Tag: recommendations

Get a Vaccine Checkup Before Traveling with Your Kids

Get vaccinated. Measles is just a plane ride away.
Get vaccinated: Bring home fun souvenirs, photos, and fantastic memories, not measles!

Got plans to travel this spring or summer?

Going out of the country?

Taking the kids?

While a trip abroad can be a great experience for kids, whether you are just site seeing or you are visiting family, don’t forget to take some simple precautions so that your family comes back safe and healthy.

Get a Vaccine Checkup Before You Travel

It is important to remember that just because your kids are up-to-date on their routine childhood immunizations, that doesn’t mean that they are ready to travel out of the country.

It might surprise some folks to know that there are many vaccines that kids in the United States don’t routinely get, like vaccines that protect against cholera, yellow fever, typhoid, and Japanese encephalitis, etc. These are considered to be travel vaccines and may be recommended or required depending on where you are going.

How do you know which vaccines your kids need?

The CDC Traveler’s Health website is the best place to figure it out. With a list of 245 destinations, in addition to offering advice on how to avoid vaccine-preventable diseases, you get recommendations on avoiding others too, like Zika and malaria.

Don’t wait until the last minute before checking on these vaccine recommendations though. These are not vaccines that most pediatricians have in their office, so call or visit your pediatrician a few months in advance to plan out how you will get them. As a last resort, if your pediatrician can’t order them, can’t help you get them from an area pharmacy, and they aren’t available at your local health department, you might look to see if there is a “travel clinic” nearby.

Don’t Forget the Early MMR Recommendations

It’s also important to remember to make sure your child’s routine vaccines are up-to-date too. Confusing things a little, that can mean getting their MMR vaccines early.

Many parents, and some pediatricians,  often forget that before traveling out of the United States:

  • Infants 6 months through 11 months of age should receive one dose of MMR vaccine. While this early dose should provide protection while traveling, it doesn’t provide full protection, doesn’t count as the 12 to 15 month routine dose, and will need to be repeated.
  • Children 12 months of age and older should receive two doses of MMR vaccine separated by at least 28 days. So even if your child is less than 4-years, he or she needs two doses of MMR before traveling out of the country. This second early dose won’t have to be repeated when they do turn 4.
  • Teenagers and adults who do not have evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days. While some adults are considered fully vaccinated with one dose of MMR, that isn’t true if they are traveling out of the country. Travelers need two doses!

Continuing outbreaks of measles linked to unvaccinated and partially vaccinated travelers highlight the need to spread the word about these recommendations.

Traveling is fun. Be sure to bring back some great memories and a few souvenirs. Don’t bring home measles or other diseases that you can then spread to others in your community or on the plane ride home.

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Pediatricians as Vaccine Pushers

We often here that pediatricians are vaccine pushers, at least from anti-vaccine folks…

If that is the case though, how come pediatricians don’t routinely push any of the following vaccines on kids:

  1. Adenovirus vaccine – only given to enlisted soldiers during basic training
  2. Anthrax vaccine – high risk people only
  3. BCG vaccine vaccine – high risk people only
  4. Cholera vaccine – recently approved in the United States as a travel vaccine
  5. Hepatitis E – not available in the United States
  6. Japanese encephalitis vaccine – a travel vaccine
  7. Meningococcal C vaccine (MenC) – not available in the United States
  8. Meningococcal B vaccine (MenB) –  has a “permissive” recommendation in that parents are told they can get it if they want their kids to avoid MenB infections, but it is not required yet.
  9. MenHibrix – a combination between Hib and Meningococcal Groups C and Y, but it is only given to high risk kids
  10. Plague vaccine – discontinued
  11. Rabies vaccine – high risk people only
  12. Shingles vaccine – seniors only
  13. Smallpox vaccine – high risk people only
  14. Tick-borne encephalitis – not available in the United States
  15. Typhoid fever vaccine – a travel vaccine
  16. Typhus vaccine – discontinued
  17. Yellow fever vaccine – a travel vaccine
The oral adenovirus vaccine is approved to prevent adenovirus infections in military populations.
The oral adenovirus vaccine is approved to prevent adenovirus infections in military populations.

Sure, it would be hard to push a vaccine that has been discontinued or not even available in the United States, but if your goal was to aggressively push vaccines, how hard would it be to get Big Pharma to start making them available?

That would more than double the number of vaccines that kids would have to get.

Those Times “Vaccine Pushers” Said No To Vaccines

And how come some of the biggest vaccine advocates have been against plans for mass immunizations if they are vaccine pushers?

In addition to Dr. Albert Sabin advising against President Gerald Ford’s plans for universal vaccination against swine flu in 1976, Dr. Paul Offit missed the chance to push the small pox vaccine on us in 2002. He instead advised for a different plan:

Here’s another way to do it. We can make the vaccine. Make sure we understand who’s going to get it, who’s going to be giving it. Then wait, wait for there to be one case of documented smallpox somewhere on the face of this earth and then we can move into vaccinating people, large numbers of people.

Dr. Paul Offit

Dr. Offit, who is routinely called a shameless vaccine pusher by anti-vaccine websites, was the sole member of a CDC vaccine advisory committee to vote against President George Bush’s 2002 plan to vaccinate about 500,000 health care workers against smallpox. He feared that the risks might outweigh the benefits.

For More Information on Vaccine Pushers

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Catch-Up Immunization Schedules

It is surprisingly easy to get behind on your child’s immunizations, even if you are trying to stay on schedule.

How do you miss a shot?

Your child could have been sick when they were supposed to get their vaccines, your pediatrician might have been out of one or more vaccines, or you might have simply missed one of your child’s well checkups.

Catching Up On Vaccines

A catch-up immunization schedule
A catch-up vaccination schedule program can help you figure out when to get the vaccines your child has missed.

If your child gets behind and misses one or more vaccines, be sure to get caught up as soon as possible.

If your child needs to get caught up quickly, like to start daycare or school, to travel out of the country, or because of a disease outbreak in your area, you can even use an accelerated immunization schedule, using minimum intervals between doses.

Depending on your child’s age, you might even be able to skip a few doses or vaccines.

For example, with rotavirus vaccines, vaccination should not be started if an infant is already 15 weeks old and the final dose must be given by 8 months of age.

And if your child gets their first dose of Hib after they are 15 months old, they don’t need any more doses. And they wouldn’t need any doses at all if they are already 5 years old.

Prevnar, IPV, and DTaP might also need to given on an alternative schedule when given on a catch-up schedule.

Specifically, your child might be able to skip:

  • the fifth dose of the DTaP vaccine, if the fourth dose was given at age 4 years or older.
  • the fourth dose of the IPV vaccine, if the third dose was given at age 4 years or older.
  • one or more doses of Prevnar, depending on when the other doses were given

Is this a good way to get out of getting some doses or vaccines?

Of course not. In addition to missing out on those vaccines, your child is missing out on the protection from those vaccines.

For More Information on Catch-Up Immunization Schedules

This Year’s Flu Season

Flu activity is decreasing, but remains elevated in most of the United States.
Flu activity is decreasing, but remains elevated in most of the United States.

Breaking News: Flu season isn’t over yet. Influenza activity is decreasing, but remains elevated in the United States, and there have been 5 new pediatric flu deaths. (see below)

While flu season typically peaks in February, it is very important to understand that there are few things that are typical about the flu.

Since 1982, while we have been twice as likely to see a flu activity peak in February than other winter months, we have been just as likely to get that peak in December, January, or March. That makes it important to get your flu vaccine as soon as you can.

You really never know if it is going to be an early, average, or late flu season.

Flu Facts

While there will likely be some surprises this flu season – there always are – there are some things that you can unfortunately count on.

Among these flu facts include that:

  • there have been 1,482 pediatric flu deaths since the 2003-04 flu season, including 89 flu deaths last year
  • about 113 kids die of the flu each year – most of them unvaccinated
  • antiviral flu medicines, such as Tamiflu, while recommended to treat high-risk people, including kids under 2 to 5 years of age, have very modest benefits at best (they don’t do all that much, are expensive, don’t taste good, and can have side effects, etc.)
  • a flu vaccine is the best way to decrease your child’s chances of getting the flu

And even in a mild flu season, a lot of kids get sick with the flu.

This Year’s Flu Season

When does flu season start?

In general, flu season starts when you begin to see people around you with signs and symptoms of the flu, including fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue, etc.

To be more accurate, you can also look at reports for flu activity in your area, especially the weekly reports from the CDC.

Those flu reports can also help you determine when flu season ends.

As of mid-March, the CDC is reporting that “flu activity decreased, but remained elevated.”

The CDC has also recently reported that:

  • this year’s flu vaccine reduces “the risk for influenza-associated medical visits by approximately half”
  • influenza A (H3N2) viruses, a component of this year’s flu vaccine, are predominating so far this flu season, which could be a sign of a severe flu season. In general, “H3N2-predominant seasons have been associated with more severe illness and higher mortality, especially in older people and young children…”
  • Is it a match? – “…antigenic and/or genetic characterization shows that the majority of the tested viruses remain similar to the recommended components of the 2016-2017 Northern Hemisphere vaccines.”
  • As often happens on the downside of a flu season peak, we are starting to see more and more influenza B each week
  • There are reports of a new avian influenza A(H7N9) epidemic in China. Although deadly, there is fortunately no reports of sustained human-to-human transmission of this flu virus strain that is usually associated with poultry exposure.
  • Next year’s flu vaccine won’t be changing much, except that “The  A(H1N1)pdm09  virus  has  been  updated  compared  to  the  virus recommended  for  northern  hemisphere  2016-2017  influenza  season.”
  • 36 states (down from 39), including Alabama, Alaska, Arkansas, California, Connecticut, Delaware, Florida, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, and Wisconsin, are still reporting widespread flu activity (the highest level)
  • 11 states (up from 8), including Arizona, Colorado, Georgia, Idaho, Illinois, Montana, South Dakota, Texas, Washington, West Virginia, and Wyoming, and Puerto Rico are now reporting regional flu activity
  • 3 states (up from 2), Hawaii, Oregon, and Utah, are now reporting local flu activity
  • no states (down from 1) are now reporting sporadic flu activity
  • there have been 53 pediatric deaths this flu season, including reports of 5 new deaths this week

Have you and your family gotten been vaccinated and protected against the flu yet?

“Anyone who has not gotten vaccinated yet this season should get vaccinated now.”

CDC Influenza Situation Update

If not, this is still a good time to get a flu vaccine.

Recent Flu Seasons

Are H3N2 predominant flu seasons really worse than others?

  • 2003-04 flu season – 152 pediatric flu deaths (H3N2-predominant)
  • 2004-05 flu season – 47 pediatric flu deaths
  • 2005-06 flu season – 46 pediatric flu deaths
  • 2006-07 flu season – 77 pediatric flu deaths
  • 2007-08 flu season – 88 pediatric flu deaths (H3N2-predominant)
  • 2008-09 flu season – 137 pediatric flu deaths
  • 2009-10 flu season – 289 pediatric flu deaths (swine flu pandemic)
  • 2010-11 flu season – 123 pediatric flu deaths
  • 2011-12 flu season – 37 pediatric flu deaths
  • 2012-13 flu season – 171 pediatric flu deaths (H3N2-predominant)
  • 2013-14 flu season – 111 pediatric flu deaths
  • 2014-15 flu season – 148 pediatric flu deaths (H3N2-predominant)
  • 2015-16 flu season – 89 pediatric flu deaths

In addition to high levels of pediatric flu deaths, the CDC reports that the four flu seasons that were H3N2-predominant in recent years were “the four seasons with the highest flu-associated mortality levels in the past decade.”

For More Information on the 2016-17 Flu Season

Updated March 22, 2017

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Vaccine Allergies

The Cervarix HPV vaccine lists latex as an ingredient - in the tip caps.
Cervarix tip caps contain natural rubber latex and can be a problem if your child has an anaphylactic reaction to latex.

Can you be allergic to a vaccine?

Of course.

In fact, having a severe, life-threatening allergy to a vaccine is one of the main reasons to not get vaccinated.

Specifically, guidelines usually state that you should not get vaccinated:

  • if you have a severe allergy to any component of the vaccine
  • if you have had had a serious allergic reaction to a previous dose of the vaccine

Fortunately, these types of serious allergic reactions are very rare. In fact, most kids with egg allergies can even get a flu shot, something unheard of just a few years ago.

How rare?

The WHO states that “The rate of anaphylaxis has been documented to be variable, with a rate of 3.5 to 10 per million doses following a measles-containing vaccine.”

Rates of 0.65 to 1.53 cases per million doses have also been reported when including more commonly used vaccines.

Vaccine Allergy Myths

Still, instead of true vaccine allergies leading to problems, it is much more common for misinformation about vaccine allergies to scare parents away from getting their kids vaccinated.

Some of the most common vaccine allergy myths include that:

  • you can’t get vaccinated if you have a history of a penicillin allergy, cephalosporin allergy, or sulfa drug allergy – you can
  • you can’t get vaccinated if you have non-vaccine allergies, have relatives with allergies, or are receiving allergy shots – you can
  • you can’t get vaccinated if you have a latex allergy that is not anaphylactic – you can
  • you can’t get the MMR vaccine if you have an egg allergy – you can
  • you can’t get the flu vaccine if you have an egg allergy – you can, although your pediatrician will observe your child for 30 minutes if he has a severe egg allergy
  • vaccines are causing a peanut allergy epidemic – they aren’t and you can get vaccinated if you have a peanut allergy.

And know that vaccines don’t actually cause allergies.

Allergies and Vaccine Components

Components of vaccines can rarely trigger allergic reactions, including:

  • antibiotics – but these aren’t antibiotics that are commonly used anymore, like Amoxil. Instead, some vaccines contain residual amounts of either gentamicin, neomycin, polymyxin B, or streptomycin. And anyway, the small amounts that could be leftover in the vaccine aren’t known to trigger allergic reactions.
  • eggs – while your child with an egg allergy can get the flu shot, and then being observed as a precaution, the yellow fever vaccine could still be an issue
  • gelatin – some vaccines use gelatin, like in Jell-O, as a stabilizer
  • latex – if your child has a severe (anaphylactic) allergy to latex, you should likely avoid vaccines supplied in vials or syringes that contain natural rubber latex
  • yeast – although they aren’t thought to be an issue for kids with yeast allergies, a few vaccines can have residual amounts of yeast in them

What about aluminum? Some recent studies, including one in Pediatrics, “Case Report of Subcutaneous Nodules and Sterile Abscesses Due to Delayed Type Hypersensitivity to Aluminum-Containing Vaccines,” do suggest that aluminum can very rarely cause a non-anaphylactic delayed type IV hypersensitivity reaction. These children could have persistent redness and nodules at the site of vaccination for weeks or months when an aluminum containing vaccine is given.

Fortunately, these are mild, non-life-threatening reactions and aren’t a reason to stop vaccinating your child. And, as another study reported, “Unexpected loss of contact allergy to aluminum induced by vaccine,” many of these children outgrow their allergy.

Keep in mind that persistent hard nodules can also be caused by irritation and may not be an allergic reaction at all.

What To Know About Vaccine Allergies

The 2011 IOM report, “Adverse Effects of Vaccines: Evidence and Causality,” while concluding that most vaccines, including MMR, varicella, flu, hepatitis B, tetanus, meningococcal, and HPV could cause anaphylaxis,  stated that “It appears likely to the committee that the risk of anaphylaxis caused by vaccines is exceedingly low in the general population.”

Do you think that your child has an allergy keeping him from getting vaccinated?

Talk to your pediatrician or a pediatric allergist. They can review the “Algorithm for treatment of patients with hypersensitivity reactions after vaccines,” which “provides a rational and organized approach for the evaluation and treatment of patients with suspected hypersensitivity.”

This is especially important if you think that your child is allergic to all vaccines, something that is almost unheard of, as vaccines have different components and are made in different ways.

For More Information on Vaccine Allergies

Vaccines in Special Situations

800px-infant_with_cochlear_implant
Children with a cochlear implant need the Pneumovax 23 vaccine.

In addition to getting routine vaccines, there are some special situations in which kids need extra vaccines or extra dosages of vaccines.

Traveling out of the country and being pregnant are almost certainly the most common special situation when it comes to vaccines.

Vaccines for High Risk Conditions

Other special situations include children with high risk conditions, such as:

  • complement component deficiencies – MenHibrix or Menveo (infants), MenB
  • chronic heart disease – PPSV23
  • chronic lung disease (not including asthma) – PPSV23
  • diabetes mellitus – PPSV23
  • CSF leaks – PPSV23
  • cochlear implants – PPSV23
  • chronic liver disease – PPSV23
  • cigarette smoking – PPSV23
  • sickle cell disease – PPSV23
  • congenital or acquired asplenia – MenHibrix or Menveo (infants), PPSV23, MenB
  • congenital or acquired immunodeficiencies – PPSV23
  • HIV infection – PPSV23
  • chronic renal failure – PPSV23
  • nephrotic syndrome – PPSV23
  • leukemia – PPSV23
  • lymphoma – PPSV23
  • hodgkin disease – PPSV23
  • iatrogenic immunosuppression – PPSV23
  • solid organ transplant – PPSV23
  • multiple myeloma – PPSV23

In general,  the 23-valent pneumococcal polysaccharide vaccine, PPSV23 or Pneumovax 23, should be given when a high risk child is at least 2 years old and at least 4 weeks after their last dose of Prevnar 13. Some will need an additional booster dose of Pneumovax 23 after five years.

Remember, most children routinely get 4 doses of Prevnar 13 when they are 2, 4, 6, and 12-15 months old.

And while most kids just get one dose of PPSV23, others, especially those with any type of immunosuppression, get a repeat dose every five years.

Getting Revaccinated

Are there ever situations when kids need to get revaccinated?

While it might be hard to believe, there are more than a few reasons that kids get revaccinated.

The most obvious is when kids lose their vaccine records, although checking vaccine titers might help avoid repeating some or all of your child’s vaccines.

Children who have had a hematopoietic cell transplant (HCT) should routinely get revaccinated:

  • starting with inactivated vaccines six months after the transplant, including a 3-dose regiment of Prevnar 13, followed by PPSV23, a 3-dose regiment of Hib, and a yearly flu shot and other inactivated vaccines
  • continuing with a dose of MMR 24 months after the transplant if they are immunocompetent and possibly the chicken pox vaccine

Children who are adopted in a foreign country also often need to repeat all or most of their vaccines. Again, titers can often be done to avoid repeating doses.

Other Special Situations

Other special situations in which your child might need to get vaccinated off the standard immunization schedule might include:

  • missing one or more vaccines and needing to catch-up
  • getting exposed to rabies (cats, dogs, raccoons, skunks, bats, foxes, and coyotes)
  • having a wound that is not considered clean and minor (usually “wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite”) if it has been more than five years since their last dose of tetanus vaccine (or a clean and minor wound and it has been more than 10 years)
  • getting exposed to chicken pox (or shingles) or measles and not being fully vaccinated (two doses of the chicken pox and two doses of the MMR vaccines) or naturally immune, as a vaccine within 72 hours may decrease their risk of getting sick

Do your kids have a medical condition that might put them at high risk for a vaccine-preventable disease?

Do they need a vaccine that other kids don’t routinely get?

For More Information on Vaccines in Special Situations

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HPV Vaccine Update

merck-hpv-vaccination-large-9
A new commercial is raising awareness about the importance of getting kids vaccinated against HPV.

How often does an update from the Advisory Committee for Immunization Practices (ACIP) mean that your kids will need fewer shots?

Not that often…

But at their October meeting, the ACIP did recommend that preteens needed only two rounds of HPV vaccine, instead of three.

This follows FDA approval for Gardasil 9 on a 2-dose regimen for individuals 9 through 14 years of age in early October.

Remember that children who are at least 9 years old (traditionally 11 or 12 year old boys and girls) have traditionally gotten three doses of Gardasil, with:

  • the second dose at least 1 to 2 months after the first dose, and
  • the third dose at least 6 months after the first dose

With the new recommendations, if your child is under 15 years old when getting the first dose, then he or she will need only two doses of HPV vaccine to complete the series, with the second dose 6 to 12 months after the first.

What if your child has already gotten three doses? Then your child is well protected against HPV.

If your child has already gotten a second dose 1 to 2 months after the first, then they will have to wait to get the third dose following the 3 dose original schedule. The same goes if your child is already at least 15 years old. Neither will benefit from the new recommendation.

In other news about the HPV vaccines:

And remember that it is no longer news that Gardasil, a vaccine that can prevent cancer, was approved by the FDA. That happened over ten years ago – June 2006.

In other vaccine news, GSK will no longer sell its HPV vaccine Cervarix in the United States because of low market demand – i.e. competition from Gardasil.

For More Information On HPV Vaccines: