By, Rebecca Bakke MD, FAAP
As a pediatrician, I am often asked the question, “What would you do if she was your child?”
I always try to answer this question as honestly as I can. Sometimes, when the answer is not very straightforward, l can say sincerely, “I don’t know. “ Other times, such as when parents have concerns about immunizations, the answer is easy.
Vaccination is one of the most polarizing issues in our country, and because I immunize infants and children every single day at work, the controversy frequently makes its way into my office. Anxious first-time parents cradle their newborn babies while nervously reviewing the vaccine schedule, then look up at me and ask what I think about delaying vaccines, trying an alternate vaccine schedule or forgoing them all together.
“What would you do if she was your child?”
Parents are not usually surprised when I say that I vaccinate all three of my children according to the recommended CDC schedule. They expect that as a pediatrician, I have seen the horrors of vaccine-preventable disease and believe in the ability of vaccines to prevent these now rare illnesses. This is, of course, true. They are usually quite surprised, however, when I tell them that my most significant experience with vaccine preventable disease happened not while I was working as a doctor, but as a first-time parent.
My first pregnancy was gloriously uneventful, and I was full of the joyous anticipation and occasional irrational terror that most first-time mothers share. I followed all the rules. I took my prenatal vitamins, avoided sushi, cut back on caffeine and made a special effort to get adequate sleep and exercise. I spent hours online reading reviews on strollers, car seats and cribs. I was pregnant during the 2009-2010 H1N1 (“swine flu”) epidemic, and I was terrified of the toll the disease could take on my unborn baby and me. I even cared for babies in the NICU who were born far too early because their mothers became critically ill from influenza while pregnant. I spent months wearing a mask at work, and I stood in line at the Department of Health to get the H1N1 vaccine just one day before it was available from Employee Health at my hospital.
Claire Noelle was born on a snowy January morning, and I remember being overwhelmed by the instantaneous love and devotion I felt for this tiny baby I had only just met. We took her home the next day, and like most new parents, spent the first several weeks of her life gazing at her and relishing in every sweet newborn expression, sigh and sneeze.
When Claire was 5 weeks old and just starting to smile, she started coughing. Initially, it was only after I nursed her, and I thought it was reflux. But when the coughing worsened, I panicked. I reflected on the fact that I was recovering from a mild cold when Claire was born, and had been coughing ever since. My cough was nothing remarkable, but Claire’s cough was starting to sound an awful lot like pertussis (whooping cough). We took her to the pediatrician. The next day he called and confirmed my fear: Claire had pertussis.
The next three weeks were the darkest of my life. Antibiotic treatment for pertussis prevents the spread of the disease, but after the coughing starts no medication can alter the disease course. If you have ever seen a child with pertussis you know why it is called whooping cough. Infants and children have such long coughing spells that they cough until their lungs are completely out of breath, then they inhale desperately (“whoop”) before the coughing fits start again.
Claire would cough cough cough cough cough and whoop, cough cough cough cough cough and whoop for an hour straight several times per day.
She coughed until her lips turned blue.
She coughed until she vomited so many times that she lost weight.
The coughing completely and violently took over her precious 9 pound body.
Infants with pertussis, especially infants as young as Claire was, are at high risk for complications.
The coughing fits can lead to bleeding in the brain.
They can get pneumonia.
They can have periods of apnea, where they stop breathing.
Many end up on a ventilator.
One to two percent of infants with pertussis die.
I knew these things, and I was terrified. But nobody could stop the coughing.
Claire was fortunate. We were fortunate. She recovered without any complications. But dozens of infants born in 2010, including at least one infant in our community, died of whooping cough. Many of these babies were too young to be vaccinated. So was Claire.
But I was not. While I was pregnant, I spent a whole lot of time researching strollers, but failed to take any time to get a vaccine that could have prevented my baby from getting a life threatening illness. And I am a pediatrician. I, of all people, should have known better. Because of this, it is now part of my mission to make sure that the families that I take care of do know better.
Today, all expectant women should be vaccinated with Tdap during every pregnancy, preferably in the third trimester (between the 27th and 36th week). By getting vaccinated during pregnancy, mothers build antibodies that are transferred to the newborn, providing protection against pertussis before the baby can get their first dose of DTaP vaccine at 2 months old. Tdap vaccine also protects mothers during delivery, which makes them less likely to transmit pertussis to their babies. This recommendation is not only supported by The American College of Obstetricians and Gynecologists, but also by the Centers for Disease Control and Prevention (CDC).
What would I do if she was my child?
I would vaccinate.
For more information, visit these special CDC webpages dedicated to whooping cough information for pregnant women and healthcare providers here.
About the author: Rebecca Bakke MD, FAAP is a pediatrician at Sanford Health and a clinical assistant professor of pediatrics at the University of North Dakota School of Medicine. She lives in Fargo, ND with her husband and three young children.
Even as temperatures climb, daylight extends and the promise of Spring lingers around the corner, the United States is still facing the threat of the flu.
While influenza activity has begun to decline across the United States in recent weeks, the CDC’s influenza surveillance systems still show elevated activity as we enter the month of March. Although the average length of a flu season for the past 13 seasons has been 13 weeks, flu activity has been elevated this season for 16 consecutive weeks so far. As of March 7, 2015 there were still 9 states reporting widespread activity, 29 states reporting regional activity and 11 states reporting local activity. Even though the season started early this year, it is expected to continue for several more weeks and we can already see that it has been dangerous, deadly and unpredictable this season.
Flu Remains Deadly
As of February 21, 2015, the proportion of deaths attributed to pneumonia and influenza remains above the epidemic threshold and has exceeded that threshold for eight consecutive weeks. Additionally, seven children have died of influenza between March 1-7, 2015, bringing the total number of flu-associated pediatric deaths reported so far this season to 104.
Death isn’t the Only Detrimental Outcome of Flu
While it’s true that the majority of individuals who suffer with the flu will survive, the CDC also monitors hospitalizations that are associated with influenza infection. So far this season the most affected age group has been adults 65 years of age and older, and they’ve accounted for more than 60% of reported influenza-associated hospitalizations. This supports the need for wide-spread vaccination among older individuals and their caregivers, to include nursing home employees and health care workers. As of February, 21, 2015, the most commonly reported underlying medical conditions among hospitalized adults were cardiovascular disease, metabolic disorders, and obesity.
Children, especially those under 5 years of age, have the second-highest hospitalization rate this season, with the most commonly reported underlying medical conditions to be asthma, neurologic disorders, and immune suppression. Among hospitalized women of childbearing age, 26% were pregnant. However, while certain medical conditions can increase your risk of complications from influenza, seven percent of adults and 39% of hospitalized children had no identified underlying medical conditions, illustrating the fact that flu can be life-threatening even to a previously healthy individual.
The Flu Came On Early, Strong and With It’s Share of Surprises
written by: Amy Pisani, MS, Executive Director, Every Child By Two
The Advisory Committee on Immunization Practices (ACIP) conducted an abbreviated meeting on February 26, 2015 due to the threat of a winter storm in the Atlanta, Georgia region. The ACIP, which consists of 15 voting members who have expertise in vaccinology, immunology, healthcare and public health, makes recommendations to the Centers for Disease Control and Prevention (CDC) regarding vaccinations approved for use by the Food and Drug Administration (FDA). The recommendations pertain to the timing and intervals of vaccines which are included on the childhood, adolescent and adult immunization schedules. At this February meeting, the ACIP conducted three important votes which altered or created new recommendations for meningococcal vaccine, influenza vaccine and HPV vaccine.
Meningococcal Serogroup B Vaccine
Two new vaccines to protect against meningococcal serogroup B, which has been spreading through college campuses in recent years, were recently approved by the FDA. The Trumenba vaccine is developed by Pfizer Pharmaceuticals and requires three doses and the Bexsero vaccine has been developed by Novartis Vaccines and Diagnostics requiring two doses. The ACIP has previously recommended one dose of MCV4 vaccine at ages 11-12, and a booster at age 16 to protects against the A, C, W and Y strains of meningococcal bacteria Nearly 80% of teens between the ages of 13 and 17 have received at least one dose of the MCV4 vaccine, which is fairly remarkable considering the fact that it is recommended, but not mandated for use within states nationwide. However, because of the complicated nature of the virus, the new meningococcal serogroup B vaccine would require a separate series of shots, in addition to those recommended for MCV4 vaccine.
The serogroup B strain of meningococcal is considered the most common cause of meningococcal disease among adolescents here in the U.S. with a fatality rate of 12 percent in 11-19 year olds and 17 percent in 20 year olds over the last 14 years. While the number of meningococcal cases have declined since 1996, many advocates believe that the aggressive nature of this disease, which often kills or maims it’s victims within hours, necessitates a broad recommendation for the vaccine. However, the ACIP discussion at the February meeting was limited to recommendations for those at high risk for serogroup B infection, with a follow up vote anticipated at the upcoming June meeting where the Committee will review data and make a determination on whether to recommend the vaccine for a broader population. Several advocates traveled to the meeting to provide their testimonials. These included parents of those lost to the disease as well as survivors who have suffered amputations and serious life-long health consequences of this invasive disease. Dr. Mary Ferris, who helped lead efforts to contain the 2014 meningococcal outbreak at University of California’s Santa Barbara campus, provided compelling testimony regarding the impact of the outbreak on the university. Ferris noted that four cases, one of which led to the amputation of a student, spread panic throughout the campus and the local community. Students were banned from volunteering at the on-campus daycare and attempts were made by the local community to close the campus entirely. Dr. Ferris urged the Committee to consider the broadest recommendation Read more…
Being a mom to Molly and Frankie is, without a doubt, the most rewarding role I’ve ever had. As we prepared to welcome another baby into our home this fall, I was reminded of just how fragile and precious a newborn can be.
In recent interviews with Fox News and CNN, I shared my concerns over the growing number of unvaccinated children in the area where we live. It frightens me to think that my baby may possibly be exposed to a dangerous and life-threatening disease before he is old enough to be vaccinated himself. It seems unfair that while I do everything in my power to protect this delicate new life, others are making a choice that puts my child at serious risk.
I have real reason to worry. When my second daughter Molly was just 10 months old she contracted whooping cough (also known as pertussis). As any parent can relate, it’s scary when your child gets sick, but it’s especially upsetting when you realize that your child is part of the largest outbreak of whooping cough in over fifty years. As an advocate for Every Child By Two’s Vaccinate Your Baby initiative, I was all too aware of the fact that whooping cough can be deadly for infants, and yet here we were facing that terrible diagnosis. We were incredibly fortunate that Molly fully recovered, but I’ll admit that I was completely rattled by the experience.
Fortunately, since that time, scientists have been closely examining the possible causes for the large number of whooping cough cases over the past few years and have made recommendations aimed at curbing the outbreaks. Part of the problem is that the immunity against the disease is wearing off so that people throughout the U.S. are less immune to whooping cough. Therefore, it’s more important than ever for infants to receive all five recommended doses of the DTaP (diphtheria, tetanus and pertussis) vaccine, followed by the booster shot of the adult version of the pertussis vaccine (Tdap) at 11 or 12 years old. It’s staggering to note that 83% of infants who are diagnosed with whooping cough got it from a family member, most often their own parents. Therefore, adults need to make sure they get a Tdap booster before a new baby arrives to protect themselves and to stop the spread of the disease to infants, who are most likely to become seriously ill from the disease.
Most important for newborns, the CDC’s Advisory Committee on Immunization Practices took a good hard look at the pertussis research and concluded that we can best protect newborns by ensuring that pregnant women receive an adult Tdap booster in their last trimester of each pregnancy. By getting vaccinated during pregnancy, not only was I protected, but antibodies were transferred to my baby through the placenta, providing my baby with protection against pertussis before he could start getting DTaP vaccine at two months of age. So I followed my doctor’s advice and not only received the Tdap vaccine during my last trimester, but I also got a flu shot.
Just as I have the ability to protect my newborn from pertussis, I also have the ability to protect him and other members of my family from influenza. I’ve learned that due to changes in a pregnant woman’s immune system, heart and lungs, I was more prone to serious complications from the flu such as pre-term labor and delivery, hospitalization and even death. And, since children can’t be vaccinated against the flu before six months of age, everyone in our family must do all we can to protect our baby boy. With my child being born in the midst of flu season, I wanted to do everything I could to protect him from a disease that causes more than 20,000 children under the age of five to be hospitalized each year. I find it upsetting to learn that with all the medical resources available to us here in the U.S., last year’s flu season claimed the lives of 109 precious children.
I’ll admit that as a parent I’m concerned about the threat of vaccine-preventable diseases, especially as a result of people choosing not to vaccinate. But I refuse to stand by and watch as others put my children’s health at risk. By getting the flu and pertussis vaccines during my pregnancy, I felt empowered that I could do something positive to protect my child. And you can too.
Talk to your doctor if you have questions about vaccines. In addition, encourage your friends and family to utilize the resources provided by reputable organizations, such as Every Child By Two and the American College of Obstetricians and Gynecologists. And be sure to immunize yourself and your entire family.
Every Child By Two Executive Director, Amy Pisani, reviews Dr. Paul Offit’s latest book.
A riveting new book by Dr. Paul Offit hits the shelves this week; Bad Faith: When Religious Belief Undermines Modern Medicine.
Dr. Offit’s latest book chronicles the stories of several families who made decisions for their children’s health based on their religious beliefs, even when the consequences have resulted in the loss of lives.
In one most respectful account, Dr. Offit delves into the psychological forces that resulted in the worst possible outcome for the Swan family. The Swans, both of whom grew up as Christian Scientists, allowed religious leaders to persuade them to deny medical care to their child even as he suffered agonizing pain. When inviting religious healers to their home, the Swan’s – who were taught that disease is a figment of the imagination of the unfaithful – believed they were seeking appropriate medical care for their child.
But is it appropriate for religion to shield a parent from denying life-saving medicines, including vaccines, for their children?
Bad Faith takes a stark and disturbing look at the surprising capacity of both individuals, and policy makers here in the U.S., to risk the health and safety of children, all in the name of religion.
Bad Faith holds no religious-based medical practices on a pedestal. The writer does not condemn any specific religion, but rather the specific practices that are followed in the name of religion. His examples include the practices of some Orthodox Jews who refuse to acknowledge 21st Century hygiene techniques to protect infants undergoing circumcisions, various extreme Christian religions who preach the denial of life-saving medicines including antibiotics and vaccines, even Catholic hospitals who deny life-saving care to women, all in the name of Jesus.
This book comes out on the heels of a measles outbreak that has spread throughout the country, sickening more than 125 people in fifteen states, Canada and Mexico. The cause of the outbreak? Parents who have chosen not to vaccinate their children, many basing their decision on personal or religious beliefs. The question at hand is how could this still be happening, and why are we letting it happen in 21st Century America?
My name is Jamie Schanbaum and I am a meningitis survivor.
I’m here to tell you that meningitis is not only life changing, but it is deadly. In 2008 I was diagnosed with meningococcal septicemia, which left me with serious life weighing decisions. Within 14 hours from my first symptom, I was told that I had a 20 percent chance of surviving. Then I was told that I was going to have to have some of my limbs amputated. At the age of 20, my life had been average. But within hours it transitioned to detrimental. Seven months later, I finally stepped out (or more so, wheeled out) of the hospital. I was alive, but I had lost the bottom half of my legs and all of my fingers.
There is no way anyone could have predicted that this would be my life. I had so many expectations for the future before I got meningitis, and suddenly all that had changed. I left the hospital with never-ending doubts of what my life would be like. I’m now 26, and every day I live with the consequences of meningitis and the fact that I was not vaccinated.
That is why in 2009, my family and I became instrumental in educating the public about the dangers of meningitis and advocating for new Texas legislation that would require college students, living in public and private facilities, to get vaccinated. Then in 2011, we worked to amend the bill so that all college students in the state of Texas would be required to get the meningitis vaccine before enrolling in classes. I am honored that ever since The Jamie Schanbaum & Nicolas Williams Act was enacted, the number of meningitis cases in the state of Texas has continued to decrease. Texas was the first state to implement this law, and I am hopeful that other states will follow.
Today we have an opportunity to save even more lives, and spare others from suffering the same permanent consequences as I have. This week the Advisory Committee on Immunization Practices (ACIP) will consider whether to recommend the newly approved serogroup B meningococcal vaccine. The current meningitis vaccine that children are recommended to receive between ages 11-12, and then again with a booster at age 16, hasn’t been 100% capable of covering all five strains of meningitis. The serogroup B strain, which can now be prevented with this newly approved vaccine, is a very dangerous strain and we’ve recently seen an increase in the number of cases on college campuses across the U.S. Now more than ever, we need to seize the moment and make sure the public is protected from as many forms of meningitis as possible. Read more…
There are five main serogroups (“strains”) of meningococcal bacteria: A, B, C, Y, and W. While the meningococcal vaccine that is currently on the CDC’s recommended immunization schedule covers the A,C, Y and W strains, it does not cover serogroup B. However, in 2012 there were about 500 total cases of meningococcal disease in the U.S, and 160 of those cases were caused by the serogroup B strain. When factoring in recent outbreaks, serogroup B now causes 40% of all meningococcal disease cases among 11-24 year olds.
Fortunately, in October 2014, the FDA approved a new meningococcal vaccine called MenB that covers the serogroup B strain. This Wednesday, February 25, 2015, the Advisory Committee on Immunization Practices (ACIP) will be voting on the details of a formal recommendation for the MenB vaccine.
In advance of this vote, we’re featuring several guest posts this week that highlight the impact of meningococcal disease.
Today’s guest post was written by PKIDS:
At PKIDs, we help families affected by infectious diseases, and we work to educate ourselves and others about these diseases. Our goal is to prevent infections.
In 2015, we’re turning the spotlight on meningitis, or more accurately, meningococcal disease.
Meningitis is scary—and confusing. For instance, if I say that I have meningitis, it sounds like I’m saying I’m infected with a germ called meningitis. But, there is no germ called “meningitis.”
Adding to the confusion is the fact that we tend to use that term loosely for what should be called “meningococcal disease.”
Meningococcal disease causes meningitis, and it may also cause blood poisoning (septicemia).