Search for tag: "vaccinations"

A lot of parents of younger children are now asking themselves a big question. I'm vaccinated against COVID, but my kids are too young for the vaccine. Can I let them play with their friends again? Do they have to wear a mask?

Kids have usually seemed to fare better with COVID than adults. But we know this isn't always the case. There are those kids who get COVID and then are affected by MIS-C, the multi-inflammatory system complication that will land a child in the intensive care unit. That is seriously scary. And that's why so many of us pediatricians worry about kids around COVID.

Another big concern has been that younger children would bring the virus home to vulnerable adult family members, and those would be the ones who would become significantly ill. So now that many places are not requiring masks anymore and places are opening up, it puts many parents in a situation where they're not sure what to do with younger kids. These kids have missed a whole year or more of socialization with friends and are really wanting to get back to playing.

The current recommendations are that if a person is not vaccinated, they should continue to wear a mask. That said, if your child is playing outside with friends that you trust and who have also been following precautions, it may be okay to let the kids play outside without masks on. There is evidence that kids who play outdoors have a low risk of being infected. There are also a lot of summer camps now, where masks are still being required. But they offer a lot of fun activities for kids who are too young to be vaccinated.

Adolescents ages 12 and up can be vaccinated now. My kids are both fully vaccinated now, and it was their choice, especially knowing that next year there will be no masks in junior high or high school in our area. They asked a lot of good questions about the vaccine and understood the science behind the vaccine. They both said it was such a relief to know that they are now protected. Vaccine trials are now underway for kids older than six months old at the time I'm recording this. The current projections are that kids ages 5 to 11 may be able to be vaccinated as early as September. And kids ages six months to four years may be able to be vaccinated by next spring.

The more people around your child who are vaccinated, the safer they will be. The bottom line is this is a choice your family needs to make. Are others in your family at high risk? Do you know who your kids are playing with? Are they outside? Is anyone sick? Or has anyone been exposed to COVID within days of the playdate? There is hope in sight for the youngest population, and science is working as fast as possible to get everything back to normal as quickly as we can.

Interviewer: You get bitten by some sort of animal, whether it's a dog or a wild animal, the first thing you probably are starting to worry about is, "Did I get rabies?" We're going to find out more about that next on The Scope.

Dr. Troy Madsen's an emergency room physician at University of Utah Health Care. You get bit by an animal, I think the first thing a lot of people think after, "Ouch," is, "Ooh, do I have rabies?" Is that a real threat?

Dr. Madsen: It's a real concern. So, primarily, you're thinking about this with dog bites, cat bites, raccoons, foxes, and bats. And one of the really interesting about bats is, and this is something I've found kind of fascinating, the Centers for Disease Control, the CDC, actually recommends if you wake up and you look at the ceiling and there's a bat there, they actually recommend getting the rabies vaccine in that situation. The idea being that you may have been bitten by the bat during the night, you may not know you've been bitten, the bite marks are usually so small you can't see them. So the concern is that great.

There are certain animals that you may get bitten by and you may wonder about the concern about rabies, animals like rabbits, rats, mice. Those are not really concerns. The big thing I think about in my mind, typically, the animals that are going to transmit rabies are animals that are not necessarily vegetarian-type animals. So rabbits, those things, they don't really transmit rabies. It's more things like foxes, skunks, raccoons, these kinds of scavenger animals that may be eating some meat here and there. Those kinds of animals are sometimes those that carry rabies and those are the ones we get concerned about in saying, "Hey, if you've been bitten by one of these animals, we probably need to think about rabies."

In terms of dogs and cats, if it's an animal where you don't know the dog or you can't observe it, you don't know if it's had its shots, those are also animals where absolutely we worried about rabies and we treat you potentially to prevent a rabies infection.

Interviewer: So if it's a neighborhood dog, good idea to go talk to that neighbor, get that information and save yourself from the rabies shots, I suppose?

Dr. Madsen: Exactly.

Interviewer: If you find out, no, they haven't had their vaccinations, but they don't seem to be showing any symptoms, or you've been bitten by another animal where you're unsure, what would the next steps be?

Dr. Madsen: Then, that's a situation where you need to get the rabies vaccine. And what that involves, first of all, is giving them a medication at the site of the bite wound to prevent rabies infection. It's not necessarily the vaccine, but it's something that kind of neutralizes the virus if it is there. And then I start them on a series of basically four shots, where they'll come in, they'll get the shot that day, they'll come back in a few more days, get another shot. These are all vaccines to prevent a rabies infection.

And that's a precaution I'm going to take on anyone who comes in after a bite from any animal that could be carrying rabies. And the reason we're very, very cautious in that situation is because there's not much you can do if someone gets rabies. It's something you really want to prevent. You don't want somebody to catch it because if someone catches rabies and they actually develop the disease, it's almost universally fatal.

Interviewer: Really? So it's bad news, it's serious stuff.

Dr. Madsen: It's bad news if you get it, yeah. It's one of those things you can try and treat it and try and get them through it, but it's a horrible thing to get. So really, the treatment for rabies is prevention.

Interviewer: Gotcha. And these shots, they used to be in the stomach, right? And I heard they used to be really painful and there are a lot of them, but you're saying there's one at the site and then four more after that. Where are those four more?

Dr. Madsen: They're just in your arm or your leg. It's not in the stomach. I remember hearing that as a kid as well.

Interviewer: Has that ever been true?

Dr. Madsen: I don't know. That's . . .

Interviewer: Oh. Not since you've been in medicine.

Dr. Madsen: Not in the last 15 years that I've been in the medical profession.

Interviewer: Okay. All right.

Dr. Madsen: I don't know. I heard that too. I remember always hearing that you had to get a shot in the stomach and I thought, "Wow, if I got bitten by a dog, no way would I want to go get the rabies shot because that sounds miserable." But no, these are shots, you give them the same place you'd give a tetanus shot or something like that. They hurt a little bit, kind of like a tetanus shot would, but it's not something, like some really crazy shot that you're getting in your stomach.

Interviewer: Yeah. And better than the alternative.

Dr. Madsen: It's much better than the alternative. Exactly. You don't want to get rabies.

Interviewer: And is this an ER-only thing or could you do an Urgent Care for this?

Dr. Madsen: I think Urgent Cares can do this. I can't say I've looked into it specifically to see if they offer the rabies vaccine in most Urgent Cares, but it's a pretty straightforward thing. If you went there and they just said, "Hey, we don't have the vaccine here," then they're going to send you to the ER, but I think it's a reasonable place to start.

Interviewer: All right. And is there a time limit? After I get bit, is it a day? Six hours? Three hours?

Dr. Madsen: I would want to get in within the first 24 hours. Really, as soon as you can. I would not put it off, especially, like I said, because one of the vaccines, one of the injections we're giving, at the site of the wound is essentially neutralizing that virus if it's there, so the sooner, the better.

updated: March 10, 2021
originally published: July 22, 2016

Interviewer: You get bitten by a non-poisonous snake, ER or not? That's next on The Scope.

Announcer: Is it bad enough to go to the emergency room? Or isn't it? You're listening to "ER or Not" on The Scope.

Interviewer: It's the game where you get to decide whether or not you would go to the ER and then we find out the correct answer from Dr. Troy Madsen, emergency room physician at University of Utah Health Care. ER or not today, you are bitten by a non-poisonous snake. Is that a reason to go to the ER?

Dr. Madsen: Non-poisonous snakes, first of all, you want to know that it is a non-poisonous snake. So in Utah, we're thinking primarily about rattlesnakes being the poisonous snake here of concern. So if you know it's not a rattlesnake, if it's a little garden snake that was in your yard, you picked it up, it bit your finger, not necessarily a reason to go to the ER.

Interviewer: Okay.

Dr. Madsen: But there is kind of one little caveat here, with this. With any bite, and we always think about it with snakebites, you have to think about tetanus. Something we have to think about with any laceration, anything like that. So if you can tell yourself, "Okay. I know I had a tetanus booster. It's been within the last 10 years. I'm covered there." In terms of the bite itself, everything's moving okay, it's not like it affected any tendons, nerves, nothing like that, it's not a real deep bite, it's probably something you can just wash out at home and not go to the ER.

Interviewer: What about infection? Is that a worry in a snakebite as well? I know it's a worry with a lot of other bites.

Dr. Madsen: It is for a lot of other bites. And again, certainly, infection is something that you think about with snakebites. But if someone comes to the ER, they've got a couple little fang marks on their finger from a snakebite, and it looks clean, it's not like a real dirty wound where they were working in the garden and their hands were real dirty and then the snakebite pushed a bunch of dirt into their finger, I'm not really going to start that person on an antibiotic for that.

Interviewer: Fascinating. So like getting bit by a dog, more worry of infection than getting bitten by a snake?

Dr. Madsen: It is. And for me, it is just because the dog bites are usually deeper. There's usually more tissue involved. I don't know. I can't say I have ever looked to see what the germ content of a dog's mouth versus a snake's mouth is.

Interviewer: There's somebody out there that probably knows.

Dr. Madsen: There probably is, but for me, it's more just the fact that the dog bites are usually a much larger area, usually deeper, usually a lot more tissue involved.

Interviewer: Okay.

Dr. Madsen: That's why with dog bites, I am usually thinking more starting antibiotics to prevent an infection where with snakebites, typically, not such a concern, but something you have to watch out for to make sure nothing develops.

Interviewer: All right. So a non-poisonous snake bite, no need to go to the ER as long as you are sure you've had that tetanus booster within the past 10 years.

Dr. Madsen: Exactly.

Interviewer: Wash it out and just watch it, at that point.

Dr. Madsen: Yeah, wash it out. You can use some antibiotic ointment on it, keep an eye on it, make sure it doesn't develop an infection.

Interviewer: And if you have not had that tetanus shot, urgent care? Can they give you...

Dr. Madsen: Urgent care is fine, yep. You get in to see your doctor within the next day or two, that's fine as well.

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Interviewer: What is pertussis, what can you do about and can adults get it? That's next on The Scope.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Interviewer: If you get a nasty cough that will not just go away it might be pertussis. The odds are slim but it could be. To find out more about pertussis in adults we're with Doctor Tom Miller here at University of Utah Health Care.

Pertussis; tell me a little bit about it and then tell me how an adult can get it.

Dr. Miller: Pertussis was commonly known as whooping cough and occurred most commonly in children prior to the development of an effective vaccine, and it was deadly. A lot of kids died of whooping cough in the old days.

Interviewer: Another one of these things that the vaccines have made a huge difference, and we forget about it, right?

Dr. Miller: We forget about it and actually what's happened is that kids all in the United States generally get this vaccination for pertussis and it effectively prevents it, but as we get older our immune system forgets about exposure to the vaccine and immunity wanes. And you know what? People coming into the country who are not vaccinated can bring pertussis in.

It's a very highly infective bacteria so you don't need much in the way of bacteria to become infected. And when you are infected, if you are older you could end up with not whooping cough but something called the 100 Day Cough.

For a few days you just feel real crappy. You feel very poorly, you have a sore throat and you develop a cough. It's awful. It's what we call paroxysmal cough. It's deep, it's rapid, it's unending and it's so bad sometimes that it will make you vomit, throw up. It's terrible.

So that's why the recommendation now is that as an adult you should receive a pertussis vaccine with your tetanus and diphtheria vaccine. You only need that once in adulthood but if you don't have that you then are at risk to pick up pertussis should you run into a child or even an adult who might be carrying pertussis. And again, it doesn't take much in the way of contact to develop pertussis.

Interviewer: So how is it transmitted?

Dr. Miller: It's transmitted through vapor droplets. Somebody coughing, they can pick up the bacteria in that way. And again, it's highly infective. Many times patients don't know they have pertussis when they are adults because they don't have this barking whooping cough that the kids used to get. They just start with a cold, but the severity of the cough is the thing that makes physicians think about it.

Now, you can treat the patient once they develop the cough and it can get rid of the pertussis bacteria but it doesn't get rid of the cough, and that cough goes on and on and on, and it's a devil to treat if you can even treat it.

Interviewer: So I guess the message here is if you haven't had that pertussis booster, you should get that.

Dr. Miller: Get the booster. Absolutely.

Interviewer: It is something you see on occasion.

Dr. Miller: I do see it on occasion. In Utah, we have an increase in the rate of pertussis in adults because of our immigrant population. They're not always vaccinated when they come into the country.

Interviewer: International Airport.

Dr. Miller: The simple way to protect yourself is to make sure you get that booster.

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updated: January 2, 2019
originally published: June 28, 2016

Interviewer: A study shows just how important getting a flu shot during pregnancy really is. Up next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope.

Interviewer: I'm talking with Dr. Julie Shakib. Assistant professor of pediatrics at the University of Utah School of Medicine and medical director of the well-baby and intermediate nursery. Dr Shakib, if you Google flu shot and pregnancy, you'll find that there are actually some very vocal people out there who say that you should not get a flu shot if you're pregnant. Did you in part do this study to address those concerns?

Dr. Shakib: I agree it's a concern that not enough pregnant women are getting the flu vaccine during pregnancy but the key driver for why we decided to do this study is we knew we had the opportunity to look at a large dataset over a number of influenza seasons.

We also knew that we had the opportunity to look at the gold standard for flu which is laboratory confirmed influenza and infants and no one had really done that before. We saw an opportunity to contribute to what's known about how maternal immunization can affect the baby.

Interviewer: What did those things tell you?

Dr. Shakib: What we found in our research is that when mom reported influenza immunization during pregnancy, their infants were 70% less likely to have laboratory confirmed flu than moms who didn't report immunization during pregnancy. Additionally we found that in the same cohort of women who did and did not report immunization, that moms who did report immunization their infants were 81% less likely to have influenza hospitalizations in their for six months of life.

Interviewer: Those are both indicators that these infants are not getting the flu if their mothers get the flu shot during pregnancy. That there's a benefit to the infant from the mom's flu shot. Why is that particularly important for the in the infant and for the mother?

Dr. Shakib: That's a great question. The reason it's important is because immunization against flu isn't indicated in newborns until they're six months of age. That's because the vaccine just isn't effective in that first six months. So maternal immunization is one of the only ways we have to provide the baby with some protection until they're old enough to receive and get benefit from the vaccines themselves.

Interviewer: What happens when infants get the flu? Is it worse for them than for say you or me?

Dr. Shakib: It is. It's much worse in the first year of life than it is for adults. They're much more likely to be hospitalized for flu. Much more likely to have complications such as pneumonia. They have higher rates of morbidity and mortality from flu than older age groups do.

Interviewer: Do we know how long the mother's immunization protects the baby after it's born?

Dr. Shakib: That's another interesting question. We do know that it's dependent on when the mom received the vaccine during pregnancy. But the mom needs to get the vaccine as soon as it's available during her pregnancy. That's not something that can be timed to be exactly right for the infant.

Interviewer: Well and of course I mean, we all know that not every flu shot works. The flu changes every year and so getting a flu shot doesn't necessarily guarantee that you're going to protect the baby?

Dr. Shakib: The one thing I would say about our study that's really interesting is that even though we looked over nine seasons of influenza data, we still saw a benefit. We know every year the vaccine isn't a perfect match. What I would suggest is there is protection. How perfect it is, no vaccine is perfect, no protection is 100%. But some protection from a serious illness that we couldn't get otherwise, is the purpose of immunizing during pregnancy.

Interviewer: How did you do the research?

Dr. Shakib: Essentially we did a data analysis of nine seasons of influenza, we basically retrieved all the records and looked at documentation for whether moms reported receiving flu vaccine versus those who didn't and then compared the specific outcomes including influenza like illness, laboratory confirmed flu and flu hospitalizations in infants based on their mom's immunization status.

Before the H1N1 pandemic a lot of women were not receiving the flu vaccine. So we had a number of years where we had low immunization rates and moms that changed thankfully a fair amount with H1N1 but didn't change enough because still only about 50% of women report getting the flu vaccine during pregnancy.

Interviewer: Pregnant women, are they particularly susceptible to flu?

Dr. Shakib: They're not more likely to get the flu, but they are more likely to have some severe outcomes from the flu because of changes to their immune system, their circulation during pregnancy. So we saw with H1N1 pandemic that pregnant women were disproportionately sicker and more severely affected. Flu vaccine is a little bit of a two for one benefit. Moms need to be protected while they're pregnant, but they're also providing protection to their baby with the same shot.

Interviewer: What's kind of the main message you want to get across?

Dr. Shakib: I think that the key message is that we need to take every opportunity to both support and provide flu vaccine to pregnant women during their pregnancy. Obstetricians, midwives, nurse practitioners, anyone who cares for pregnant women needs to actively endorse and offer flu vaccine to their patients. Patients need to feel empowered to ask for it if they haven't been offered it during their pregnancy.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

Dr. Ed Clark: Immunizations today are a hot button issue. How do you as parents approach the issue with your health care provider?

Announcer: Medical news and research from University of Utah physicians and specialists that you can use for a happier and healthier life. You're listening to The Scope.

Dr. Ed Clark: Hello this is Dr. Ed Clark, chair of the department of pediatrics and I have with me today Professor Seth Mnookin from MIT who's the author of the book "The Panic Virus". Professor Mnookin, many families are concerned about immunizations and about the risks that it poses for their children. How would you encourage a family that is approaching immunizations to think about this?

Professor Seth Mnookin: Well one thing that I would really strongly recommend is that if this is something that they want to discuss with their healthcare provider, that they let that health care provider know beforehand. I think anyone who has children knows how stressful a wellness appointment can be, because you don't have a lot of time and there's a lot to get done. And I know that doctors and nurses often times feel very under the gun when they're in that setting and then on top of that a mother or father says, oh and by the way I heard that vaccines are bad for X or Y reason, that's often times not very conducive to a discussion.
So when you're making the appointment, or when you call to confirm the appointment, if you can say, one thing I would like to make sure we have time to discuss is my concern about vaccines. And then your health care provider is going to know that that'll be an issue and hopefully will be prepared either to say, we don't have time to fully discuss that today, but here are some online resources that I would recommend you look at, here is the CVC website, here is someone in our office that you can schedule a time to talk with, something like that. So in the same way that I think parents don't like to come into an appointment and be told, oh and by the way, we're also going to be doing X, Y, and Z to your child today, doctors don't like having an appointment that they think is going to be a standard appointment and then all of a sudden being told, oh and I want to discuss, in the 30 seconds we have remaining, these very volatile issues.
I would also really recommend to parents that if this is something they're concerned about, instead of going online and typing in vaccines concerns, or whatever, as a Google search term, they really think about the source of the information and be intelligent consumers of information. So go to places like the American Academy of Pediatrics website, the Centers for Disease Control and Prevention, the Children's Hospital of Philadelphia has a very good vaccine information center. These are all resources that today, thank goodness, are written in such a way that are comprehensible to people without medical or scientific backgrounds, and really in a pretty detailed, in a pretty detailed manner address a lot of these concerns.
Another thing that I think is really important to remember is vaccines are the most studied medical intervention that we have. So this is not something where we're kind of flying blind and saying, oh well, I think this is going to be the right thing for you to do, so let's do it. Parents can be very assured that when they go to the CDC site or the AAP site, what they're getting there is distilled research from decades of studies, literally done on millions of children. So I would recommend that and then really just kind of giving a heads up to your health care providers beforehand.

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Dr. Gellner: The HPV vaccine, should you get it and is it safe? I'm Dr. Cindy Gellner and let's explore that today on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Gellner: So you may have recently seen Katie Couric talking about this vaccine on her show, and you were maybe wondering, is this something I should get for my kids? Is it safe? Why is it important?

So this vaccine comes in many different names, Cervarix and Gardasil, and the bottom line is it protects against human papillomavirus. Now human papillomavirus is the most commonly sexually transmitted infection. Currently, based on the 2013 CDC data, 79 million Americans have HPV and 14 million people become newly infected each year.

So not only does HPV cause genital warts, but it also is the major virus that causes cervical cancer. It causes other cancers as well, including vulvar cancer in women, and penile cancer in men. HPV can also cause a rare condition called recurrent respiratory papillomatosis. It's a disease where warts will actually grow in a persons' throat, it can actually affect a persons' ability to breath because they become so large, these papillomas, they're like big warts, the warts become so big in the persons throat, that they will block the persons airway.

Now, kids can be affected by this too. If the Mom has human papillomavirus while she's pregnant, she can actually transmit this to children. It can only be diagnosed by someone actually taking the child to the operating room and looking down their throat and looking for these warts, and these are one thing, the child is going to have to have them cauterized or burned off or frozen off recurrently, over and over and over, to keep their airway open as they go through life. So it's not something to really take lightly. So the vaccine actually can prevent most cases of cervical cancer and these other cancers.

The important thing is your child would need to get the entire series before they start having sexual activity. HPV actually is pretty easy to acquire, again, there's so many people that have it. Even if you only have one sexual partner and that person has it, you can get it.

So who should receive this vaccine and why? Pediatricians currently recommend that both boys and girls get the vaccine around age 11 to 12 when junior high vaccines are given. So what do I recommend to my patients at Parents, who are unsure about the vaccine. I always advice that the parents and the patients, the kids themselves, seriously consider getting this vaccine. It's the first vaccine developed to prevent a major type of cancer. Think about that. If we just give three shots and we eliminate several different types of cancers, or significantly reduce the amount of cancer, how awesome would that be?

The other thing to remember is a person can be infected with HPV for up to 10 years before symptoms appear, again, why it's so important to get the kids vaccinated before they start having sex so they get vaccinated before they even come in contact with this virus. Treatment, once a patient has it and has symptoms, can include anything from cryotherapy, which is freezing off of the warts, to actually surgically removing part of the reproductive system, again, something to think about. Three shots, versus something that could be extraordinarily painful. And even if a person is asymptomatic, if they are infected they spread HPV to others through unprotected sex.

The safety of the vaccine has been studied in clinical trials of 30,000 males and females before the FDA even approved its' license for general public use. The vaccine has been shown to be highly effective and research shows that the protection is long lasting. You may need boosters of this vaccine in the future, but three vaccines are all that's needed. So with concerns about the side effects of this vaccine, the bottom line is, the benefits of vaccines outweigh the risk. So your pediatrician will be able to answer any other questions that you have, but I can't stress enough how important it is to protect your child against this virus that actually can cause a lot of serious harm in the future if it's not taken seriously.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.