Posted tagged ‘vaccinations’

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.

Measles vaccine: A real immunity super-booster

October 29, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

What if there was an intervention that could reduce a child’s risk of death from infection—from any infection—by half? And that one intervention’s immune-boosting power lasted 2 or 3 years. It’s also very safe, with a very small risk of any serious side effects.

Pat yourself on the back. Your child has probably already had it, and your entire community is getting benefit from fewer circulating infections.

A recent study published in Science looked at long-term changes in immunity following measles vaccination in populations worldwide. It’s known that measles infection put people at risk for other infections for several weeks or months afterwards – natural infection seemed to suppress the immune system. Using data correlating vaccinations, measles cases, and infectious disease deaths, the authors found that the immune suppression had a much more serious and lasting impact than had been thought. For two to three years after natural measles, the all-cause infectious mortality spiked upwards. Measles vaccination, in other words, doesn’t just prevent measles deaths—it prevents deaths from any infection. For years.

The effect is striking in its intensity. Overall, when measles was common years ago, it accounted for about half of all deaths from infection (combining the direct effect of measles infection itself with the immune suppressive effect.) In some of the most resource-poor countries, it probably accounted for up to 90% of all infectious deaths. Think about that. One vaccine, preventing all of those deaths. The authors only looked at mortality—if you consider other morbidity, hospitalizations, costs, and misery, the positive effect of measles vaccinations would be much, much higher.

Boosting immunity doesn’t just help the individual child. The entire community is protected when the risks of infection drop, including the risk to newborns and elderly people, or people who are already sick.

Don’t be fooled by the fake immune-boosters—the colon cleanses, the “Airborne”, the pills and potions pushed by the multi-billion dollar supplement industry. Real immune boosting does not rely on magic. Get enough quality sleep, eat a healthy diet, get some exercise, and take reasonable precautions like washing your hands and avoiding sick people. And, please, make sure you and your children have received all of the recommended vaccines. Protect yourself, protect your kids, protect your communities. Vaccinate!

Immunity, breastfeeding, and the timing of measles vaccine

January 27, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

Leave it to Disney to make a splash—any day now, we’ll hear that Anna and Elsa have caught the measles themselves (imagine a link to the sisters all covered with spots, looking miserable in the hospital, with a worried snowman and moose cowering in the background. “For the first time in forever… measles is back….”)

I’ve already covered the outbreak in detail. Briefly: over the December holiday someone at one of Disneyland’s theme parks in California brought in measles. At least 5 employees and probably about 40 park visitors caught it, almost all of whom were unvaccinated. Since then, despite a massive public health effort to identify and isolate potentially infectious contacts, the outbreak has spread to about 100 cases in 6 states. Again, and this can’t be repeated too much, almost all of the cases are occurring in people who have not been fully vaccinated, either because they’re babies who are too young, or for other reasons. It’s not yet clear exactly what that breakdown is. Some of the cases could have and should have been vaccinated; it’s likely that others had health issues that prevented timely vaccination. In any case, since measles is super-contagious, it will likely continue to spread, especially among communities with poor immunization coverage. Sadly, this has been an entirely predictable and avoidable outbreak.

A few comments and notes sent in—thanks especially Emily and Jennifer–have asked for more details about the MMR vaccine and how immunity affects how it works. I feel another Q&A coming on….

 

Aren’t newborns pretty well protected against measles, from mom’s antibodies?

The placenta sends lots of important things to baby—oxygen, nutrition, growth factors, love, and what’s called “passive immunity” via maternal antibodies. These are large molecules, a kind of immunoglobulin called “IgG” which mom had made previously after exposures to diseases or vaccines. Good maternal immunity to things like influenza and measles does provide good protection for their newborns. That’s why it’s important for pregnant women to get flu vaccines, and for all girls to get all of their vaccines—so later, when they’re pregnant, their little babies get protection, too.

But those IgGs from momma, they don’t last so long. The “titers” drop off fairly rapidly, and the protection falls quickly. Best protection probably lasts weeks, with some protection falling off over months. By six months of age, there’s probably no protection from maternal IgGs.

However, there’s still some small amount of IgGs circulating. Though they’re not protective, they can interfere with some kinds of vaccines (especially live, attenuated vaccines like MMR and chicken pox.) That’s why these vaccines are ordinarily given at 12 months of life or later. It’s not dangerous to give them early—it’s just that they probably won’t work as well to provide strong, lasting protection. Maternal IgGs do not interfere with the effectiveness of many other vaccines, like the Hepatitis B, DTaP, polio, and the other vaccines given in the first year of life.

 

Can you give MMR vaccine earlier, say if exposure risk is high?

Yes, though it may not work as well or provide protection that’s long-lasting. Current recommendations are to give the first dose of MMR routinely at 12-15 months of life. It should be given early (as early as 6 months) if the risk of exposure is high. For example, the CDC currently recommends early MMR for international travel to Europe, Asia, the Pacific, and Africa. I think it would also be prudent to vaccinate early for travel to California, especially if your baby will be in crowded places like airports or theme parks (California officials have said that these places are safe—IF you’re vaccinated.)

A dose of MMR vaccine given in the 6 – 11 month window will provide some protection, but since the lingering maternal IgGs will prevent it from being fully effective the dose doesn’t “count.” Two further doses will still be needed, following the typical schedule at 12-15 months and at 4-5 years of age.

 

Doesn’t breastfeeding give baby antibodies? Wouldn’t that prevent measles? Or can breastfeeding interfere with the MMR vaccine?

Breastmilk does contain antibodies, but they’re a different kind of antibodies. They’re not the IgG antibodies that circulate in the blood, they’re IgA antibodies that concentrate more in body secretions, including nasal mucus and breast milk. These IgA molecules don’t interfere with vaccines. They provide modest protection against mostly gastrointestinal infections (think diarrhea and vomiting illnesses)—which makes sense, because the breastmilk IgA molecules are swallowed. They don’t make their way into the blood, or at least not very much—like other proteins, if you swallow them they’re mostly torn apart during digestion. Breastmilk IgA provides just a little protection against infections that are caught via the respiratory tract, including the common cold and measles. For instance, a breastfed baby on average statistically will likely get one half of an ear infection fewer in the first year of life. Not a huge impact, at least not in respect to those kinds of infections.

 

Is there any way to test for those maternal measles IgG antibodies? I mean, if my baby’s antibodies are low enough at 9 months of age, could I get him vaccinated then?

Well, you can test for them, but the exact amount doesn’t perfectly correlate with whether the baby will become immune after the vaccine. You won’t know if the vaccine given at 9 months worked well unless you test your baby afterwards—and even then, there’s a grey zone in the measurements.

 

Maybe we should test for immunity? I mean, should we be testing children after the MMR to make sure it worked?

After one dose of MMR, about 85% of children will get complete, lifelong protection against the three components: measles, mumps, and rubella. The second dose, traditionally given at age 4-5, will pick up almost all of the remaining unprotected 15%, leaving only 1% non-immune. Those odds are really, really good—and if a community has high vaccination rates, that 1% of kids whose MMR didn’t take are still well protected by herd immunity. Of course, if vaccine rates fall, it all falls apart. The 1% who didn’t respond are vulnerable, as are babies too young to vaccinate and people with health conditions that preclude vaccination.

Testing for immunity can done under special circumstances, sometimes to help control an outbreak, or in people at risk for losing immunity after chemotherapy, for instance. But the testing is expensive and kind of a hassle (it’s not always easy to draw blood from children, and they don’t like it very much.) Because the vaccine is so safe, it makes more sense to just give the two doses than to test everyone.

Measles at Disneyland: A predictable, avoidable public health nightmare

January 12, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

On January 8, NPR reported “Measles makes an unwelcome visit to Disneyland.” Nine people who visited Disneyland theme parks in California over winter break had caught measles, almost all of them unvaccinated children. The next day, January 9, ABC reported that the number of cases has grown to 19. Of these, only two had been fully vaccinated. Some of the cases were too young to receive vaccines, others apparently chose not to get vaccinated. Since measles is one of the most contagious illnesses on earth—it can spread just through the air, with infectious particles floating around for hours after a victim has left the room—we can expect these cases to lead to dozens, or hundreds more. A lot of these sick people were probably traveling on planes all over the country. Who knows how many people have now been exposed?

Measles is a serious illness. Prior to widespread vaccinations, 3-4 million people caught measles each year in the USA; of these, 400-500 died, 48,000 were hospitalized, and 4,000 developed encephalitis (brain swelling, which can lead to death or permanent disability.) We’ve kind of forgotten that, because measles has become so rare. We do not want measles to come roaring back.

Measles vaccine itself is very, very effective—98% of people who’ve gotten the two dose series remain completely immune for life. That’s incredibly effective, and just as effective as “natural immunity” from the disease, but without the misery and risk of the disease itself. But 98% effective means that 2% of vaccinated individuals are still susceptible. In a huge Disney theme park with thousands of people wandering around in mouse ears, even a highly vaccinated crowd is going to include some people who are not well protected. And they don’t know who they are.

Some people can’t be vaccinated at all. Babies less than one (who have a high risk of complications from measles) can’t receive the vaccine; nor can many people who have immune deficiencies.

The only way to protect susceptible individuals (those who can’t get the vaccine, or those in whom the vaccine didn’t work) is to avoid contact with measles. If measles is very rare, even unvaccinated people will probably be safe. But once measles isn’t rare, well, we’re asking for trouble.

We had measles beaten—in the 2000’s, it had been completely eliminated from transmission in the US, thanks to a very safe and effective vaccine. Then one nutjob created anti-vaccine hysteria with one fraudulent study. He made the damn thing up. And we’re paying the price.

We can beat this. Parents need to make sure they’re vaccinating their kids, on time and on schedule. They need to let their neighbors know it’s the right thing to do. Parents who are genuinely afraid need honest, reliable information about the great wealth of information we have, which overwhelmingly supports the safely and effectiveness of vaccines. People who are just loudmouths and liars, fanning fear for their own twisted reasons, should be shunned. It is time to end the fake “vaccine controversy” to protect the health of our children and our communities.

More:

Dr. Bob Sears says skipping vaccines is not good for public health

Dr. Bob’s alternative vaccine schedule? He made it up

Vaccine posts on this site

Vaccine information from the Immunization Action Coalition

Infection Report 5: What you really should be worried about

October 10, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

This week’s posts have all been about infections, new and old—infections newly found, and infections sneaking back. On the one hand, the media is agog with news of Ebola and the mysterious paralysis virus; on the other hand, threats that are far more likely to kill us are being largely ignored.

One infection is on the verge of sneaking back, which is a shame. We had it beaten, and now we’re allowing it to gain a foothold. We’ve got a great way to eradicate measles, but fear and misinformation have led to pro-disease, anti-vaccine sentiment, especially among those white, elite, and wealthy. As we’ve seen, we’re all in this together—so those anti-vaccine enclaves are going to affect all of us.

Measles, itself, is just about the most contagious disease out there. You don’t need to have infected fluid splashed on you (Ebola), and you don’t need to actually even touch a contaminated surface (influenza). All it takes to catch measles is to breathe the same air as someone with the disease. The measles case doesn’t even still have to be in the same room—particles of infectious measles can float around long after the patient has left. Measles can also be transmitted from contaminated surfaces (and even if person A who touches the surface is immune, he can spread it later on to person B.) Measles is so transmissible that 90% of non-immune people who come near someone with measles will themselves get it. To make matters worse: a person with measles starts spreading virus 4 days before they get sick (compare that to Ebola, which has no transmission until symptoms appear.)

And it’s serious, too. Measles is far more than spots. In the USA, about 1 in 20 people with measles require hospitalization for pneumonia; about 1 in 1000 get brain swelling, which can lead to permanent disability. Measles still kills close to 200,000 people, worldwide, every year (about 1 in 4 people with measles die in the developing world.)

While no vaccine is 100% effective, the measles vaccine is pretty darn close. About 95%-100% of people develop lifelong protective antibodies after the two-dose series. Unfortunately, not everyone can be vaccinated—the vaccine isn’t routinely used less than 12 months, and some people with certain health conditions and immune problems can’t safely be vaccinated. Still, when vaccine uptake rates were strong throughout the developed world in the 1990s, there was very little transmission of measles in the United States, just a handful of cases each year.

And now, it’s back. 2014 is going to have by far the most measles cases in 20 years. Though overall rates of vaccination remain strong, some neighborhoods have immunization rates poorer than third-world countries. And cases that begin or are imported into those areas become outbreaks that public health officials struggle to contain.

Think about this: in west Africa, thousands of people are dying of Ebola, for the lack of rubber gloves and other ways to isolate cases. Here, we do have a safe and effective vaccine against a disease that’s far more transmissible—and some people choose not to get it. There, they battle a lack of basic health resources. Here, our enemy is fear and misinformation. That’s what American families really need to worry about.

This week’s posts about infections new and old were meant to contrast the kinds of challenges faced here, versus the challenges faced in most of the rest of the world. We’re so safe and rich that we can afford to be afraid of things that really shouldn’t scare us (vaccines), while the media becomes preoccupied with things that aren’t likely to become a threat here (Ebola.) We don’t get our flu vaccines because “I heard the flu vaccine can give you the flu” – an utter falsehood that is probably contributing to thousands of deaths. At the same time, we guzzle unnecessary antibiotics for viral infections that do us far more harm than good.

Preventing infections is always the best strategy. Wash your hands, stay away from sick people, keep your kids home when they’re ill, and listen to what every legitimate health authority on the planet says: get yourself and your kids vaccinated. As long as we get them, vaccines are one thing you do not have to worry about.

This week’s posts: The Infection Report

Why are infections such a problem again?

Ebola and you

The single biggest infectious health risk is preventable

Two newcomers and the importance of paying attention

What you really should be worried about