Tag: febrile seizures

Can I Give My Kids Tylenol When They Have Their Vaccines?

Many parents ask about acetaminophen (Tylenol) when kids get their vaccines.

Is it okay to give kids Tylenol when they get their shots?

The Tylenol and Vaccines Controversy

As you can probably guess, there is no real controversy about Tylenol and vaccines.

Instead, what we are talking about are the myths surrounding Tylenol and vaccines that anti-vaccine folks have created, including that:

  • giving Tylenol right before a child gets their shots somehow increases the risk that they will have side effects
  • giving Tylenol right after a child gets their shots somehow masks the symptoms of serious vaccine damage
  • giving Tylenol after the MMR vaccine is associated with developing autism

Fortunately, most parents understand that like other anti-vaccine misinformation, none of these statements are true.

Why do some folks believe it?

Well, there have been studies warning people about giving Tylenol before vaccines. It had nothing to do with side effects though. They suggested that a vaccine might be less effective if the child got Tylenol before his vaccines. It is important to note that they never really found that the vaccines didn’t work as well, as all of the kids in the study still had protective levels of antibodies, they were just a little lower than kids who didn’t get Tylenol.

Other studies have found the same effect if Tylenol was given after a child got his vaccines. Although interestingly, other studies have found that giving Tylenol after vaccines does not affect antibody titers.

“Antibody titres to diphtheria and tetanus toxoids and pertussis bacteria of the placebo (n = 25) and acetaminophen (n = 34) groups did not differ significantly from each other. It is concluded that acetaminophen in a single dose schedule is ineffective in decreasing post-vaccination fever and other symptoms.”

Uhari et al on Effect of prophylactic acetaminophen administration on reaction to DTP vaccination

Giving Tylenol after the MMR vaccine is not associated with autism.
Giving Tylenol after the MMR vaccine is not associated with autism.

The only thing that this had to do with side effects though, is that the kids who got Tylenol had a little less fever.

Could giving Tylenol mask something like encephalitis, which some anti-vaccine folks think can be vaccine induced?

Nope. It typically can’t even keep someone from getting a febrile seizure.

What about the association of MMR, Tylenol and autism? Although one study did suggest that to be true, the study, a parental survey, was found to be “fatally flawed.”

Can I Give My Kids Tylenol When They Have Their Vaccines?

So, can you give your kids Tylenol when they get their vaccines?

The better question is, should you give your kids Tylenol either before or after they get their vaccines?

Have some Tylenol or Motrin on hand after your kids get their vaccinations, just in case they need a dose.
Have some Tylenol or Motrin on hand after your kids get their vaccinations, just in case they need a dose. Photo by Vincent Iannelli, MD

Notwithstanding the very small chance that giving Tylenol might cause decreased immunogenicity (lower antibody production) if you give it before your kids get their vaccines, since there is a good chance that they won’t have any pain or fever and won’t even need any Tylenol, then why give it?

Skip the “just in case” dose and wait and see if they even need it.

What about afterwards?

If your kids have pain or fever and are uncomfortable, then you should likely give them something for pain or fever control, such as an age appropriate dose of either acetaminophen or ibuprofen. Will that cause lower antibody production? Maybe. Will that mean that their vaccines won’t work. That’s doubtful. It certainly won’t lead to increased side effects though, unless they a reaction to the dose of Tylenol itself.

Should you give a pain or fever reducer after a vaccine “just in case?” Again, there is a good chance that your kids might not need it, so it is likely better to wait and see if they do, instead of giving a dose automatically after their shots.

There is even some evidence that giving acetaminophen or ibuprofen before vaccines, or as a routine dose right after, especially with booster shots, doesn’t really prevent side effects that well anyway. They work better if given on an as needed basis instead, and these kinds of doses are less likely to be associated with decreased antibody production.

What to Know About Tylenol and Vaccines

Giving a pain or fever reducer either before or after your child’s vaccinations likely won’t affect how it works, but since it often isn’t necessary, it is likely best to only given one, like Tylenol or Motrin, if it is really needed.

More on Tylenol and Vaccines

There Is a New Treatment for an Old Vaccine Induced Disease

Mutation screening of the SCN1A gene can help diagnosis kids and adults with Dravet syndrome.
Mutation screening of the SCN1A gene can help diagnosis kids and adults with Dravet syndrome.

Many children who once developed seizures after getting a pertussis containing vaccine were thought to have a vaccine injury.

In fact, HHE and seizures from DPT were once table injuries.

Since then, many of those children have been found to have Dravet syndrome, which is not a vaccine injury or vaccine induced disease. Dravet syndrome includes children who develop severe, fever-related seizures before their first birthday.

First described by Dr. Charlotte Dravet in 1978, using mutation screening of the SCN1A gene, in 2006, Dr. Samuel Berkovic found that many adults had Dravet syndrome too.

“We present here the cases of 5 children who presented for epilepsy care with presumed parental diagnoses of alleged vaccine encephalopathy caused by pertussis vaccinations in infancy. Their conditions were all rediagnosed years later, with the support of genetic testing, as Dravet syndrome.”

Reyes et al on Alleged cases of vaccine encephalopathy rediagnosed years later as Dravet syndrome

Others soon replicated Berkovic’s work and found other children with the SCN1A mutation that causes Dravet syndrome. These children had hard to control seizures, developmental delays, and autism-like characteristics and included some with an “alleged vaccine encephalopathy.”

That they didn’t have a vaccine injury wasn’t a surprise to many people, as many of the early reports about the DPT vaccine and seizures were wrong. In 1973, Dr. John Wilson took to the media to scare parents because he had “seen too many children in whom there has been a very close association between a severe illness, with fits, unconsciousness, often focal neurological signs, and inoculation.” What followed was a drop in DPT vaccinations in many countries and vaccine lawsuits, even though his study was later found to be seriously flawed, with most having no link to the DPT vaccine.

“Although Dravet syndrome is a rare genetic epilepsy syndrome, 2.5% of reported seizures following vaccinations in the first year of life in our cohort occurred in children with this disorder.”

Verbeek on Prevalence of SCN1A-Related Dravet Syndrome among Children Reported with Seizures following Vaccination: A Population-Based Ten-Year Cohort Study

What’s the association between Dravet syndrome and vaccines?

Since infants with Dravet syndrome have febrile seizures, any fever can trigger those seizures. Of course, vaccines can cause fever. And so infants with Dravet syndrome who get a fever after their vaccines can have seizures. Even without getting vaccines, they will eventually have seizures, so skipping or delaying vaccines isn’t a good idea for these kids.

There Is a New Treatment for an Old Vaccine Induced Disease

Have you ever heard of Dravet syndrome?

Even though Dravet syndrome is now known to be at least twice as common as once thought – at about 1 in 15,000 children, many parents have still never heard of it.

“Multiple prolonged febrile seizures in an otherwise well child, usually starting by 8 months of age, are the early clinical hallmarks of Dravet syndrome. Other typical features of this devastating disorder include refractory and multiple seizure types after 12 months of age, including partial, myoclonic, atonic, and absence seizures, and developmental delays and motor impairment such as ataxia and spasticity.”

Wu et al on the Incidence of Dravet Syndrome in a US Population

If you have been locked into the idea that your child was vaccine injured or vaccine damaged after the DPT vaccine, then you have likely not have heard of Dravet syndrome.

Without a diagnosis, Cossolotto said, she would probably still believe — erroneously — that the DPT shot caused Michaela’s illness. “I understand this is a genetic condition,” she said. “Having an answer does make a difference.”

Medical mystery: Seizures strike baby after routine vaccine

That’s unfortunate, as there is a new treatment for Dravet syndrome that is showing a lot of promise. Although not a cure by any means, use of cannabidiol (CBD) oral solution has been shown to reduce seizures in children with Dravet syndrome.

And no, getting a prescription for cannabidiol oral solution from a neurologist is not the same as buying CBD oil, hemp oil, or CBD hemp oil on the internet. While they are all free of THC, you have no idea of the real concentration of CBD when you buy these substances on the internet. Also, hemp oil doesn’t even contain CBD, so won’t control seizures or do much of anything else.

“Previously, many children with severe epilepsy and intellectual disability did not receive a specific diagnosis; there was only limited ability to take the diagnosis further. With advances in clinical epileptology, genetics, and neuroimaging, specific forms of severe epilepsy that lead to progressive intellectual deterioration can be identified.”

Samuel Berkovic, MD on Cannabinoids for Epilepsy — Real Data, at Last

How would you know if your child has Dravet syndrome? Mutation screening of the SCN1A gene, something that is now routinely done for infants with repeated febrile seizures.

Is mutation screening of the SCN1A gene to test for Dravet syndrome something your MAPS doctor would suggest for your older child?

What to Know About Getting Diagnosed and Treating Dravet Syndrome

Children with Dravet syndrome were once misdiagnosed as having a vaccine encephalopathy and may have some new hope in having resistant seizures treated with cannabidiol oral solution.

More on Getting Diagnosed and Treating Dravet Syndrome

 

What Are the Pro and Con Arguments for Vaccines?

Is it still OK to “debate” vaccines and vaccine safety?

Sure.

pro-con-vaccines
Using fallacious arguments and anti-vaccine propaganda can not be part of any real debate about vaccines.

What’s not up for debate anymore is the idea that vaccines aren’t safe or necessary or that vaccines don’t work.

Folks who use those arguments against vaccines aren’t debating, they are pushing anti-vaccine talking points.

What Are the Pro and Con Arguments for Vaccines?

Why talk about pro and con arguments if we know that vaccines are safe and necessary?

It’s because vaccines aren’t perfect.

 Pro Con
Vaccines save lives. Shots hurt.
Vaccines are cost effective. Vaccines are expensive.
Vaccines work most of the time. Vaccines aren’t 100% effective.
You are much more likely to get shingles after having a natural chickenpox infection. You can get shingles after having the chickenpox vaccines.
Vaccine preventable diseases are much more likely to cause febrile seizures, non-febrile seizures, and worse. Some vaccines cause febrile seizures.
Most vaccine side effects are mild and they prevent life-threatening diseases. Vaccines aren’t 100% safe.
Vaccines can create herd immunity. Some people can’t be vaccinated.
Kids can get protected against at least 16 vaccine-preventable diseases. Kids get at least 13 different vaccines.
Immunity from some vaccine preventable diseases isn’t lifelong either and some diseases, like tetanus, don’t even provide immunity. Immunity from some vaccines isn’t lifelong.
Some vaccine-preventable diseases, like polio, only provide protection against a single serotype, not against all forms of the disease (there are three serotypes of polio). Some vaccines require booster doses.

And sometimes it doesn’t make sense to recommend a vaccine, except in specific circumstances.

“A MenB vaccine series may be administered to adolescents and young adults aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16–18 years.”

ACIP on Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015

The MenB vaccine, for example, unlike most other vaccines, only has a permissive recommendation – parents may get it for their kids, but they don’t have to.

“First-year college students living in residence halls should receive at least 1 dose of MenACWY before college entry. The preferred timing of the most recent dose is on or after their 16th birthday.”

ACIP on Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices

In contrast, the recommendation for most other vaccines state that kids “should” receive them.

Why the difference?

Experts aren’t yet sure that the pros of the MenB vaccine, helping avoid MenB disease, outweigh the cons, which include the high cost of the vaccine, short duration of protection, and that it doesn’t cover all MenB subtypes. The cons aren’t about safety.

The Real Vaccine Cons

What about the “cons” you see on some websites about toxins, vaccine-induced diseases, and vaccine deaths?

Beware of folks trying use anti-vaccine talking points to scare or con you when talking about vaccines.
Beware of folks trying use anti-vaccine talking points to scare or con you when talking about vaccines.

This is when it becomes helpful to understand that the word “con” has multiple definitions.

vaccine-conThese sites use anti-vaccine experts and other anti-vaccine websites as sources, present anecdotes as real evidence, and cherry pick quotes when they do use real sources.

They also work hard to:

  • Scare you away from vaccinating and protecting your kids by never mentioning the benefits of vaccines and overstating the side effects and risks of getting vaccinated.
  • Downplay the risks of vaccine-preventable diseases and overstate the benefits of natural immunity over the protection you can get from vaccines.
  • Make you think that vaccines don’t even work.

Worst of all, they talk about informed consent and choice, all of the while taking away many parents’ choice to make an informed decision by confusing them with misinformation, myths, and propaganda.

Of course, parents who have taken the time to get educated about vaccines don’t fall for any of these arguments.

What to Know About the Pro and Con Arguments for Vaccines

In any real debate, getting vaccinated and protected wins every time, because vaccines work and they are safe and necessary.

More About the Pro and Con Arguments for Vaccines

Measles Propaganda from The Physicians for Informed Consent

Most people understand that measles can be deadly.

“Measles is a highly contagious, serious disease caused by a virus. Before the introduction of measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every 2–3 years and measles caused an estimated 2.6 million deaths each year.”

WHO Measles Fact Sheet

In the United States alone, in the pre-vaccine era, “an average of 549,000 measles cases and 495 measles deaths were reported annually.”

That roughly translates into about one death for every 1,000 cases, or a case-fatality rate of about 0.1%.

That’s in line with the typical case-fatality rate of measles of 0.1 to 0.2%.

Just How Deadly Is Measles?

Not surprisingly, many others have reported a similar case-fatality rate for measles.

Not everyone though.

The ironically named Physicians for Informed Consent suggests that it should be much, much lower.

Why?

Because of a 1989 report that said that “Before measles vaccine was available, more than 400,000 measles cases were reported each year in the United States. However, since virtually all children acquired measles, the true number of cases probably exceeded 4 million per year (i.e., the entire birth cohort).”

Their idea is that if there were more cases (i.e., the entire birth cohort), then even if almost 500 people died each year, the extra cases would make the death rate lower.

There are a lot of problems with that reasoning though…

For one thing, 500 people dying each year of a now vaccine-preventable disease is a lot of people, no matter how you to frame it!

I fixed this graph from The Physicians for Informed Consent to more accurately represent measles mortality data in the pre-vaccine era.
I fixed this graph from The Physicians for Informed Consent to more accurately represent measles mortality data in the pre-vaccine era.

And the traditional stat about the measles fatality rate clearly mentions that this is about reported cases.

You can’t change the number of measles cases to a theoretical number, the entire birth cohort, and keep the number of deaths based on the number of reported cases, and think that you are still talking about the same thing. What if deaths from measles were under-reported too?

“Death from measles was reported in approximately 0.2% of the cases in the United States from 1985 through 1992.”

CDC Pink Book

And there are plenty of more recent statistics, when far fewer people were getting measles, that show a similar case fatality rate.

What Is the Measles Fatality Rate?

How else do we know that The Physicians for Informed Consent is misinforming people?

“…any parent who has seen his small child suffer even for a few days with persistent fever of 105 F, with hacking cough and delirium, wants to see this prevented…”

Alexander D Langmuir, MD on the Medical Importance of Measles

Their measles ‘information’ sheet, made by folks who have likely never treated a child with measles, say that “most measles cases are benign.”

That’s a bit different than Dr. Langmuir’s 1962 account of how the typical child suffered with measles and why he welcomed the new measles vaccine.

“Nevertheless, a resurgence of measles occurred during 1989–1991, again demonstrating the serious medical burden of the disease. More than 55,000 cases, 123 deaths, and 11,000 hospitalizations were reported”

Orenstein et al on Measles Elimination in the United States

What was the case fatality rate during the measles outbreaks in the late 1980s?

It was a little over 0.2%. Did we again under-count cases or was the case-fatality rate so high because most of the cases were in younger, preschool age children?

Anyway, whether the case fatality rate is 1 in 1,000 or 1 in 10,000 (the UK lists their measles case fatality rate at 1 in 5,000), it doesn’t mean that someone will die when you hit case number 1,000, 5,000, or 10,000. It could be the 1st case in an outbreak or the 15,000th.

Measles can be deadly. That’s why most of us choose to have our kids vaccinated and protected.

Do you know how many people had measles in the 2013 outbreak in Brooklyn when a pregnant woman developed measles and had a miscarriage? The outbreak that was started by an unvaccinated teenager included a total of 58 cases.

How about the 2015 outbreak in Clallam County, Washington in which an immunocompromised woman died of pneumonia due to measles? There were only five other cases, almost all unvaccinated.

And in many European countries last year, many of the deaths are in countries with few cases. When the 17-year-old unvaccinated girl in Portugal died, there were just 31 cases. In Switzerland, a vaccinated man with leukemia died in an outbreak with just 69 cases. There were only 163 cases when an unvaccinated 10-month-old died in Bulgaria. And there were fewer than 1,000 cases in Germany when a partially vaccinated mother of three children died.

More Myths About Measles

The Physicians for Informed Consent pushes a lot of other myths and misinformation about measles:

  • about using vitamin A to treat measles – where this works, in developing countries, untreated measles has a case fatality ratio of 5 to 40% because of malnutrition! It isn’t usually thought to be very helpful in an industrial country without malnutrition. And no, simply having a picky eater or one who eats a lot of junk food doesn’t mean that he will be helped by vitamin A if he gets measles
  • about using immunoglobulin to treat measles – the MMR vaccine and immune globulin can be used for post-exposure prophylaxis, but it is not a treatment once you have measles!
  • they misuse VAERS data to try and say the MMR vaccine is more dangerous than getting measles
Not surprisingly, the information that The Physicians for Informed Consent provides rarely matches that of the references they cite.
Not surprisingly, the information that The Physicians for Informed Consent provides rarely matches that of the references they cite.

The Physicians for Informed Consent even talks about benefits of getting measles, but somehow leaves out any talk about the risk of getting SSPE after a natural measles infection.

What else do they leave out? The idea that people who survive a measles infection can have some immunosuppression for up to two to three years! This measles-induced immune damage puts them at risk of dying from other diseases and helps explain why kids who are vaccinated against measles are also less likely to die from other childhood infections.

They even published a press release claiming that they “recently reported in “The BMJ” that every year about 5,700 U.S. children suffer seizures from the measles, mumps and rubella (MMR) vaccine.”

Their report? It was a  “letter to the editor” that anyone can submit online…

Get educated so that you aren’t fooled by this kind of propaganda and anti-vaccine talking-points.

What to Know About Measles Propaganda from The Physicians for Informed Consent

The Physicians for Informed Consent push propaganda to make you think that vaccine-preventable diseases, like measles, aren’t that bad and that vaccines are really, really dangerous.

More on Measles Propaganda from The Physicians for Informed Consent

Are Vaccines Tested Together?

If you are on the Fence about vaccines, one issue that might have you scared is that the idea that vaccines aren’t tested together.

So maybe they tested the Prevnar vaccine, but did they test it with the Hib vaccine?

And did they test the Prevnar and Hib vaccine with the Pediarix vaccine?

After all, kids get all of those vaccines at their two, four, and six month well child checkups.

Vaccines Are Tested Together

It is not hard to find evidence that most combinations of vaccines are in fact tested together.

For example (and this is not a complete list):

  • Rotarix was tested with Pediarix (DTaP-HepB-IPV), Prevnar, and Hib
  • Prevnar 13 was tested with DTaP, IPV, hepatitis B and Hib
  • Prevnar 13 was tested with MMR, Varicella, and hepatitis A
  • MenC with DTaP-IPV-HepB-Hib
  • MenC with MMR
  • MMR and Varicella with Hib, Hepatitis B, and DTaP
  • hepatitis A and hepatitis B with either MMR or DTaP-IPV-Hib
  • HPV vaccine for babies
  • Flumist with MMR and Varicella
  • Kinrix (DTaP-IPV) with MMR and Varicella
  • HPV9 with Tdap and Meningococcal vaccines
  • Tdap with influenza vaccine
  • Meningococcal vaccine with influenza vaccine

And even after a vaccine is added to the immunization schedule and it is given together with other vaccines, our post-licensure vaccine safety monitoring systems, from VAERS to the Vaccine Safety Datalink, kick in to make sure that they are indeed safe and effective.

The Myth That Vaccines Aren’t Tested Together

If it is clear that vaccines are in fact tested together, then why do some folks still believe that they aren’t?

Bob Sears appeared on Fox & Friends in 2010 for the segment
Bob Sears appeared on Fox & Friends in 2010 for the segment Vaccines: A Bad Combination?

Hopefully everyone sees the irony in Dr. Bob saying something about vaccines being untested, as he is infamous for pushing his own made up and completely untested alternative vaccine schedule.

“Babies get as many as 6 or 7 vaccines altogether…and the CDC is admitting that they don’t always research them that way.”

Dr. Bob Sears on Fox & Friends Vaccines: A Bad Combination?

When did they admit that???

“We’ve researched the flu vaccine in great detail and it seems safe when it’s given alone, but the CDC has never researched the flu vaccine when you give it in conjunction with all the other infant shots…and that’s what we’re worried about. ”

Dr. Bob Sears on Fox & Friends Vaccines: A Bad Combination?

So, what about the flu vaccine?

A 2013 report from the Institute of Medicine found that there was no evidence that vaccines caused ADHD.
A 2013 report from the Institute of Medicine stated that “Each new vaccine considered for inclusion in the immunization schedule is tested within the context of the existing schedule and reviewed by clinical researchers, who analyze the balance of demonstrated benefits and risks.”

While most kids get their flu vaccine by itself, just before the beginning of flu season, some might get it when they see their pediatrician for a regular checkup, at the same time they are due for other vaccines.

Not surprisingly, Dr. Bob was wrong, and several studies have shown that the flu vaccine can be safely given with other vaccines.

And don’t forget, any problems with co-administration of vaccines would show up in post-licensure vaccine safety testing.

That’s how a very small increased risk of febrile seizures was found during the 2010-11 flu season in toddlers who received either DTaP or Prevnar and a flu shot at the same time.

The very small extra risk doesn’t mean that you still can’t get the vaccines at the same time if your child needs them all though. Remember that febrile seizures “are temporary and do not cause any lasting damage.”

It will be even more reassuring to some parents that another study “examined risk of febrile seizures (FS) after trivalent inactivated influenza vaccine (TIV) and 13-valent pneumococcal conjugate vaccine (PCV13) during the 2010-2011 influenza season, adjusted for concomitant diphtheria tetanus acellular pertussis-containing vaccines (DTaP)” and found no extra risk for febrile seizures.

“Vaccines can generally be co-administered (i.e. more than one vaccine given at different sites during the same visit). Recommendations that explicitly endorse co-administration are indicated in the table, however, lack of an explicit co-administration recommendation does not imply that the vaccine cannot be co-administered; further, there are no recommendations against co-administration.”

Summary of WHO Position Papers – Recommendations for Routine Immunization

Also remember that “there are no recommendations against co-administration of vaccines,” unless of course, you are getting your advice from Bob Sears…

 

What To Know About Vaccines Being Tested Together

Vaccines are thoroughly tested for both safety and efficacy and they are also tested in many of the different combinations on the routine childhood immunization schedule.

More On Vaccines Being Tested Together