CHERUBS Medical Expert Series: CDH & Vaccinations (Oct 1-7, 2013)

[Dawn Torrence Ireland]

Join us tomorrow for CHERUBS Medical Expert Series: CDH & Vaccinations

Christopher Barry, PA will guest speak and answer your questions about vaccinations on CHERUBS CDH Family Forums during October 1st through the 7th.

Chris is a Medical Liaison to the American Academy of Pediatrics
American Academy of Physician Assistants and a Physician Assistant at Jeffers, Mann, and Artman Pediatric and Adolescent Medicine, which is affiliated with Duke University Medical Center.

Chris is also a published author on the importance of vaccinations and the father of 8 year old CDH survivor, Jessica.

All forum rules of courteous behavior apply and will be enforced if necessary.

[ChrisBarry]

Disclaimer: I cannot give specific medical advice to your child. Please consult with your child’s health care provider for information on your child’s health.

As a parent and health care provider, one of my main concerns is to keep children healthy and safe. There are many ways to protect children, including proper sleep positioning, child-proof safety latches, and child passenger safety seats. Vaccines, also called immunizations, are another very important tool to keep children healthy. Vaccines allow the immune system to make antibodies to illnesses they have never actually encountered. That way, if the body then encounters one of these serious illnesses, it will be more likely to fend off that illness.

Vaccines also confer protection to the community through a phenomenon called the “herd immunity”. If enough people are immunized against a particular illness, then the rate of disease is lower for everyone in the community, including those who are not immunized. However, when a vaccine preventable disease strikes a community, those who are not immunized will be affected first.

In addition to the standard vaccines, Cherubs may also be eligible for a vaccine against Respiratory Syncytial Virus (RSV), a serious viral lung infection that affects mainly infants during the winter months every year. RSV can produce symptoms ranging from a mild cold all the way to respiratory distress. The RSV vaccine is expensive and is given monthly during “RSV season”. I encourage you to ask your child’s health care provider about the RSV vaccine to see if your child is eligible.

The safety of vaccines and the child’s ability to handle several vaccines at a young age is occasionally questioned by my patients. Many brilliant scientists have spent their careers researching vaccines and the body’s immune system, ensuring that vaccines are safe and effective. Vaccines go through rigorous pre-marketing studies, and are constantly monitored for safety, even after the vaccines are released. Data on vaccine safety and effectiveness is presented to a CDC committee for review 3 times a year. The CDC committee then makes recommendations, which are then adopted by such respected organizations as the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).

In the past, there have been several misstatements about vaccines, the most famous of which was made by Dr. Andrew Wakefield, a British physician. His 1998 Lancet paper stating that the MMR vaccine was the cause of autism led to an increase in child fatalities from a vaccine preventable illness (Measles) because many parents stopped immunizing their children against MMR after hearing about Dr. Wakefield’s paper. Legitimate research into a possible link between the MMR vaccine and autism has repeatedly failed to show a causal relationship. Dr. Wakefield’s work has subsequently been disavowed and he was convicted of fraud. Dr. Wakefield’s motive for creating the stir about the MMR vaccine appears to have been purely financial.

As a parent of a Cherub, as well as a pediatric health care provider, I urge everyone to protect their Cherubs to the fullest by immunizing them on the recommended immunization schedule and being a vaccine advocate among your friends. Both of my children received all of their immunizations per the recommended schedule. In general, unless there is a true allergy to a vaccine or vaccine component (or another extenuating circumstance), Cherubs can and should receive all vaccines according to the recommended schedule (this includes the flu vaccine as well). Vaccines are among the most important advances in health care, and vaccines have saved countless lives.

I am looking forward to hearing your comments, thoughts, and questions on vaccines/immunizations this week on the Cherubs forum.

[Dawn Torrence Ireland]

Thank you so much for being here and doing this, Chris, we really appreciate it!

[ChrisBarry]

Glad to be here! If anyone has questions or comments, fire away. If I don't know the answer, I will try to find the answer for you!


Thank you so much for being here and doing this, Chris, we really appreciate it!

[mslarrison]

What is the difference between DTP, DTaP and Tdap?

[Chris and TracyMeats]

If your child is on a steroid treatment, is the chickenpox (Varicella) and MMR vaccinations safe?

[christinastembler]

RSV Shots, with what information can a parent approach an Insurance Company to better the possibility of Qualification after 2nd year of life?

[ChrisBarry]

Hi,
D=Diphtheria (a type of throat infection)
P=Pertussis (whooping cough)
(aP=acellular pertussis)
T=Tetanus (lockjaw)

Thanks for the first question! All 3 vaccines contain protect against all 3 (tetanus, diphtheria, and pertussis). The only difference is the amount of each component in the particular vaccine. Whether you or your child gets DTaP or Tdap depends mainly on the age.

Pertussis is whooping cough, which has made a resurgence lately. We used to use DTP, which was whole cell pertussis. DTP caused a lot of high fevers, which the more purified DTaP does not. DTP is not used any more because of the more favorable side effect profile of DTaP. Did you know that pregnant women are now recommended to receive the Tdap vaccine with EACH pregnancy? This is a new recommendation. Also, caregivers of infants, such as parents and grandparents should receive the Tdap vaccine.


What is the difference between DTP, DTaP and Tdap?

[ChrisBarry]

Great question. In general, if your child is on a SHORT duration steroid treatment (2 weeks or less), then it is perfectly fine to receive Varicella and MMR (both live) vaccines. If your child is on a longer term steroid treatment, you should wait at least 3 months to receive a live vaccine like MMR or varicella.


If your child is on a steroid treatment, is the chickenpox (Varicella) and MMR vaccinations safe?

[Dawn Torrence Ireland]

Chris, what about the cherubs who are on long-term steroids like Albuterol?

[christinastembler]

Chris, RSV Shots, with what information can a parent approach an Insurance Company to better the possibility of Qualification after 2nd year of life?

[ChrisBarry]

Hi Dawn,
Actually albuterol is a bronchodilator, not a steroid, and it is fine to give immunizations with albuterol. Also, for children on inhaled steroids like Pulmicort, Flovent, etc, it is perfectly fine and recommended for them to receive immunizations on schedule.


Chris, what about the cherubs who are on long-term steroids like Albuterol?

[ChrisBarry]

Excellent question. Getting RSV vaccines covered by insurance can be difficult, especially as the children get older. The vaccine is extremely expensive, and has to be given monthly during the RSV season. I recommend talking with your child's pediatrician's office to see if they have a RSV vaccine coordinator who can help work with the insurance and vaccine companies. Best of luck!


Chris, RSV Shots, with what information can a parent approach an Insurance Company to better the possibility of Qualification after 2nd year of life?

[HeidiForney]

As the parent of a very complex CDH kiddo (16+ yrs old, who lost a large portion of intestine both small and large as an infant due to NEC) we were told that he is not allowed to have any live vaccines. I asked at his most recent appt and that is still the case, per his surgeon. When Sean was a baby he also suggested it would be prudent to consider doing just one vaccine at a time rather than doing them as typical babies, several per visit, even if that meant delaying some of the vaccines a little bit. What are your thoughts on this?

[ChrisBarry]

Hi there,
I would do as your surgeon recommended. In general, we recommend getting vaccines done per the recommended schedule. Many vaccines have a range of ages during which they may be given. In a complex case like your son, sometimes variations to the schedule are permitted.

As the parent of a very complex CDH kiddo (16+ yrs old, who lost a large portion of intestine both small and large as an infant due to NEC) we were told that he is not allowed to have any live vaccines. I asked at his most recent appt and that is still the case, per his surgeon. When Sean was a baby he also suggested it would be prudent to consider doing just one vaccine at a time rather than doing them as typical babies, several per visit, even if that meant delaying some of the vaccines a little bit. What are your thoughts on this?

[jcrawford]

as the parent of a now adult 22 yearold surviour what about the guardisil shot for girls does she need it or not

[ShellyMoore]

With the large amounts of blood products some of our Cherubs sometimes need (especially during ECMO) and the frequent in & out of the hospital, are Hepatitis A and B vaccines warranted & if so when?

Shelly

[ChrisBarry]

Hi,
The HPV vaccine is recommended for females from ages 11-26, so your daughter is in that age range. Gardasil is also indicated for males up to age 21.


as the parent of a now adult 22 yearold surviour what about the guardisil shot for girls does she need it or not

[ChrisBarry]

Good question. Especially for children who are exposed to blood products, and even those who aren't, Hepatitis B vaccine is definitely recommended. Hep B is a 3-dose series that can be started as soon as the child is born. Hepatitis A is spread through food and fecal to oral contact. It is also recommended to get the Hep A 2-dose series after age 1 year.


With the large amounts of blood products some of our Cherubs sometimes need (especially during ECMO) and the frequent in & out of the hospital, are Hepatitis A and B vaccines warranted & if so when?

Shelly

[ChrisBarry]

Here is a link to the CDC's recommended vaccines for adults. Figure 2 "Recommended vaccinations indicated for adults based on medical and other indications" has a column for "Chronic Lung Disease", which would apply to many Cherubs.

http://www.cdc.gov/mmwr/preview/mmwrhtml/su6201a3.htm

[JulieYounce]

What about the pneamonia vaccine? And how often should they recieve it?

[NeilRubenstein]

Are there any vaccines that we should be asking our pediatricians about that are outside the typical ones given during the first couple years because our child is a cherub?

[ChrisBarry]

Excellent question. There are 2 different vaccines referred to as "pneumonia" vaccines-- PCV13 (Prevnar) and PPSV23 (Pneumovax). Both are designed to prevent not only pneumonia, but also invasive pneumococcal disease, a bacterial infection of the bloodstream and/or the central nervous system. The following link has excellent information on these vaccines and who needs which ones. I will try to summarize below.
http://www.immunize.org/askexperts/experts_pneumococcal_vaccines.asp

Routinely, all children are recommended to get PCV13 at 2, 4, 6, & 12-15 months of age. There is a catchup schedule for children over 15 months who have not completed the primary PCV13 series.

In addition, certain children should receive the PPSV23 vaccine. This may apply to some Cherubs. The PPSV23 vaccine is recommended for certain children with chronic health problems, including chronic lung problems and long-term steroid use. If your child fits these criteria (or any of the other ones listed in my link), and your child is over age 2, ask your health care provider about getting the PPSV23 vaccine. Your child will typically receive an initial immunization with PPSV23, followed by a booster 5 years later.


What about the pneamonia vaccine? And how often should they recieve it?

[ChrisBarry]

Great question. It is very important for all children to receive the all of the recommended vaccines on schedule, including the flu vaccine. Cherubs may be eligible for the RSV vaccine (Synagis) and/or the PPSV23 (Pneumovax) vaccines, depending on their age and specific medical conditions. See my posts above for more info on those vaccines.


Are there any vaccines that we should be asking our pediatricians about that are outside the typical ones given during the first couple years because our child is a cherub?

[Megan Smith-Weedon]

My daughter is 9 years old. Is the PPSV23 and PVC143 vaccinations typically given at those ages you had mentioned? Or is it something that must be asked for? I don't have a copy of her immunization record in front of me. We see the pediatrician for a weight check today and was wondering if it were something I should mention. Alyssa is on a daily inhaler and also has a rescue inhaler. She has a small right lung and quarter of the left one. She has also had Pneumonia in the past.

We are also talking about the flu shot. Is the mist just as effective or should we stick with the injection? Is it important that she does get the flu shot as well?

[ChrisBarry]

I would talk to your pediatrician to see whether your daughter needs the PPSV23 vaccine, given her lung issues. A flu vaccine is recommended for all children, especially if they have asthma or a chronic lung problem. For people with asthma or lung problems, a flu shot is recommended, because the FluMist is a weakened live virus, and has a theoretical risk of causing wheezing (although I have never seen it in practice, better to be on the safe side).



My daughter is 9 years old. Is the PPSV23 and PVC143 vaccinations typically given at those ages you had mentioned? Or is it something that must be asked for? I don't have a copy of her immunization record in front of me. We see the pediatrician for a weight check today and was wondering if it were something I should mention. Alyssa is on a daily inhaler and also has a rescue inhaler. She has a small right lung and quarter of the left one. She has also had Pneumonia in the past.

We are also talking about the flu shot. Is the mist just as effective or should we stick with the injection? Is it important that she does get the flu shot as well?

[Ourfamily Wilson]

Hi Chris, we are in Canada and at 22 weeks gestation with a LCDH baby boy.

What vaccines or flu shots should the rest of the family be getting to help make our home a healthy home for when our baby is born and comes home? We are all up to date now with the normal stuff for our ages (42, 40, 16, 13, 1.5), but are there boosters that you would recommend?

Should we be getting flu shots this year for everyone? Should my pregnant wife get a flu shot?

Thank you.

Sean

[ChrisBarry]

Hi Sean. Thanks for the question. I like that you are planning ahead, and I'm glad to hear everyone is up to date on their recommended immunizations. Everyone in your family should definitely get a flu vaccine, including your pregnant wife. This will make your baby less likely to contract flu, since children under 6 months can't receive a flu vaccine. I would have your wife talk to her OB about getting a flu shot AND a Tdap vaccine while she is pregnant. A Tdap shot is recommended with EACH pregnancy now (helps protect the mother and unborn child against pertussis (whooping cough)), since he won't get a pertussis vaccine until 2 months of age. All family members over 11 should receive a Tdap vaccine if they have not already received one. This will protect everyone around the baby from pertussis, and will "cocoon" the baby from being exposed to this dangerous illness.


Hi Chris, we are in Canada and at 22 weeks gestation with a LCDH baby boy.

What vaccines or flu shots should the rest of the family be getting to help make our home a healthy home for when our baby is born and comes home? We are all up to date now with the normal stuff for our ages (42, 40, 16, 13, 1.5), but are there boosters that you would recommend?

Should we be getting flu shots this year for everyone? Should my pregnant wife get a flu shot?

Thank you.

Sean

[freedom]

Chris - Thank you so much for taking the time out of your busy schedule to help our members.

[ChrisBarry]

You are welcome! I got lots of great questions. People can send me a DM with any additional questions that come up.

Chris - Thank you so much for taking the time out of your busy schedule to help our members.