Showing posts with label immunization. Show all posts
Showing posts with label immunization. Show all posts

Tuesday, April 14, 2015

Sir Yes Sir! Some Sharp Points About Vaccine Coverage Rates in Military Dependents

          Are you aware the Military Health System provides universal coverage of all recommended childhood vaccines?  Are you aware that despite this, 28% of young children of military parents are not up-to-date on their recommended vaccines?  So how can this be in the setting of such universal coverage?   
     Dunn et al. (doi:10.1542/peds.2014-2101) compared vaccine coverage in military dependents to other non-military insured and uninsured children and found some disappointing results for children in military families. So why is this finding happening?  
      The authors inject some key thoughts into the discussion section of this article with the hope of designing better strategies to improve vaccination rates in military infants and toddlers.  March over to this early–released study and learn more.

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Wednesday, March 11, 2015

Measles in the United States: Not Just Imported from Disneyland but from China

By: Lewis First, MD, MS; Editor-in-Chief  

     We have all read by now, and perhaps some have experienced, children with measles in our practices thanks to the recent outbreak that seems to have started at Disneyland.  But taking a family vacation to the theme park is not the only way to spread this virus into our country. 
     Su et al. (doi: 10.1542/peds.2014-1947) remind us this week about the introduction of measles into the US in 2013 via newly-adopted children with cerebral palsy adopted from China who had gone unimmunized in both China prior to adoption and after arrival into this country. The authors explain how this might have happened and what needs to be done to prevent this kind of measles importation from occurring going forward.       
     This article makes for a most fascinating read, especially in light of what we have been experiencing with the surge of this virus in our country, largely in unimmunized children.  Spread the word (rather than the measles) about this article especially to those who see newly arrived internationally adopted children so appropriate vaccinations such as the MMR can be administered as soon as possible to those previously unimmunized.

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Wednesday, March 4, 2015

Spreading Out the Vaccine Schedule: Do We Do What Some Patients Request?

By: Lewis First, MD, MS; Editor-in-Chief
          With the ongoing measles epidemic, vaccine discussion has again reared up with lots of debate on the merits of giving live vaccines like the MMR, with some parents more concerned about the potential for side effects (rare though they may be) compared to the serious risk of their young child actually getting the disease that can be prevented by the vaccine.  
     One strategy to combat vaccine refusal is to stagger or delay giving live vaccines until a child’s brain has developed past the point where they might be detected with an autism spectrum disorder or other behavioral or developmental abnormality for which vaccines are being inappropriately and inaccurately blamed.  So how many of us are asked to delay routine vaccination until children are older? (despite young children being more susceptible to the infections to which we immunize at a young age)
     Kempe et al. (doi:10.1542/peds.2014-3474) surveyed pediatricians and family physicians to look at the frequency of requests being made to them by families to spread out vaccines for children less than 2 years.  They also report on whether pediatricians and family physicians agree to that request, and what strategies they use to hold the line and not delay the schedule. 
     One of the more shocking statistics revealed in this troubling study is that 93% of health care providers note they experience requests to delay vaccination  with almost a quarter of pediatricians surveyed noting that one out of ten parents makes this request. What is even more thought-provoking is that almost ¾ of those surveyed agreed sometimes or always to spread out the vaccines despite knowing that timely administration is in the best interest of the patients they care for. 
     Take a shot at reading this provocative study and then reflect on whether you can empathize with the pediatricians who responded to this survey—or better yet, share your response to this study or what you do in practice with us by sharing a comment at the bottom of this blog or via an e-letter or posting on our Facebook or Twitter sites.

Monday, September 15, 2014

Post-Vaccination Seizures: Though Infrequent, Why do They Occur?

Photo by the World Health Organization
By: Lewis First, MD, MS; Editor-in-Chief 

Much anti-vaccine spin has been attributed to the risk of seizures and subsequent epilepsy occurring after administration of some vaccines, and while ongoing epilepsy has not been proven to be a common complication after a post-vaccine seizure, one wonders why epilepsy occurs.

Is it something about the vaccine or is it something about the wiring of a child’s brain that predisposes it to an increased risk of ongoing seizure activity? As it turns out, the latter appears to be true—at least according to an article by Verbeek et al. (doi:10.1542/ peds.2014-0690) being early released online this week.

The investigators studied a cohort of almost 1,000 children in the Netherlands who experienced seizure activity 24 hours after getting an inactivated vaccine or five to 12 days after a live attenuated vaccine and followed those who were given the diagnosis of epilepsy to see if an etiology is found other than the vaccine for ongoing seizures. As it turns out, genetic and anatomic structural defects are identified in the majority of these children, thus making those without such predisposing factors at minimal if any risk for ongoing epilepsy after receiving a vaccine.

This study can be very useful in helping convince families to vaccinate their children in the absence of neurologic underlying abnormalities—but don’t take our word—read this study yourself and see if you don’t agree.

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Tuesday, July 1, 2014

Vaccine Safety Systematically Reviewed

By: Lewis First, MD, MS
Photo by El Alvi, via Flickr

Ever wish you could get all the information reported in prior studies on vaccine safety integrated into one systematic review article? While the Institute of Medicine (IOM) has looked into vaccine safety before, additional studies have come out since then including some on newer vaccines not in the IOM report.

Thanks to Maglione et al. (doi: 10.1542/ peds.2014-1079) we are able to release this week an updated systematic review on vaccine safety using active surveillance studies with controls with strength of evidence for findings also shared. Of more than 20,000 articles identified on vaccine safety, only 67 met rigid study criteria for inclusion in this article, and as a result, some sharp points are made on vaccines and their association with complications.

While the review indicates an increased association between the MMR vaccine and febrile seizures and increased complications if the varicella vaccine is given to an immunocompromised child, there was strong evidence of no association of the MMR vaccine with autism, reaffirming the earlier IOM report findings. Despite the adverse effects identified with a few vaccines, the incidence of these effects was extremely rare and the benefits of administering these vaccines to children continue to outweigh the risks.

Additionally, we have asked infectious disease specialist Dr. Carrie Byington (doi: 10.1542/peds.2014-1494) to share her opinion on the take-aways from this important review in an accompanying commentary.

If you want to inject some hard evidence into your discussions of vaccine safety with families, this article and commentary are a must-read.

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