Posted tagged ‘immunizations’

Vaccines: We’re all in this together

July 17, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

When we work together, great things can happen.

Polio has been around since ancient times – there are depictions of it in art thousands of years old. Improved sanitation helped, but it was vaccines that have nearly eradicated polio from the world. This is a disease that paralyzed over 21,000 people in the US in 1952. There are still plenty of people around living with deformities and chronic pain from polio they suffered through years ago. Our children will never have to face this, because our parents and grandparents were sure to get us vaccinated.

Smallpox – gone.

Rinderpest – gone, too, though you may not have known what it was. It’s a neat story. Rinderpest was also known as cattle plague or steppe murrain, and may have been one of the biblical plagues. Our livestock no longer have to worry about it (I’m not sure they ever did, really. That’s livestock for you. But for farmers & pastoral nomads, rinderpest was a big deal.)

Measles – another ancient disease, and a serious one that continues to kill people – was almost eradicated from the western world. It’s no longer endemic (constantly circulating) in the USA, though pockets of certain populations can still support local outbreaks. And that exactly what happens, when vaccine rates fall. Measles cases rapidly return. It’s happening in Europe, and it’s happening in communities in Minnesota who’ve fallen for the lies of the antivaccine propagandists.

Have you or your kids had tetanus, lately? Diphtheria? No. And it’s not because you’re lucky. It’s, again, because our parents and grandparents got us vaccinated, and almost all of us continue to vaccinate our children.

Most parents get it, that vaccines protect not only our children, but everyone else’s children – especially babies too young to get their immunizations, or children who have cancer or other immune problems. Elderly people, adults on medicine for their psoriasis or rheumatoid arthritis, or in chemotherapy – all of us, in every community, benefit when parents vaccinate their children.

And when parents don’t vaccinate, bad things quickly happen. The diseases will wait, patiently, until we let our guard down and invite them back into our homes. They’re not busy. They’re waiting.

There’s a choice, here. Live in fear – fake fear, made-up fear, fear based on lies and propaganda and the same stuff that tries to fool you into e-mailing your bank routing number to a Nigerian prince. You’re not getting that $26 million (or $43 million), and your doctors and the CDC and governments all over the world are not trying to poison your children. Honestly. Let us protect your kids. Great things can happen when we all vaccinate. Protect your children, your community, and yourself.

Bonus! Another example – great things can happen when we all work together. Or, in this case, sing together. Listen, it’ll give you goosebumps.

Nursing and vaccines: Two good things, great together

April 28, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Stefanie wrote in:

My question is related to the MMR vaccine. Would it be better to stop breastfeeding at 11 months and then get the MMR 1st shot vaccine at 12 months? Or did I understand correctly that the maternal antibodies from breastmilk will not interfere with the MMR vaccine to work? If they do not have an effect on neutralizing the vaccine, I would prefer continuing to breastfeed.

Stefanie, you can continue to nurse if you’d like – there’s no recommendation for anyone to stop or delay nursing before any vaccine.

What Stefanie is talking about here are the immunoglobulins in breast milk, and whether they could somehow interfere with the effectiveness of vaccinations. There are no clinical studies that have shown this to be a problem for MMR or any other vaccine. Breast milk antibodies don’t make vaccines less effective or less safe.

One study of a different vaccine, one that protects against the diarrheal illness caused by rotavirus, confirmed that breast milk contains antibodies against the virus. The titers of these antibodies were especially high among women from the developing world, compared with women from the United States. The authors speculated that this might explain why the vaccine is more effective in more-developed countries, and proposed a study to see if delaying (not stopping) breast feeding could make the vaccine more effective. In the US, the rotavirus vaccine is highly effective at preventing severe disease and hospitalization, both in nursing and formula-fed babies. Moms can continue nursing right before or after the vaccine is given (it would be awkward to nursing during administration of this vaccine—it’s given orally. Not sure how that could be done.)

I’ve had a run of questions about nursing and vaccinations, some implying that breastfeeding is better than vaccinations, or that vaccinations and breastfeeding are somehow competing with each other, or that those that support vaccinations are somehow shortchanging or weak on breastfeeding. These kinds of stories seem to be a new “fad” among those who wish to sow an overlay of vague mistrust and doubt about vaccinations. Please, the science is overwhelmingly positive. Don’t rely on the Googlers and scaremongers. Immunizations are safe and effective. You do not need to worry. Protect your children. Vaccinate.

National Infant Immunization Week Blog-a-thon with woman holding baby. #ivax2protect

 

Vaccinations are the best immune booster

April 26, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

The human immune system is an amazing thing. There are thousands of microorganisms – millions, maybe – that are lurking out there, eager to make you sick. You breathe them in. They’re in every bite of food, and all over your hands when you rub your nose. We live in constant bombardment.

And they’re sneaky, too – with changing DNA and proteins to fool us. We’ve got soap and water and some pretty good antibiotics to fight them off, but, really, the vast majority of the work to keep us healthy is done by our own immune systems.

Wouldn’t it be nice to give your immune system a boost, to help it fight off infections? We know moderate (but not heavy) exercise can help, as can a good night’s sleep. What about those “immune booster” vitamin packs they sell? Hint: there’s a reason they say right on the package that they don’t prevent or treat any disease. Save your money.

Another idea: you can just get sick, and at least the next time around your immune system can recognize the germ and fight it off more effectively. Of course, you have to get sick first to enjoy those benefits. And some of those sicknesses can be pretty serious. Or might kill you. Still, no pain no gain, right?

Wrong. There’s a great way to get a real immune boost – a way to help your own immune system, or that of your children, fight off diseases without having to get sick first. They’re vaccinations. They give your immune system a glimpse, a quick safe view, of an infection in a way that won’t make you sick, but will still teach your immune system to recognize the infection if you ever have to fight it off. It’s the best way to prepare your immune army for battle against the infectious enemy, in a way that’s almost risk-free.

Get your sleep and exercise, and eat tasty, home-made foods. Grow a vegetable garden. Hug your kids. Sing like no one is listening, and dance like no one is watching. And vaccinate, too.  These are all great ways to keep your children happy, healthy, and safe.

National Infant Immunization Week Blog-a-thon with woman holding baby. #ivax2protect

Breastfeeding and vaccinations protect your baby in different ways

April 24, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

“Since I’m nursing my baby, she’s getting all of the antibodies in my breast milk. Doesn’t that protect her the same way vaccines do?”

There are antibodies in breast milk, and they can help protect your baby from some kinds of infections. But those kinds of antibodies are different from the ones your baby will make herself after vaccinations. Breastfeeding contributes to one kind of protection, but the protection from vaccines is more powerful and longer-lasting.

Antibodies (also called “immunoglobulins”) are proteins that are part of your immune system. They work by attaching to invading microorganisms and viruses, which helps signal your immune system to attack. Antibodies have to be specific to each kind of infection—one antibody doesn’t fight multiple germs—and your immune system learns how to make different antibodies based on your body’s exposures to infections.

There are two ways for your baby to get antibodies. She can get them passively, from mom, either across the placenta or via breastmilk. Both are important. Placental antibodies are IgGs, which circulate in the blood. These kinds of antibodies help fight off invasive diseases. After a baby is born, placental IgG antibodies fade away over several months. Moms can boost their own ability to give these IgGs by being vaccinated, themselves, during pregnancy (that’s why moms should get influenza and pertussis vaccines while they’re still pregnant.) Breast milk contains a different kind of antibody, IgAs, which aren’t found in the blood. They are a part of intestinal and respiratory mucus, protecting people from infections before they get to the blood. The effect of these IgA antibodies in breastmilk is especially important in the developing world, where safe water and food is harder to find, and where moms have especially high titers of their own antibodies from ongoing infectious exposures.

The other way for babies to get antibodies is to make them on their own. To learn to do this, they must either be exposed to the infection, or get an immune-boosting “glimpse” of the infection by receiving a vaccine. That’s the point of vaccines: to allow someone to make their own strong, protective antibodies without the risk of having to suffer through the disease. These antibodies, made after “active immunization”, are of very high titers and are long-lasting – in some cases, for a lifetime. They’re much more protective than the passive antibodies gained across the placenta or through breast milk.

Bottom line: families can help protect their babies from infection in many ways. Sick people should be kept away from newborns. Moms should get their own recommended vaccines. Nursing can help (though in the developed world, the impact of nursing on infections is modest.) And babies should get their own vaccines, as recommended, on schedule, to get the best possible protection.

National Infant Immunization Week Blog-a-thon with woman holding baby. #ivax2protect

Great news about pertussis protection for newborns: Vaccinate mom!

April 3, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Pertussis (AKA “whooping cough”) is a nasty bear of an illness in older children and adults. People with pertussis cough for about 100 days – and it’s a horrible cough that sometimes makes people puke, pass out, or wet their pants. Seriously. Three months of that.

But it’s even worse for little babies, especially newborns, who just don’t have the lung power to expel the mucus. They cough, sure, but a lot of them get encephalitis and seizures, and some of them just stop breathing. So it’s especially important to protect the youngest babies.

Rates of pertussis have been climbing, in part because the newer vaccine that we started using in the 1990s doesn’t seem to give as lasting immunity as the old-school, whole-cell vaccine of earlier days. And as more pertussis circulates in communities, it’s the little babies who suffer the most. Pertussis vaccines are given to babies at 2, 4, and 6 months – and that means they build own protection slowly over the first year. Fortunately, a study published today shows that we can prevent most cases of newborn pertussis – even in babies too young to have gotten the full benefit of their own vaccines.

Researchers from the Kaiser Group of Northern California looked at records of all of the babies born at their facilities from 2000-2015 (those years spanned two big California pertussis outbreaks, in 2010 and 2014.) They hypothesized that a strategy of vaccinating pregnant women against pertussis, recommended since 2011, would help prevent pertussis in their newborns. Since people enrolled in Kaiser get all of their care at Kaiser locations, they could track which babies caught pertussis and they could tell which moms got a dose of pertussis vaccine during pregnancy.

They had a lot of babies to track – about 150,000. 17 of those babies caught pertussis in the first 2 months of their lives, and 110 caught it within the first year. The authors compared the rates of pertussis among babies whose mom got the Tdap (tetanus-diphtheria-pertussis) vaccine during pregnancy versus those who did not.

Of the 17 newborns less than 2 months with pertussis, only 1 had a mom who was vaccinated during pregnancy – working out to a vaccine effectiveness of about 90%. Looking down the road as the babies got older and received their own doses of pertussis vaccine, the effectiveness of maternal Tdap remained strong throughout the first year. There were no signs that maternal vaccination interfered with the effectiveness of the babies’ vaccines.

This is great news – an easy and effective easy way to prevent a potentially devastating disease of young babies. Previous studies have shown that this vaccine is also very safe for both pregnant women and their babies. Keep your babies safe – make sure, moms, you get a dose of Tdap during every pregnancy.

Great news about cancer prevention!

October 6, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

The first large, population-based study of real-world changes in cervical cancer screening in the era of HPV vaccination has delivered some great news: the HPV vaccine not only works, but it’s working better than expected.

Researchers looked at rates of CIN, the growth of abnormal cells in the cervix detected by Pap smears, among young women in New Mexico. Even though fewer than 40% of eligible women had received all three doses of the HPV vaccine, rates of these pre-cancerous lesions dropped by over 50%. That’s a huge impact. A safe intervention has cut the incidence of a common cancer by 50%, even in a community where HPV vaccine uptake wasn’t very good. It’s great news, and it hints at even greater news: if we can get more people vaccinated, this cancer-preventer can work even better.

Why did the vaccine work better than expected? There’s a herd effect, where vaccinated individuals help protect everybody by preventing spread of the virus. Plus, the vaccine seems to offer at least some protection against related strains. And it turns out that even women who receive less than the recommended three doses get at least some helpful immunity.

The most-used HPV vaccine in the United States goes by the brand name Gardasil-9, and it protects not only women, but men, too—especially from many cancers of the mouth and throat. Since there’s nothing analogous to a Pap smear for men, it will take longer to see these kinds of cancer-beating effects in the male population, but initial studies relying on rates of infection look very promising.

The HPV vaccine is very safe, and it’s already having a big positive effect in communities. Unfortunately, some parents have been scared away from this vaccine by irresponsible and often flagrantly false internet rumors. Don’t believe the scaremongers. Protect your kids from cancer by making sure they get their HPV vaccines.

Here’s a detailed and well-referenced post from The Skeptical Raptor explaining far more about the Gardasil vaccine, and debunking many of the myths being used to scare parents.

 Q&A from the CDC about HPV and HPV vaccinations

 

MERCK - Merck's HPV Vaccine, GARDASIL®9, now available in Canada

Serious allergic reactions to vaccines: Something else not to worry about

April 18, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

A huge study of over 25 million doses of vaccines has shown that serious allergic reactions are super-rare, and even when they do occur they’re typically easy to treat.

Published in the October, 2015 edition of The Journal of Allergy and Clinical Immunology, the study looked at a huge database of 17,606,500 visits for a total of 25,173,965 vaccines. This is seriously Big Data, people. After all of these vaccines, only 33 cases of a severe allergic reaction occurred. Even among those 33, only one child required hospitalization, and none died.

More reassurance: there were zero serious reactions among children less than four years of age. And most of the 33 reactions (85%) occurred in children who had a history of other allergic diseases.

Despite its rarity, anaphylaxis is a potentially serious reaction. If your child experiences a widespread rash, trouble breathing, severe GI symptoms, or fainting after a vaccine, it might be an allergic reaction – a medical evaluation is needed. Most of these reactions won’t turn out to be serious or life-threatening, but they do need attention. Almost all teenagers who faint after vaccines have just fainted, and will be fine, but they need to be watched and their blood pressure checked. If further evaluation shows it’s an allergic reaction, medical therapy given quickly can help stop the reaction.

But: we need to keep these reactions in perspective. They’re really phenomenally rare. 33 out of 25 million vaccines means that your children have a higher chance of being hurt in a car accident on the way to their appointment than of having a serious allergic reaction to a vaccine. Other, non-allergic but serious reactions are really very rare, too. The internet has made otherwise well-adjusted people into parents worried stiff over vaccines. Don’t let it happen to you. Don’t live in fear and worry. Immunizations save lives, they’re safe, and they’re something you don’t need to worry about.

Wemberly Worried