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Responsible Vaccine Advocacy: How To Make A Difference

I lost a patient this season, an infant, to whooping cough (pertussis). After falling ill, he lived for nearly a month in the intensive care unit on a ventilator, three weeks of which was spent on a heart/lung bypass machine (ECMO) due to the extent of the damage to his lungs. But all our efforts were in vain. The most aggressive and advanced care medicine has to offer couldn’t save his life. The only thing that could have saved him would have been to prevent him from contracting pertussis in the first place.

He was unvaccinated, but that was because of his age. He was part of the population that is fully dependent on herd immunity for protection, and that is exquisitely prone to a life-threatening course once infected. This is a topic we’ve covered ad nauseum, and I’m not inclined to go into greater depth in this post. Suffice it to say his death is a failure at every level. We, both as medical professionals and as a society at large, need to do a better job of protecting our children from preventable diseases. Read more »

*This blog post was originally published at Science-Based Medicine*

Health Tips For Back-To-School

I was lucky enough to be asked by one of the local TV stations to talk about some back-to-school issues when it comes to health. I don’t know about where you’re at, but most of the local schools around here started [yesterday, August 23rd].

Keeping up-to-date on immunizations is always important. Other important issues are getting kids back on their school sleep schedules and making sure the backpack isn’t overwhelmingly heavy.

Check out the video below. Also check out the Back To School Video 2 and the Back To School Video 3 (Yup, that’s right — three segments in one day.) If you find those helpful, I encourage you to check out my You Tube page and click on “My TV Interviews” for more health segments from local TV news. Enjoy!

*This blog post was originally published at Doctor Anonymous*

“Buzzy” Pain Relief For Kids

Buzzy Pain ReliefHere’s Buzzy, a reusable pain relief device developed by a pediatrician. It works based on the gate control theory of pain:

Buzzy is a newly developed reusable pain relief device that children can bring to the doctor’s office with them to help dull the pain of shots! As the brainchild of Pediatrician Amy Baxter, Buzzy rapidly reduces pain when pressed onto the skin. Buzzy is especially helpful for children who receive shots often, like those suffering from diabetes. Buzzy can also be used for the small things, like taking splinters out! Not only is Buzzy a kid-favorite, but it’s safe, effective immediately on contact, FDA compliant, and environmentally friendly, too.

*This blog post was originally published at ScienceRoll*

Important reminders for parents of newborns

A big part of pediatrics is what we call “anticipatory guidance” and preventive medicine.  This is where we get to impart our wisdom on parents, particularly the vulnerable, first-time ones.  For them, everything is new, exciting and, yes, anxiety provoking.  We hope that we can teach and guide them to raise medically and psychologically healthy children.  One of the first and most important things we can do is stress the importance of immunizing children on time.  I know – I have talked about this ad nauseum!!  But that is because when newborns, children and, yes, adults, are not adequately immunized, they are at risk of developing serious illnesses.  As you may recall, I blogged a couple of months ago about the haemophilus influenzae outbreak in Minnesota, where several children became ill and one died.  Well, guess what?  Now there are cases of measles in my hometown, Rockville.  It appears that an unimmunized adult contracted it and has infected several others, including an 8 month old child who is too young to have received the routine immunization.
But, believe it or not, I am not blogging about immunizations today.  It appears that this is just an example of what happens years after a successful plan has been implemented.  Because we don’t see many of these infections anymore, we aren’t routinely reminded of the importance of preventing them.   We seem to have forgotten that the reason we don’t see many of these deadly infections is precisely because children have been vaccinated.  So … the vaccination rate drops, and as the vaccine rate drops, the risk of contracting one of these illnesses rises.  I can guarantee that if we had an epidemic of measles here, with kids dying, parents would be lining up to ensure their kids were adequately immunized.
Well … it’s the same with ALWAYS putting your infant to bed on the back.  Multiple studies have demonstrated a significant increase in the risk of sudden infant death syndrome (SIDS) with placing your infant stomach-side down to sleep.  My recollection from when this recommendation first came out is that almost all parents put their infants on their backs to sleep.  Now, however, more and more parents are telling me that they are putting their infants on their stomachs to sleep because they sleep better.  Or, they are watched by a grandparent during the day, who puts them to sleep on their stomachs.  Well … it is even worse to put an infant on its stomach sometimes rather than always (not that I am EVER recommending stomach sleeping).
A study published in this month’s journal, Pediatrics, evaluated 333 infants in Germany over a 3 year period.  As noted in previous studies, those who were placed prone to sleep were at greater risk of dying from SIDS, particularly those who were not used to sleeping prone.  Other factors which increased the risk of SIDS were covers, sleeping at a friend or relative’s house, and sleeping in a living room.  The only factor which decreased the risk of SIDS was the use of a pacifier at night.   With such compelling evidence which supports many other studies on SIDS risk factors, there is no reason to place our infants on their stomachs to sleep – ever.    This includes when they are with any caretaker, including grandparents, nannies, and other relatives.
So let’s not become complacent about treatments that work.  Continue to immunize.  Continue to place infants on their backs to sleep.

Parents need to know about vaccine safety

By Stacy Beller Stryer, M.D.

After my blog last week discussing the recent increase in Haemophilus influenzae B (Hib) cases in Minnesota, I received a comment from “Indian Cowboy,” who is a blogger and fourth year medical student. While Indian Cowboy admits that he isn’t completely against vaccines, he does question their safety and says that, “if my (future) patients were to ask me specifically, scientifically, what the risks of vaccines are, I would be forced to shrug my shoulders and say I actually have no idea.” He suggests that pediatricians, in general, are not open and honest with their patients about any side-effects associated with vaccines. Furthermore, Indian Cowboy comments that he is a member of the “current generation of medical students,” where evidence-based medicine is important. Does this mean that we old-timers (yes, I am an ancient 45 years old), don’t practice medicine based on results of quality studies and proof of what actually works?

 

That is far from the truth. My colleagues and I practice medicine based on what has been proven to work and not just what we learned on a whim. We continue to read reputable journal articles and other medical literature, often discussing treatment changes based on new research. And I do not know any pediatrician who makes a blanket statement that vaccines are 100% safe. Personally, I spend a fair bit of time talking to parents who question vaccine safety. I tell them that anybody can have a reaction to a vaccine, just like anybody can react to an antibiotic, food, or something in the environment. I also discuss more common side effects of vaccines, such as fever, redness, and irritation at the injection site. In addition, I mention that there are very rare, more serious side effects associated with some vaccines, such as seizures and encephalitis. I am certainly not the only honest pediatrician in the United States. In fact, reputable organizations such as the Centers for Disease Control (CDC), which are major advocates for vaccines, clearly state on their website that no vaccine is 100% safe or effective.

 

Just as importantly, and an absolute necessity is discussing that the risk of becoming seriously ill or dying secondary to a vaccine is much lower than the risk of developing a serious illness or dying if a child becomes ill with one of the infections for which they could have been vaccinated. Parents must be aware of the benefits of receiving these vaccines. And they should know that vaccines are one of the greatest medical discoveries of the 20th century and have increased life expectancy and quality of life significantly.

 

Back to Indian Cowboy – he also comments that we really don’t know much about vaccine safety because studies only last days or, at most, a couple of weeks. This is also far from the truth. Before a vaccine is licensed, the Federal Drug Administration (FDA) requires testing. Once the vaccine is being used, the CDC and FDA look for any problems and investigate them through the Vaccine Adverse Event Reporting System. It’s true that this system depends on pediatricians and parents to report side effects. This was recognized as a problem, so in 1986 a National Childhood Vaccine Injury Act was developed which, among other things, required experts to intensively review any possible adverse effects of vaccines. In 1990 the Vaccine Safety Datalink project was developed, where researchers gained access to the medical records of over 5.5 million people to evaluate for common and rare side effects associated with vaccines. All of these different safety methods have led to changes in vaccines to make them safer. In 2000, children began to receive the inactive polio instead of the live polio vaccine due to the rare risk of developing polio from the oral vaccine. More recently, the pertussis vaccine was changed from a whole cell to an acellular one because of the increased risk of rare neurological side effects.

 

I could continue, but the bottom line is that immunizations have been tested extensively for safety and continue to be monitored by reputable, quality organizations. There is an abundance of information available on safety for every vaccine. It is true that we cannot assure parents that their child will not develop a severe allergic reaction or a rare side effect to a vaccine. And we cannot say that we are 100% sure that vaccines do not affect the brain or the immune system, such as we cannot assure them that they will not get into an accident when they step into a car or that they will not be hit by a car when they cross a street. But we can reassure them that the chances of such an event are rare and that the benefit of receiving the vaccine far outweighs the risk of not receiving it.

 

I certainly hope that the one case of epiglottitis and pertussis that Indian Cowboy saw last year makes him realize not only how serious these infections can be in infants and children, but also that he only saw one case of each whereas, without immunizations, he would have seen many more and, most likely, a few deaths.

 

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