Are You Ready for Flu Season?

Rarely, I take time out on this blog to discuss regular health issues I find important. I am a proponent of vaccines. I’ve seen non-immunized children suffer the effects of illnesses that they could have been protected against.

While doing an on-line education program for my nursing job, I came across some very valuable statistics that I wanted to share with you. I don’t have an author of the CEU but the company is called CHEX and the module is called Influenza Introduction (v.6.14). The information in this post comes directly from that program to give credit where it’s due.

Did you know that pediatric influenza deaths numbered 830 between the years of 2004 and 2012? Does that surprise you? It surprised me and I work in the healthcare field. When flu season hits, we test for Flu A and Flu B. What’s the difference? Flu A is capable of infecting animals like wild birds. Flu A is also responsible for the majority of deaths in the pediatric category (78%). Flu B is only found in humans and is less likely to cause pandemics. There is also Flu C but infection is usually mild and well tolerated. It is not thought to cause pandemics either.

Of the pediatric deaths mentioned above the mean age was seven. Thirty-five percent died before hospital admission and 43% had no high risk complication (something like asthma.) The majority of deaths were among children who had not been immunized.

The flu vaccine is not perfect. It’s effective in about 60% of cases or has a moderate rate of effectiveness.

The benefits of getting a flu vaccine are decreased illness, decreased unnecessary use of antibiotics, decreased incidence of hospitalizations and decreased deaths.

The age old question is why some people still get the flu despite being immunized. Chances are they were exposed shortly before the vaccine or in the two weeks before they had immunity from the vaccine. They could have gotten a virus that wasn’t covered by the vaccine or they didn’t get an adequate immune response after the shot. I have a personal friend who doesn’t mount an immune response when she gets normal immunizations.

No vaccine is perfect but, personally, I don’t like the risks of not immunizing my children every year for the flu.

What about you? Will you be getting your flu shot this year?

The Problem with TNT’s The Last Ship

There’s nothing like a good TV show about a virus running amok especially with the largest Ebola outbreak EVER in history happening to make it even more realistic.

I’ll update you with the story line if you’re not familiar with the show. Be warned, this post will contain spoilers.

A deadly virus is wiping out much of the earth’s population. It’s swift, but supposedly not airborne, which may present the first issue with the theory behind the show.

One U.S. Navy vessel was sent to Antarctica under the guise of military exercises. On board, a research scientist tagged along and spent a lot of time on the ice. It was only later disclosed that she was trying to find the “primordial strain” to help her develop a vaccine. She was able to find the strain needed. What her mission truly entailed was developing a vaccine for the disease. Essentially, the crew has had to stay away from civilization until this was developed.

It’s actually a very good set-up. Of course, what generally trips a show up is those pesky medical details and I want to highlight the biggest violation here today.

Of course, this research scientist develops a vaccine but she needs to test it out before she can truly say it works. Six volunteers are picked from the crew that meet certain age, race, and gender requirements.

First, this group of six gets the vaccine and then fairly immediately– gets dosed with the pathogen.

Sure.

What’s misleading here is the time it takes for a person to develop immunity. It’s never mere minutes. Generally, it takes weeks to months. The flu vaccine (which I hope all of your are planning on getting) takes about two weeks for immunity. This link from the CDC states it takes 4-5 weeks for seroconversion for the MMR vaccine.

Needless to say, it’s unrealistic to portray a vaccine working in mere moments. This is also the reason for multiples injections– some people gain immunity only after a couple of doses. You can read more about that from the above link.

The kicker is– I actually don’t think it would have destroyed their story line in any way. There’s plenty of drama to be had with a deadly virus killing off the majority of the world’s population. Whoever owns the cure, rules the world.

Overall, I liked this show but there wasn’t a need to cheat on the medical details.

Up and Coming and Vaccine Myths

Hello Redwood’s Fans!

How has your week been? Is everyone else loving Autumn right now? Football season is in full swing and I’m happy to note that my team, the Broncos, are currently undefeated. I was not one that quickly jumped on the Peyton Manning boat. I still am pining the loss of Tebow but I may now be seeing the light. We’ll see if Manning can go all the way this year.

Last week I posted about some common fall/winter illnesses: flu and RSV. I got this comment from a reader (Yes! I absolutely read them.) I thought I’d expand here.

From Andrea:

Here’s my thinking on the flu shot. If everyone around me gets it, then why should I? LOL I am always on the fence. I’ve only had the shot once. They always guess at the strain of flu that will come so you have a 50-50 shot. (ha pun not intended but it works!) I’ve also heard if it isn’t given correctly, there can be other complications. Truth??

Jordyn says:

There are a couple of myths around vaccines I’d like to speak on here. I am pro-immunization. I know others who read this aren’t and I know why you are– because I’ve been in pediatrics for seventeen years and have heard your reasons. What frustrates me is that I think there is little voice to the other side. Anti-vaccine people get a lot of lime light and it does risk lives when people choose not to immunize.

This is a common myth– if everyone else is vaccinated– why should I be? They’ll protect me.

For one– more and more people are choosing not to vaccinate so you can’t rely on “herd immunity” that much anymore. Herd immunity is the number of vaccinated individuals in a population. The problem is for certain diseases, you need a high percentage of herd immunity to afford protection. For something like measles– the herd immunity needs to be 95%. This news story reports immunization rates in Colorado dropping to 85% in 2011. What that means is that if measles breaks loose in CO– people are going to be infected. Here’s a recent news story about a measles outbreak in Alberta, Canada.

As a physician is quoted in the above article: “Some have become more afraid of the vaccine than they are of the disease.”

And the reason for this is partly due to the success of immunizations preventing the disease and the general population not seeing children sickened, ill and dying from these diseases.

Which I have seen— and why I believe in immunizations.

The second part to Andrea’s question was even if the vaccine is given properly– there can be complications. Yes, this is true. As with any shot there is risk of localized shot reaction (which some may think is cellulitis but often times is not), pain, tenderness, swelling and risk for infection.

Most physicians think the benefits (not getting measles) is worth these possible side effects.

Do they just guess as to what goes into the flu shot? Yes and no. You can read about that here

It’s like predicting a football game– you look at the data for both teams and make a prediction. It is still a guess but it’s based on data.

One last myth: It’s better to get the actual disease. This is absolutely not true.

Ask those who lost kids to H1N1– about 90% weren’t vaccinated. They might have a different
opinion.

Here is the series I did on immunizations if interested:

http://jordynredwood.blogspot.com/2011/11/pediatric-controversies-immunizations.html

http://jordynredwood.blogspot.com/2011/11/pediatric-controversies-immunizations_30.html

http://jordynredwood.blogspot.com/2011/12/pediatric-controversies-immunizations.html

There ARE risks to vaccines– so educate yourself and decide if you think the risk is worth it. But also read about the complications of diseases you’re choosing not to protect your child against and decide if you can live with that risk as well.

For you this week:

Tuesday: Just exactly how do people forge prescriptions? This is a must-read article for every writer/author.

Thursday: Signs of child abuse. Just what are we in pediatrics looking for?

Have a GREAT week– and get your flu shot.

Jordyn

Treatment of the Newborn with Fever

I’m highlighting some blog posts this week that I did for Erin MacPherson’s Christian Mama’s Guide last year. Some of you may not know but I am a real live pediatric ER RN. As always, these posts are meant to be educational and do not replace a doctor’s visit if your child is ill.

Erin has a WICKED sense of humor and is releasing a series of books this spring so I hope you’ll keep an eye out for them.


Question:  Is it really a bad idea to take a newborn out in public? What will really happen if he/she gets sick?

Jordyn Says:
 
I can remember when my youngest was born and was just a few days old when my in-laws came by to visit. My father-in-law was horribly ill with bronchitis, coughing and hacking at the doorway. I held the baby up for them to see from a distance and kindly asked them to go on their way. They could come back around when he was well.
Here’s the issue: An infant less than two months (some doctors will say three months) that presents with a fever of 100.4 or greater generally gets a septic work-up. The concern is that an infant’s immune system hasn’t quite revved up yet and it can become easily overwhelmed by infection. Therefore, we approach this age infant very cautiously to prevent this from happening.
A septic work-up entails gathering specimens from the most likely places that would become infected. This includes placing an IV to get blood for a blood culture and blood counts, doing a urine cath (placing a small plastic tube into the bladder) for urine and doing a spinal tap (lumbar puncture) to collect cerebrospinal fluid (CSF) which is the fluid that bathes the brain.
Infants are generally admitted into the hospital for 24-48 hours at a minimum on IV antibiotics until their cultures are negative. If their cultures are positive, then they would stay longer to get a full course of antibiotics.
This is not always done but is your “worst case scenario” for ER management. There are some situations that may alter the physician’s medical approach. One may be that we can prove the infant has another source for the fever like an ear infection or RSV (in fall and winter). We generally look for these first. If another source cannot be found, then generally, these other tests are performed.
Unfortunately, a small percentage of infants do die from sepsis. This is why we are very cautious. 
As you can see, these are very invasive procedures and this is why I personally encourage minimal public contact when the infant is under two months.
If you choose to take your new baby in public, here are a few guidelines:
1. Use good hand washing. Before anyone touches the baby, they should wash their hands with soap and water. If water is unavailable, then use antiseptic hand gel.
2. If you develop a cold (runny nose, cough) wear a medical mask around the infant. These can be picked up at stores that have a pharmacy.
3. Keep sick siblings away from the newborn.
4. Encourage younger siblings to kiss the baby’s feet or the back of their head.
5. Immunize.
6. Well newborns need to stay out of the ER! A common scenario is for the whole family to show up with a sick older sibling and bring the new baby. This should only happen if that’s your only option. Otherwise, keep the newborn at home with a responsible adult. There isn’t a way to fully decontaminate the ER waiting room. It’s likely the baby will pick something up during the ER visit of the other sibling.

 

Pediatric Controversies: Immunizations 3/3

I’m concluding my three part series on one area of pediatrics that causes a lot of controversy. Immunizations.

Why don’t people choose to immunize their children? I would say a large majority of these parents would claim a concern about Thimerisol (covered in Part One) and the much talked about but unsupported risk that there is a link between autism and the MMR vaccine (covered in Part Two). This link is not supported by the medical research.

Some people choose not to vaccinate because they’re possibly suspicious of western medicine or in general prefer herbal or homeopathic remedies. 

Another reason? I think it’s because we largely don’t see children suffering or dying from these illnesses that we vaccinate against. People who lived during times when polio was a known affliction in the US probably had a different opinion about vaccinating against polio.



H1N1/Widipedia

 An interesting thing happened early in the fall of 2009. H1N1, otherwise known as the “swine flu” made an outbreak. It affected a large number of people but the pediatric population, particularly late elementary through early high school, had some very serious complications. Several children nationally required mechanical ventilation (a breathing machine) to save their life. Several children died.

There is a vaccine for H1N1. In fact, it’s been included in the regular flu vaccine this year and last year. However, in 2009, distribution came a few months after the outbreak. The interesting part? It was scarce because so many people wanted it for themselves and their children. They didn’t want them to die from the swine flu. Most people don’t see children ill or dying of the diseases we routinely vaccinate against. The immediacy of the experience is lost.

If you have chosen not to immunize, I hope you’ve taken the time to research the diseases and their complications. Choosing not to immunize is a risk as well. How does this play out in fiction?

Let’s say a 6 month old child presents to the ED with high fever and a rash and has never been immunized. Now, we as the ER staff have to worry about all those diseases the child is not protected against. This may set the child up for additional lab tests and procedures. Parents aren’t generally happy when we explain why we have to add these other tests. This is an excellent way to add conflict.

What are your thoughts about immunizations? I’m happy to post any dissenting, well-articulated opinion in the comments section. No derogatory remarks please. I know this issue has a lot of passion on both sides.

Pediatric Controversies: Immunizations 2/3

How many of you have heard the name Dr. Andrew Wakefield? His uber-small, sample study that linked childhood vaccines to autism was retracted by the British Medical Journal. Why is this important? This study fueled the fire for many people choosing not to immunize. But really, what harm is it not to immunize your child against common childhood diseases? You can read about this retraction and the impact it has by following this link: http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html

I want to introduce a concept to you. It’s called herd immunity. I can already see index fingers flying up, scratching a few temples. Cows? She’s talking about cows? This girl has lost her mind– been working too many 12 hour shifts.



Malibu56/Photobucket

Let me explain. Herd immunity is the number of immunized individuals in a group (be it people or cows). It affords certain protection if the “herd” is largely immunized. Let me paint a scenario for you. Take a population of 100 people. Now, 99 of them are immunized against measles. There is a measles outbreak in the next town five miles over. Measles is highly contagious. What’s the chance of measles taking hold in this community where 99% of individuals are immunized? What if the herd immunity in that town was 80%. What are the chances then?

In this scenario, the likelihood of measles taking hold in the community where 99% of people are immunized is low. Dr. Paul Offitt, in his book, Deadly Choices, states that likely 95% herd immunity will protect a community against measles. In 2008, the following states all had immunization rates <70%: Washington, Vermont, Idaho, Montana and Nevada. The likelihood of a measles outbreak taking hold in those state is high.
In the article above concerning Dr. Wakefield, it lists some of the ramifications of people choosing not to immunize.

“The now-discredited paper panicked many parents and led to a sharp drop in the number of children getting the vaccine that prevents measles, mumps and rubella. Vaccination rates dropped sharply in Britain after its publication, falling as low as 80% by 2004. Measles cases have gone up sharply in the ensuing years.”

The 95% herd immunity for measles seems to hold true.

“In the United States, more cases of measles were reported in 2008 than in any other year since 1997, according to the Centers for Disease Control and Prevention. More than 90% of those infected had not been vaccinated or their vaccination status was unknown, the CDC reported.”

But really, what’s the problem with a case of measles? Why did they invent that vaccine anyway? You can read more about measles infection on the following links but one possible complication of measles infection is encephalitis (1:1000 measles cases). I was a little shocked by that number. Encephalitis is an infection in the brain.

1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002536
2. http://kidshealth.org/parent/infections/lung/measles.html

The main concern with measles is that it is highly contagious. There is no “cure” once a case is contracted, merely symptomatic support. Measles is very concerning if a pregnant woman contracts it. Read the following:

“If you’re not immune to rubella and you come down with this illness during early pregnancy, it could be devastating for your baby. You could have a miscarriage or your baby could end up with multiple birth defects and developmental problems. Congenital rubella syndrome, or CRS, is the name given to the pattern of problems caused when a baby is born with the virus.”

I think the following paragraph lends support to the point of having high herd immunity when it come to measles.

“Rubella has become quite rare in the United States, thanks to a very successful vaccination program. Before the rubella vaccine was developed in 1969, a rubella epidemic in 1964 and 1965 caused 12.5 million cases of the disease and 20,000 cases of CRS in the United States. In contrast, between 2001 and 2005, there were a total of 68 reported cases of rubella and five reported cases of CRS. And in 2006, there were just 11 reported cases of rubella and only one case of CRS.”

Here is the link for these quotes: http://www.babycenter.com/0_rubella-german-measles-during-pregnancy_9527.bc.

How often do you hear this side when it comes to the immunization debate? What good is this for fiction? I talked to a pediatrician in our area and asked him what his current rates of immunization were. He stated he was lucky to have 50% of his kids immunized. Some of those children are now women of childbearing age. I think it would be easy to add as a pregnancy complication for any story. What about a measles outbreak?

What do you think?

Pediatric Controversies: Immunizations 1/3

I’m going to focus on aspects of the pediatric immunization controversy that could easily be a whole novel in itself (and has been), but can add layers to novels that have a pediatric character or perhaps you want to add conflict to an issue that involves a child.

Issue based novels that are preachy typically perform poorly. It has to be about characters first. A novelist who does this well is Jodi Picoult. There is generally a central issue in her novel but the characters are likely why you keep reading.

One of the largest areas in pediatrics that is a main source of controversy and angst amongs parents is whether or not to immunize their child. Much of this stems from the fear that there is a link between autism and vaccines, particularly the MMR vaccine. Thus far, no credible scientific study has proven a link between autism and any vaccine.



67cupchamps

Let’s start by talking about thimerosal. Thimerosal is a preservative that contained mercury that was added to vaccines. This additive has largely been removed from immunizations since 2001. It can still be found in some influenza vaccines so if you’re concerned, ask your healthcare provider about it.

However, did you know that since thimerosal has been removed from vaccines, rates of autism have continued to rise? I’m going to list some articles that talk about this revelation. Is it known among parents that this is the case? I’m not convinced.

Check out these resources:

1.http://journals.lww.com/neurotodayonline/Fulltext/2008/02070/Removing_Thimerosal_from_Vaccines_Did_Not_Reduce.6.aspx

2.http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/UCM070430

3.http://leftbrainrightbrain.co.uk/2010/09/thimerosal-in-vaccines-did-not-cause-an-autism-epidemic/

Unfortunately, the power of celebrity is over-riding sound medical study and research in some cases. Millions in research dollars have gone to disproving and have disproved many of these vaccination myths. The question to ask now is whether or not we should continue to investigate these myths or put these limited dollars into research that actually supports the autism community in finding a cure.

Not immunizing your children has risks as well. We’ll be talking about this next post.

How can this add conflict to your novel? What if a child died from a disease that he could have been protected against but the parents chose not to immunize? Would that parent have guilt? Would the medical team caring for the child place blame on the parent? What are your thoughts?

I am very interested in comments, however, I know there is a lot of passion on both sides of this debate. So, keep it respectful and curse word free and it will stay posted– even if you disagree.