Shot of Prevention

By Christine Vara

I’m a parent, not a doctor.  But often times I’ve wished I had gone to medical school.  Maybe then I could diagnose my children’s ailments without having to wait for an appointment.  Maybe then I could understand all the complex medical jargon I come across when trying to educate myself in regards to various health concerns.  But then again, maybe I would just rather not.

There was a time when I envied doctors, but not anymore.  When I think of all that doctors need to know these days and all the complications of insurance, malpractice and so on, I am no longer envious. 

Take for instance the many different opinions people have in regards to vaccinations.  Personally, I am convinced that vaccines are an effective way to prevent, and in some instance, almost eliminate, certain diseases.  I vaccinate myself and my children to protect us from these diseases.  I feel a sense of duty to help protect others as well through the concept of herd immunity.  However, there are plenty of parents who may not agree with me.  Some would question whether the vaccines are safe.  Some argue that they are not very effective.  Some are concerned about the number of vaccines recommended these days.  While others question whether there is even a need.

Unfortunately, doctors these days often represent the “front line” in the vaccine debate.  They are typically the ones who come face to face with the parents and their often pre-conceived opinions.  I’m not saying parents shouldn’t have a healthy skepticism in regards to the medical advice they are given, but I do think that it is important that a doctor and their patients develop a special relationship of trust between them. 

For instance, I would venture to say that most people want to trust that their doctor is familiar with the scientific data in regards to vaccine safety and effectiveness.  They need to trust that their doctors are committed to providing the best care possible. 

On the flip side, a doctor should also be able to trust that their patients will consider their advice and honor their expertise.  Given these considerations, it is easy to see how a lack of trust and mutual respect can interfere with the doctor/patient relationship.  

In hearing from Dr. Paul Offit, in his article entitled, “Dealing With Parents Who Want to Delay, Withhold, or Space Out Vaccinations,” I understood the challenges that face doctors these days.  (Read the article by creating a free account on Medscape.) When parents decide to delay or withhold vaccinations, doctors are often faced with a moral and professional dilemma. They may be confident in their own recommendations, but if those recommendations, and those of the CDC and AAP, are not considered by their patients, they are knowingly offering substandard care.  Do they turn them away, or hope that in keeping these patients in their practice that they can eventually persuade them to consider the benefits of vaccinating on time?  Let us know your opinions on this.  We want to hear from doctors, as well as parents and patients.  What is a doctor to do?  What do you think is most effective?  

Below is a synopsis of the article reference above.  Log onto Medscape to create a free account and read it in it’s entirety.

Dealing With Parents Who Want to Delay, Withhold, or Space Out Vaccinations” Medscape (July 7, 2010) – “…What I thought I would talk about today is something I think has become a growing problem for pediatricians and family practitioners alike, which is what to do with parents who are choosing to delay, withhold, separate, or space out vaccines for their children… On the one hand, a physician could say, ‘okay, I’m going to try the best I can to give these children as many vaccines as I can give them,’ realizing that for some children, there may be a significant delay in a vaccine, a delay which can only increase their chance of getting a vaccine-preventable disease… I think that when the CDC and the AAP recommend vaccines that they know are safe and effective and they know that can prevent disease, and a parent says, ‘I don’t want to do it that way,’ you’re being asked to practice substandard care, which could result in harm. In the Philadelphia area, we’ve had — in the past year — 3 children who died of Haemophilus influenzae type B meningitis. They died because their parents were more frightened of the vaccine than the disease it prevented… Probably the best comparison that I can give is that it would be like someone coming in and saying, ‘I don’t want to use a car seat for my under 4-year-old child. I want to hold my child in the car; could you just tell me the best way to hold them?’” – Dr. Paul Offit”

By Christine Vara

What is more manly than a NASCAR star taking a needle in the arm for the sake of children’s health?  Jeff Gordon may be a famous race car driver, but he is also a real guy.  Just like he prepares for a race by wearing his seatbelt and helmet, he is preparing for the birth of his second child by getting a vaccine. 

The Tdap booster he recently received was orchestrated around the launch of a new national education campaign by Sounds of Pertussis.  By protecting himself with the adult pertussis booster vaccine, Jeff Gordon is also helping to ensure that his own child will be protected as well.

Jeff Gordon receives his Tdap booster.

Pertussis is a highly contagious condition caused by bacteria that spreads through airborne droplets when an infected person coughs, sneezes or talks very closely to another individual.  Adult symptoms are often mistaken for a bad cold or even bronchitis. However, in some cases, as seen with infants,  pertussis causes severe coughing and gasping for breath created by a sticky, thick mucus that makes it difficult to eat, drink and breathe. 

Unfortunately, in the case of pertussis, if an infant contracts the disease there is an alarming 90% chance that it will result in death.   Surprisingly, 70% of infant cases can be attributed to infection by a caregiver or family member, and 50% of the time it is linked directly to the parents.  These shocking statistics are why Jeff Gordon is promoting the Sounds of Pertussis campagn to raise awareness about the threat of pertussis to young children and to encourage everyone who has contact with infant children to be sure to get vaccinated.

 “Even though Ingrid and I have a 3-year-old daughter, we had no idea when Ella was born that we needed a pertussis booster, and that without it, we were putting her at risk,” said Gordon. “Now, with a new baby on the way, we’re not taking any chances — we’re getting vaccinated. I’ve already rolled up my sleeve, and Ingrid will get her immunization shortly after our son is born.”

As Jeff Gordon launched this campaign, he was joined by Daryl Dube.  Though not a celebrity, he is a hero in his own right – a father who lost his son to pertussis at 7 weeks of age and won’t stand by and allow this to happen again. 

Daryl Dube also receives his Tdap booster, wishing he had known about the importance of this vaccine prior to his son Carter's birth.

The tragic story of his son Carter, and the battle he fought with pertussis, is featured on the Vaccinate Your Baby website.  

After suffering such a heartbreaking loss, Daryl and his wife Felicia are finding the courage to take action and help others to protect themselves and their children from this life threatening disease.

“I don’t want people to think, ‘It couldn’t happen to me.’ You don’t know,” said Felicia Dube. 

“You never think. We took home a perfectly healthy beautiful little boy and 7 weeks later he’s gone,” Dube said.  

Carter Dube was a victim of pertussis at just 7 weeks of age.

Although the recommended vaccine schedule already includes the DTaP vaccine for children (which offers immunization against diphtheria, tetanus and pertussis), infants remain susceptible to this highly contagious disease prior to receiving at least three of the recommended doses.  Since many adults do not realize there is a booster, both adolescents and adults can contract pertussis and are often unaware that they are infected.  Subsequently, they unknowingly pass it on to others and continue to put more children at risk.  That’s why the CDC recommends that all adults and adolescents between 11 and 64 years of age, especially those who have close contact with an infant, be immunized with a Tdap booster like Jeff Gordon and Daryl Dube.  The challenge now is to ensure that more people are informed of these recommendations.

Daryl and Felicia Dube are committed to helping Jeff Gordon spread the word in a Race Against Pertussis

Last week, Shot of Prevention provided a review of the pertussis epidemic that has been declared in the state of CA. However several other states, such as NJ, TX, MI, OH and SC are also seeing an alarming rise in pertussis cases this year, some over a 50% increase in cases over last year.    As we continue to see a this trend nationwide, it is increasingly important that we educate people on the importance of Tdap boosters.

It is our hope that the concept of cocooning our children, as explored in a previous post on Shot of Prevention, will continue to gain support through public service campaigns like that being promoted by Jeff Gordon, Daryl and Felicia Dube and the Sounds of Pertussis campaign.  

 Please help us spread the word about the importance of vaccinating against pertussis.  Every Child By Two is looking to create a task force to help address this issue from within the medical community and we are encouraging anyone who may be interested in participating to contact them at info@ecbt.org. Additionally, please comment below if you have a story you would like to share or a comment to add regarding these efforts.

By Mary Beth Petraco

During this time of summer vacations and large family gatherings, I’m often prompted to reflect on my mother’s life and how it was changed forever one summer that she spent on holiday with her parents and two siblings.  The summer of 1923, when my mother was just three years old, is when she contracted polio.

Dr Koslap-Petraco celebrates her mother Mildred Bliss Koslap on her 90th birthday.

During that period in our history, it was common for families like mine to escape the heat of New York City and travel upstate to cooler weather.  That summer, the family chose to reside in a guest house in Utica, NY.  My mom arrived to Utica a fully-functioning and fun-loving child, but on a subsequent Sunday morning, she remembers not being able to get out of bed due to paralysis on the right side of her body.  She was able to scream out for help initially, but her voice consistently diminished throughout the day, only to disappear for a week.

Her father called for medical assistance, but during this time in Utica, people strictly followed what were known as Blue Laws—forbidding any type of work or major exertion to be made on Sunday.  With time, my grandfather was able to convince a kind-hearted Jewish doctor  to come over.  He instantly recognized my mother’s condition as polio.  The periodic massages and other treatments that my mother had to undergo were hassle enough for a young child, but the emotional strain for her was even worse.  After a short time, her siblings were not allowed to play with her, for fear that they might come down with polio themselves.  And when my mother—born right-handed—entered school, she was constantly punished by the nuns who directed her to write using her right hand.  What they did not understand was that my mother had lost the ability to grasp objects with this hand as a result of her polio.  To this day she remains able to hold nothing more than a glass of water with her right hand.

To me, it’s important that I never lose sight of the experiences like this that my mother and her family had to endure that one hot summer in 1923.  What’s even more important is that I acknowledge the fact that polio is no longer a significant threat to the health of people in America.  Science and research have delivered so much to us, including the means to eliminate the threat of major preventable diseases like polio. 

 My mother celebrated her 90th birthday this year and she is very grateful for the long life that she has been able to live. But, she still bears the scars of polio which serve as evidence of the impact this disease has had on her life, her parents’ lives, her siblings’ lives . . . my life.  This summer and this Independence Day, I can say that I’m grateful for the advances science has bestowed upon us.  And I’m happy that my children will never have to suffer through the same experiences thanks to the preventive power of vaccination.

Mary Beth Koslap-Petraco, DNP, PNP-BC, CPNP is the Coordinator for Child Health at the Suffolk County Department of Health Services in New York, where she is also a primary care provider. Dr. Koslap-Petraco is a Clinical Assistant Professor and Preceptor for graduate and undergraduate students at the Stony Brook University School of Nursing, a fellow of the National Association of Pediatric Nurse Practitioners (NAPNAP), and a member of the advisory board of the Immunization Action Coalition (IAC).  She has served on the National Vaccine Advisory Committee (NVAC) of the Centers for Disease Control and Prevention (CDC) and she continues to be a consultant for the CDC.