Wednesday, January 29, 2014

Pediatrician & Mother Talks About Flu Vaccine

This was originally posted on The Mom's Guide to San Diego and was written by Dr. Jaime Friedman.

As a local pediatrician, and part of the medical group that partners with the Mom’s Guide to San Diego, I felt it was very important to respond to a recent thread of posts on the Mom’s Guide Facebook page regarding flu vaccines. The media often highlights extreme medical cases for the sake of the “story”, sometimes without providing thorough information on the topic for the viewer to come to their own educated conclusion.

Every year many thousands of people become ill with influenza.  Of those, hundreds to thousands die.  Unfortunately, while the very old, very young and chronically ill are most severely affected, many who die of influenza are perfectly healthy.  Influenza should not be confused with the common cold or a viral illness causing vomiting and diarrhea.  It is more severe, causing sudden onset of high fever, body aches and fatigue.  Many people also experience a cough, headache, sore throat, or diarrhea. The illness is very uncomfortable and can result in pneumonia, bronchitis or sinusitis.  It also can exacerbate chronic illnesses including asthma.  Most people are sick for 1-2 weeks.

The best ways to prevent the flu are good hand washing and vaccination.  The vaccine was first introduced in the 1940s for the military.  Since then it has repeatedly been perfected and proven to be safe and effective.  In fact, each year the vaccine is altered to keep up with the mutating virus.  The vaccine works by introducing proteins from the surface of the virus into the body so that the individual can make their own antibodies to the virus.  The injected vaccine is NOT a live virus and one cannot get the flu from the vaccine.  Because the vaccine is given during respiratory virus season many people develop other illnesses around the same time as vaccination and mistake that illness for “getting the flu from the shot”.  Also, it takes 2 weeks for the vaccine to be effective so exposure to the virus around the time of vaccination can still result in illness.  Some common side effects include soreness at injection site, feeling achy and low grade fever for 1-2 days.  These symptoms are far less severe than actually having an influenza infection.  There is also a live attenuated vaccine available that is sprayed into the nose. While this is a live virus it is weakened so that it does not cause infection.  However, side effects may be more prominent than injection, including runny nose, headache and wheezing.  It should not be given to people with a history of asthma.  

While serious reactions, such as allergy or anaphylaxis, are rare they do occur.  Do not get the vaccine if you have had a reaction in the past or if you have a severe allergic reaction to eggs.  Signs of a severe reaction include hives, paleness, dizziness, difficulty breathing and racing heart rate.  The number of severe reactions to the vaccine is far less than the number of severe infections that occur every year.  

Here at Children’s Physicians Medical Group we believe that vaccination is safe and the best way to prevent infection.  Our doctors offer the vaccine to children 6 months and up.  For more information, and to determine which type of flu vaccine is best for your child, please contact your pediatrician or go to the CDC website  

Thursday, January 23, 2014

Map Shows Vaccine Preventable Outbreaks

The Council on Foreign Relations released an interactive map in October 2011, and it gained a lot of attention earlier this week. The map is regularly updated and shows worldwide vaccine-preventable outbreaks from 2008-2014.

There are a few important things to note about the map. The red dots represent measles, and it’s covered the United Kingdom and is showing up in the United States as well. Mumps (dark green dots) are also completely covering the United Kingdom, and showing up in the United States; both of these are part of the MMR vaccine.  Whooping cough (bright green dots) has really only been a problem in the United States, and there is quite a bit of it.

Michael Hiltzik of the Los Angeles Times wrote an article about the map, and commented:

“The lesson of all this is that vaccination is not an individual choice to be made by a parent for his or her own offspring. It’s a public health issue, because the diseases contracted by unvaccinated children are a threat to the community. That’s what public health is all about, and an overly tolerant approach to non-medical exemptions – and publicity given to anti-vaccination charlatans like Wakefield and McCarthy by heedless promoters like, sadly, Katie Couric, affect us all.”

The map highlights the imperative need for parents to vaccinate their children. All parents should consult their pediatrician when making vaccination decisions that will impact public health.

Thursday, January 16, 2014

A Positive Spin on Vaccines

Negative stories about vaccines dominate the news, as activist groups continue to spread misinformation. But, vaccines are important to our health and safety, and many are speaking out about their positive effects.

NASCAR driver Jeff Gordon joined the Sounds of Pertussis campaign with the March of Dimes and Sanofi Pasteur. The campaign is a national education program educating adults about the importance of getting an adult Tdap (tetanus, diptheria and acellular pertussis) vaccination. The booster vaccine prevents adults from contracting pertussis and passing it along to unvaccinated infants, who will receive the vaccine at two months of age.

The Centers for Disease Control and Prevention (CDC) reported there were more than 41,000 cases and 18 deaths reported in 2012 for pertussis, the largest outbreak in fifty years.

“Eighty percent of the time…these young infants are getting it from family members so it’s really about prevention (efforts),” Gordon states. “Prior to the baby being born, family members, when they come to the hospital, when they come to the home to visit, you know they need to make sure they’re protected.”

Gordon is not the only person speaking in favor of vaccines.  Jeanne Sager wrote an impassioned blog post for The Stir about the importance of vaccines. She asks parents to also consider all of the diseases that vaccines prevent, rather than just focusing on vaccine safety.

Sager references Amy Parker’s story on Voices for Vaccines. Parker grew up un-vaccinated in a “health nut” family. Parker states:

As healthy as my lifestyle seemed, I contracted measles, mumps, rubella, a type of viral meningitis, scarlatina, whooping cough, yearly tonsillitis, and chickenpox, some of which are vaccine preventable. In my twenties I got precancerous HPV and spent 6 months of my life wondering how I was going to tell my two children under the age of 7 that mummy might have cancer before it was safely removed...

If you’ve never had these illnesses you don’t know how awful they are -- I do. Pain, discomfort, the inability to breathe or to eat or to swallow, fever and nightmares, itching all over your body so much that you can’t stand lying on bed sheets, losing so much weight you can’t walk properly, diarrhea that leaves you lying prostrate on the bathroom floor, the unpaid time off work for parents (and if you’re self employed that means NO INCOME), the quarantine, missing school, missing parties, the worry, the sleepless nights, the sweat, the tears and the blood, the midnight visits to A and E, sitting in a doctor’s waiting room on your own because no one will sit near you because they’re rightfully scared of those spots all over your kid's face.

Dr. Daniel Gilstrap of Durham, North Carolina notes that, “The list of vaccines for adults has expanded quite a lot in the last few years. Not only that, the knowledge of the safety of these vaccines has increased.”

Vaccination efforts have enabled entire generations to grow up without knowledge of the severity of
polio, measles, whooping cough, and others. Gilstrap and other physicians are working to educate people on the importance of vaccines because they don’t know how bad the diseases can be.

Finally, Lisa Murakami wrote a blog post last September, Vaccination: A Layperson’s Perspective. Her post generated 482 comments and tackles all of the vaccination myths.  Her husband is a medical resident at Dana Farber.

She notes, “That means, he has 14.5 years of grueling medical training that I don’t have. And – conservatively estimated – 28,160 hours. My father has infinitely more; he’s seen tens of thousands of patients over the course of his forty-year career as a pediatrician. Clearly, I can’t run a Google search on a complex medical topic and eventually cobble together a better answer on it than these two can.”

Murakami concludes by noting that she can’t link to many of the sources she used when debunking vaccine myths because you have to pay for a subscription to major medical journals and other legitimate scientific sources. She has subscriptions to these sources, but the average person does not. The best information on vaccines isn’t available by Googling the Internet, however the worst information is available.

Those with questions about vaccines should consult their pediatrician. The Internet and other sources is not a substitute for years of medical training, and the diseases are much worse than the vaccines.

Tuesday, January 7, 2014

Vaccines: Where are the facts?

Parents are barraged with a lot of anti-vaccine materials through the Internet and media, and it’s hard to sort out what the facts are, and which stories are myths and conspiracy theories.

“I think vaccines have become a scapegoat for our fears about medicine, the government, and mistrust of authority,” Dr. Julia Getzelman states. Her pediatric practice in San Francisco attracts vaccine skeptics, and some of her patients follow an amended vaccine schedule in an effort to increase vaccination.

A recent article in Forbes magazine supported Dr. Getzelman’s statement. A study showed that climage change deniers, anti-GMO activists and vaccine conspiracy theorists all overlap each other on a tendency to believe in conspiracies.

Another study refutes this and showed that Americans reluctance towards vaccines isn’t from a distrust of science or misinformation, but from divisive forces that turn scientific findings into uninformed politically charged controversies. Dan M. Kahan of Cultural Cognition Project at Yale Law School argues: “The problem isn’t media sensationalism. Uninformed and counterproductive risk communication is the inevitable byproduct of the absence of a systematic, evidence-based alternative.”

For many spooked parents, data and studies don’t ease their fears. Instead, pediatricians like Dr. Jane Finlay in British Columbia are using humor, validation and compromise to work with parents. Finlay can’t acknowledge these parents beliefs as true, but she will work with them to adapt the vaccine schedule because it is in the best interest of the child to get their vaccinations.

According to Noni MacDonald, a professor of pediatrics at Dalhousie University in Halifax, just spending 5 to 10 minutes on an anti-vaccine website can influence a parent to opt out of vaccines. Doctors are pushing for more regulation on websites that push anti-vaccine messages. The Australian government is working to force the Australian Vaccine Network to run a consumer-warning banner stating it has a misleading name.

“We all like to think we make our decisions based on incredible evidence and we weigh it out. Well, we don’t. A lot of our decisions are based on our beliefs at the unconscious and subconscious level,” MacDonald states.

Finlay and MacDonald recommend that pediatricians work with parents on a vaccine schedule, use a non-confrontational tone, hear parents out, and not assume that all parents have the same concerns.

“They’re doing what they feel is honestly the best thing for their child,” Finlay points out. She further recommends that pediatricians combat Jenny McCarthy-style stories with compelling information on children damaged or killed by vaccine-preventable diseases.

Lessley Anderson wrote a blog post about vaccine deniers for the Verge in October, and focused on the San Francisco Waldorf School, where only 35% of incoming kindergarteners are up to date on vaccinations. “But if I decide not to vaccinate my kid, I make him a potential carrier. He may be able to fight off measles, mumps, rubella, and other illnesses — but what if he spreads a disease to somebody who, for whatever reason, isn’t so lucky?”

Vaccine Watch encourages parents with concerns about vaccines to talk with their pediatrician and about their concerns. Vaccines are the best invention of the twentieth century, and as recent outbreaks of measles and other preventable diseases have shown, very necessary to public health.

Wednesday, January 1, 2014

Pregnant Nurse Fired for Refusing Flu Vaccine

Photo: Miller, Los Angeles

Horizon Healthcare Service in Lancaster, Pennsylvania has fired a pregnant nurse who received a company mandated flu vaccine. Dreonna Breton was three months pregnant when she refused the vaccine, and after suffering two miscarriages in the past, did not want to take any chances with her pregnancy.

The company requires all workers to be vaccinated to protect patients and other employees from catching the flu. Horizon Healthcare Services stated: “Like our requirements for TB skin testing and MMR (measles, mumps and rubella) vaccination as a condition of employment, mandatory flu immunization protects our patients, employees, and community from getting this potentially serious infection.”

“Not only does the flu shot offer some protection to the pregnant woman, but there is a bonus – the pregnant woman can pass some of that prevention into her newborn baby,” notes William Schafner, an infectious disease doctor at Vanderbilt University.

The American College of Obstetricians and Gynecologists also advises all pregnant women be vaccinated against the flu, calling it an essential element of prenatal care. There have been no adverse consequences of flu vaccine in pregnant women or their offspring.

Reports on flu outbreaks from the Centers for Disease Control and Prevention (CDC) for the week of December 21, 2013 say the flu is now widespread in Alabama, Alaska, Kansas, Louisiana, Massachusetts, New York, Pennsylvania, Texas, Virginia and Wyoming.

Flu activity is also picking up in Tennessee, the CDC report notes. They further state that 1,156 flu-associated hospitalizations have been confirmed since October 1st, but that many hospitalizations could be prevented by vaccination.

“Nationwide, seasonal flu causes an average of 250,000 hospitalizations and up to 36,000-49,000 deaths in a severe influenza season. Typically, flu season increases in January and peaks in February or early March,” states Anne Roche, a spokeswoman for the Massachusetts Department of Public Health.