Shot of Prevention

By Amy Pisani

The recent conference call hosted by Every Child By Two about preventing the spread of pertussis couldn’t have come at a better time.  Joined by Dr. Ari Brown, a pediatrician and author based in Austin, TX, and Danielle Romaguera, the mother of a child who lost her life to pertussis, we were able to have a pretty passionate discussion with some of the smartest child health advocates and bloggers that we know.  Recent cases of pertussis in California are further evidence that this disease presents a significant threat to children across our country.  It remains extremely important that parents understand ALL of the options at hand to protect their children–and themselves–from preventable diseases, like pertussis, that embody major risks to public health.  Recent articles that may interest you include:

• “San Mateo County officials work to stem whooping cough,” San Jose Mercury News

http://www.mercurynews.com/breaking-news/ci_15391435

• “Vaccination role unclear in whooping cough outbreak,” CNN

http://www.cnn.com/2010/HEALTH/06/28/california.whooping.cough/

• “State’s whooping cough surge may be tied to lagging immunization rate,” Los Angeles Times

http://www.latimes.com/news/health/la-me-whooping-cough-immunization-20100627,0,508371.story

• “Health Buzz: Whooping cough epidemic strikes California,” U.S. News & World Report

http://health.usnews.com/health-news/family-health/cancer/articles/2010/06/25/health-buzz-whooping-cough-epidemic-strikes-california.html

If you have thoughts on any of these articles, please leave us a comment.

By Christine Vara

So often media messages regarding children’s health are directed towards women – or more appropriately “moms”.  In emphasizing the role of mothers in immunization decisions, we must not forget the importance of the men in our lives.  Historically, men have been considered the head of the household, the provider for the family and, in essence, the leader of the pack.  Men feel it is their duty to protect their families from harm and families often depend on that protection. 

Introducing the Real Guys Immunize social media campaign.  This is clearly a message that has relevance in today’s society: Empowering men to protect themselves and their families from vaccine preventable diseases.

So what can a real guy do?

• First, they can immunize themselves to increase the protection offered to the “pack” by herd immunity, which is critical in preventing the resurgence of diseases such as measles and mumps. 
• By keeping up to date on their own vaccinations, they can effectively “cocoon” their loved ones.  Take for instance the recommendation that fathers receive a Tdap booster to protect their infant children from whooping cough during the period before these infants begin receiving their own vaccinations.
• Fathers should be involved in the decisions to immunize their children and can be essential in ensuring their children are up to date on vaccinations.
• Young boys and adolescent men are encouraged to receive vaccinations for HPV and meningitis. 
• Elderly men should also receive immunizations for flu, shingles and other diseases to not only protect themselves, but to limit the possibility that they might infect younger members of their family such as grandchildren. 

The fact is that the more guys immunize, the more they will protect their families and be hailed as heroes.

In honor of Father’s Day, tell us about your father, husband, grandfather, uncle, brother or friend in the captains’ corner of the Real Guys Immunize website.   We invite you to include include your own story about the real guys you know who immunize and check out the information within the i Herd section.  Visit the Facebook page to include a message and share a photo about these real guys in your life.  Share the website on twitter so that we can spread the word that “Real Guys Immunize”.  Honor the men in your life by sending them a special Father’s Day e-card from the Real Guys Immunize campaign.  They will certainly appreciate it and you will be doing your part to support healthy families.  There is even a collection of informative, and sometimes humorous, videos on youtube for you to share.

Let us know your thoughts about this exciting new campaign by commenting below.

By Christine Vara

Cocooning: A transitive verb meaning to protect somebody from unpleasantness or danger.

And who wouldn’t want to protect infants from danger?  The question is what do we need to protect them from and how do we do it?

In the case of whooping cough (also known as pertussis) infants are in very real danger.  Whooping cough is a serious bacterial infection that attacks the respiratory tract, resulting in severe coughing spasms.  Adults who contract pertussis often have symptoms that can persist for as long as 3-4 months, which is why it has been coined the 100 day cough.  Symptoms in adults often mimic a severe cold and so many go patients are undiagnosed, perpetuating the spread of the disease. 

However the infection has proved to be particularly life threatening for newborns and infants since the coughing spasms can escalate, restricting an infant’s airways and resulting in dangerous apnea.  The disease is highly contagious and is spread from exposure to infected persons through droplets in the air that come from coughing and sneezing.  Complications from pertussis can lead to pneumonia, seizures, brain damage, mental retardation, and death.  While the mortality rate from whooping cough may not seem alarmingly high, the fact is that 90% of people who die from this disease are babies less than one year old.  Since this is a disease that can be prevented through vaccination, any death seems unacceptable. So what can we do to protect our children?  

The good news is that there is a vaccine available for children called DTaP, which provides immunization against whooping cough, (as well as tetanus and diphtheria).  The CDC recommends that infants receive 5 doses at ages 2, 4, 6, and 15-18 months, followed by another at 4-6 years of age to complete the series.  Unfortunately, since infants don’t begin the multi-dose vaccine until 2 months of age,and it requires multiple doses to build immunitity, children are virtually unprotected in the early months of their lives.   

It is possible that a mother’s antibodies can pass to a baby to protect them during this critical time.  However, since immunity may only last 10 years, people who received the vaccination when they were young are typically no longer immune as adults, but don’t even realize this.  This was recently publicized by Dr. William Cochran, a pediatric gastroenterologist from Geisinger Medical Center in Danville, PA who contracted the contagious bacterial disease from a child he was caring for last year and described his battle with whooping cough as the worst illness of his life.  

Fortunately, in 2005 the Tdap vaccine was approved for adults, up to the age of 65, in an effort to reduce the rising rates of pertussis.  Surprisingly, unlike many other diseases, even those who have contracted the disease in the past do not remain immune from the disease in the future.  In recognizing this, many states are now requiring a booster shots for middle school students in order to extend a child’s immunity, but many adults still don’t receive booster shots for themselves because they just aren’t aware that they should.  The alarming fact is that 70% of infants who contract pertussis are actually infected by family members including mothers, fathers, grandparents and siblings.    

Enter the concept of cocooning – a practice of ensuring the vaccination of all individuals that newborns will come into contact with during their early days in order to protect them from the transfer of harmful illnesses like pertussis.  By getting the public to understand the risk of whooping cough to infants in our community, hopefully more people will request the Tdap vaccine from their doctor.  Some local pharmacies are now administerering the Tdap vaccines to adults, so while accessibility may not be an issue, clearly education is. 

While we know that the adult vaccine has been available since 2005 and is easily accessible, we must question why most adults are still not aware of the need to vaccinate against pertussis as a preventive measure for ourselves and our children.  Our collective efforts must now turn to generating a patient driven initiative to increase the number of people who seek immunization.      

While the vaccine is not recommended for use during pregnancy, we need to educate women so that they are seeking vaccination prior to getting pregnant, or immediately after giving birth. With increased awareness of the risk, perhaps OB-GYNs will begin to make this suggestion during pre-conception or pre-natal visits. Additionally, since the body’s immune response to the vaccine may take as long as 4 weeks, the recommendation is for all family members and care givers who will come in contact with the baby to be vaccinated at least 4 weeks prior to delivery.    Taken one step further, it would be prudent for hospital workers and  pediatric offices employees, who are often the first contacts for newborns, to be vaccinated against this infectious illness as well.  

Unfortunately, we are seeing a noticeable increase in the cases of pertussis this year in comparison to years past.  Consider recent articles regarding a rise in cases in such places as California. It is a tragedy that 4 infants have already lost their lives this year in the state of California alone as a result of pertussis.

At the Vaccinate Your Baby website, victims of vaccine preventable diseases have shared their heartbreaking stories in an effort to help save other children.  The Romagueras detail their experience with their daughter Brie who was born, and subsequently died, as a result of whooping cough in 2003, prior to the introduction of an adult booster shot.  Yet Katie Van Tornhout’s recent story of the death of her daughter Callie illustrates that parents are still not aware of the risks that pertussis poses, or the steps that they can take to reduce those risks through widespread immunization.  Therefore, while we have a way to prevent these deaths, we don’t have enough awareness prompting families to receive the vaccinations they need to protect their own children. 

Please help us to do our part to inform parents of the cocooning concept and share this information with others.  Of course, we also welcome any suggestions or comments you may have so I encourage you to join the conversation here.      

 I would like to thank Ari Brown, MD, FAAP and Danielle Romaguera for their contributions to this article.  Hearing them speak at length on this subject is what facilitated me to write this piece.  I think it is important to note that there are people working hard to get the word out and both Dr. Ari Brown and Danielle Romaguera are very committed to educating families regarding the risks of pertussis.  

  Not only is Dr. Brown an award-winning pediatrician who works full-time in private practice in Austin, Texas, she is a mother to two boys, an official spokesperson for the American Academy of Pediatrics, an expert contributor to WebMD and author of two best-selling parenting books, Baby 411 and Toddler 411.  Her newest book, Expecting 411 is her latest accomplishment in a comprehensive series of great resources for expectant parents. 

By Christine Vara

My last post left me a bit disillusioned.  Do we really need to exploit the tragic stories of families who have lost their children to vaccine preventable diseases in order for vaccine reluctant patients to reconsider their choices?  There must be another way….

I spent a few days pondering this sad situation, while also reviewing responses to my post.  The comments were encouraging.  We must continue to educate.  If fear is a motivating factor in choosing to vaccinate or not, than we need to accept that fact and use it to generate the response we are looking for. Overall, the comments were caring, considerate and noteworthy. 

That’s when it suddenly dawned on me.  I was lying in bed at the time, trying to get my mind off of the many things I should have been doing rather than sleeping, when I found myself thinking about my children and their fears.  Fear of not making the soccer team.  Fear that they were going to embarrass themselves at the school talent show.  Fear of performing poorly on their school achievement tests. With five children let me just say there is more than enough fear to keep mom up at night.   As a parent, I feel it is my job to help my children overcome their fears, while building their confidence and preparing them for the never-ending challenges of life.   (OK- so perhaps you think I have digressed with my parent talk, but remember, this is my pre-slumber mind racing.)  And that’s when it occurred to me. 

As their mother, I have a special relationship with my children. My words, my actions and my genuine concern for them are all things that help them to overcome their fear.  They know I would never do anything to hurt them.  They trust me to take care of them.  They understand that I want to help them.     

Suddenly I realized the value of a similar relationship between doctors and patients which could ultimately make the difference in helping people to overcome their vaccine related fears.   Just as parents help their children, so can doctors provide valuable guidance to their patients.  Patients just need to feel confident in their physicians.  They must trust them and communicate with them. 

Take for instance those people who commented on my post.  They represent doctors and health advocates whom we should trust to be informed, educated and acting in our best interest.  Even as we encourage parents to reference reputable resources on the internet, I believe that the face to face interaction with a doctor can be a crucial part of vaccine education and awareness.  Doctors who are understanding of parental concerns and take the time to address them should be commended. 

Ultimately it is our doctors, nurses and various health care professionals that suggest vaccinations.  But what is there response when the patient refuses?  They can present the facts.  They can advise of the risks in not vaccinating.  They can overcome the misconceptions and reduce the fear.  They may even find that there are times when fear is the motivating factor.  Each interaction calls for a different set of responses, depending on the situation at hand.  Of course, it takes time and compassion to address patients on such a personal level.  However, in doing so I believe that physicians could be very effective in endorsing immunization for infants, as well as adults and adolescents. 

Of course, we can’t rely on these doctors alone. In order for people to understand the research behind vaccines and the effectiveness of immunizations, we must support our health professionals.  That’s where we must commit to promoting effective public service campaigns, responsible media coverage and excellent health care so that we can motivate people to immunize without having to cultivate fear.    

I may not have discovered the entire solution, but at least I am encouraged now.  The doctors can make the difference … and now maybe I can get some sleep.

By Christine Vara

Yesterday, I read an LA Times article, written by Pamela Nguyen, a resident physician in pediatrics at UCLA’s Mattel Children’s Hospital.  Sadly, the article confirmed what I had already suspected.  Due to the fact that vaccines have been highly effective, it is not uncommon for medical students and residents to go through their training without ever seeing vaccine preventable diseases such as measles, mumps and pertussis.   

While on the one hand this statement can be considered a rallying cry for vaccine advocates, on the other hand, some are smart enough to realize that this is why we find ourselves at risk.   Without prevalent disease society fails to see a threat.  Subsequesntly there is less fear of disease and some wrongly believe less need for immunization.     

In referring to measles, Ms. Nguyen states that, “In four years as a medical student and three years as a pediatric resident, I have never seen a case. As a result, all I know about the illness, I learned from textbooks.”  However, she substantiates the significance of measles by stating that “According to the Centers for Disease Control and Prevention, the disease remains the leading cause of vaccine-preventable deaths in children. In 2007, there were 197,000 measles deaths worldwide, 90% of them in children younger than 5. That is nearly 450 deaths every day.”

What these statistics suggest is that although vaccines have been effective in limiting the number of cases we see in this country, vaccine refusal and inaccessibility continues to perpetuate the risks of diseases making a comeback here in the states, as they still remain a concern worldwide. 

What I found to be especially compelling was her recent encounter with a patient who had brought her five year old child in for an H1N1 shot.  Surprisingly, the child had never received any other immunization.  When offered other vaccines, she again declined.    

As Ms. Nguyen states, “She explained matter-of-factly that it was because the flu was “going around” whereas the other vaccine-preventable diseases, she said, were no longer a threat.  She went on to tell me that she was a lawyer who had grown up in a country where measles is still endemic. Since moving to the U.S., she had never known anyone to suffer from measles, but she did know several children who had autism. So, while she understood that vaccinations had not been definitively shown to cause autism, she felt that, here in America, the risk of autism was a bigger threat than that of vaccine-preventable diseases.”

Basically what this says to me is that fear is an effective motivator.  In this case, fear of the unsubstantiated suggestion that vaccines can cause autism prompted this parent to decline all vaccines for her child.   However, publicized deaths as a result of H1N1 created enough fear to drive this same person to receive a vaccine. 

Does this make sense?  Are we a society that only responds to fear and not common sense?  And if so, are we not fearful when we hear of an infant diagnosed, or even dying, from a vaccine preventable disease? 

We need only to look at another LA Times article to prove this point.  It details a “cautionary tale” of a new mom, who unknowingly infected her two children with pertussis, resulting in the death of her 17 day old son Dylan. 

The article explains that the problem was in the diagnosis.  Dylan’s mother had a serious cough for several weeks prior to delivery.  She encountered a variety of doctors and medical personnel during that time, but only the pediatrician checking Dylan seemed to suspect that she had pertussis. Even then, that suspicion failed to elicit treatment.  When following up with her physician, he dismissed the possibility of pertussis and diagnosed her with a cold. Perhaps this goes back to the “learning from textbook” phenomenon.  As a doctor, if you’ve never seen it and think it’s rare, than it’s unlikely you would diagnose it.    

The sad reality is that pertussis is highly infectious and extremely dangerous for infants.  As the article states, four newborns, all younger than 3 months, have died in California so far this year, already exceeding last year’s total of three whooping cough-related deaths. 

I would venture to guess that the Bianchi family would encourage others to receive booster shots in order to protect themselves and other infant children from pertussis; much like we are seeing with Callie Van Tornhout’s family and countless other parents who currently advocate for vaccines.  But why does this kind of awareness have to come at such a price?  What steps must we take to ensure that every child is protected? 

Ms. Nguyen’s concludes her article with a call to action.  “It is time to change our perspective and make the safety of all children our priority.  The first step is to demand stricter guidelines for personal-belief exemptions. Vaccinations should be mandatory for public school entry in all but the rarest of cases. The next step is to put pressure on private and charter schools to follow these same guidelines. It is selfish for parents who intentionally don’t vaccinate to make other children vulnerable.”  I would like to add that we should be encouraging booster shots for adults as well, to limit disease in general and to protect those too young to be vaccinated. 

Do you feel the need to address vaccine refusal in order to reduce risk of disease to the greater public?  Is fear the only motivator that will prove to be effective?  In what ways can we approach this challenge?  Share your comments so that we can all be part of the conversation and solution.