Posted tagged ‘whooping cough’

Fear the diseases, not the vaccines

October 30, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

About 3 million children’s lives are saved each year by vaccination. In the United States alone, 20 million cases of serious illness are prevented every single year, because of the power of immunizations. That’s why immunizations are among the greatest public health achievements of all time.

With vaccine-preventable illnesses at historic lows, some parents are becoming more fearful of vaccines than of the diseases themselves. That’s a tragedy. Vaccines are the most intensely studied and researched health interventions we have, and there is a tremendous amount of data supporting their safety. Yet, rumors and internet sites have contributed to a mistrust of not only vaccines, but to the doctors who recommend them, the governments who supply them, the scientists who invent them, and the companies that manufacture them. Somehow, the diseases themselves are no longer the bad guy.

Vaccine-refusers expose their children to a 23-fold increased risk of pertussis, a 35-fold increased risk of measles, and a 9-fold increased risk of chicken pox. You get the idea. These vaccines work. They prevent illness, and prevent death.

Refusing vaccines hurts your children and your community. There are always people in a community who are at high risk for disease. This includes the very young and old, and people who for health reasons have poor immunity or who can’t be vaccinated. It also includes some people who were vaccinated, but who didn’t develop good immunity. Though vaccines work very well, they’re not perfect, and some people don’t develop protection from their vaccinations. If almost everyone in a community is vaccinated, it helps protect the most vulnerable among us. And once enough families refuse vaccines, this protective effect will evaporate. Not vaccinating doesn’t only affect your own children. It can affect mine, and your neighbors’, and the people in the nursing home. It affects us all.

Fear of vaccines has led some parents to want to “space them out”—the exact wrong thing to do, if you want to keep your children and your community safe. One idiot doctor even made up an alternative schedule, and he’s sold a lot of books about it. But why would anyone think his made-up schedule is safer than the one recommended by every important health authority in the world? Why is that one guy more trustworthy than your own pediatrician? Think about this: if vaccines were in some way unsafe, why is making more separate visits so your child gets more days with shots better than bunching them up and getting them over with? There is no evidence, and no plausible scientific reason, to think that the stretched out schedule is safer. It just leaves your child more vulnerable, longer. Fear drives the use of this weirdball schedule—a misguided fear of vaccines, instead of a fear of disease. There are different reasons why some parents refuse vaccines, but the common thread is fear.

The media hasn’t always done a great job presenting the science of vaccines, preferring sometimes to stick with sensationalism over useful information. And the internet, by its very nature, tends to exaggerate freaky new stories over context and followup, leaving parents reeling. Parents want to keep their kids safe and healthy. But with “all those stories on the internet”, who can they believe?

I’ll tell you who to believe. Believe the doctors and scientists around the world who’ve dedicated their lives to keeping children safe. Believe the parents, the millions of them, whose children have been saved by vaccines. Believe your own pediatrician, not celebrities and fear-mongerers on the web. Believe the science that continues to study and monitor and improve vaccines. Don’t give in to an irrational, unnecessary, and harmful fears. Protect your kids and mine. Vaccinate.

The long and winding cough

April 12, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

Ilana wrote in, “My child has had a cough for at least a year. It comes and goes, but it’s almost always there. I don’t know if she needs a specialist or what, but we’re tired of the cough! What can we do?”

Chronic or frequent coughing is a fairly common complaint, and working out the why’s-she-coughing and the how-to-stop it isn’t always simple. Some of the most common causes I see are:

Asthma—far and away the most common cause of frequent or prolonged cough. Asthma can be a tricky diagnosis to confirm, but it’s easy to treat: so often we treat it if the history and exam are suggestive of asthma. If the child gets better, that confirms the diagnosis.

One cold after another—very common, especially in day care kids. What is perceived as one long, forever cough is really a bunch of cold viruses stacked one after another. Frustrating for all!

Allergies—more commonly causes congestion/sneezing/itchy nose, but many kids w/ allergies also cough. “Testing” for allergies has many false positives and negatives, so the best “test” is a history and physical exam.

Chronic or recurrent sinusitis—both the most undertreated and overtreated condition I see. I know that sounds weird, but it’s true. Sinusitis causes a cough from mucus drip.

Habit cough—common! Sometimes also called “psychogenic cough,” this is the cough that disappears when kids fall asleep.

Reflux—Gastroesophageal reflux can be sneaky, and can trigger a cough that’s especially bad at night, even without obvious symptoms like heartburn.

Pertussis—In many communities, “whooping cough” is making a comeback, thanks in part to families who choose not to immunize. Protect yourself and your children from this “100 day cough”—though the vaccine isn’t 100% effective, it’s the best protection we’ve got. Once the cough of pertussis sets in, no treatment is effective.

There are many other causes of cough, but almost all chronic/frequent cough in kids is from one of these things. The key to the diagnosis is almost always in the history. To help figure out the cause of cough, the most important “test” is a good, careful log. Keep track of when the cough occurs, what time of day or night, and what your child is doing during the cough. What makes it better? What makes it worse? What other symptoms might be going on, like fever, nasal drip or congestion, abdominal pain, shortness of breath? Go over the details with your pediatrician to help figure out the most-likely culprit.

Sometimes, fancier tests can help. These might include a chest x-ray, blood tests, or endoscopy. If your child does undergo these or other tests, keep track of the results to share with other specialists that might get involved. Depending on the initial impression, helpful specialists to assist with a cough workup include pulmonologists (lung specialists), ENTs (ear, nose, throat), or allergy/immunologists.

Meanwhile, help a coughing child feel better with some comfort care. Though OTC cough meds and rubs probably don’t work very well, steamy showers, a humidifier, or honey can help. Whatever the cause, coughing can irritate the throat, leading to more mucus production, more swelling, and more cough—so soothing lozenges (for older kids), popsicles, or ice cream can be far more effective than any medication. Stay away from regular use of narcotic-based prescription cough syrups, which can be habit-forming and potentially dangerous especially in young children. A cough can linger and annoy, but don’t choose a remedy that’s worse than the disease.

Parents need pertussis vaccination

July 28, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

Sheri wrote, “A friend sent me a link to information regarding the pertussis vaccine for adults. I have a 6 month old. What are your thoughts?”

I wrote about vaccines for parents of newborns last year, but recent news about several outbreaks of pertussis make this question especially important. It’s time for an update.

Pertussis, also called “whooping cough,” is bad news. For children and adults it causes literally months of coughing, at times so severe that it causes vomiting and broken ribs. But for infants and especially newborns, pertussis is much worse: they can’t tolerate the respiratory infection, and sometimes just stop breathing. Pertussis can also lead to seizures and encephalopathy (brain inflammation) in the young. There is no effective therapy for the severe cough and other symptoms of pertussis short of intensive care and mechanical ventilation on a machine. Though antibiotics are prescribed, those do not help the victim recover faster—they only prevent further spread of the infection.

Worldwide, about 300,000 deaths occur from pertussis each year, 90% in developing countries. (That’s second only to influenza in vaccine-preventable deaths.) The rate of pertussis had been as high as 160 per 100,000 person-years in the USA prior to the introduction of the vaccine; it then dropped to probably 1 per 100,000 years.

Pertussis is now making a comeback. California has declared an epidemic, and local health authorities near my home in Georgia are also posting warnings about outbreaks. In my own practice, we’ve seen at least half a dozen kids with pertussis in the last 12 months, far more than I’ve ever seen before.

Why is pertussis sneaking back?

  • The vaccine isn’t 100% effective. Getting fully immunized provides good protection probably 80% of the time. That’s why it’s especially important for everyone to stay vaccinated—if you or your child is one of the unlucky ones who didn’t get good protection from the vaccine, you’ll still be relatively protected if all of your neighbors are vaccinated.
  • We are more aware of pertussis and looking out for more cases. Nowadays if I see a child who coughs until he vomits, or has a cough longer than three or four weeks, I’m thinking about pertussis. More awareness leads to more testing and more diagnosing.
  • Some parents are choosing to skip, delay, or somehow split vaccines. It’s considered the hip thing to do in certain neighborhoods, and has the support of playboy bunny starlets (lots of good vaccine info links underneath the video.) Remember it’s the youngest babies who will suffer most from vaccine-preventable illnesses. You wouldn’t dream of driving around without a car safety seat; don’t delay or skip the protection your child needs from vaccines.

Until recently, only children were vaccinated against pertussis, using the “DTaP” immunization. Though children are affected more seriously and account for most of the mortality, adults also get quite ill with pertussis and are a source of contagion in the community—so an adult version, abbreviated “Tdap” or “TdaP,” was introduced a few years ago for use from age 10-65. (Both the children’s DTaP and adult Tdap includes tetanus, diphtheria, and pertussis protection. There is no “single-agent” vaccine against pertussis alone in the United States.)

All adults up through age 65 should receive a dose of Tdap, especially those with children, and absolutely especially those with babies and newborns.

Tdap is recommended as long as it has been 5 years or more since your last tetanus shot. In some situations, even 2 years is a sufficient gap, depending on the likelihood of exposures and other household risk factors. You’ll want to review these specifics and other information about risks, benefits, and possible side effects with whomever will be administering the vaccine.

Where can you get it? Here in Atlanta hospital maternity wards offer it to moms after birth (though not to dads, which I find odd.) We also offer this and other vaccines to parents and grandparents of kids in my practice, so you might want to ask you own child’s pediatrician if you and your husband can be vaccinated there. You can also ask your own physician and obstetrician (though admittedly adult-oriented docs have not been as keen to stock vaccines as pediatricians and family physicians.) County health departments should also be able to administer this vaccine.

Got it? Good! Haven’t gotten it? Get it, before it gets you!