Category Archives: Vaccinations

Measles

You’ve almost certainly heard about measles outbreaks in the news lately. Also called rubeola, measles is a highly contagious respiratory disease caused by a virus. It causes a rash over the entire body, a fever and runny nose. According to the Centers for Disease Control and Prevention, “About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia.” Encephalitis is another severe complication that can occur. Measles can also, rarely, be fatal. Between one and two children in 1000 who get the disease will die from it. The disease can also strike adults.

Measles, as you can see, is more than just an annoying rash. It can be quite dangerous.

If you thought measles was a disease left in the past, think again. Outbreaks this year in New York and other states have health departments all over the country concerned, because such an event can happen anywhere. Over 1000 cases in nearly 30 states have been reported, the most cases since 1992—and this year is only half over. In 2000 the US was declared free of endemic measles, but this designation will soon be lost if the current epidemic is not brought under control.

Outbreaks typically begin when unvaccinated people travel abroad to places where measles is more common because a larger percentage of the population is unvaccinated.

It’s no coincidence that we used the word “unvaccinated” twice in that last sentence. The reason measles is spreading again in the United States is because of a drop in MMR (Measles, Mumps and Rubella) vaccinations.

Those who decide not to be vaccinated (or to have their children vaccinated) put themselves, their families and their communities at risk for dangerous diseases. As with most diseases, those at highest risk are the very young, the very old, and those with compromised immune systems.

The MMR vaccination is required for students in Scott County Schools, and HIGHLY recommended for all other children. The State of Kentucky requires two doses of the MMR vaccine before your child can enter school.

If you have concerns about vaccinations, talk to your pediatrician.

Remember that the extremely rare risk of a reaction to a vaccination is much smaller than the risk of being unvaccinated against a dangerous illness.

What you need to know about Hepatitis A

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If you’ve been listening to the news lately, you may have heard about the Hepatitis A outbreak in Kentucky. Over 300 people have been affected in an area that comprises several counties. Other states have also seen outbreaks. The source has yet to be confirmed, but some other recent outbreaks have been linked to tainted food.

Though it’s a highly contagious viral infection, Hepatitis A can be fairly easily prevented by getting vaccines and practicing good hygiene, like washing your hands.

There are several types of hepatitis. Here is a good article from the American Academy of Pediatrics that discusses Hepatitis A infections in children. According to the article, “Hepatitis symptoms tend to be similar from one virus type to another. Many of these symptoms are flu like, such as fever, nausea, vomiting, loss of appetite, and tiredness, sometimes with pain or tenderness of the liver in the right upper abdomen. A hepatitis infection is also associated with jaundice, a yellow discoloration of the skin and a yellowish color to the whites of the eyes. This is caused by inflammation and swelling of the liver with blockage and backup of bile (bilirubin) into the blood. This backup also usually causes the urine to turn dark orange and stools light yellow or clay colored. However, many children infected with the hepatitis virus have few if any symptoms, meaning you might not even know that your child is sick. In fact, the younger the child, the more likely she is to be symptom free. For example, among children infected with hepatitis A, only about 30% younger than 6 years have symptoms, and most of them are mild. Symptoms are more common in older children with hepatitis A, and they tend to last for several weeks.”

From the same article about how the virus is transmitted to children: “Hepatitis A is contracted when a child eats food or drinks water that is contaminated with the virus or has close contact with a person who is infected with the virus. Hepatitis A is present in the stool as early as 1 to 2 weeks before a person develops the illness. The infection can be spread in child care settings when caregivers do not wash their hands after changing the diaper of an infected baby or from infant to infant because most very young infants do not wash their hands or have their hands washed for them.”

Here’s the good news: Hepatitis A vaccines work! As a matter of fact, beginning with the 2018-19 school year, Kentucky will require all students K-12 to have received two doses of the Hepatitis A vaccine.

If your child is a patient at Georgetown Pediatrics and is at least one year old, we’ve already discussed this with you.

Are you unsure if your child’s vaccinations are up-to-date for the next school year? Give our office a call and we can access your vaccinations records.

There is still time to get a flu shot, and if your children haven’t had theirs, they should

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Everyone knows someone who has had the flu this season. Many people think it’s too late to get a preventive flu shot (vaccine), because surely it has run its course in our community. Well, it isn’t too late, and the flu season isn’t over by a long shot.

We will be seeing flu cases until at least spring break. Last year we still had cases in April, so there are eight weeks of flu season left.

If your child hasn’t had a flu shot yet, now is the time. We see in our practice how effective the vaccine is for your family.

This year to date we have had 279+ cases of the flu in our practice alone. In the previous two flu seasons, the total number of cases in our practice were 234 (2016-17) and 148 (2015-16). As you can see, the numbers are higher this year, which means your family has an increased exposure.

But the vaccine helps a great deal. Of the 279 cases so far, 125 cases were of Type A flu among those who had not had the vaccine. Only 46 children who’d had the vaccine got Type A flu. There have been 80 cases of Type B among those with no vaccine, and only 28 cases of Type B in kids who’d had the flu shot.

We have given over 3,500 doses of flu vaccine this season, and we find the chances are much greater of contracting flu when patients haven’t had the shot.

Every year we notice in our practice:

Patients that get the vaccine have a milder course. According to an article by the Centers for Disease Control and Prevention (CDC), “During past seasons, approximately 80% of flu-associated deaths in children have occurred in children who were not vaccinated. Based on available data, this remains true for the 2017-2018 season, as well.”
In families where everyone is vaccinated and someone gets the flu, the entire household may not be affected
Even when the vaccine fails for one strain, it will protect against other strains. As you can see above, we are seeing plenty of both types.
Getting one strain will not protect you from the other (if you’ve had Type A already, you may still get Type B, and vice versa). So even if you’ve had the flu, you should still get the shot.
It takes two weeks for the vaccine to be protective. For infants and toddlers, it takes 2 doses of vaccine to be effective. Note: Infants and children 6 months to less than 9 years of age who received at least 2 doses of trivalent or quadrivalent influenza vaccine prior to July 1, 2017 need only 1 dose of the 2017 to 2018 seasonal influenza vaccine. The 2 doses need not have been received during the same season or consecutive seasons. All other children less than 9 years of age (including those whose vaccination status cannot be determined) should receive 2 doses separated by 4 or more weeks in order to achieve effectiveness, according to the CDC.
If you don’t remember when your infant or child had a vaccine, call our office.
Tamiflu is not a guaranteed back up plan if your family gets the flu. We are now starting to experience shortages of Tamiflu and it may not be widely available in the next few weeks. However, we still have vaccine available.

Bottom line: the flu is still prevalent, but you can help protect your family by getting everyone vaccinated.

Call us for an appointment.

Back to school ALREADY???

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It seems as though summer just started, and we’re already talking about going back to school. That’s because now is the right time to be thinking about getting your child’s medical exams and immunizations covered.

Exams and physicals. Most sports (both school and community) will require that your child or teen have an annual physical. You’ll see ads for retail clinics in stores and also physicals being held at the schools, but keep these things in mind:

Those places don’t have your child’s medical records. Medical and immunization histories aren’t available to the person doing the physical or administering the immunizations.
They haven’t developed a relationship with you to know what is normal and appropriate for your family.
Follow up is minimal or altogether unavailable.
No nutritional counseling is available, which we believe to be extremely important.

For all those reasons and more, we highly recommend that you see your own pediatrician for back-to-school exams and immunizations. (Check out our 2013 blog on store-based clinics here.)

Immunizations. Many immunizations are required by the state, and there are some additional ones recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC). For example, Kentucky requires the meningitis vaccine for the 6^th grade; we also are doing a booster at the age of 16 which isn’t state required but is recommended by both the CDC and AAP. A printable immunization schedule for parents is available here from the CDC.

Concerned about immunizations? Read the article, “Why Immunize?” at the CDC website. Also, find here a series of articles from the AAP about a variety of immunizations.

Plan to arrange your pediatric appointments soon, so your teens and children will have everything they need before school starts.

In between your summer travel plans, pool days and sporting events, don’t forget to make room for health.

Flu vaccinations are working

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Having encouraged all of you to be vaccinated against the flu, we think this is a good time to give you a local update.

Here are some very interesting statistics:

So far this season, Georgetown Pediatrics has administered 4200 doses of flu vaccine, including both shots and nasal mist.
We have had 76 positive flu tests in our office. Of those 76, one was influenza type B, one was both influenza A and B, and 74 were influenza type A (H1N1).
Only 22 patients who received flu vaccine in our office also tested positive in our office for the flu. Of course, some patients may have been diagnosed with the flu elsewhere or had the flu and weren’t diagnosed at all, or some may have received the vaccine elsewhere. Even so, we are happy to note that only 1 in 190 patients who received our vaccines tested positive for flu here.

The bottom line is that flu vaccine works.

Something else you should know: it isn’t too late to get the vaccine. Even if you’ve already had the flu, it was likely type A, and you can still contract type B. Both types are covered by the vaccines. Once kids are back in school after these snow days the virus is bound to be spread more.
We often see cases of influenza B all the way until spring break, so don’t hesitate to come in. Just remember that if you receive the nasal mist you will test positive for the flu for about two weeks, because it’s a live vaccine and the test is a nasal swab.

As winter drags on, you may not be able to stop the snow and ice, but you can certainly lower the risk of your family getting the flu.

Whooping cough–don’t take it lightly

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Whooping cough. It sounds like one of those old-fashioned diseases that shouldn’t be around anymore. In reality, it’s as modern as today’s news, and more common than you might think.

The good news is that it’s mostly preventable and treatable; the bad news is that it’s still a dangerous disease, especially for the very young.

A few confirmed cases of whooping cough (pertussis) in the Scott County Schools have spurred us to remind you of the dangers of this disease.

Whooping cough is a bacterial infection whose most striking symptom is described in its name—a loud, persistent cough that doesn’t easily go away. In an older child, there is a “whooping” sound made as the child tries to catch her breath between coughs. Infants may not “whoop,” but you should call the pediatrician if your infant has a persistent cough that seems to exhaust him, and his appetite has decreased.

This disease affects the lining of the bronchial tubes , and is very contagious because the vigorous coughing disperses the bacteria into the air. Anyone of any age can get it, but it’s most dangerous among the very young.

Infants and young children, in particular, can develop life-threatening illnesses from whooping cough, including pneumonia. Hospitalization is often required. This means that they, and the people around them, should be immunized.

We cannot stress enough the importance of getting the appropriate immunizations at the right ages. The pertussis vaccine doesn’t last forever, and must be taken at intervals to be effective.

Children should have a total of 5 pertussis (whooping cough) vaccines before they start school.
The youngest children are at highest risk and the most vulnerable to this disease, and should have vaccines at 2 months, 4 months, and 6 months of age.
Booster shots are given at 12-18 months, and
again at 4-5 years of age.
The College of Gynecology and Obstetrics recommends that pregnant women receive a pertussis vaccine with each pregnancy to reduce the chances of whooping cough in their newborn.
Caregivers and other adults who live or work with infants should also be re-immunized, because they’ve lost immunity from their childhood vaccines. They may not even realize they have whooping cough, because symptoms are not as severe. It may simply feel like a lingering cough from a cold, but they can transmit it to the children in their care.

When should you bring your child to the pediatrician for whooping cough? If he has cold symptoms, and you notice that the cough is worsening at about the time when it should be getting better, call our office for an immediate appointment.

There is a test we can do in the office, but it has to be sent to a lab, which takes several days. In the meantime, if the pediatrician suspects pertussis, your child will be started on a five-day course of antibiotics. The child is considered contagious and should not return to school or daycare until the five-day course has been completed.

To read more, check out this article from the American Academy of Pediatrics. Also, see our Facebook November 8 reposting of an article from two years ago by our own Dr. Hambrick. The experience of one of his own children having been made dangerously sick by this disease makes him particularly diligent in trying to keep your child healthy. artwork by Macy

: artwork by Macy

It’s time for flu vaccine!

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Georgetown Pediatrics has this year’s flu vaccine ready for your child. Here are a few answers to common questions about the vaccine.

Why get a flu vaccine? Influenza can be a very dangerous disease, and at the very least can make your child be sick for several days. With a vaccine, even if your child gets the flu, it is typically a milder case.
My child had the flu vaccine last year. Does she really need to have one this year, too? Yes. Each year the vaccine is specifically designed and manufactured to be effective against the expected flu outbreaks for that particular flu season. In addition, the vaccine is effective for a few months. For both of those reasons, the vaccine should be administered every year.
Should my infant or toddler get a flu vaccine? Yes, if he’s at least 6 months old. Children who are 6 months to 2 years old are especially susceptible to the flu and it can be very dangerous for them.
Should my child get the flu vaccine as an injection or as the nasal mist? That depends. The nasal mist is easier for most people to take, and is approved for those between the ages of 2 and 49. Since it is a live (though weakened) virus, the short-term side effects (cold-like symptoms) can be a little stronger as the body’s natural reactions take effect. Children who have a compromised immune system (or who have close contact with someone who has a compromised immune system) should get the flu shot instead of the nasal spray. Also, those with certain health conditions like asthma or wheezing, or conditions requiring long-term aspirin usage should take the shot rather than the mist. More information about the flu mist is found here.
Who should NOT get any flu vaccine? Check with your doctor if any of these conditions apply:
- NOTE: If your child has an allergy to eggs, she may still be able to take the vaccine. Check with your pediatrician.
- If your child or adolescent has had other vaccines within the past four weeks.

We have flu vaccine available now. Call for an appointment. And read more about influenza and the vaccines here.

artwork by Josh

Preparing for (owie!) shots

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No one likes to get a shot, but we all know they are necessary. Whether getting an annual flu vaccine or immunizations for school, your child will sometimes be coming to our office to receive a shot. How you prepare your child is important and may make the event go better for all concerned.

While every child is different, some basics are helpful.

Tell the truth. If you tell your child she’s not getting a shot, or that it won’t hurt, she may not want to go to the doctor’s office again, even when she won’t be getting a shot.
Tell the truth–again. Explain that though the shot will hurt a little, it won’t last long and it will keep him healthy for a very long time.
Don’t blame the doctor or nurse. They often hear some version of: “If you don’t behave, the nurse will give you a shot.” Vaccinations are not punishment; they are insurance against future illness. Words spoken against the nurse or doctor, even in jest, can harm your child’s view of medical personnel—the people who are there to help. Your child should feel positively about our staff; it will make it easier for you to bring him the next time he’s sick.
Have a conversation and plan a reward. Some children can’t keep from crying, but you can help them refrain from dramatic overreaction. Let them know what is going to happen, and that you expect them to be kind and behave appropriately for their age. A promised reward can help—a bike ride with you, a favorite dessert, a play date with a friend.

Getting a shot isn’t fun, but with some assistance from you, we’ll make the experience as painless as possible for all concerned!

This week’s artwork

HPV vaccine: the who, what, when, and why

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You’ve heard of HPV (Human Papillomavirus), but you may not be sure what it is or what (if anything) you should do about preventing it in your children and teens.

[Most of the information that follows is adapted from the websites of the Centers for Disease Control and Prevention (see here at CDC).]

THE WHAT: HPV is the most common sexually transmitted infection (STI), and there are more than 40 types of HPV. It’s unrelated to HIV, herpes, or any other STI. HPV can cause genital warts, cervical and other types of cancer.

There are two types of vaccine. Cervarix is for females only, and protects against cervical cancers. The other, Gardasil, is for both males and females, and protects against genital warts as well as cancers of the cervix, anus, and vulva. As of 2012, over 46 million doses had been distributed in the US (most of them Gardasil). The vaccine is considered to be very safe and highly effective.

THE WHO AND THE WHEN: Both males and females can contract HPV, from genital contact or from oral or genital sex. It’s recommended that preteens (ages 11-12) of both sexes receive the series of three doses so that they can develop an immune response before they become sexually active. Gardasil is considered effective in teenagers and young adults through the age of 26.

THE WHY: Since a person can contract HPV even if he/she only has one sex partner, and since someone can have HPV for years without symptoms and therefore not even know that she or he has the virus, parents should consider whether this vaccine is right for their preteen or teen. The very good news is this: studies indicate that the vaccine is highly effective: the HPV rate of transmission in adolescents is declining faster than expected.

Ask your pediatrician about this. That’s why we’re here.

artwork by Camille

A new take on whether or not to give Tylenol (Acetaminophen) right before or after a vaccination

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A new study has pediatricians (including us) rethinking previous recommendations about acetaminophen and vaccinations.

Often, children get a slight fever after a vaccination. This is a normal response of the immune system, reacting to the presence of something new in the body. Physicians have long recommended taking acetaminophen before, and every four hours for the first 24 after a vaccination to prevent or reduce fever and make the child more comfortable.

The study, reported in The Lancet, finds that giving acetaminophen does indeed decrease fever after the vaccination. But there was an unexpected finding: acetaminophen appears also to reduce the effectiveness of the vaccine.

More studies are required, and the reasons behind this lowered effectiveness are not fully understood. However, for now we believe it is best NOT to give doses of acetaminophen right before or within the first 24 hours after the vaccine. If, though, your child exhibits a fever of 101º or above, or experiences soreness, then it’s okay to give a small amount to ease those symptoms.

Speaking of amounts, Tylenol and other makers/distributors of acetaminophen have recently changed the concentration of their product for infants. It’s now the SAME as the concentration for children, but the dosage is of course smaller. So be sure not to use a medicine dropper from an old infant Tylenol bottle with the new infant Tylenol concentration.

Always check dosing instructions on any over the counter medication.

Stay healthy, and don’t forget to keep your immunizations up to date!

Corinne, age 3