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MMR vaccine

measles trunk front PHILmeasles trunk back PHIL

So, I will say that tackling MMR vaccine in a blog is a biggie, although it shouldn’t be.

The measles/mumps/rubella vaccine is an unsung hero in pediatrics. It has saved more lives than any other vaccine.  Until the MMR vaccine’s introduction in the 1960’s, measles alone killed over 2.5 million people worldwide per year.  Now that number is consistently under 100,000 per year, with almost no deaths in the US.  It’s a really effective vaccine, it’s known to be safe and is done in only 2 doses, complete for life by 4-6 years old.

But then there’s everything else.

20 years ago, in 1998, a paper was published by some British researchers which claimed the MMR vaccine caused autism.  This paper, which has since been retracted and denounced, caused many countries and communities to stop the routine use of MMR vaccine.  Battle lines were drawn, with the medical community on one side, fervently discussing the science and herd immunity, and with a well-spoken and outspoken group of parents and patient advocates on the other side with just as much emotion, claiming a medical conspiracy and arguing for individual choice.  In the end, everyone lost.  The MMR controversy ate up countless dollars and media hours, caused arguments between families and their doctors, and sowed a mistrust of modern medicine that we still have not recovered from.  Today, measles outbreaks due to under-vaccination cause tremendous chaos for public health officials, and even here in my home state there are communities where 20% or more of elementary school children have gotten vaccine “exemptions” from their doctors.  See photos of a child with measles, above.  Only occasionally do I escape from an MMR discussion with a parent for an entire week at a time.  Not that I mind these discussions; I actually love them.  It’s just that we only have 1440 minutes in a day, which includes sleep and coffee time.

MMR vaccine protects against measles, mumps and rubella; all viral infections with different symptoms.  The MMR vaccine in a live attenuated viral vaccine; that is, it has a weakened form of all 3 viruses, which cause the body to make antibodies to fight off these infections when an exposure occurs.  It is given as a subcutaneous (just under the skin) injection, given routinely at 12-15 months of age and again at age 4-6 years old.  Immunity is considered lifelong, although there have been some mumps outbreaks in young adults which has caused discussion about giving a third dose of MMR in the late teens.

Safety of MMR vaccine: the MMR vaccine is very safe.  It does NOT cause autism.  Side effects can and do occur; most commonly pain at the injection site, fever (starting 5-12 days after vaccination) and rash (with or right after the fever).  Sometimes the fever can be high, and when MMR and varicella vaccines are given at the same time in infants, the risk of developing a febrile seizure is increased, which is why most offices give them at separate times.

“Splitting” of MMR into separate components: until several years ago it was possible to give separate measles, mumps and rubella vaccines, which some parents elected to to to hopefully reduce the incidence of side effects.  Most doctors were against this splitting, as it was not shown to improve health in any way, tripled the number of injections needed for prevention of these infections, caused more record-keeping errors, and caused longer periods of under-vaccination.  It is now impossible to split MMR as the manufacturer no longer makes the separate components for use in the US.

There – done!  Questions??????

See this NY Times article on what happened in Europe when vaccination rates dropped.

Read about a child who could not get vaccinated who died from another child’s measles:

9/6/2018 Update: see this Wall Street Journal article on the current measles outbreak in Romania:


Usual Pediatric Schedule:

  • 1st dose age 12-15 months old
  • 2nd dose age 4-6 years old

No More Benzocaine (Orajel, Anbesol and others) for kids!

Baby Orajel          Baby Anbesol

This week the FDA took a more firm approach to stopping the use of benzocaine-containing products in children.  Long sold as topical medicines for mouth pain such as teething and canker sores, these medicines are also known to cause an uncommon condition called methemoglobinemia.  In this condition, benzocaine reacts with the hemoglobin in a person’s red blood cells, preventing the uptake and transport of oxygen.  Symptoms can include blue or gray appearance of the face/lips, fingers, and mucous membranes.  As the blood can carry less oxygen, there is a risk of organ damage and suffocation.  The reaction can be immediate or can occur within several hours of medication use and can occur even with a tiny dose, even in people who have used the product safely in the past.

The small chance of developing methemoglobinemia while using benzocaine has long been known, and many doctors for years have recommended against using these medicines, but the FDA announcement goes further, and likely will be the end of these products for pediatric patients.  If a manufacturer continues to sell one of these products, the FDA states it would take “regulatory action”, but it is unlikely that anyone will continue making these products for pediatric use given the FDA’s clear and firm restriction.  Commonly sold brands include Orajel, Anbesol, Cepacol, and Hurricaine, as well as private-label versions.

The FDA has also in the past recommended against the use of homeopathic teething medications being sold as benzocaine alternatives, as some had been found to contain small amounts of some ingredients (including belladonna) that can cause neurological, respiratory, and musculoskeletal system complications, including potentially seizures.

Instead of using teething medication, the AAP recommends using hard rubber chew toys for babies and toddlers to gnaw on.  These can be kept cold (but not frozen) to help even more.  Use of acetaminophen or ibuprofen is not recommended as teething can last for a prolonged period of time and these medicines are not meant for chronic use.

The new restriction is for children only.  Adults can still use these products but likely there will need to be new safety warnings on the packaging.

 

Will the School Shootings Never End?

My heart goes out to the victims and families of the seemingly-endless stream of shootings in our nation’s schools.  We send our children to school to learn, to grow, to gain confidence and to learn their place in the world.

Of course, above all, we expect them to be safe in those schools.

I am horrified to hear that our town, in addition to locking all doors to the schools, is conducting “active shooter” drills.  I’m not arguing against the need to be prepared, but all of the drills in the world cannot hope to protect against the ever more-powerful weapons that even teens can get access to in the U.S.

When a nation fails to protect its youngest and most defenseless citizens, over and over, what does that say about its leaders and those who elect them?

 

See an interview with the president of the AAP regarding gun control here:

 

Hepatitis B vaccine – for newborns and everyone else

  Recombivax                               Engerix

What is Hepatitis B?

Hepatitis B infection is a viral infection of the liver.  It can lead to jaundice, abdominal pain, liver failure, cirrhosis, and liver cancer.  Hepatitis B is extremely contagious and can be transmitted through intimate contact, by sharing IV drug use materials and any other method in which bodily fluids may mix, including sharing a tooth brush or a razor with someone who is infected or by becoming exposed to the blood or sores of an infected person.  Hepatitis B is many times more contagious than HIV in this respect, although not nearly as deadly.  Pregnant women can also pass the virus to their newborns.  Testing for Hepatitis B infection is done via a blood test.

 

Does Hepatitis B go away?

Many people who get infected with viral hepatitis (usually either Hepatitis A, B, or C, although there are other types as well) get mild symptoms or no symptoms at all and never realize they are sick; for most adults the viral infection goes away and they completely recover.   Hepatitis B and C have more potential to remain active and cause chronic infection, but this occurs in a minority of adults.  However, a larger number of children who get Hepatitis B develop chronic disease, and 9 out of 10 newborns who get hepatitis B during childbirth remain chronically infected for life unless the infection is prevented in the newborn nursery – see below.  Those who develop chronic Hepatitis B infection must be monitored for signs of liver failure and liver cancer for life.

 

The Hepatitis B vaccine

In 1981 the first vaccine to prevent Hepatitis B was licensed in the U.S.  It is given by injection and it is indicated for anyone at risk of contracting Hepatitis B, which is basically everyone.  Almost all newborns receive Hep B vaccine at birth, and if a pregnant woman is known to have Hep B infection, her newborn should receive both the vaccine and a dose of Hepatitis B Immune Globulin (HBIG).  When a newborn receives both HBIG and the full series of Hep B vaccines on time, the chances of preventing chronic infection are excellent.  The Hepatitis B vaccine was the first vaccine to be able to prevent cancer (now HPV vaccine also prevents cancer as well, but of the cervix).

 

What is the timing for Hepatitis B vaccination?

For infants and young children, Hep B vaccine is given in 3 doses: dose 1 (ideally on the day of birth), followed by dose #2 given 1-2 months later, and dose #3 given 6 months after dose 1.  For those who did not receive the Hep B vaccine series at birth, the same 0/1-2/6 month schedule is used for most older children and adults, but there is also a 2-dose schedule for older teens and adults and a different dosage for some people with chronic disease such as kidney failure.  In the U.S. today Hep B vaccine use for newborns is almost universal, but in other countries it is used much less consistently or not at all.

You can learn more about Hepatitis B infection and the Hepatitis B vaccine at the CDC’s Hep B website here.


Usual Pediatric Schedule:

  • 1st dose at birth (prior to hospital discharge)
  • 2nd dose at 1-2 months old
  • 3rd dose at 6 months old
  • **Many babies get 4 doses total in the first 6 months due to combination vaccines (less shots AND full protection)

Tdap vaccine for adolescents and adults (especially pregnant women)

Boostrix               Adacel

The Tdap vaccine, normally given to preteens, teens and adults, is different from the DTaP vaccine that we use in infancy and young childhood.  It protects against the same diseases (tetanus, diphtheria and pertussis), but the relative amount of each component is different.  We get asked about this a lot because it is given routinely to pregnant women during their third trimester and many times the rationale is not fully explained.

Some basics:  The vaccine protects against tetanus, diphtheria and pertussis.

-Tetanus is a bacterial infection commonly acquired through a contaminated wound. The bacteria often lives in dirt and in humans can produce a toxin that can cause severe muscle contractions.  The old term for tetanus was “lockjaw,” named for the severe clenching of the mouth that some patients developed.  Most people have never seen a person with tetanus, partially because the vaccine is so effective.  It advised to get a routine tetanus vaccine every 10 years, or after 5+ years if you get a dirty wound.

-Diphtheria is a bacterial infection that causes respiratory symptoms including cough and fever.  It can be severe, especially in the very young and old.  We see very little diphtheria in the U.S. today, but some countries that cut back on immunizing against it have seen a resurgence.

-Pertussis is also known as “whooping cough,” named after the sound that some people make when they have this infection.  Pertussis in most people causes a pronged coughing illness which can be quite contagious to their close contacts.  Some people with pertussis also develop fever, wheezing, and pneumonia.  Often it is not diagnosed because a doctor or nurse does not think of testing for it, as other causes of cough are more common.  Diagnosis requires a special test which takes a long time to get results.  It is treated with an antibiotic.  The biggest problem with pertussis is that it can be fatal for the elderly and for newborns.

 

Tdap vaccine is normally given only once to most people.  Preteens get it somewhere between 10 and 12 years old.  After that most people continue to get a “Td” vaccine, also just called a tetanus shot, every 10 years.  However, about 5 years ago, some obstetricians began giving Tdap vaccine to pregnant women.  The rationale for this was that the pertussis antibodies would pass through the placenta to the fetus and the baby would be born with some immunity (called passive immunity) from the mother’s vaccination.  Normally a baby is not given their first pertussis vaccine until 2 months old, so immunizing mothers during pregnancy gives the baby some protection until then.  This elegant strategy works very well, so now it is standard to immunize all pregnant women with Tdap with each pregnancy.  For those who never received a Tdap, having a newborn is a great excuse to push grandparents, aunts, uncles and fathers to get the shot they should have anyway, as well as anyone else who will have frequent contact with the newborn.  This would also apply to daycare workers, nannies, etc.

In the near future, we are likely to have an improved version of Tdap, and when we do it may replace Td for all adult doses. Stay tuned!!

Here’s a story from NPR regarding Tdap vaccine during pregnancy:


Usual Pediatric Schedule:

  • One dose only, at age 11-12 years
  • Pregnant women get a dose with EACH pregnancy, in 3rd trimester

Vaccine Side Effects

It has been said that pro-vaxers (i.e. docs, especially pediatricians), always talk about vaccine benefits and rarely about side effects.  I agree!  So today I want to talk about some of the side effects most commonly encountered with the routine vaccines we give to children.

Overall I think the reason that we accentuate the positive with vaccines is for 2 reasons: time and odds.  Time is the biggest reason, at least for me.  In my usual 15 minutes for a well visit, I need to take a history, discuss concerns, examine my patient, show parents growth charts, discuss any abnormal findings, AND then talk about labs and vaccines that are due.  As we already give out a Vaccine Information Statement (aka VIS) that lists individual vaccine side effects with each vaccine, most docs, me included, are a little fast and loose with discussing vaccine side effects in detail unless a parent has specific questions.

Odds are a different story.  Doctors are trained in thinking about risk:benefit ratios, making choices that serve the greatest good, and taking a global perspective of a patient’s health.  This means (I hope) that we presume that a parent will share our perspective of, say, the value of receiving a measles, mumps and rubella vaccine despite the pain of vaccination, the chance of rash and fever, and the small possibility of more severe side effects such as a febrile seizure.

Some side effects of vaccination are common to almost all vaccines given, while some are particular to a certain vaccine or when certain vaccines are given together.  Also, due to how side effects are monitored, almost any symptom might occur after a vaccine, whether it was an actual side effect or just a coincidence.  Some definite side effects are very serious but also very rare, which makes the vaccine “worth” giving to people in general although horrible for those who experience the severe side effect (see “odds” above).

So in no particular order, here is my take on some vaccine side effects.

Side effects of most most or all vaccines:

Pain: ok, I know this is obvious, but it’s also by far the biggest factor for all young children and lots of older ones as well.  Any injection is likely to cause pain although some kids seem not to care very much, even after the shot has been given.  Pain is most commonly present for up to a day or two after vaccination, at the site of the injection.  Pain meds like acetaminophen and/or ibuprofen work well.  If one is averse to medication, an ice pack can help.

Fever: also a biggie; timing varies by vaccine but commonly one should expect a fever in the 1-3 days following most vaccines.  The big exception is the measles vaccine (either MMR or MMRV), which can cause fever starting anywhere from 5-12 days after vaccination and can last several days from then.  Just like with pain, normally the best treatment for this is acetaminophen and/or ibuprofen.  Also you can consider cool cloths draped onto your child.  Do not try to put a child with a fever into a cold bath, because if he/she does have a febrile seizure (see below) that is the last place you want him or her to be, at risk for hitting the head or inhaling  bath water or both.

Fussiness: many children are more fussy in the day or two after a vaccine; often it is hard to tell if this is due to fever or pain or the vaccine itself

Rash: common after MMR and varicella (aka chickenpox) vaccines or the two combined as MMRV, rash usually happens in a similar time period as fever. There’s not much to do about it unless it itches, in which case a topical anti-itch medicine or moisturizing lotion may help.

 

 

More uncommon side effects:

Febrile seizure: this is an uncommon side effect but one that can occur after vaccination.  Febrile seizures usually occur as a child’s temperature is rising, and the is usually not any warning beforehand.  They are most common in children from 6 months to 5 or 6 years old, which is also an age range when lots of vaccines are given.  Thankfully, febrile seizures are usually very brief (under a minute) and almost always stop on their own.  If this occurs, after making sure the child is in a safe place (safe from falls, sharp objects and other dangers) you should call you child’s doctor but there is usually not much to do as the seizure is usually over before you reach anyone.  Of course, a prolonged seizure should prompt a call for an ambulance.  See below for a reference about this.  *It has been found that in 12-15 month olds, febrile seizures are more common when the MMR and varicella vaccines are given at the same time, so many doctors give them at different visits, say one at 12 months and the other at 15 months old.

 

Fainting: fainting, if it occurs, is most common in the 10-30 minutes right after a vaccination.  It seems to happen much more commonly with teens than with younger children.  The biggest worries are getting injured during a fall, especially head injuries.  Some people are prone to faint after vaccines, so with them a period of waiting while sitting down for 15 or 20 minutes after being vaccinated is advised.

 

A rare one but a big deal:

Guilian-Barre Syndrome: this is a rare but serious condition that usually occurs after infections but can also rarely occur after influenza vaccination.  It is a rapidly worsening tingling of nerves and weakness of muscles and can be life-threatening for some.  Again, rare but very serious.  People with a history of GBS are not given flu vaccine.

 

Whew!  That is a quick summary of some more common vaccine side effects.  There are many more as well, feel free to comment if you like.

 

 

This reference on measles-contains vaccines is from the CDC; it’s long but pretty comprehensive; with an excerpt below:

https://www.cdc.gov/mmwr/preview/mmwrhtml/00046738.htm

The following recommendations concerning adverse events associated with measles vaccination update those applicable sections in “Measles Prevention: Recommendations of the Immunization Practices Advisory Committee” (MMWR 1989; 38{No. S-9}), and they apply regardless of whether the vaccine is administered as a single antigen or as a component of measles-rubella (MR) or measles-mumps-rubella (MMR) vaccine. Information concerning adverse events associated with the mumps component of MMR vaccine is reviewed later in this document (see Mumps Prevention), and information concerning the rubella component is located in the previously published ACIP statement for rubella (18).

Side Effects and Adverse Reactions

More than 240 million doses of measles vaccine were distributed in the United States from 1963 through 1993. The vaccine has an excellent record of safety. From 5% to 15% of vaccinees may develop a temperature of greater than or equal to 103 F ( greater than or equal to 39.4 C) beginning 5-12 days after vaccination and usually lasting several days (19). Most persons with fever are otherwise asymptomatic. Transient rashes have been reported for approximately 5% of vaccinees. Central nervous system (CNS) conditions, including encephalitis and encephalopathy, have been reported with a frequency of less than one per million doses administered. The incidence of encephalitis or encephalopathy after measles vaccination of healthy children is lower than the observed incidence of encephalitis of unknown etiology. This finding suggests that the reported severe neurologic disorders temporally associated with measles vaccination were not caused by the vaccine. These adverse events should be anticipated only in susceptible vaccinees and do not appear to be age-related. After revaccination, most reactions should be expected to occur only among the small proportion of persons who failed to respond to the first dose. Personal and Family History of Convulsions

As with the administration of any agent that can produce fever, some children may have a febrile seizure. Although children with a personal or family history of seizures are at increased risk for developing idiopathic epilepsy, febrile seizures following vaccinations do not in themselves increase the probability of subsequent epilepsy or other neurologic disorders. Most convulsions following measles vaccination are simple febrile seizures, and they affect children without known risk factors.

An increased risk of these convulsions may occur among children with a prior history of convulsions or those with a history of convulsions in first-degree family members (i.e., siblings or parents) (20). Although the precise risk cannot be determined, it appears to be low.

Nasal spray flu vaccine (aka LAIV, or FluMist)

FluMist 5-pack     FluMist

Influenza prevention is getting more complicated, sort of. Until 15 years ago, the only way to prevent influenza was to get a flu shot in the fall and hope it would protect you from getting the flu.  The flu vaccine was grown in eggs and given annually.  Since then the options have expanded to include egg-free formulations, high-dose versions for older individuals, and a needle-free nasal spray.

In 2003 FluMist was approved for use  – a live attenuated influenza vaccine (LAIV) delivered as a spray into each nostril.  Intranasal administration made a lot of sense – this is the way that influenza virus enters the body and if we could create a barrier to entry, it would theoretically work better than waiting for the virus to enter the body before starting to fight it.  The big plus, of course, was that  it was not a shot.  This made it an immediate win with patients, especially kids.  For docs, it was faster to administer and easier to use – no needles, blood, bandages or sharps boxes.  Also, the back room management was easier, without need to draw fluid into a separate syringe.

However, although in some years the nasal spray vaccine worked well, there was a 2-year span when it seemed to work no better than a placebo.  Although there are differences of opinion as to why, with no evidence of protection, in 2016 the CDC had to pull its recommendation for use of this vaccine.  As a result, for the past 2 years, the only way to get vaccinated against influenza has been to get a shot.

For the influenza season starting in the fall (called the 2018-2019 flu season), FluMist is again on the list of possible vaccines for approval.  It will need to be approved based on data collected over the past 2 years, and although it’s not a sure thing, the CDC would certainly love to have a faster, painless product back in the office, and so would many patients.

Some basics about the nasal spray flu vaccine:

1. It is called FluMist (only 1 brand exists)

2. It is given as a tiny spray into each nostril

3. It is given in the same season that you would get any flu vaccine, August through May

4. It is approved for ages 2 years to 49 years (I’m too old for it now)

5. Many doctors are reluctant to use it in patients with asthma, as it makes an asthma exacerbation a little more likely in the few weeks after receiving it

6. It costs more than the cheapest injected flu vaccine but should be covered by insurance, including Medicaid, private insurance and government-provided insurance.


Usual Pediatric Schedule:

  • Can only be used in ages 2 years and older
  • Yearly dosing between August and May; earlier is better
  • Children receiving flu vaccine for first year ever get 2 doses, 1-2 months apart

Off to College!

College

Hopefully all of your graduating seniors have had a good year.  For those going off to college, don’t forget about their pre-college physical.  At this visit, which is otherwise much like prior physicals, your teen’s doctor will review his/her vaccines and there may be several to discuss getting now:

1. Flu vaccine- if this visit occurs in late August, then the chances are your child will be offered a flu vaccine.  Say yes!

2. Meningococcal vaccine- this comes in 2 varieties (A/C/Y/W-135, also called “quadrivalent,” and B).  Most preteens get a first dose of the quadrivalent vaccine at age   11 and a booster at age 16.  If one of these has been missed, now is the time to catch up.  Meningococcal type B vaccine is most commonly used in those with immune system problems but some docs do use it routinely.  In the end, because MenB infection is much less common, most docs do not recommend it for otherwise healthy young adults.  Great topic for discussion with your doctor!

3. Tdap booster- also normally given once at age 11, if your senior has not had this she/he should get it now.

4. HPV vaccine- yes, your senior should have had this series years ago, but if for any reason did not get all necessary doses, now is the time (see my earlier post).

5. All the rest- I’m assuming that all of the routine vaccines normally given in younger childhood (such as MMR, polio, HepB, etc) are done, but your doc will review these with you as well as college needs an official record of all vaccines prior to arrival.

Good luck to your college-bound students!!

Influenza – almost gone but back again soon

Flu shot poster

This is a piece on obtaining flu vaccines in pharmacies and other non-physician’s office locations.  As you can see, I’m in favor…

This year’s influenza season was a long and hard one. We had a longer season with more complications and more hospitalizations than usual. As we are just about finished with flu this time around, one looks back and wonders why. Doctors always complain that too few people get vaccinated and that too many patients call for antivirals (like Tamiflu) at the first sign of a respiratory infection. Patients are unhappy that it’s so hard to get to see their doctor on short notice, whether they are sick or trying to prevent an illness.
Some numbers: each year about 30,000 people in the U.S. die from influenza or its complications. These are usually the very old or the very young, and often those with heart, lung, or immune system conditions. Many more get sick and miss work or school. By early November 2017, less than 40% of U.S. infants, children and adults had received a flu vaccine, which was in line with recent years. Finally, in the past 10 years, the effectiveness of the influenza vaccine has ranged from 37 to 60% according to the CDC. As it is always hard to estimate this until a season is over or close to over, let’s agree on an average 50% vaccine effectiveness against “real” influenza (not against colds and stomach viruses). This means that for every 2 people who get the vaccine, one will not get the flu (and the other person will) if they are exposed. To get this 50% benefit, you have to: make an appointment with your doctor, likely miss some work, show up (although you may have to wait anyway), and get a shot, unless you qualify for a nasal spray. Or you could go to CVS, Walgreen or one of the many other places that offer flu vaccines. These are called retail clinics, or what I like to call quick-serve healthcare and immunization providers, or Q-SHIPs. Here, you still get your shot or spray, but it’s on your own time, and likely will still be covered by your health insurance. Some lucky employees may even have flu vaccine provided by their workplace.

Docs much prefer that patients get vaccinated. Why? First, it works on our schedules and we get paid (a little) to provide the service. Second, given the duration of illness of about a week, there is no question that preventing flu with a vaccine costs much less that treating it with medication or missing work, or both. Also, the flu vaccine is very good at preventing severe illness, and vaccinating people helps to prevent epidemic outbreaks in places where people congregate, such as at school, work, daycare, nursing homes, hospitals, etc.

On the other hand, patients often prefer the “I’ll take the risk” approach. Why? First, the patient decision-makers are usually adults, and they are often employed. This means that scheduling a visit to a doctor’s office usually involves missing work. So even if the vaccination is free, there is an opportunity cost associated with lost work or vacation time. Second, the effectiveness of about 50% leaves a lot of people underwhelmed. Also, many people who get vaccinated may later get a seasonal cold virus, which flu vaccine does NOT prevent. This may lead one to presume that the vaccine didn’t work for them. Also, many otherwise healthy adults feel that medication can be used instead, IF they get sick, and this can often be gotten over the phone, without the pain, time or expense of vaccination. Although the cost of a course of an antiviral for influenza may be hundreds of dollars, an insured patient’s much lower copay insulates them from this cost, so that medication costs are a tiny consideration for many. Of course, all those who got vaccinated and don’t get sick don’t really know if this was due to vaccination or just luck. Due to these issues, overall many patients feel that the value they get from a flu vaccine is low. When a busy doctor looks at it from the busy patient point of view, it makes sense.

So how to meet in the middle? A few simple suggestions to reduce the pain for everyone, both literally and figuratively:
1. Many pediatric offices offer flu vaccines on weekends. Offices serving adults should consider doing the same.
2. Medical offices should offer flu vaccines at ALL appointments to ALL patients during flu vaccination season (August through May). Vaccinating today means that your patient need not come through the office again for a vaccination visit this season.
3. Patients should accept this offer of vaccination if possible (and no, August is not too early).
4. Medical offices should use the nasal spray influenza vaccine when possible. This was not used for the past 2 years due to effectiveness issues, but it has been placed on the list of likely vaccines for the upcoming 2018-2019 season. It is approved for use in people from 2 to 49 years old.
5. Doctors should encourage patients to use Q-SHIPS, and should work to get documentation of their vaccination. Rather than worry about lost business, we should be HAPPY when a patient receives a vaccine at CVS or another pharmacy – it preserves office supply for others who will need it. Instead of worrying that business is going elsewhere, seek more of these partnerships and make sure that you have a system in place to document the vaccination. Remember, in the end the goal is more vaccinated patients and less influenza along with its complications.

 

 

Mumps Booster for College?

mumps neck swelling CDC

Photo above: a child with mumps (with swelling of the parotid glands in the neck)

 

There has been a lot of press in the vaccine community about recent outbreaks of mumps on college campuses.  This caused a debate over whether students should receive a booster of MMR vaccine prior to starting college.

The Facts:

1. In the U.S. children receive MMR vaccine routinely at 12-15 months old and again at 4-6 years old.

2. By college age most people are still protected (but not everyone).

3. Outbreaks of mumps are uncommon but they do happen.

4. Current CDC recommendation is to consider an MMR booster in people at high risk of exposure to mumps in consultation with local health authorities.  **This means that a graduating high school senior will NOT routinely need an MMR booster but it may be recommended if her/his college experiences an outbreak.  This vaccination would likely happen on campus.  This would be safe and would make sense.

5. Given medical privacy rules and the fact that most college students are over 18, families may or may not be notified of an event such as this (just like the fact that you will normally not get a copy of your child’s grades directly from the school).

Any thoughts???


Usual Pediatric Schedule:

  • 1st dose (as part of MMR vaccine) at 12-15 months old
  • 2nd dose (as part of MMR vaccine) at 4-6 years old
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