Search for tag: "vaccine"

Needle phobia. It's something that as a pediatrician I see every day, several times a day. At least two-thirds of children have a fear of needles. It's hard to tell who is worse with it though, little kids or teenagers.

Unfortunately, vaccines are still given as shots at this time, and kids get a lot of shots to help build their immune system. At the mere mention of being due for vaccines or blood work, some kids will just burst into tears.

So what can you as a parent do to help when your child is due for a vaccine or needs blood work done? I always will tell parents and kids at the well visit before they are due for vaccines that the next time they have a checkup, there are shots involved.

Mainly, I do this to avoid surprises. Often parents will say that they had no idea their child was due for shots. So when I tell the kids, they remember the next time and that actually seems to help them be better prepared. It's the surprise "you need a shot" announcement that catches kids off guard more and their anxiety goes through the roof.

Parents also feel better knowing that they can tell their child that, "We talked about this," and that they can prepare their child in advance, not spring it on them on the drive to the office or once they get here.

One thing we as pediatricians ask that you don't do is tell your kid that if they don't behave, they'll get a shot. I hear that all the time as a scare tactic and it really bothers me. I'm not going to give your child a shot if it's not needed.

If you tell your child in front of me that I will give your child a shot if they misbehave, I will tell your child that I don't give shots for behavior, but I do have time out spots in the clinic.

And for the teenagers, if they get out of hand, we do have security officers who can help with behavior outbursts. And yes, sometimes that has been needed when the teenagers become violent.

Kids often will ask me if the shots hurt. Well, they are shots. They're not fuzzy caterpillars. Same with the needles we use to draw blood. I tell kids that, "Yes, they hurt just a little, but it's over quickly," and, "We have to use the needles, but for a good reason," and it's to make sure that they are healthy.

I try to be upfront and honest with the kids. Even little kids understand when you tell them the truth in a calm manner and explain why we are doing what we are doing.

I had a vaccine one day and I saw a patient later who was afraid of getting a shot. I showed her my Band-Aid and she was so surprised. She was like, "But you're the doctor." And I said, "Yes, I am, and I sometimes have to get shots too." She then said if I was brave enough to get one, then so was she.

I also tell kids when they're old enough what vaccines they're getting and why they're getting them. I ask if they have any questions about the vaccines, and that seems to help them understand the importance of the vaccines.

Same with the blood work. I explain everything to them so that they know I'm not ordering labs just because I want to torture them. It's because I'm trying to figure out what is going on in their bodies and how to make them healthier.

I also have the advantage of telling kids and parents that my medical assistants are who I trust with my own family and who I trust to draw my blood and give me any immunizations. So they know that they're in good hands.

I let them know that I don't like getting needles poked in me either, so they know they're not alone and that I get it.

I talk directly to the kids so they know they're heard and we are doing what we can to make this as easy an experience as we can. And they know that they get a sticker when they're done for being so brave, no matter how old they are.

So while needle phobia is a real thing, there are ways as parents that you can help make immunizations and blood draws less scary, which goes a long way when the kids are here in the office.

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 may have heard there's a new shingles vaccination, and your doctor might have recommended that you get it. Should you? Well, we'll talk about that next on The Scope.

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

Interviewer: Let's talk about shingles. First of all, let's just set the stage. What is shingles?

Dr. Miller: Let's talk about that. So shingles is what we call recurrent chicken pox. Now, before the chickenpox vaccine was given routinely to children, most of us, probably greater than 95% of us, have had chicken pox and may not even remember it as kids. Now, once you've had it, it never goes away. The virus goes into your nerves in your spine and hides, and for reasons that are not entirely clear, probably because our immune system sort of forgets that the virus is hidden over time, chicken pox comes out again as shingles or herpes zoster. So it doesn't present as a fulminant, itchy rash like we get when we're kids, but it comes out in specific areas where the nerves innervate parts of the skin.

Interviewer: Meaning it's painful.

Dr. Miller: Well, it's painful, and what's even more concerning and more damaging, probably 10% to 20% developed what we call postherpetic neuralgia, which is a pain that continues after 90 days. And it's very severe and very hard to treat. Some people when they have postherpetic neuralgia can't even wear a shirt because it's painful.

Interviewer: Sounds miserable.

Dr. Miller: Treatments are not very good either. So the best you can do is prevent shingles.

Interviewer: And there is a shingles vaccine. And a lot of people have already gotten it, and now I'm hearing about a new shingles vaccine. So help me kind of reconcile if I should get it or not.

Dr. Miller: Well, that's right. So we say there's about a 30% lifetime chance that you'll develop shingles, and shingles rises in incidence after the age of 50, and by the time you're 80 years old, probably about 20% of people who develop shingles will have postherpetic neuralgia, which is this chronic pain that goes on and on and on.

If you vaccinate, it's basically waking up your immune system to watch out for that virus sneaking out of its hidden cave and coming back and bothering you. So the first vaccine was a live vaccine that was developed in the middle of the last decade. And it was pretty darn effective. But there's a new vaccine that is recommended even if you've had the older vaccine, that is not a live vaccine. And the advantage to that is we can now give this newer vaccine to patients who are immunocompromised. That is to say that their immune system is not quite up to par. It would have been dangerous to give them even a weakened live vaccine because they could develop full chicken pox. So we didn't we didn't give that older vaccine to folks who are immunocompromised.

Interviewer: So if you've been told you couldn't get the shingles vaccine before, now you can?

Dr. Miller: Now you can.

Interviewer: Okay.

Dr. Miller: If you have a history of being immunocompromised.

Interviewer: So that person for sure should get it. Who else should think about getting it?

Dr. Miller: Well, anyone who's over the age of 50 and certainly over the age of 60, the advantage to the newer vaccine is it is a more potent and efficacious vaccine. It works better than the older vaccine. So, in time it will become probably the sole vaccine available.

The issue with the newer vaccine is, one, it has more side effects. And two, it's costly and the older vaccine was costly, but this is a little more costly. So side effects, and what I mean by that is about 10% of the time people after getting the vaccine will develop a flu-like illness that's bad enough that they may not want to go to work.

Interviewer: So symptoms like chills, body aches . . .

Dr. Miller: Chills, aches, malaise, you just don't feel quite right. It lasts for 24 hours to 48 hours and then it's gone. This is not a reason to not get the vaccine. It's self-limited. It doesn't mean that it's going to go on. It was also a sign that this is a very immune genetic vaccine, that it is revving up the immune system and making the immune system remember that it has to go after the zoster or go after the shingles virus if it comes out of the nerves in the spine. And we know that this new vaccine is more effective in the sense that it lasts longer.

Interviewer: So if I got a shingles shot a couple years ago, and I'm 65, if I'm over 50, should I really consider turning around and getting this one?

Dr. Miller: The recommendation is to receive the new vaccination, even if you had Zostavax, the first vaccination, the live vaccination that was out.

Interviewer: At any point?

Dr. Miller: At any point.

Interviewer: Okay.

Dr. Miller: Well, I probably say, if you've had Zostavax, you would wait a year, maybe two or three years before getting the new one.

Interviewer: You can talk to your physician about that if that's the case, yeah.

Dr. Miller: You can talk to your physician. And then I think the second thing is some people assume that this particular vaccine is covered under Medicare. Certain vaccines are covered under visits during for people who have Medicare insurance, such as the flu shot and a couple of other vaccines, pneumococcal vaccine for instance. This one is not. It's covered under Part D. So you really need to find out from your insurance what the cost of this vaccine will be. The other slight disadvantage with the newer vaccine is it's a two-shot vaccine. You take the first shot and then come back in three months for the second shot.

The total course of therapy on average or treatment on average is about $340 if you were just to pay out of pocket, and for many people who don't have insurance, that's a big inhibitor. But since most of us over 65 will have Medicare and some coverage, it'll be cheaper. But again, check with your private insurance or check with Medicare to know what it's going to cost you so you don't get hit with sticker shock.

Interviewer: Yeah, and then take a look at I mean, it sounds like if it develops into the long-term chronic pain, not being able to put on a shirt, I mean, that sounds like it might be worth figuring out how you could come up with a little extra money if you're not able to.

Dr. Miller: Well, that's true. I think one of the problems that we see folks experience, they come in and they hear about it, and then they get the vaccine, but they experience the sticker shock. And either they decide not to get the vaccine or they wait.

And just as long as you know what the cost is, you can make an informed decision. And I certainly recommend it in all of my patients over the age of 50 and certainly over the age of 60.

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Interviewer: HPV virus vaccine, questions that are answered, that's next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Deanna Kepka from Huntsman Cancer Institute. This interview, we want to get to some of the common misconceptions that people might have about the HPV vaccination. Maybe some common reasons why they don't have their children get it in time when they should. But first of all, let's start with why should somebody get the HPV vaccination. Why is it important?

Deanna: Why should you have your children get the HPV vaccine? It is because we have a cancer prevention vaccine. But it's not that it prevents seven different types of cancers, it also prevents a lot of pre-cancers and hundreds of thousands of cases of genital warts each year in the United States.

Interviewer: But a lot of children aren't getting it. First of all, what are the CDC recommendations for when a child should get the vaccines by?

Deanna: Children should get the vaccine at ages 11 and 12. They should be received when they're receiving their other immunizations at the same time, which is the Tdap vaccine and the meningococcal vaccine. If they get the vaccine at ages 13 and older, it's considered a late immunization, but they can still receive the HP vaccine all the way up until their young adulthood years.

Interviewer: Okay. But it's recommended to get it at those earlier ages.

Deanna: Eleven and 12 or younger.

Interviewer: And don't just assume that it's going to be something that your physician's going to offer, because a lot of them just make it optional or don't even mention it.

Deanna: Exactly. That's one of our biggest barriers is that it's not presented strongly by primary care providers.

Interviewer: And since it's a cancer preventing vaccine, it should be.

Deanna: As a parent, you need to ask for it.

Interviewer: All right. So let's talk about some of the common misconceptions. And I think one of the main ones is that they're afraid that they give their boys or girls that are 11 or 12 a vaccine that prevents not only cancer but a sexually transmitted disease that now, all of the sudden, their kids are going to become more sexually active.

Deanna: Yeah and that is just not true. It's just a myth. And it's been disproven by a lot of research that's been shown that even if you vaccinate kids at a younger age with the HP vaccine and then you take others and you don't vaccinate them and you randomize the groups, the kids that received the vaccines aren't any more likely to engage in sexual activity at an earlier age than the ones who did receive the vaccine.

Interviewer: All right. And for a lot of parents, it seems to be some sort of an ego thing almost, like my child's not going to do that. That seems to be a big barrier. They have a hard time getting past that.

Deanna: Well, I mean, we give our kids . . . we have no problems giving our kids the Hepatitis B vaccine as babies, do we? And that's a sexually transmitted infection. I'm thinking that when you're talking about a sexually transmitted infection, your child is age 11 and 12, parents start to get really, I don't know, cold feet, a little queasy because puberty is right around the corner or right there. And I think that sense of anxiety around that time in their child's life just makes them turn off and shut down instead of thinking about this vaccine as a cancer prevention vaccine.

Interviewer: You did a much better job of putting it than I did. Thank you. So another one of the misconceptions is a lot of people think it's a new vaccine, so there's not a lot of history out there of side effects. That's not true either.

Deanna: It's been around for more than 10 years. We have hundreds of thousands, hundreds and hundreds of thousands of doses have been given in the United States. And the CDC does an excellent job collecting adverse responses to vaccinations in our country, reports of adverse responses, and this vaccine doesn't have any higher rates of adverse reactions than any other immunizations that we give our children in our country.

Interviewer: And then there's another misconception that it's just a girl's vaccination.

Deanna: And again, that's not true. There are a number of cancers that only affect boys or men. There's HV related penile cancer. HPV-related oropharyngeal cancer affects both girls and boys or men and women, because it does affect people when they're in their older years, 50s and 60s, but it has a higher incidence in men. Meaning that more man than women have HP oropharyngeal cancer than women. So when you give your son the HP vaccine, you're not only protecting transmission to women, but you're also protecting your son from HP-related cancers, including anal cancer, penile cancer, oropharyngeal cancer, and genital warts.

Interviewer: And there's also a really good reason to get it at a young age. Tell me about how that actually helps develop stronger protection.

Deanna: Right. Studies have shown that your immune system is stronger at those younger ages, 11 and 12. You're more likely to develop a stronger immune response, and we have data to prove it. And that's why we have the recent CDC recommendations out now where if you get the vaccine under age 15, good news parents, you only need to get two doses now because two doses is strong enough. If you get it at ages 15 and older, you need three doses.

Interviewer: All right. And here in Utah, there is some additional challenges for the HP vaccine. Explain what those are.

Deanna: I know, it's so sad to me because we have . . . I work at Huntsman Cancer Institute, we have this cancer prevention vaccine, and this has been my passion for the last 10 years, and when the data came out, way about a year ago, we were state number 49 for girls.

Interviewer: Not in a good way.

Deanna: Not in a good way. We had one state doing a little bit worse than us, and that's Wyoming, our neighbor. So I'm working with them too. And this means that we have less than half of our girls getting this HPV vaccine in the state of Utah. So we've a lot of room for improvement here.

Interviewer: Any final thoughts or anything that I forgot to mention when it comes to misconceptions of people have about the HP vaccination and why they should get it?

Deanna: I think we all need to think about friends and family members that we know who have struggled with cancer, who've fought against cancer, people that have lived with cancer, battled cancer, died from cancer. If you ask any of them if they could've prevented their cancer with the vaccine at ages 11 and 12, they would've said yes and gotten that vaccine. So please do that for your child.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: May 1, 2018
originally published: June 13, 2017

Dr. Gellner: No more flu mist means another shot for your child. How can you help your child prepare for this and other vaccines? I've got some advice today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: You've probably heard that the Centers for Disease Control and Prevention is dumping FluMist. I know, my kids are disappointed too. But a CDC advisory panel found that the spray is so ineffective at protecting from the flu that it shouldn't be used anymore. Vaccine experts aren't sure why the mist isn't working but none of that really matters to parents who are now wondering how to prepare their children to face the flu shot needle.

There's definitely a lot of hype when it comes to those dreaded shots. Needles strike fear into the hearts of many people, no matter how old they are. The most important thing a parent can do is to keep calm. If you're freaking out, your kids will follow suit.

Honesty is most important when it comes time to get any shot. Explain to your child that it may hurt for a second and tell them why the shot is important to protect them. Ask them to think about how strong their body is going to be, and how well the good immune systems cells will be able to fight the bad germs that this vaccine is protecting them against. Kids will be more receptive to shots if they understand why it's important for them to get them.

However, while honesty is key, don't give your child too much time to stew over the fact that a shot is coming. They may get more worked up, or they may be cool with a shot, it all depends on the child. And if they are going to be extremely anxious during the entire visit, I recommend telling them at the end of the visit. If they're older kids or kids that are not too afraid, then being honest with them before the appointment is best.

Once at the appointment, present a united front with the person who is giving the shot. Don't let your child cower, kick, or hide in your arms. That could end up hurting them more than the shot and may also result in an injury to the person giving the shot. Instead, help the person giving the shots put your child in the position that is the safest for administering shots, while still being there to comfort them.

Talk to your child while they're getting the shots. Make eye contact with them. Let them know you're right there and you'll give them the biggest hug when they're done because they've been so brave. I've sung to my boys when they were younger and had their kindergarten shots. That seemed to help.

Taking steps to help with the pain from shots can help as well. Give your child acetaminophen or ibuprofen but not until after the shot to reduce inflammation that may cause pain. We don't recommend giving anything beforehand anymore since some studies show that blocking the fever response may interfere with the immune system response.

With some shots, the pain, redness, and swelling may last for up to 24 hours. Pain may occur when medicine in the shot goes into the body and then again over the next few days as the body's immune system does its job building up antibodies. When all else fails, it may be time to make a deal with your child. One word: bribery. It goes a long way with kids. A special treat after the appointment for their bravery is always a hit.

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Interviewer: The quest for a better cancer vaccine. We'll talk about that 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. Mingnan Chen, Assistant Professor of Pharmaceutics and Pharmaceutical Chemistry at the University of Utah. And with his graduate student Peng Zhao, he's co-author of a new study on developing a vaccine system that could one day be used against cancers and other disorders. So vaccines against cancer, I think that's a concept that a lot of people are still trying to understand. Dr. Chen, can you explain what that is?

Dr. Chen: Yes. Our body actually has a well-fired system to protect us and immune system to protect us from cancer or various infections. However this system, by nature, is not strong enough. So we want to actually use the vaccine to boost these immune responses so we can use these immune responses against cancer. One step further we are here trying to develop the vaccine delivery and the adjuvant system, to further enhance the effectiveness of the vaccines. So then we can use it to prevent the cancer or to treat the cancer if someone gets cancer.

Interviewer: So how does the vaccine work? Is it different from, say, a flu vaccine?

Dr. Chen: Largely, it is the same as a flu vaccine. So if we know a group of people who may have a high risk of some type of cancer, like breast cancer, we can give this group of people breast cancer vaccines. So later on this vaccine will protect these people from developing breast cancer. Or we can use it as a treatment, say if a person develops breast cancer, we can use the vaccine together with surgery to treat breast cancer, to prevent the metastasis, or to prevent recurrence of breast cancer.

Interviewer: What is the vaccine made from?

Dr. Chen: The vaccine can be made from cancer cells, can be made with protein from the cancers, or from peptide from cancers. In our specific case we used peptide from cancers. This peptide will be presented by the cancer cells, sort of as the label for the cancer cells. We deliver this vaccine to our bodies so our immune system can recognize the cells with this kind of label.

Interviewer: So you're kind of teaching the immune cells how to attack that cancer?

Dr. Chen: Yes. Yes. We are teaching the immune cells. We are also using this vaccine to boost the immune cells that can attack this type of cancer cells.

Interviewer: Now obviously it's not so easy or else some of us would be getting these vaccines already. So what's kind of the tricky part in developing these vaccines?

Dr. Chen: The tricky part of the vaccine, first, is efficacy. The second is safety. The third is cost. So for the efficacy. Right now, the cancer vaccine, there's still quite a large number of clinical trials on the cancer vaccines.

However, right now there are only two of them that have been actually approved for clinical use. So we want to use this very unique vaccine delivery and adjuvant system to drastically boost the effectiveness of the cancer vaccine so it can actually show the effect in the clinics. On top of that, our vaccine delivery system also has advantage in terms of safety and in terms of preparation. So it could have a very low cost to produce this type of vaccine.

Interviewer: Some of your research is focusing on optimizing this delivery and adjuvant system. Peng, could you give me a basic idea of what that is?

Peng: The basis of the delivery system, we're using a nanoparticle based system to deliver the vaccine. Comparing to the flu vaccine, which usually are delivered by peptide, this nanoparticle delivery is actually preferred by immune cells. So the uptake is actually better.

Second, and more important, we can incorporate different abnormalities with the vaccine. In nanoparticle, just by one protein, one peptide. So it kind of addresses a problem other people cannot address. So when we are incorporating abnormalities there together, they work together to immediately show effect. Other people they have to mix it, which, generally speaking, is not that effective. That's the basis of our delivery system.

Interviewer: The nanoparticle, what does that do? Does it help stabilize the vaccine?

Peng: There are multiple views of it. So peptide is much smaller than a nanoparticle. So when we inject them they diffuse everywhere, so it's kind of like the efficiency of the immune cell to take the peptide is low. Immune cells are not designed to do that. Think about, immune cells naturally like particles like viruses, bacteria. So if you put peptides on some particle, artificial particle, it will help the immune cell to recognize them, and it gets them.

Interviewer: But it turns out you can get the particle to the immune cells, but that's only half the battle.

Peng: For a vaccine to work, after they are taken by the cells they need to be processed in order to be recognized before they are presented. So our particle actually has this responsive characteristic, which means when they are taken into the cell they can dissociate and they release the peptide for the cell to further present to other immune cells.

Dr. Chen: So we said that this system has a very good contrast of changeable stability. When we want them to be stable, they are very stable. And when we want them to become unstable, they become unstable.

Interviewer: Do you intend to take this to clinical trials?

Dr. Chen: Yes. Bringing a vaccine delivery system from benchside to bedside has been our goal from the very beginning of this project. When we set out to develop this vaccine delivery and adjuvant system about four years ago. One of the most important criteria that we had was that this system has to be biocompatible and immune compatible not only to mouse but also to human beings. So then we could actually test this system preclinically in animal models, which is very important, but also clinically in human beings.

Now that we have this system we are very excited about the idea that this system could benefit patients in the near future. We are working very hard to push this system forward so this system can be tested clinically. First we are testing this system in animal melanoma models. The results are very exciting and promising now because this system did enhance the anti-melanoma immune responses. Second, we are continuing to finesse this system so this system will have the capacity to overcome the multiple barriers that are facing cancer vaccines. So, hopefully we can bring up an even stronger delivery system so that this system will have a high likelihood to be successful in the clinic.

Lastly I want to mention that we have the intellectual properties for the system. We are looking for investments that can help us bring this system from our benchside to the hospital bedside.

Announcer: Interesting. Informative. And all in the name of better health. This is The Scope Health Sciences Radio.