Posted tagged ‘vaccines’

When polio was wild

September 12, 2018

The Pediatric Insider

© 2018 Roy Benaroch, MD

“Polio. I’ve seen polio.”

Last night, I was speaking with one of the most experienced pediatricians I’ve ever met, Dr. Jack Burstiner. I’ve known him for 50 years. I would have known him even longer if I had been born earlier. He lived in my neighborhood, two doors down. He was my pediatrician.

Jack is almost 90 years old. But he still looks like a pediatrician. He’s got a smile a child could trust, now hidden under a white mustache. His green eyes twinkle when he talks about his patients, the kids he’s seen. There are some things about a pediatrician that never change.

Though he stopped practicing in the 1980’s, Dr. Burstiner worked for 30 years in pediatrics, at a time when pediatricians did everything. Hospitals, emergency departments, newborn deliveries, everything. And in 1955, just starting his training, Dr. Burstiner was a pediatric intern at Kings County Hospital, Brooklyn. It was a busy hospital, sure, but it was especially busy in the summer. Polio season.

“That’s where they’d all come, the kids with polio. They didn’t look right. They’d be dragging a leg, or not moving right. Sometimes an arm wouldn’t move, but usually a leg. And all night, every third night, I admitted all of them. It was just me. I’d do the spinal tap, and I’d look in the microscope, and I’d count the cells. If they had a lot of cells, that was polio. Of course we knew it anyway, but we had to tap all of them to be sure. All night long.”

Polio is caused by specific virus, an enterovirus that circulates especially in the summer and fall. It’s spread by contaminated water, sometimes in swimming pools or from unsafe taps, or from household contamination via stool. Most kids with polio develop a fever and then recover, but many develop paralysis of their skeletal muscles. It doesn’t affect their thinking, or their ability to feel sensations or pain. But it can make it impossible to walk or use other muscle groups, and can sometimes shut down the muscles that keep them breathing.

“It’s funny,” Dr. Burstiner said. “It was a big hospital, and upstairs – up above the emergency department, and the wards, the rooms the patients – upstairs were some of the smartest people in the world. They had dedicated their whole lives to fighting polio, and they knew all about it. But we still couldn’t really do anything to treat it. I was there, this intern, and I could tap them and I’d admit them, and then hopefully they’d keep breathing.”

In 1955 there were about 29,000 cases of polio in the United States. Dr. Burstiner estimates he admitted about 100 of those, ten a night, on the every third overnight he worked at the Brooklyn Hospital for one month during that hot summer.

“100 cases, I think I admitted, just in that one month. And all of those smart people upstairs, what could they do? But you know what happened next? The vaccine came out, and everyone wanted it. And in just a few years, it wasn’t 100 a month in one hospital. There wasn’t any, there was no polio anymore. I saw more polio in that one month than there was in the entire country, just a few years later.”

The first polio vaccine was introduced in 1955. By the mid-sixties, there were fewer than 100 cases of polio per year in the United States. We beat it. There have been zero cases of polio transmitted in the US since 1979; the last imported case to reach our shores from overseas was in 1993. There are still pockets of polio transmission, but it’s very possible the disease will be wiped off the earth entirely in the coming years.

Dr. Burstiner and I talked a while more, trading war stories, talking about cases. I’ve never seen polio, but I have seen children die of pneumococcal meningitis, and I’ve seen complications of chicken pox that put children in the ICU for weeks. Those are some of the diseases I may have the pleasure of never seeing anymore. Maybe someday I’ll tell the next generation of pediatricians about how we knocked out rotavirus diarrhea, and HIB septicemia, and HPV-related cancer. Measles, diphtheria, hepatitis A and B, we’ve got the tools to beat these and other diseases. We just need the will to see the fight to the end.

There’s a lot that hasn’t changed. Parents still worry about their kids, and kids still get sick. But there are many diseases that parents just don’t have to worry about anymore. That’s incredibly good news for you and your family. Protect your children, protect your communities, and help be a part of making the world healthier for the future. Vaccinate.

Advertisements

Vaxxed versus unvaxxed children: What a real study shows

July 26, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

You may have seen it on Facebook: A published study claiming to be “The First Ever” comparing vaccinated and unvaccinated children supposedly showed that vaccinated children are more likely to have a number of health problems. Let me promise you: there’s nothing to worry about here. The study is one of those garbage-in-garbage-out whackjobs that’s almost indescribably bad and unreliable. And: a much better study of the same thing – children who are vaccinated, versus children who are not vaccinated – shows that there are not any worrisome risks. The long-term health of vaccinated children is just fine, and even better than unvaccinated kids (because they don’t have to suffer through vaccine-preventable diseases.)

Let’s cover the good study, first. It was published in 2011, and tracked over 13,000 randomly selected children in Germany, tracking their health status and correlating that with their documented vaccine histories. The authors could find no examples of any increased risks of infectious or allergic diseases in the vaccinated children.

And now, this more-recent, execrable study. They didn’t use randomly selected children. What it actually compared were the 666 children of homeschoolers who chose to complete the survey (which was promoted on antivaccine websites), using their self-reports of vaccine histories and health status. Of these, 40% hadn’t been vaccinated, at least according to the surveys. No attempt was made to track who received the survey, what percentage of respondents completed it, and what kind of respondents completed it. Do you think it’s possible that a high proportion of vaccine-distrusting parents would complete a survey like this? Hint: if you did a survey of musical tastes at a Justin Bieber concert, you’re not going to find many Cab Calloway fans.

The “study” was really just a survey, and a biased one at that – a survey among people who were guaranteed to say exactly what the study authors wanted them to say. It had already been retracted, once previously (and, laughably, by a bottom-feeding journal that looks like it requires authors to pay to publish their studies. This isn’t the way legit journals work.)

Vaccines are safe, and they save lives. Make sure your kids are fully vaccinated. Don’t believe the Facebook rumors, or idiocy dressed up like science – what the real science shows is what parents should feel confident about. There’s no need to worry about vaccines.

A more detailed evaluation of this fakakta survey is here, and here’s more information about reliable vaxxed versus unvaxxed studies. Yes, they’ve been done before. Yes, they consistently show that vaccines are safe and that vaccinated children are healthy.

26

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

 

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

Goodbye, Flumist: Why science is important

June 23, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Yesterday the CDC announced that its Advisory Committee on Immunization Practices (ACIP) voted to stop recommending the nasal spray flu vaccine, Flumist, for anyone. Bottom line: it doesn’t work. Though their recommendation against the use of Flumist still has to be approved by the CDC director to make it “official”, it’s pretty much a done deal. The AAP’s president has already endorsed the announcement, too.

Bye, Flumist. We’ll miss the ease of use and the not-scaring-children part, but the data’s clear. The mist doesn’t work. There was a sliver of good news, though—we have solid surveillance data from last year re-confirming that the traditional flu shot does work, with an estimated effectiveness of 63% last year. That’s not outstanding, but it’s pretty good. From a public health point of view preventing 63% of influenza cases can have a huge impact. Remember: every case prevented is one fewer person out there spreading influenza. Effective vaccinations not only help the person who got the vaccine, but the whole family and community.

Older data, at one point, had shown that Flumist was as effective (or even more effective) than the flu shot. For a few years, the mist was even considered the “preferred product” for children, because it seemed to work better.  Last year, Flumist lost its “preferred” status when data emerged showing that it wasn’t looking as good as the shot. Now, enough newer data has accumulated to show that at least against the strains that have been circulating recently, Flumist doesn’t work at all.

There’s going to be a scramble (again!) this year to ensure an adequate supply of injectable flu vaccine. I don’t know if MedImmune will suspend the Flumist program, or if they’ll still try to sell their product – but I am sure that there are a lot of docs out there scrambling this morning, trying to cancel Flumist pre-orders and increase our orders for alternatives. In the long run, that will be better for everyone. In the short run, it’s a problem. Families ought to plan to get their flu shots as early as possible this year, before they run out.

Science isn’t a set of answers, or a body of knowledge etched on a stone somewhere. It is a method of arriving at the truth, involving repeated observations and the continuous re-assessment of data. Estimates of vaccine effectiveness (and safety) are initially based on licensing studies, but they’re then adjusted by real-world data that continues to be collected, year after year. We should always make the best decision we can, based on the best data, even if that means we have to sometimes admit we’ve made a mistake, or that we have to change our minds. That’s not a weakness of science or medicine – that’s a strength. We can’t always promise to get it right, but we’ll keep studying and learning and trying to do it better.

Squirt!

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