I’m a pediatrician. Here’s what I want you to know about vaccines.

By Dr. Katherine Williamson, a CHOC Children’s pediatrician

dr-katherine-williamson
Dr. Katherine Williamson, a CHOC Children’s pediatrician

Proper vaccination is important for all people, but especially infants and babies. When children follow the recommended immunization schedule outlined by the American Academy of Pediatrics (AAP), they are better protected against potentially life-threatening diseases.

As a pediatrician, I get a lot of questions about baby vaccination and vaccines for children. In observance of national immunization month, here are the most common questions I get about vaccines.

Are vaccines safe?

Vaccines are one of the most important things we can do to help protect our children’s health. Vaccines and proper handwashing, more so than all other interventions, have proven to be the most safe and effective ways to prevent disease.

What is the proper vaccine schedule?

The current immunization schedule outlined by the AAP and Centers for Disease Control & Prevention has been researched and proven to be the most effective and safest way for children to be vaccinated against potentially fatal diseases. It’s important to know that no alternative schedule has been shown to be as safe and effective.

I get frequent questions from expectant and new parents who are concerned about the number of vaccines given to kids at one time under the recommended schedule. The amount of antigen (protein) in the vaccine that is put into your child’s body is 100,000 times less than if your child has a common cold, so there’s no concern about overwhelming their immune system when they get their vaccines.

Do I really need a flu shot every year?

Yes. Influenza causes a higher number of death and illness over any other disease annually in the US, and your best chance of preventing influenza is the flu vaccine. Symptoms of influenza include high fevers, chills, muscle aches, and respiratory symptoms that can lead to pneumonia and respiratory failure. Children under 2 years and adults over 60 years of age are at the highest risk of becoming seriously ill if they are exposed to influenza.

The CDC recommends an annual influenza vaccine for everyone 6 months of age and older. You should be vaccinated as soon as the influenza vaccine becomes available. Although flu season peaks between December and February, it can start as early as October and last through May.

What can I do to make my child more comfortable while receiving a vaccination?

Studies have shown that preparing your child for vaccinations should ideally include three components” explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Here’s more tips on how to make shots less stressful.

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Can HPV really lead to cervical cancer?

Human papilloma virus, or HPV, affects nearly all sexually active men and women at some point in their lives. Many people “clear” or fight off their infections without ever knowing that they had an infection at all. However, a percentage of people with the virus do not clear their infections and may develop genital warts, cervical cancer, or other types of cancer.

We spoke to Dr. Terez Yonan, an adolescent medicine specialist at CHOC Children’s, to get the facts on HPV and how it can indeed lead to cervical cancer.

terez-yonan-do
Dr. Terez Yonan, an adolescent medicine specialist at CHOC Children’s.

How common is HPV?

There are nearly 80 million people currently infected with HPV in the United States, according to the Centers for Disease Control, and nearly 14 million people, including teenagers, become infected with HPV each year.

How does HPV lead to cervical cancer?

The most common way to contract HPV is through sexual contact, from a direct transmission from one person’s genitals to the other. When transmitted vaginally, the HPV cells will integrate into cells of the vaginal wall and cervix. This changes the composition of the normal, healthy cells and you end up with dysplasia, also known as abnormal and pre-cancerous cells. This can worsen and turn into cervical cancer.

For people with a normal immune system, it could take years for HPV to turn into cervical cancer, but for someone who is immune-compromised, that process could take just a few months.

HPV does not always lead to cervical cancer. There are what we call high-grade infections and low-grade infections. Low-grade infections are easily cleared by the body on its own. It takes about two years for a healthy person to clear HPV. High-grade infections can last longer in the body and put you at risk for cervical cancer or genital warts. Although not considered dangerous, genital warts are unsightly and can cause irritation depending on where they are. If not treated, warts can grow into different types of cancer, including oral and anal and penile cancer.

What are the warning signs of cervical cancer?

Most of the time, people don’t know they have HPV because there are no warning signs. In some cases, genital warts may appear. Abnormal vaginal bleeding can be a sign of cervical cancer. If you notice abnormal bleeding, consult your primary care provider, gynecologist, or adolescent medicine specialist.

Can I get tested for HPV?

A Pap smear, also called a Pap test, is a pelvic exam designed to test for cervical cancer in women. An HPV test can be done using the same sample of cells collected during a Pap smear.

When should I get my first Pap smear?

A Pap smear is intended for healthy, sexually-active people. They are generally not recommended before 21 years of age. For people who are immunocompromised, Pap smears are recommended when you become sexually active regardless of age because of the increased risk for picking up infections , and for those infections to more quickly develop into cancer.

How often should I get a Pap smear?

Someone who is immunocompromised needs two Pap smears within the first year of becoming sexually active. If those are normal, the exam can be done annually. Healthy women in their 20s need a Pap smear every three years. Beginning at age 30, Pap smears can usually be done every five years.

Who can do my Pap smear?

You can get a Pap smear from your adolescent medicine specialist, family medicine provider, internal medicine provider, or gynecologist. Nurse practitioners and physician assistants  in each of these offices can perform the exam as well.

What does an abnormal Pap smear mean?

If your results are abnormal, you will undergo more frequent Pap smears for monitoring, until your results are in the normal range. The frequency of these Pap smears will be determined by your doctor, but it could range from every three months to every year. Since many people’s bodies clear HPV on their own, when the results are clear again, you will return to an every three- or five-year schedule for Pap smears, depending on your age.

Your doctor may suggest a colposcopy, another type of cervical cancer test. This gives them a better view of your cervix. If they identify cells that may be abnormal, they will perform a biopsy and remove a tiny sample of tissue from either the inside or outside of your cervix. If the biopsy confirms the presence of abnormal cells, your doctor will discuss specific treatment options.

How can I prevent cervical cancer?

Receiving the HPV vaccine is the only way to protect against cervical cancer. Each year in the U.S., 13,200 women are diagnosed with cervical cancer. This number has decreased since the introduction of the HPV vaccine.

What happens if I get cervical cancer?

If you are diagnosed with cervical cancer, you will be referred to a gynecologic oncologist—a doctor who specializes in cancers of the female reproductive system. Most cases require chemotherapy, and some require radiation as well. Surgery may be a treatment option.

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Measles outbreaks: What parents need to know

Measles is one of the most contagious infections. It is so
contagious that up to 90% of close contacts of someone with measles will also
get measles if they are not immune. To prevent the spread of measles in a
community, about 95% or more of the population must be vaccinated or immune to
measles. This is called herd immunity.

Q: What caused the
current measles outbreak?

A: Because of global outbreaks and frequent travel, measles
is brought back to the U.S. and can spread in populations of under-vaccinated
individuals.

Q: What are symptoms
of measles?

A: Measles is highly contagious and transmitted through the
air. Contagious particles can remain in the air for hours after an infected
person leaves an area. Symptoms typically begin eight to 10 days after initial
exposure to the virus, and then develop in stages. Early symptoms include a
high fever – typically between 103 and 105 degrees Fahrenheit – cough, red
watery eyes and runny nose. A rash develops around the third day of symptoms, starting
on the face and continuing to spread downward over the body as the disease
progresses. People are contagious for about four days before the rash begins
and four days afterward, according to the U.S. Centers for Disease Control
(CDC).

Q: How do you treat
measles?

A: There is no specific antiviral treatment for measles.
Supportive care is provided while monitoring for possible complications, such
as dehydration due to diarrhea or pneumonia. The CDC reports that pneumonia is
the complication most likely to cause death in young children.

Q: When can you
receive the measles vaccine?

A: The MMR vaccination — which covers measles, mumps and rubella — is administered in two doses. The first does is usually given between 12-15 months and the second dose at 4-6 years of age. However, the second dose can be given as soon as 28 days after the first dose. For children traveling internationally, the vaccine is recommended as an extra dose for infants 6 to 11 months of age. To protect those who are unable to receive the vaccination, it’s vital that everyone eligible be vaccinated. Some people, including those with a weakened immune system due to disease or medical treatments, or pregnant women may not be eligible. Ask your healthcare provider for more information. Here’s some tips for making shots less stressful.

Q: Do I need an MMR
booster?

A: According to the U.S. vaccination schedule, people who
received two doses of the MMR vaccine as children are usually considered
protected for life and don’t need a booster dose.

Q: Is the measles
vaccine safe?

A: The measles vaccine is safe and readily available.
Following the vaccination, some children have mild reactions, such as
short-lived, low-grade fever.

Q: Can you die from
measles?

A: Measles is a very dangerous disease and can lead to complications including ear infections, pneumonia, a brain infection called encephalitis, and death. Before mass vaccination in the 1980s, measles affected three to four million people per year in the U.S., and 400 to 500 died. We have a very effective and safe vaccine to prevent measles. Getting the measles vaccine is the very best way to prevent measles. All parents should be vaccinating their children at the recommended ages.

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Does my child need the HPV vaccine?

Human papilloma virus, or HPV, affects nearly all sexually
active men and women at some point in their lives. Many people “clear” or fight
off their infections without ever knowing that they had an infection at all. However,
a percentage of people with the virus do not clear their infections and may
develop genital warts, cervical cancer, head and neck cancers, and penile
cancers.

We spoke to Dr. Marisa Turner, a CHOC Children’s pediatrician, on the most common myths she hears from parents regarding the HPV vaccine.

dr-marisa-turner-choc-childrens-pediatrician
Dr. Marisa Turner, a CHOC Children’s pediatrician, addresses the most common myths about the HPV vaccine.

Myth 1: My child is
too young. They don’t need the vaccine yet.

Some parents decline the HPV vaccine because they think
since they have years until their child is sexually active. However, many
parents don’t realize the vaccine is more effective the earlier it is given.
The immune response to the vaccine is better when given younger, therefore only
two doses are needed if the series is started prior to the 15th birthday.

The
number of recommended doses depends on the child’s age when they receive their
first dose.
A two-dose series is given for children starting the
series before their 15th birthday. Children who start the series on
or after their 15th birthday will receive a three-dose series.

Myth 2: You can only
get HPV if you’re sexually active.

Although sexual intercourse is the most common way to get HPV, it is
not the only way to get it. It could take just one encounter to catch the
virus, and most people who carry the virus have no symptoms and don’t realize
they even have it. Even for those that are having protected intercourse, you
can still catch HPV despite using a condom.

Myth 3: Giving my
child the HPV vaccine will make them become sexually active.

Multiple studies have shown that giving this vaccine doesn’t
increase rates of sexual activity in those patients compared to those who don’t
receive it.

It’s important for adolescents to take a part in their own health
and begin to realize that decisions they make now can affect them later in life
and their future health.

Myth 4: Getting the
vaccine will guarantee my child does not contract HPV.

Most adults are likely to get HPV at some point in their
lives. Some people clear it on their own, but others do not. If your child is
vaccinated against HPV and later contracts HPV, it’s s likely to be a strain
you can clear on your own.

The HPV vaccine prevents against the nine strains of HPV
most likely to lead to cancer. About half of all new infections are in people 15-24-year-olds,
the peak age at which one should receive the HPV vaccine.

Myth 5: HPV only affects females, so my son does not need the HPV vaccine.

The HPV vaccine has benefits for males too. It prevents oral,
anal and penile cancer, and genital warts. Getting vaccinated will also help
prevent them from passing it on to other partners, which can happen even in the
absence of visible symptoms of HPV.

Myth 6: This vaccine
is new, so it must not be safe enough to give my child.

The HPV vaccine was first administered in 2006. Prior to
coming to market, it was studied for many years. Ongoing studies have tracked
patients for years after receiving the vaccine, and they have not shown any
adverse effects. The HPV vaccine is administered and studied all over the
world.

Each year in the U.S., 13,200 women are diagnosed with
cervical cancer. This number has decreased since the introduction of the HPV
vaccine.

Myth 7: My child
doesn’t need the HPV vaccine. If they contract HPV, we’ll just treat it.

There is no good treatment for HPV. Some strains clear on
their own, but others do not. It’s better to get vaccinated and lower your risk
of getting HPV in the first place.

Myth 8: Getting the
HPV vaccine will affect my child’s fertility later in life.

Receiving the HPV vaccine will not affect fertility. However, having HPV can cause changes in the cervix which can later affect fertility.

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Should My Kids Get the Flu Shot This Year?

Many parents have expressed concern over the last few months that this year’s influenza vaccine may be less effective than in years past and wondering, “Should my kids get the flu shot this year?” These concerns stem from data released after Australia’s flu season, where recent reports indicated low effectiveness of the vaccine.

“We’re using the same vaccine here in the United States, so people think it won’t be effective,” says Dr. Jasjit Singh, a pediatric infectious disease specialist and medical director of infection prevention and control at CHOC Children’s.

dr-jasjit-singh-choc-childrens
Dr. Jasjit Singh, a pediatric infectious disease specialist and medical director of infection prevention and control at CHOC Children’s., addresses parents’ annual concerns over, “Should my kids get the flu shot this year?”

These doubts are misguided, says Singh. Although reports show Australia’s vaccine was only 10 percent effective, that data was specifically looking at the H3N2 strain that had dominated the southern hemisphere this year, she says. Effectiveness against the same strain in the US has been as high as 30-40 percent, and even higher against other strains of influenza in the past.

“We can’t take that one statistic and apply it to all strains of the flu in the US this season,” Singh says.

It’s important for parents to remember that the although the vaccine helps prevent children and adults from getting the flu, physicians are especially concerned with preventing influenza-related hospitalizations or even death.

“People forget that children and adults can die from influenza. So far in the U.S. there have been nine pediatric flu-related deaths this season,” Singh says.

Since the 2004-2005 flu season, flu-related deaths in children have ranged from 37 to 171 each season, according to the Centers for Disease Control.

A recent study published by the American Academy of Pediatrics examined vaccine effectiveness in 291 pediatric influenza-associated pediatric deaths from 2010-2014. Vaccine effectiveness was 51 percent in children with high-risk conditions, compared to 65 percent in children without high-risk conditions.

“This shows that many of our deaths are in otherwise healthy children,” Singh says.

Although it’s best to get vaccinated early in the season, it’s better to be vaccinated later in the winter than not at all.

“Very often, people get vaccinated because someone they know has the flu. It takes two weeks for the vaccine to take effect, so if your child has been exposed to the flu in that time period, they can still get sick,” she says.

Parents should remember that children cannot get from the flu from getting a flu shot.

“The vaccine is not a live vaccine, so it’s impossible to get the flu from getting a flu shot,” Singh says. “the vaccine prevents influenza virus, but during winter months there are many other viruses that cause colds and respiratory viruses, that are usually milder than the flu.”

Those who decline a flu shot because they “never get the flu” still need to be vaccinated, she adds.

“It’s important to remember that some people may have minimal symptoms, but can still pass the virus to others who may be vulnerable to more severe disease.”

The single best way to protect your child from the flu is by getting them vaccinated each year. In addition to receiving an annual influenza vaccine, there are other things parents and caregivers can do to help prevent the flu. Use proper hand-washing techniques, use respiratory etiquette, and stay home from work or school if you are sick with the flu, to prevent spreading it to others.

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