric practice experience and an additional 12 years as a Pediatric Hospitalist in which I care primarily for newborns. 

I’ve been asked every question you can imagine about immunizations. I’ve studied the literature and attended conferences to be sure that I am giving parents accurate information. I believe every child deserves the best of care and the safety of immunizations is as important to me as it is to parents.

The questions I’m asked most often are: “Why do babies get so many vaccines so early in life? Wouldn’t it be better to spread them out? Isn’t it too much for their immune system?”

Vaccines are offered at the earliest age at which they are proven to be both safe and effective. In the U.S., hepatitis B is the only vaccine offered before 6 weeks of life. The hepatitis B vaccine is as safe and effective in a newborn as it is in an adult.  

There are other vaccines that we wish we could use in newborns, particularly the pertussis vaccine, but most vaccines can cause fever. Newborns with fever end up getting checked out for serious infections, so we hold off on those vaccines for safety reasons until 6 to 8 weeks. The hepatitis B vaccine rarely causes any fever and even one dose of the vaccine is 85 percent protective when there is a known exposure to the virus.

Why do we give hepatitis B vaccine so early? Hepatitis B is a blood and body fluid-born virus, much like AIDS virus. It is more common in the U.S. than AIDS, and unlike the AIDS virus, can live on surfaces for up to three weeks. 

There are millions of copies of the virus in a teaspoonful of blood. About a third of people who catch hepatitis B don’t know where they got it from and about a third of those who have the chronic hepatitis B infection don’t know that they have it until they develop liver cancer or cirrhosis.

Newborns that catch hepatitis B most often develop chronic infection that causes liver failure or cancer in their teens or twenties. We can test all of our moms for hepatitis B, but we can’t test all of the dads, grandparents, babysitters, housekeepers, friends and relatives who the baby will come in contact with. 

I once diagnosed a 13-year-old boy with chronic hepatitis B who caught it from his father who did not know he was a carrier until his son’s diagnosis.

The earlier we can vaccinate, the more diseases we can prevent. Delaying a vaccine that is proven safe and effective at birth is like waiting until your child gets older before you start using a car seat.