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.

Parents will often come into well-child visits with their little ones and are shocked to learn that their child is due for shots, or they're pleasantly surprised to find out their child doesn't need any shots. So here are the basics on when kids are due for childhood immunizations.

This is the schedule from the Centers for Disease Control in conjunction with the Advisory Committee on Immunization Practices, which help set out the schedule based on a ton of research.

First, it's the hepatitis B vaccine, and that's normally given with the vitamin K shot at birth.

The next set of vaccines is given at 2, 4, and 6 months old. Now, this will seem like a lot of shots, but it's designed to give babies the maximum protection against bacterial and viral illnesses that hit infants and toddlers most and provide protection after they lose the natural immunity they got from their mothers through the placenta before birth.

At the 2-, 4-, and 6-month well-visits, they get three shots and they get one oral vaccine. The shots are Pediarix, which is a combination vaccine containing DTaP for diphtheria, tetanus, and whooping cough. It also contains hepatitis B and polio.

The second is Hib, for Haemophilus influenza type B, which can cause ear infections and meningitis, a bacterial infection of the lining of the brain and spinal cord, which can be fatal.

The third is Prevnar, and that protects against streptococcal pneumonia bacteria that cause ear infections, meningitis, pneumonia, and infections of the bloodstream.

The oral vaccine is called RotaTeq and protects against rotavirus, which is a nasty viral infection that causes vomiting and diarrhea severe enough to hospitalize babies due to dehydration. This is a virus that I saw a lot when I was in residency. The vaccine didn't come out until just after my oldest son was 4 months old. The first dose has to be given before 3 months old, so he didn't get it. I was pregnant with him when I caught rotavirus after being on the inpatient service and he got it at 5 months old. It was definitely not fun.

At 9 months, unless it's influenza season, babies get a break from shots, but they are still due for a well-visit.

The next well-visit is at 12 months. At that age, they get their fourth Prevnar, and then they have completed that series. They also get their first hepatitis A vaccine and they get vaccines to protect them from measles, mumps, rubella, and varicella, also known as chicken pox.

Then at 15 months, they get the DTaP and the Hib again, which completes the Hib series.

And at 18 months, they get the second hepatitis vaccine and complete that series.

Then we give kids a break again.

The next vaccines are what most parents call the kindergarten shots. We give them at age 4, but they can be given any time after age 4 and before the child starts kindergarten. The schools will need documentation that your child has had these when you register them.

The kindergarten shots are combination vaccines also, which is good because, again, it means fewer pokes for more protection.

The first is Kinrix, which is DTaP and polio. The second is called ProQuad, which is measles, mumps, rubella, and varicella. This finishes the polio, measles, mumps, rubella, and varicella series.

The next vaccines are given at 11, and many parents call these the junior high vaccines.

Now, let me clarify. There are current recommendations to start the HPV, human papillomavirus vaccine, at age 9. That is a new recommendation that is just now being put out. The HPV vaccine protects them from a virus that causes warts and cancer in the mouth, throat, and genitals. It's the one that causes cervical cancer in women, and one of the biggest causes of oral cancer in men.

The other junior high vaccines include the first dose of Tdap, which is the adult dose of tetanus, diphtheria, and whooping cough. The P stands for pertussis, which is whooping cough.

And people still need them every 10 years pretty much for the rest of their lives. This is the one that everyone asks about if they have a puncture wound. The whole "if you step on a rusty nail, you have to have this vaccine." Yeah, it's that one.

They also get one for meningitis groups A, C, W, and Y. There are several brand names for this vaccine. Menveo is the one we give at our clinic. This vaccine protects against the Neisseria meningitidis bacteria that causes meningitis. They get the second dose at 16.

There is an additional vaccine for meningitis group B that some teens need for college. It can be given from ages 16 to 23.

So those are the basic vaccines, the ones that are needed for school specifically. Of course, there are always other vaccines like for influenza and COVID.

Also, if you are traveling outside of the United States, there may be other vaccines you need to visit other parts of the world. For those, you would be best to check with the health department or a travel clinic of your local hospital, as your pediatrician would not have those vaccines at their office.

If you have any questions about any of these vaccines, please talk to your child's pediatrician.

You are pregnant and trying to do the right thing to keep yourself healthy and provide a safe place for your growing pregnancy. Is it time to get a COVID vaccine?

I have tragic memory of being part of a team that cared for a wonderful young woman who was pregnant and got influenza. Influenza isn't usually lethal to healthy young people, but it's dangerous in pregnancy. We knew this young woman. She worked in our unit, and she and her baby died of influenza. This was before my hospital required all employees to be vaccinated for the flu each year. Now we have over a decade of information about the influenza vaccine in pregnancy and safety, and we encourage every one of our patients to get the flu vaccine. It saves lives.

Now we have this other virus, COVID-19. COVID isn't new to us as humans. We've seen several other COVID viruses that were quite deadly in the past 20 years, but they didn't go that far and we see coronaviruses, the COVID family, make up some of the virus that caused the common cold. But COVID-19 is very contagious and causes severe illnesses and death all too frequently and lingering illnesses in many of those who weren't even really sick.

So when we first offered the COVID-19 vaccine, we had little information about COVID vaccine in pregnancy, but we had almost nine months of data on the COVID-19 virus infection and how it affected pregnant women. Here at the University of Utah, Dr. Torri Metz, a specialist in high-risk pregnancy, helped lead a national team to collect information about pregnant women who were infected with COVID-19. We talked with her, and she said it was sobering to see that young, healthy women who were pregnant had much more serious courses of the infection than women of the same age who weren't pregnant. They were more likely to get hospitalized, they were more likely to be admitted to the intensive care unit, they were more likely to be put on a ventilator, and if their oxygen levels became too low, they were more likely to lose their babies and sometimes they lost their lives.

But it took us another nine months to collect information about women who were pregnant and were vaccinated and compare outcomes to women who were pregnant and were not vaccinated. And the news is good and compelling about the safety of the COVID-19 vaccine in pregnancy.

So what is true? One, the Moderna and Pfizer vaccines had no adverse effects on fertility, pregnancy, and offspring in lab animals. Two, in 35,000 women who were pregnant and received the COVID-19 vaccine, headache, muscle aches, chills, and fever were less frequent in pregnant women than in non-pregnant patients. Three, injection site pain, where you got the shot, was more frequent in pregnant women, but it wasn't really all that bad. Four, the safety data following 4,000 pregnancies in women who were vaccinated showed no higher rates of miscarriage, no higher rates of preterm birth, no higher rate of newborn birth defects, or deaths compared to what we normally experience in pregnancy. I'm going to say that again. There were no higher rates of miscarriage, preterm births, or birth defects in women who were vaccinated compared to women who aren't vaccinated. Number five, women who are infected with COVID-19 have an increased risk of harmful abnormalities in the placenta. Women who are vaccinated don't have these harmful changes. Six, women who are vaccinated are five times less likely to get COVID-19 compared to pregnant women who are not vaccinated, one-fifth the rate of getting COVID compared to non-vaccinated pregnant women. Seven, women who are vaccinated give good antibodies to COVID-19 to their newborn babies. So there are seven true things.

What's not true? One, the COVID-19 vaccine causes infertility. It doesn't. Two, the Moderna and Pfizer vaccines have DNA in them and will alter the DNA of the fetus. Nope. These vaccines have mRNA in them, and these molecules are very short-lived and act mostly in the muscle around the shot. They don't change the DNA of the fetus or the mom. Three, the COVID vaccine has a microchip in it to track you. Really? I don't know where that ever came from, but it's one of the silliest of the vaccine myths.

Women who are pregnant are at high risk if they become infected with COVID-19. Pregnancy may lower women's immune responses, but the vaccine is still very protective against women developing complications from COVID-19.

With the information about the risks of COVID-19 infection to the pregnant mother and now the efficacy data from the vaccine outcome data collection and the safety information from more than thousands of women who were vaccinated while pregnant, the Centers for Disease Control and Prevention, the American College of Obstetrics and Gynecology, and the Society of Maternal-Fetal Medicine have strongly recommended that women who are considering pregnancy, trying to get pregnant, who are pregnant, or who are breastfeeding get vaccinated with the COVID-19 vaccine.

I think back to the day when I saw a young woman die of influenza and how much the flu vaccine is part of our counseling to pregnant women during flu season. So if it's flu season and you're pregnant or breastfeeding, don't forget to get your flu vaccine. And no matter what season it is, if you are pregnant, trying to get pregnant, or breastfeeding, please talk to your clinician and get vaccinated against COVID-19. And because no vaccine is perfect, please wear a mask that covers your nose and mouth when you're indoors in groups of people and practice social distancing if you're with people who aren't vaccinated.

And thanks for doing what you can to protect yourself, your baby, and those around you. And thanks for joining us on The Scope.

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.

Dr. Spivak: The vaccine looked 100% effective. There were 16 cases of COVID in those 2600 kids, all of them were in kids that got placebo, no infections in kids that got the vaccine. So it looks really safe and really effective, maybe even more effective than an adult.

Interviewer: How we know the COVID-19 vaccine is safe for kids and why your children should get it? Dr. Emily Spivak is an Associate Professor of Medicine in the Division of Infectious Diseases at University of Utah Health. So first of all, should kids get the COVID vaccine? I mean, I've heard that kids are a lot less likely to get sick from COVID-19. So is the vaccine necessary? And is that a true statement?

Dr. Spivak: That is a true statement. But I'd like to point out that they're not immune or completely protected from getting sick, right? There have been over 400 kids hospitalized in Utah since the pandemic hit from COVID-19, and I think around two or three have died. Nationally, over 300 children have died from COVID-19, and that's 50% higher than like our worst influenza year, deaths-wise in kids nationally. And then I'd also point out, we don't talk about whether you want to call it long COVID, long haulers, any sort of long-term side effects from other viruses, like influenza or other respiratory viruses. We don't see that like we do with COVID-19. And so, I think the long-term side effects that happens in children as well. And that should be a reason to get your kids vaccinated as well just protecting them from being hospitalized.

Interviewer: We hear that they don't transmit it as readily as adults, is that a true statement?

Dr. Spivak: I don't know that that is totally true. And a lot of that original data and understanding came in the setting of, you know, last spring, when we had shut schools down, kids were sheltered at home. And then, when we brought them back to school, in many places, it was with masks. And so, it's a little bit confounded understanding how well kids can transmit it.

I will say clearly, we are seeing an uptick in cases in younger populations so less than 18, people who are less likely to be vaccinated, relative to nationally cases going down overall and going down and over. . .going down in older populations that are vaccinated. So clearly, kids are susceptible. And I think if you ask most kids, they would tell you, "I would like to get vaccinated because then I can start seeing my friends. I can start doing sports. We can start riding in cars or doing things together without a mask. And I want to protect my friends, my grandparents, and the people around me." So, there's a lot of personal reasons for them to do it to not get sick. But also just to get back to the things that are fun for them and that they want to do.

Interviewer: So we've got the why. There's a couple good why reasons. What about the safety aspect? So I mean, there's some skepticism from some individuals if it's safe for adults. So is it safe for kids? Is it more risky for kids? What do we know about that?

Dr. Spivak: It looks safe. And I will say just talking about this vaccine in general, we have. . .so almost over 275 million doses have been given of COVID vaccines in the United States. Again, all. . .most of that is to adults. But I would just point out, we have, you know, the most intensive safety monitoring in U.S. history for this vaccine compared to any other vaccine that we have given. So there's been new safety monitoring systems in additions to the ones that existed that have been deployed, essentially, to monitor COVID-19 vaccine safety.

These vaccines look incredibly safe. And we have much longer-term data right with adults since we've been doing this since about December in adults. But the data that exists looks also like these are quite safe in children. Same side effects, right, 80% are going to have some arm soreness after the injection and about 20% to 30% will have this flu-like symptoms fever, myalgias, headaches, you know, muscle pain after the second dose. And that is. . .that's just your body showing you that the vaccine is working and your immune system is responding. But there do not seem to be any serious side effects.

Interviewer: And you have children yourself. When it comes to the question of getting your children vaccinated when it's time, because right now 12. . .as of the recording of this, children 12 and older can get vaccinated. It is not been approved for any younger. What are you going to do with your decision-making process?

Dr. Spivak: I'll be honest with you, I have three girls ages nine, almost seven, and three, but I will get my kids the vaccine as soon as it's available for them. I don't have any concerns.

Interviewer: So there have been some side effects with adults and some negative outcomes, the blood clotting, for example, is one. As a parent, does that worry you that that could happen to your child? I mean, that would be scary, right?

Dr. Spivak: It would be scary, but I'm not worried. So the blood clotting there's no signal to blood. . .to my knowledge for blood clotting with the mRNA vaccine, so with Pfizer or Moderna. And currently what we're talking about with adolescents is the Pfizer vaccine is approved. We expect the Moderna trial to be finished in 12 to 15, 16-year-olds and that one to be approved in the very near future. The blood clots are with the adenovirus vector vaccines specifically in the U.S., the Johnson and Johnson vaccine that has been licensed. So that vaccine is not really in the pool and available for adolescents. So, you know, again, the overall risk really is lower than getting COVID, depending on how much is in the community and also of these long-term side effects from COVID. So we're still talking minuscule risk.

Interviewer: Give me your two-sentence summary about for a parent that's hesitant to get the vaccine for their children, you know, maybe they would get it for themselves, but not their kids. What can we say to make parents feel better about the decision to get their children vaccinated?

Dr. Spivak: These concerns exists in parents who ran to get the vaccine for themselves, but they're still concerned about the safety, I think is the main thing for their kids balancing that with, we hear kids don't really get that sick. So if I'm unsure about safety, does my kid really need to get it?

Interviewer: Yeah, that risk-benefit kind of question that you as a physician face all the time.

Dr. Spivak: Yeah. There is a lot of data in adults showing that these vaccines are highly effective and safe. Again, probably more data than any other vaccine in U.S. history. The risks of getting COVID and severe consequences maybe not death, but this multi-system inflammatory syndrome MIS-C or sort of long haulers or long COVID is real in kids. And then, also just even the more proximal goal of getting your kids comfortably back socializing, playing, camp, sports with their friends. And I think if you asked your kids as sort of what they want to do, they would probably. . .many of them say, "I'd like to do this for myself, but do it for my friends and do it for my teachers and other people as well."

Interviewer: And if somebody wants more information beyond what we talked about, what's a good reliable source for them to go to?

Dr. Spivak: I'd say coronavirus.utah.gov. The state website also cdc.gov. If you Google cdc.gov... CDC COVID vaccine, there's a lot of frequently asked questions, fact sheets in there, that's a good resource as well.

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.

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.

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: 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.

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.

Interviewer: How many times have you heard from somebody, "You know, the only time I ever got the flu was the year I got the flu shot." Well, it's actually impossible, but what might be happening that would cause somebody to think that? We'll explore that next 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.

Interviewer: Dr. Susan Terry is Executive Medical Director for the Community Clinics at University of Utah, and for the person that says that the only time that I got the flu was the year I got the flu shot, and that's their excuse for not getting the flu shot ever again. What would you say to that? First of all, is it possible to get the flu from the flu shot?

Dr. Terry: No. It's really not possible to get the flu from the flu shot.

Interviewer: All right. And why is that?

Dr. Terry: Because the virus that's in the flu shot is inactivated, and it's only there to help your body promote immunity. It's not really there to, in any way, make you sick.

Interviewer: So the fact that it's deactivated 100%, you cannot get the flu from the flu shot.

Dr. Terry: Correct.

Interviewer: All right. But yet there are some people that still say, "I got the flu shot and that was the year I got the flu." What might be going on there? Let's talk about the four possible reasons. Number one.

Dr. Terry: Sure. We know that it takes at least two weeks to become immune to the flu after you have your vaccination. So, you could pick up a virus in the meantime and come down with the flu.

Interviewer: All right. So you've got that two-week period there where you're kind of vulnerable.

Dr. Terry: Correct.

Interviewer: All right. The reason that somebody says that they got the flu after they got their flu shot number two.

Dr. Terry: We know that this time of year and any parent of school-age child will tell you, there are a lot of infections going around. We have the kids back in school. They're all together, and viruses of other kinds can spread like wildfire. And then, of course, they come home. So, you might feel really bad, and feel like you have the flu, but the likelihood that it is actually true influenza for which you have been vaccinated is pretty low.

Interviewer: So it's likely something else and you just you need to say it's the flu to feel better about the whole deal.

Dr. Terry: Right.

Interviewer: Okay. All right, reason why somebody might say they got the flu from the flu shot, number three.

Dr. Terry: You could be exposed to a flu virus that's not included in seasonal flu. We try to get as close as we can to what we expect to see in the influenza season, and it is a scientific process that's done, but we aren't always 100%.

Interviewer: So it's possible the flu you got was not accounted for in the shot.

Dr. Terry: Correct.

Interviewer: All right. And the reason somebody might think that they got the flu from the flu shot number four.

Dr. Terry: This is actually a little bit later on in the course in that some people just get infected with the flu virus after having a flu vaccine. Now, it is most likely to be the most protective for older children and younger healthy adults, but there are still people who have other types of illnesses or younger kids or older adults with chronic disease who, even though they are vaccinated and develop some immune response to the flu, can still come down with influenza.

Interviewer: And still can come down with one of the flu strains that they were... It's about 70% effective if I understand correctly.

Dr. Terry: That's right.

Interviewer: Yeah. All right. So, we've gone ahead and established that you cannot get the flu from the flu shot. People still deny that. Hopefully, we've given them some reasons why they might think that they got the flu from the flu shot, but bottom line is...

Dr. Terry: You won't get the flu from the flu shot. So, we strongly recommend that everyone over the age of six months gets a flu shot.

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Interviewer: Dr. Terry, why is it that some people seem to be so freaked out about flu vaccines? It seems like there is a movement. Is it a small movement, a large movement? I don't know. They think there is a conspiracy theory or we shouldn't get them, or something of that nature. What is going on with that?

Dr. Terry: Well, my personal opinion is that most of those people are afraid of shots.

Interviewer: They'll do anything.

Dr. Terry: They will use any excuse not to get stuck with a needle. The flu vaccine is given with tiny, tiny little needle. You can barely feel it when it goes in. It's not really a good reason not to get a flu shot. I think there are many people who have been conditioned through their lives to avoid needles. There are some people who have religious objections and, of course, we want to be respectful of that. But we now have evidence that for people who are allergic to eggs, whom we've always said they shouldn't get an egg based vaccine, we're finding there are ways to help them get through that and be able to get a flu vaccine.

Interviewer: I probably did one of the worst things I could possibly do. I went on the internet.

Dr. Terry: Oh, no.

Interviewer: Yeah, and I did a little reading on the flu vaccine and there are some people out there that talk about all the other bad things that are in them. Could you elaborate on what they seem to be concerned about?

Dr. Terry: They're probably concerned about some of the things that we use as a base, for example, for the flu vaccine, preservatives that are placed in the flu vaccine. But because there has been over the years such an uproar over the danger of the flu vaccine, all those things have been studied and been found to be really benign and safe and really not the issue.

Interviewer: So the medical community is not trying to hide anything from anybody.

Dr. Terry: No, not at all, not at all.

Interviewer: And you would have no problem getting a flu shot yourself.

Dr. Terry: I already had mine this year.

Interviewer: Or giving it to your kids.

Dr. Terry: My husband has had his and I hope the grown up kids have had theirs.

Interviewer: So I should rest at ease is what you're telling me.

Dr. Terry: Yes, rest at ease right after you get your flu shot.

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