Category: Vaccine Preventable Diseases

What to Do If Your Child Is Exposed to the Flu

During a bad flu season, especially when effectiveness of the flu vaccine is less than ideal, parents want to know how to protect their kids from the flu.

Protecting Kids from the Flu

Cover your coughs and sneezes so you don't spread the flu virus to other people.
Covering your coughs and sneezes might help prevent the spread of the flu virus to other people.

Of course,  the best way to protect kids from the flu and serious complications of the flu is to get a flu vaccine each year.

Still, the flu vaccine isn’t perfect.

So, what else can you do?

Like other respiratory diseases that are mainly spread by coughing and sneezing, you can help reduce the risk that your kids will get sick by:

  • as much as possible and practical, keeping your kids away from other people, especially those who are obviously sick
  • encouraging your kids and others to properly cover their coughs and sneezes
  • teaching your kids to wash their hands properly
  • encouraging your kids to not touch their eyes, nose, or mouth, or to bite their nails or put things in their mouth, like their pencil or pen
  • cleaning and disinfecting surfaces that your child will likely touch
  • encouraging others to stay home from school or work when they have the flu until they are fever free for at least 24 hours, although they might be contagious for even longer

While these techniques might not work, they are certainly better than doing nothing and simply letting your kids catch the flu.

What to Do If Your Child Is Exposed to the Flu

If your kids do anything outside the home, even if they don’t go to daycare or school, there might come a time during a long flu season when they get exposed to someone with the flu.

What do you do?

“Prevention (prophylaxis) is a term used when someone who does not have flu symptoms is given Tamiflu to help stop them from getting the flu because they are exposed to or come into close contact with someone (for example live with or take care of someone) who has the flu.”

FDA on Tamiflu: Consumer Questions and Answers

In addition to watching for classic flu symptoms to develop over the next one to four days, if your child is unvaccinated or it is a year during which the flu vaccine is not very effective, if your child is in a high risk group for severe complications from the flu (under age two to five years or any age with chronic medical problems), then you might ask your pediatrician about:

  • a once a day dose of Tamiflu (Oseltamivir), which is recommended as a preventative in infants as young as three months old
  • a once a day dose of Relenza (Zanamivir), which is recommended as a preventative in children as young as five years old, unless they have respiratory problems, like asthma

But that doesn’t mean that everyone should take these flu medicines every time they are exposed to someone with the flu. If these medicines are overused, flu viruses will develop resistance and they won’t work, just like happened to some of the older anti-viral flu medicines, amantadine and rimantadine.

Still, if your child with diabetes, uncontrolled asthma, muscular dystrophy, or healthy four month old is closely exposed to someone with the flu, then taking Tamiflu to prevent a potentially severe case of the flu is likely a good idea.

What to Do If Your Child Gets the Flu

And if your child gets the flu?

Believe it or not, most healthy school age kids with the flu don’t need to be seen by their pediatrician.

“When treatment is started within two days of becoming sick with flu symptoms, antiviral drugs can lessen symptoms and shorten the time you are sick by about one day. They may reduce the risk of complications such as ear infections in children, and pneumonia and hospitalizations in adults. For people at high risk of serious flu complications, early treatment with an antiviral drug can mean the difference between having milder illness instead of more severe illness that might require a hospital stay.”

CDC on What You Should Know About Flu Antiviral Drugs

You should see your pediatrician or other health care provider at the first sign of flu symptoms if they are at high risk for serious complications of the flu and they might benefit from Tamiflu, which includes those under two to five years old and children with any chronic medical problems.

And of course, seek medical attention if your child with the flu is showing signs of a severe case of the flu, such as trouble breathing, dehydration, or being inconsolable, etc.

You should also seek medical attention if your child with the flu was getting better, but then starts to get worse again, with a return of fever, worsening cough, or severe headache, etc.

When in doubt, call your pediatrician!

What to Know About Protecting Kids from the Flu

In addition to avoiding people who are sick with the flu, see your pediatrician as soon as possible if your younger, high risk child is gets sick after being exposed to someone with the flu.

More on Protecting Kids from the Flu

What to Do If Your Child Is Exposed to Mumps

Although things are much better than they were in the pre-vaccine era, we still have mumps outbreaks in the United States.

How does that work?

Waning immunity and folks who are unvaccinated.

How Contagious is Mumps?

Mumps is contagious, but not nearly as contagious as other vaccine-preventable diseases, such as measles.

“Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.”

CDC on Transmission of Measles

Unlike measles, which is so contagious that you can get it if you are simply in the same room with someone that is sick, mumps typically requires prolonged, close contact.

“When you have mumps, you should avoid prolonged, close contact with other people until at least five days after your salivary glands begin to swell because you are contagious during this time. You should not go to work or school. You should stay home when you are sick with mumps and limit contact with the people you live with; for example, sleep in a separate room by yourself if you can.”

CDC on Mumps Outbreak-Related Questions and Answers for Patients

How do you get mumps?

Since the virus spreads through saliva and mucus, you can get sick if you are in close contact with someone with mumps and they:

  • cough or sneeze
  • use a cup or eating utensil that you then use
  • touch an object or surface that you then touch (fomites)

And like many other vaccine-preventable diseases, people with mumps are usually contagious just before they begin to show symptoms.

“The mumps virus replicates in the upper respiratory tract and spreads through direct contact with respiratory secretions or saliva or through fomites. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps.”

CDC on Mumps for Healthcare Providers

The need for prolonged, close contact is likely why most outbreaks these days are on college campuses.

Is Your Child Protected Against the Mumps?

Tips to prevent getting sick with the mumps.
You can prevent the mumps.

The MMR vaccine protects us against mumps – and measles and rubella.

One dose of MMR is 78% effective at preventing mumps, while a second dose increases that to 88%. Unfortunately, that protection can decrease over time.

Kids get their first dose of MMR when they are 12 to 15 months old. While the second dose of MMR isn’t typically given until just before kids start kindergarten, when they are 4 to 6 years old, it can be given earlier. In fact, it can be given anytime after your child’s first birthday, as long as 28 days have passed since their first dose.

“Evidence of adequate vaccination for school-aged children, college students, and students in other postsecondary educational institutions who are at risk for exposure and infection during measles and mumps outbreaks consists of 2 doses of measles- or mumps-containing vaccine separated by at least 28 days, respectively. If the outbreak affects preschool-aged children or adults with community-wide transmission, a second dose should be considered for children aged 1 through 4 years or adults who have received 1 dose. In addition, during measles outbreaks involving infants aged <12 months with ongoing risk for exposure, infants aged ≥6 months can be vaccinated.”

CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices

And although it won’t count as their first dose, in special situations, kids can get an early MMR once they are six months old.

What to Do If Your Unvaccinated Child Is Exposed to Mumps

To be considered fully vaccinated and protected against mumps, kids need two doses of MMR – one at 12 to 15 months and another when they are 4 to 6 years.

“Although mumps-containing vaccination has not been shown to be effective in preventing mumps in persons already infected, it will prevent infection in those persons who are not yet exposed or infected. If persons without evidence of immunity can be vaccinated early in the course of an outbreak, they can be protected prior to exposure.”

Surveillance Manual

If your unvaccinated child is exposed to mumps, you should talk to your pediatrician or local health department, but unlike measles and chicken pox, there are no recommendations to start post-exposure prophylaxis.

Mumps quarantine sign

Unfortunately, neither a post-exposure dose of MMR nor immune globulin work to prevent mumps after you are already exposed. They should still get an MMR though, as it will provide immunity against measles and rubella, and mumps if they don’t get a natural infection.

“Persons who continue to be exempted from or who refuse mumps vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”

Manual for the Surveillance of Vaccine-Preventable Diseases

Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.
Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.

Unvaccinated kids who are exposed to mumps will likely need to be quarantined, as you watch for signs and symptoms of measles developing over the next 12 to 25 days.

If your exposed child develops mumps, be sure to call your health care provider before going in for a visit, so that they can be prepared to see you and so you don’t expose other people to mumps. Your child with suspected mumps should be wearing a mask before going out in public and if possible, will be put in a negative pressure room in the emergency room or doctor’s office.

It is very important to understand that simply wearing a mask doesn’t eliminate the risk that your child with mumps could expose others, it just reduces the risk. You still want to avoid other people!

What to Do If Your Vaccinated Child Is Exposed to Mumps

If your fully vaccinated child is exposed to mumps, does that mean you are in the clear?

Again, it depends on what you mean by fully vaccinated.

It also depends on what you mean by exposed. Is it someone in the same school that your child has had no real contact with or a sibling that he is around all of the time?

And is your child fully vaccinated for his age or has he had two doses of MMR?

Since kids get their first dose of MMR at 12 to 15 months and the second when they are 4 to 6 years old, it is easy to see that many infants, toddlers and preschoolers who are following the immunization schedule are not going to be fully vaccinated against mumps, even if they are not skipping or delaying any vaccines.

“In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.”

Ask the Experts about MMR

In most cases, documentation of age-appropriate vaccination with at least one dose of MMR is good enough protection. That’s because the focus in controlling an outbreak is often on those folks who don’t have any evidence of immunity – the unvaccinated.

And one dose of MMR is about 78% effective at preventing mumps infections. A second dose does increase the vaccine’s effectiveness against mumps to over 88%.

An early second dose is a good idea though if your child might be exposed to mumps in an ongoing outbreak, has only had one dose of MMR, and is age-eligible for the second dose (over age 12 months and at least 28 days since the first dose). Your child would eventually get this second dose anyway. Unlike the early dose before 12 months, this early dose will count as the second dose of MMR on the immunization schedule.

“Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

And in some cases, folks should now get a third of dose of MMR.

This third dose of MMR is not for post-exposure prophylaxis though, which again, doesn’t work for mumps. It is to prevent mumps from ongoing exposures.

You should still watch for signs and symptoms of mumps over the next 12 to 25 days though, as no vaccine is 100% effective. Your vaccinated child won’t need to be quarantined though.

Most importantly, in addition to understanding that vaccines are safe and necessary, know that the ultimate guidance and rules for what happens when a child is exposed to mumps will depend on your local or state health department.

What to Know About Getting Exposed to Mumps

Talk to your pediatrician if your child gets exposed to mumps, even if you think he is up-to-date on his vaccines, as some kids need a third dose of the MMR vaccine during on-going mumps outbreaks.

More on Getting Exposed to Mumps

What to Do If Your Child Is Exposed to Measles

Although the endemic spread of measles was eliminated way back in 2000, we still have measles outbreaks in the United States.

How does that work?

They are usually imported from outside the country, often by an unvaccinated child or adult who travels overseas, gets measles, and returns while still contagious.

How Contagious is Measles?

Measles is highly contagious.

“Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.”

CDC on Transmission of Measles

In addition to the fact that people with measles are contagious for at least four days before they develop the classic measles rash until four days after, the measles virus can survive for up to two hours in the air and on contaminated surfaces wherever that person cough or sneezed. So you don’t technically need to even be in direct contact with the person with measles – simply entering a room or getting on a bus that the infected person recently left can do it.

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died.
An infant hospitalized during a measles outbreak in the Philippines in which 110 people died. Photo by Jim Goodson, M.P.H.

Still, you are not going to get measles from simply being in the same city as someone else with measles.

The tricky part though, is knowing what to do if your child is exposed to someone with measles, even if you think they are up-to-date with their vaccines.

Remember, kids get their first dose of MMR when they are 12 to 15 months old. While the second dose of MMR isn’t typically given until just before kids start kindergarten, when they are 4 to 6 years old, it can be given earlier. In fact, it can be given anytime after your child’s first birthday, as long as 28 days have passed since their first dose.

“Evidence of adequate vaccination for school-aged children, college students, and students in other postsecondary educational institutions who are at risk for exposure and infection during measles and mumps outbreaks consists of 2 doses of measles- or mumps-containing vaccine separated by at least 28 days, respectively. If the outbreak affects preschool-aged children or adults with community-wide transmission, a second dose should be considered for children aged 1 through 4 years or adults who have received 1 dose. In addition, during measles outbreaks involving infants aged <12 months with ongoing risk for exposure, infants aged ≥6 months can be vaccinated.”

CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices

And although it won’t count as their first dose, in special situations, kids can get an early MMR once they are six months old.

What to Do If Your Unvaccinated Child Is Exposed to Measles

To be considered fully vaccinated and protected against measles, kids need two doses of MMR – one at 12 to 15 months and another when they are 4 to 6 years.

“During measles, rubella, or mumps outbreaks, efforts should be made to ensure that all persons at risk for exposure and infection are vaccinated or have other acceptable evidence of immunity.”

CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices

If your unvaccinated child is exposed to measles, you should talk to your pediatrician or local health department about starting post-exposure prophylaxis as soon as possible, including:

  • a dose of immune globulin (IGIM) if they are less than 6 months old
  • either a dose of immune globulin (IGIM) or the MMR vaccine if they are between 6 and 12 months old (this dose of MMR doesn’t count as the first dose of MMR on the immunization schedule and will need to be repeated when the child turns 12 months old)
  • a dose of the MMR vaccine if they are at least 12 months old
  • a dose of immune globulin (IGIV) if they are severely immunocompromised (even if they were previously vaccinated)

Immune globulin should be given within 6 days of exposure, while a dose of MMR vaccine within 72 hours of exposure can decrease their chances of getting measles.

“Persons who continue to be exempted from or who refuse measles vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”

Manual for the Surveillance of Vaccine-Preventable Diseases

Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.
Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.

What if your child is incompletely vaccinated, with just one dose of MMR? They could get their second dose of MMR, as long as they are over 12 months old and it has been at least 28 days since their first dose (see below).

Unvaccinated kids who don’t get post-exposure prophylaxis should be quarantined, as you watch for signs and symptoms of measles developing over the next 21 days. Your child might still need to be quarantined if they got immune globulin instead of the vaccine, and the quarantine might extend to 28 days, as immune globulin can prolong the incubation period.

If your exposed child develops measles, be sure to call your health care provider before going in for a visit, so that they can be prepared to see you and so you don’t expose other people to measles. Your child with suspected measles should be wearing a mask before going out in public and if possible, will be put in a negative pressure room in the emergency room or doctor’s office. If a regular exam room is used, it can not be used again for at least two hours. It is very important to understand that simply wearing a mask doesn’t eliminate the risk that your child with measles could expose others, it just reduces the risk. You still want to avoid other people!

What to Do If Your Vaccinated Child Is Exposed to Measles

If your fully vaccinated child is exposed to measles, does that mean you are in the clear?

Again, it depends on what you mean by fully vaccinated.

Is your child fully vaccinated for his age or has he had two doses of MMR?

Since kids get their first dose of MMR at 12 to 15 months and the second when they are 4 to 6 years old, it is easy to see that many infants, toddlers and preschoolers who are following the immunization schedule are not going to be fully vaccinated against measles, even if they are not skipping or delaying any vaccines.

“In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.”

Ask the Experts about MMR

In some cases, documentation of age-appropriate vaccination with at least one dose of MMR is good enough protection, which means that toddlers and preschoolers don’t necessarily need an early second dose. That’s because the focus in controlling an outbreak is often on those folks who don’t have any evidence of immunity – the unvaccinated.

And one dose of MMR is about 95% effective at preventing measles infections. A second dose does increase the vaccine’s effectiveness against measles to over 99%, but it isn’t a booster. The second dose of MMR is for those kids that didn’t respond to the first dose.

“Available data suggest that measles vaccine, if given within 72 hours of measles exposure to susceptible individuals, will provide protection or disease modification in some cases. Measles vaccine should be considered in all exposed individuals who are vaccine-eligible and who have not been vaccinated or have received only 1 dose of vaccine.”

AAP RedBook

An early second dose is a good idea though if your child is exposed to measles, has only had one dose of MMR, and is age-eligible for the second dose (over age 12 months and at least 28 days since the first dose). Your child would eventually get this second dose anyway. Unlike the early dose before 12 months, this early dose will count as the second dose of MMR on the immunization schedule.

You should still watch for signs and symptoms of measles over the next 10 to 21 days though, as no vaccine is 100% effective. Your vaccinated child won’t need to be quarantined though.

Most importantly, in addition to understanding that vaccines are safe and necessary, know that the ultimate guidance and rules for what happens when a child is exposed to measles will depend on your local or state health department.

What to Know About Getting Exposed to Measles

Talk to your pediatrician if your child gets exposed to measles to make sure he doesn’t need post-exposure prophylaxis to keep him from getting sick, even if you think he is up-to-date on his vaccines.

More on Getting Exposed to Measles

What to Do If Your Child Is Exposed to Shingles

Pediatricians often get calls from worried parents because their kids have been exposed to someone with shingles.

Would you know what to do?

Shingles and Chicken Pox

Shingles is definitely contagious.

“A person with active shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before the blisters appear. Once the rash has developed crusts, the person is no longer infectious.”

CDC on Shingles Transmission

Herpes zoster was described as early as 1867, as can be seen in the lithograph from the Atlas der Hautkranheiten, although the connection with chickenpox didn't come until later.
Herpes zoster (HZ) was described as early as 1867, as can be seen in the lithograph from the Atlas der Hautkranheiten, although the connection with chickenpox didn’t come until later.

Not surprisingly, the biggest factor that will determine what needs to be done is whether or not your child is immune to chicken pox (primary varicella). Has your child ever had a natural chicken pox infection or completed a two dose chicken pox vaccine series?

Chicken pox vaccine?

Yes, because while shingles is contagious, you won’t get shingles if you are exposed to someone with shingles, but you can get chicken pox.

Remember, shingles is a reactivation of the varicella zoster virus (VZV), which also causes chicken pox. After a natural chicken pox infection, or less commonly after having the chicken pox vaccine, the chicken pox virus can stay dormant in the dorsal root ganglia of a spinal nerve. And you get shingles if the virus ever reactivates.

The type of exposure also matters.

Shingles is usually thought to be less contagious than chicken pox and requires direct contact with the rash, while it is in the blister phase, to spread disease. You shouldn’t catch the virus by simply being in the same room as someone with shingles. So if their shingles rash was completely covered by clothing, that decreases the chance of any real exposure.

“Not only was the risk of secondary infection with HZ comparable to that of primary varicella, the risk was similar regardless of the anatomic location of HZ. This finding contradicts the assumption that coverage of active skin lesions with dressings or clothing reduces VZV aerosolization and, if substantiated through further investigation, may warrant a change in current recommendations for VZV prevention.”

Bloch et al on Varicella Zoster Virus Transmission in the Vaccine Era: Unmasking the Role of Herpes Zoster

Covering the shingles rash doesn’t eliminate the risk of exposure though.

Another problem is that it isn’t always easy to recognize that someone has shingles, especially when younger children or teens have it.

“Anyone who has recovered from chickenpox may develop shingles; even children can get shingles. However, the risk of shingles increases as you get older.”

CDC on Shingles Clinical Overview

After all, no one expects an infant or toddler to have shingles, but it is important to remember that you can get shingles at any age, it is just more common the older you get.

Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant.
Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant. Photo by Kaoutar Zinelabidine et al.

And since it is often less severe in children and younger adults, who get a lot of rashes anyway, shingles isn’t usually the first thing a parent or many pediatricians will think of as a diagnosis.

That increases the risk of exposure before a diagnosis of shingles is finally made.

What to Do If Your Unvaccinated Child Is Exposed to Shingles

If your unvaccinated child, or incompletely vaccinated child, who has never had chicken pox is exposed to shingles, you should talk to your pediatrician about getting him vaccinated with the chicken pox vaccine. The vaccine should be given as soon as possible and preferably within 3 days of the exposure, but it can work even if it is given as long as 5 days afterwards.

“Vaccination within 3 days of exposure to rash was >90% effective in preventing varicella whereas vaccination within 5 days of exposure to rash was approximately 70% effective in preventing varicella and 100% effective in modifying severe disease.”

ACIP on Prevention of Varicella

This post-exposure vaccination can greatly reduce your child’s chances of developing chicken pox and even if your child does develop chicken pox, it will reduce the severity of the disease.

Otherwise, you should watch your child carefully over the next 10 to 21 days for the development of the classic symptoms of chicken pox, including a rash and fever, keeping him quarantined until after this incubation period so that you don’t expose others.

Certain high risk children who aren’t immune and who can’t get a chicken pox vaccine should get VariZIG (varicella zoster immune globulin) after being exposed to shingles (or chicken pox). This includes:

  • immunocompromised patients
  • hospitalized premature infants born at or after 28 weeks gestation, if their mother wasn’t immune to chicken pox
  • hospitalized premature infants born before 28 weeks gestation, even if their mother was immune to chicken pox
  • pregnant women who are not immune to chicken pox

VariZIG is given as soon as possible and within 10 days of exposure.

What to Do If Your Vaccinated Child Is Exposed to Shingles

If your child has already had chicken pox or two doses of the chicken pox vaccine, then you can likely safely assume that he is protected if he is ever exposed to shingles.

Still, since no vaccine is 100% effective, you should watch him over the next 10 to 21 days in case he does develop any signs or symptoms of chicken pox.

And keep the shingles rash covered to prevent further exposure.

What to Know About Getting Exposed to Shingles

Shingles is contagious and can cause someone to develop chicken pox if they haven’t already had it or aren’t vaccinated and protected.

More on Getting Exposed to Shingles

What to Do If Your Child Is Exposed to Hepatitis B

Hepatitis B is a vaccine-preventable disease.

“In the United States, based on national health surveys, there are approximately 850,000 persons living with chronic HBV infection. However, estimates based on other methods and data yield estimates as high as 1.29 to 2.2 million persons with chronic HBV infection.”

Manual for the Surveillance of Vaccine-Preventable Diseases

That doesn’t mean that your child can’t be exposed at some point though.

What to Do If Your Child Is Exposed to Hepatitis B

Hepatitis B is mainly spread through blood and body fluids, which is why some folks consider the hepatitis B vaccine an STD vaccine.

“If you are concerned that you might have been exposed to the Hepatitis B virus, call your health professional or your health department. If a person who has been exposed to Hepatitis B virus gets the Hepatitis B vaccine and/or a shot called “HBIG” (Hepatitis B immune globulin) within 24 hours, Hepatitis B infection may be prevented.”

CDC on Hepatitis B FAQs for the Public

It is also possible to get hepatitis B from exposure from an infected family member or caretaker, or much more rarely, in a daycare or school setting.

So what do you do if your child is exposed to hepatitis B?

It depends.

Kids should complete the three dose hepatitis B vaccine series by the time they are 18 months old.
Kids should complete the three dose hepatitis B vaccine series by the time they are 18 months old.

Not surprisingly, one of the biggest factors that will determine what needs to be done is whether or not your child has completed a three dose hepatitis B vaccine series.

First things first though.

Before going any further, you will want to confirm that the person that exposed your child actually has hepatitis B (has a positive HBsAg level).

Next, confirm that it was a real exposure, which the AAP Red Book defines as “a discrete, identifiable percutaneous (eg, needlestick, laceration, bite or nonintact skin), mucosal (eg, ocular or mucous membrane), or sexual exposure to blood or body fluids.”

Keep in mind that the hepatitis B virus is not spread by casual contact, like hugging, kissing, holding hands, or even sharing silverware. It can be spread by having unprotected sex or sharing needles with someone who is infected, but also by coming into contact with open sores, getting bitten, sharing personal-care items, sharing chewing gum, or an unintentional needle stick at a doctor or dentist office or from a needle picked up in the community (park, playground, or street, etc.).

And of course, a newborn baby can be exposed if their mother has hepatitis B.

Biting and Hepatitis B

Young kids, especially toddlers, often go through a biting phase.

Do you have to worry about hepatitis B every time your child gets bit or bites someone?

Fortunately, no.

If any of the kids involved include one that is known to have hepatitis B, then talk to your pediatrician and follow the exposure guidelines.

Keep in mind that one of the reasons we don’t have to worry about these very low risk situations is because most kids are now vaccinated. There were more reports of kids and adults getting hepatitis B in unusual ways in the pre-vaccine era.

What to Do If Your Unvaccinated Child Is Exposed to Hepatitis B

If your unvaccinated child, or incompletely vaccinated child, is exposed to hepatitis B, you should talk to your pediatrician or local health department about starting post-exposure prophylaxis as soon as possible and preferably within 24 hours of the exposure (and not longer than 7), including:

  • a dose of HBIG
  • the first dose of hepatitis B vaccine, with plans to complete the three dose series as quickly as possible over the next 6 months

If you aren’t sure if the person had hepatitis B, then your unvaccinated child should likely just complete the three dose hepatitis B series without getting HBIG.

What to Do If Your Vaccinated Child Is Exposed to Hepatitis B

Unfortunately, if your vaccinated child is exposed to hepatitis B, you can’t simply assume that your child is protected and ignore the exposure. That is, unless your child has already had testing to confirm that he was a responder to the hepatitis B vaccine series – a HBsAb level of 10 or greater.

Since this titer test isn’t routinely done, your child will likely need a booster dose of the hepatitis B vaccine. A dose of HBIG isn’t needed.

If you aren’t sure if the person that exposed your child had hepatitis B, then your fully vaccinated child doesn’t need any additional treatment.

Getting Exposed to Hepatitis B in a Healthcare Setting

It should be noted that the guidelines are a little different and more aggressive if you are exposed in a healthcare setting vs your child having a nonoccupational exposure to hepatitis B.

Why?

There is probably more risk of getting infected from an occupational exposure where patients might be sick with hepatitis B. That’s why post-exposure testing on the exposed person is routinely done.

And since they are at risk for continued exposures, post-treatment testing, if required, to confirm a good response to the hepatitis B vaccine is also usually done.

What to Know About Getting Exposed to Hepatitis B

Hepatitis B exposures can come from more than just having sex or getting stuck with a needle. Learn what to do if your child is exposed to hepatitis B, especially if they aren’t already fully vaccinated and protected.

More on Getting Exposed to Hepatitis B

There Is a Vaccine For That

Many diseases were once big killers.

Diphtheria, tetanus, polio, measles, rubella, Haemophilus influenzae type b, pertussis, rotavirus, and smallpox, etc.

Some still are.

There Is a Vaccine For That

Fortunately, many have been brought under control thanks to vaccines, at least in certain parts of the world.

diphtheria-vax-for-that
There is a vaccine for diphtheria and many other diseases that unfortunately continue to be big killers where vaccines are not readily available.

Smallpox, of course has been eradicated.

Polio, will hopefully soon be next.

What other diseases do we have vaccines to protect us against?

You might be surprised that the list is so long, as many of these vaccines aren’t routinely used in developed countries, but “we” have a vaccine for:

  1. adenovirus
  2. anthrax
  3. chicken pox
  4. cholera
  5. dengue
  6. diphtheria
  7. hepatitis A
  8. hepatitis B
  9. hepatitis E
  10. HPV
  11. Haemophilus influenzae type b
  12. influenza
  13. measles
  14. meningococcal disease types A, B, C, W, Y
  15. mumps
  16. pneumococcal disease
  17. pertussis
  18. polio
  19. Q-fever
  20. rabies
  21. rotavirus
  22. rubella
  23. smallpox
  24. shingles
  25. tetanus
  26. tick-borne encephalitis
  27. tuberculosis
  28. typhoid fever
  29. yellow fever

Other diseases, including Rocky mountain spotted fever, plague, and typhus, were once vaccine-preventable, but their vaccines were discontinued and are no longer available.

How many of these available vaccines are on the CDC immunization schedule?

In the United States, children routinely get 13 vaccines that protect them against 16 vaccine-preventable diseases including diphtheria, chicken pox, hepatitis A, hepatitis B, Hib, HPV, influenza, measles, meningococcal disease, mumps, pertussis, pneumococcal disease, polio, rotavirus, rubella, and tetanus.

Some of the other vaccines on the list are also given in special situations, like if your kids have chronic medical problems, or if they travel out of the country.

What to Know About Available Vaccines

We are fortunate that there are vaccines for many diseases that once caused deadly epidemics and outbreaks and unfortunately are still around in many parts of the world.

More on Available Vaccines

Typhus vs Typhoid Fever

Typhus and typhoid have both been in the news recently.

  • Texas officials issue alert about typhus threat
  • Typhoid: Two children die‚ 60 ill after drinking from contaminated stream in South Africa

Should you start panicking?

Of course not.

Even before they knew which bacteria actually caused typhus and typhoid fevers, they knew they were different diseases.
Even before they knew which bacteria actually caused typhus and typhoid fevers, they knew they were different diseases.

While neither is usually a threat to most people in developed countries, instead of panicking, get educated and learn how you can prevent these still common infections.

Typhus Fever

Epidemic typhus fever is spread by human body lice (not head lice!) that are infected with the Rickettsia prowazekii bacteria.

Symptoms of typhus fever can include the sudden onset of:

  • fever
  • muscle aches (myalgias)
  • headache
  • chills
  • not feeling well (malaise)
  • cough

Some patients develop a characteristic rash made up of small red spots (macules) that start on the upper trunk. It then spreads to the rest of the body, but spares the face, palms, and soles. The rash can eventually become petechial.

Untreated, the fever may last up to two weeks, followed by a slow recovery of two to three months for all of the other symptoms. Typhus fever can be fatal.

Fortunately, treatment is available – the antibiotic doxycycline.

How do you prevent epidemic typhus fever? You avoid body lice. And avoid flying squirrels, which can be infected with Rickettsia prowazekii bacteria.

Is typhus fever vaccine-preventable? No, although a typhus vaccine was once available, it was discontinued in 1979.

Keep in mind that in addition to epidemic typhus, which is now very rare, typhus can also be spread by fleas (murine typhus) and chiggers (scrub typhus).

Murine or endemic typhus is common in tropical and subtropical climates, where it is spread by rats and fleas. In the United States, it is mainly found in California, Hawaii, and Texas, where it has also been associated with cat fleas found on cats and opossums.

Scrub typhus is associated with chiggers in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia.

Typhoid Fever

Although typhus and typhoid some very similar, there are some big differences between these two diseases.

What are they?

Unlike typhus, typhoid fever is:

  • caused by the Salmonella typhi bacteria
  • spread by ingesting contaminated food and water
  • characteristic by symptoms that include a gradual onset of fever, with stomach aches, headache, loss of appetite, and sometimes a rash.
  • still vaccine preventable – in fact, there are two typhoid vaccine, one oral and the other a shot

Fortunately, typhoid fever can be treated with antibiotics, although it is sometimes multi-drug resistant and some people become chronic carriers, even with treatment (Typhoid Mary).

While adventurous and fun, eating street vendor food is probably a good way to get typhoid fever.
While adventurous and fun, eating street vendor food is probably a good way to get typhoid fever. Photo by Sam Sherratt (CC BY-SA 2.0)

That it can still be treated is a good thing, because unlike epidemic typhus, typhoid fever is still very much around.

The CDC estimates that there are about 5,700 cases of typhoid fever in the United States each year, mostly in travelers that leave the country.

Worldwide, there are about 21 million cases of typhoid fever and 222,000 typhoid-related deaths each year!

In addition to getting vaccinated, if traveling to the developing world, to avoid typhoid, you should avoid risky food and be sure to “Boil it, cook it, peel it, or forget it.”

What to Know About Typhus and Typhoid Fever

Typhus and typhoid fevers are two very different diseases that can both be avoided with good hygiene practices.

More on Typhus and Typhoid Fever