Posts for tag: Vaccinations
Prevention is better than cure! This often told precept is widely accepted in many settings but it oddly doesn’t enjoy the same courtesy with childhood immunizations in our experience.
Since its antecedents in the days even before Edward Jenner (1749-1823), who’s widely credited for his pioneering work on immunizations and immunology by showing that small pox can be prevented through rather crude but effective vaccination methods. Louis Pasteur and others built on this and vaccinations rose to be the most significant public health achievement of the 20th century. This iconic success of vaccination programs around the world has bred an untoward side effect: many people no longer grow up in a time where childhood diseases like measles, pneumococcal bacterial infection, diphtheria etc. were almost always deadly. Some evolve in their understanding of vaccines and their role and view them with undue suspicion and anathema. This attitude led to the re-emergence of diseases like polio in western Africa and south East Asia after a nearly successful global eradication was within sight.
Many parents would gasp, when I tell them that barely a century ago measles claimed more than 500,000 children annually in the USA and that Diphtheria (immunized against with the DTaP vaccine) claimed 12, 230 lives in 1921 and only one case was documented by 1998. The polio epidemic that ravaged the nation involved 60,000 cases in 1952 alone and more than 3,000 deaths. The work of Drs Jonas Salk and Albert Sabin during this period eliminated the specter of children who are wheel chair bound or crutches dependent for life from the eyes of the public and numbed us to the reality of polio. The success of the vaccination program that followed the epidemic eliminated polio from the USA by 1979 and the entire western hemisphere was rid of the disease by 1991.
The concern that vaccine refusal is spreading and may become so prevalent it may actually ebb away at the fragile protection conferred by “herd immunity” in the coming dispensation was reflected in this statement from one of the past presidents of the AAP, David Tayloe MD in 2009 when he stated: “Our citizens need to understand that the vaccine program has been extremely successful. It's the most effective public health program in the history of man, and we cannot let down our guard just because we’ve done such a good job. We must continue to protect our children and our population”. After the now discredited report linking Autism and the MMR (Measles Mumps Rubella) vaccine was published in the medical journal Lancet, there was a sharp reduction in MMR vaccination rates between 2006 and 2007 and the number of cases of measles quickly rose to 971 in that time frame- A few dozen vaccination refusals can bring us to the tipping point of an epidemic depending on where we are as a community on the spectrum of disease control and prevention with, mother nature. Pertussis (whooping cough) is re-emerging as a key player because of an interval lapse in the immunity of the public to this infection. We now recommend adolescents get a booster and pregnant or new mothers do the same. Young infants have a more severe disease course if infected with pertussis, and adolescents and adults have been shown to be the reservoir of this disease in the community, outbreaks of pertussis were reported in 2010 in California with pediatric fatalities.
Because we don’t see children suffering from vaccine preventable illnesses does not mean they don’t exist. Because many more people deciding to immunize their children inversely protect yours if you should choose not to immunize them doesn’t mean the risk of a chance exposure in an increasingly shrinking global village is moot. In 2008, an unvaccinated child from California travelled to Sweden and was exposed to measles while abroad, he promptly spread the infection to his friends and classmates upon his return and spawned the California measles outbreak that year.
The opportunities to naturally acquire illnesses like chicken pox and then acquire life-long immunity without being vaccinated is statistically negligible in most communities in the USA today; immunizations fill this void. There are other challenges in vaccine development for diseases like malaria and HIV which are scourges in parts of the world not far-flung from us and costs and better delivery methods are seismic challenges in primary care for pediatricians and primary care providers like myself. The state provides vaccines for free for qualifying residents including those that do not have insurance, your local public health office is available to provide information on vaccination dates etc. The AAP’s parenting website: www.healthychildren.org offers guidance on many topics including vaccinations. Don’t take your chances with vast technicians blessed with encyclopedic knowledge only like Dr. search engine.com, the signal-noise-ratio can be easily rigged against the discerning parent and only credible sources of information can provide you with the knowledge to make an informed health decision for your children and yours. www.springfieldpeds.com offers links to some of these resources. I’ll paraphrase, Maya Angelou: “ when you know better; you do better”
Vaccinations, save lives.
This information is for educational purposes only and not a substitute for professional medical care or advice. Always follow your healthcare provider’s instructions.
How many shots are we getting doc? We hear this a lot in primary care pediatrics. As I run through the vaccination counseling and touching on key points in the Vaccine Information Statement, the brow crease I often see on the forehead in the visibly anxious Mom and ah! yes, the crying infant - I get the keen sense the number of shots to be administered and by attrition the pain is a far bigger concern to the family in front of me than the peculiarities of each vaccination type I’m talking about.
How can we best relieve pain in these young ones during vaccination visits? We traditionally use comfort measures that often include administration of Acetaminophen to young ones after vaccinations as an adjunct in our practice. A group of researchers conducted a well designed study, on Effective analgesia using physical interventions for infant immunizations published this month in Pediatrics, 129(5):815-22 May 2012.
The 5 S’s (swaddling, swinging, shushing, suckling and side/stomach positioning) are well known comfort measures, what’s not known is how these fare when compared to a popular method of analgesia using pacifiers dipped in concentrated sugar solution (24% Sucrose). The sucrose is believed to soothe the infant in a complex way that involves the body releasing chemical signals from within that have a lot of similarity to powerful pain medications like morphine. Sucrose dipped pacifiers are popular during procedures like circumcision.
Groups of patients with infants at their 2-month and 4-month vaccination visits were assigned into a group that received comfort measures with the 5 S’s and another group that received 24% Sucrose dipped pacifiers. Their pain response was assessed using a standardized pain scale tool. The results which were recorded over a 7-minute period of observation in both groups and scoring assessment showed that the physical interventions of the 5 S’s decreased crying time and provided proof of effective analgesia that was as effective as what was seen in the group treated with the 24% Sucrose dipped pacifiers.
Hello Moms, lets cheer up! swaddling, rocking and raining all your best TLC moves on your babies after shots works very well for pain control. Now, we can continue the vaccination counseling conversation....