Dr Mouzoon - Hot Shots!

BLOG HAS MOVED

2010-03-16T15:32:00.000-07:00

Thanks for stopping by! Dr. Mouzoon is still blogging, but she's using a different site. Visit her new blog here.

More Invisible Success?

2010-03-15T14:54:00.000-07:00

It is now March, and the annual seasonal flu epidemic has not yet materialized. I’m wondering if this is more evidence of vaccine success, but the evidence won’t be out for awhile. Flu epidemics have hit as late as May in some years.

Last August, the country was in the midst of the H1N1 pandemic. Although the H1N1 vaccine wasn’t out, the seasonal vaccine was available early – and the concern over H1N1 led many people to get the seasonal vaccine who otherwise might not have.

Our clinic, Kelsey-Seybold, and many other health organizations actually ran out of vaccine, unusual in a year when the supply is good. Although this vaccine could not protect against H1N1, it seems clear to me that we are seeing the benefit now of the high rates of immunization.

Lest anyone tell you we didn’t really have a pandemic, The Centers for Disease Control and Prevention (CDC) is estimating that around 57 million individuals in the United States have had the H1N1 infection since April 2009.

With our population currently at around 300 million, that means that almost one in five individuals has been ill with H1N1 flu. Seasonal influenza usually strikes around 1 in 10 individuals.

Fortunately, there have been only around 11,700 deaths from the pandemic in the U.S.; and 257,000 hospitalizations. In comparison, the usual seasonal flu causes only about 200,000 hospitalizations with 36,000 deaths.

Most seasonal influenza hospitalizations and deaths are in those over age 65 – about 60 percent of the hospitalizations and 90 percent of the deaths. Since those over 65 have some natural immunity to H1N1, 90 percent of the hospitalizations and 87 percent of the deaths have been in younger individuals, including twice as many confirmed deaths in those under age 18 as in a usual year.

Younger individuals have better health, in general, and are more likely to recover from even serious infections than older individuals.

Travel Smart: Get Vaccinated Before Going Abroad

2010-03-02T09:48:00.000-08:00

People are traveling more and more these days – and much farther than ever in the past. Our parents were lucky to go to Europe once in a lifetime, and most spent their lives in the same city or state they were born in.

Increasingly, people are traveling for work or for pleasure to faraway places. Many of these travelers have exciting itineraries that include rainforests and savannahs as well as urban locales.

Most people who are relocating or traveling abroad only think of getting immunizations if they are going somewhere “underdeveloped” or to the “tropics.” That is unfortunate, because there are many “developed” nations and regions where the risk of vaccine-preventable disease is higher than in the United States.

Pertussis, or whooping cough, is common in Eastern Europe and Russia, where they have also had diphtheria outbreaks in recent years. Measles is in constant circulation in Britain, Israel and many other parts of Europe, where it once was eradicated due to vaccine refusal.

Travelers should have updated tetanus boosters, which now contain not only diphtheria but also pertussis. Individuals born after 1957 should have two doses of measles-containing vaccine before traveling anywhere in the world.

Travelers to many countries, such as Mexico, South America and India commonly need hepatitis A, hepatitis B and typhoid vaccines.

A particular group of travelers who don’t think to check if immunizations are needed are those born abroad who plan to visit friends and relatives in their home country. These individuals have often lost some of the immunity to common illnesses they acquired during childhood, and can become quite ill because they generally aren’t as careful with mosquito and food precautions.

It is true that certain tropical destinations require unusual vaccines. Meningitis vaccine is recommended for pilgrims on Haj, as well as travelers to the middle part of Africa – the “meningitis belt” – in certain seasons.

Japanese encephalitis vaccine may be needed for long stays in Asia, especially to rural areas. Yellow fever vaccine is necessary for much of Africa and South America, either due to risk of illness or as a requirement for entry. Yellow fever vaccine is available only at approved travel medicine clinics.

It is a good idea to schedule an appointment to discuss your itinerary with a travel medicine nurse so that you can receive not only vaccines, but also advice about food and water precautions, mosquito avoidance, and other safety issues. Traffic accidents and sexually transmitted infections are other hazards of international travel to be wary of.

Travelers over the age of 60 should carefully consider modifying their travel itinerary if it includes areas where yellow fever is common. Although yellow fever vaccine is safe and effective for most individuals, recent evidence suggests that the vaccine may have severe side effects in older individuals, particularly if they have never received it before and are over 70.

Stay healthy on your trip of a lifetime – take the time to prepare for it by getting immunized as well as advised! A good Web site for more information is the CDC.

Schedule an appointment with Kelsey Seybold Clinic's Travel Medicine Department to get vaccinated before your trip. Call 713-442-TRIP.

Immunization: An Army Against Germs

2010-02-19T09:28:00.000-08:00

What is a vaccine, anyway? How is it different from other medicines, and how is it different from being exposed to an illness and becoming immune “naturally?”

The germs that infect us, in general, have a surface coat of proteins that have distinctive characteristics which make them look different to our immune system than our own cell surfaces. These distinctive proteins are called antigens.

Like a fortress, our immune system is designed to recognize the invading antigens and remove them from our bodies. The way our bodies mark foreign antigens is with a protein our blood cells make. These are called antibodies.

Antibodies can take many days to produce in the early stages of an infection - unless we have had exposure to the antigen before. If we have been exposed before, our body can make antibodies within hours.

Once the antibody recognizes the foreign invading antigens, the rest of the immune system kicks into action, killing the invading germ with specialized white cells and our liver and spleen filters it from our system.

Like in grade school, it’s as if our cells are all in uniform. When outsiders come in out of uniform, we have hall monitors that can learn to recognize them and send them to the office. Once our body has recognized a germ, future attacks are responded to more quickly, often preventing an infection altogether.

Medications usually have a specific action: imitating a hormone, killing a germ or blocking a symptom. Vaccines are designed to imitate infection. Most are copies of the germ’s protein coat – its antigens – which can be derived from the infecting germ or produced in labs by other means.

Many vaccines these days are purified antigens without the rest of the germ components – not DNA or cellular parts. Some are weakened live versions of the germ, which are only able to cause mild symptoms, but generate strong immunity.

Live vaccines tend to produce immunity not only in the bloodstream, but also “mucosal immunity” in our gut or nasal passages, fending off infection where it usually enters the body.

Finally, a few vaccines are made from killed germs, or from the toxins they produce, and obviously can’t cause infection, but have more types of proteins in them than the purified antigens made in a lab.

The advantage of vaccines is that your body develops immunity naturally, but without serious illness. Antibodies are made to the small amount of vaccine given – whether by shot, by mouth, or by nasal spray – and our bodies remember how to make that particular antibody for years to come.

When we are exposed to the real deal, we produce those antibodies in large quantities, and fight off the infection much more quickly than if we had never been immunized.

Instead of needing medicine to fight the symptoms or kill the invaders after they have already established themselves in our bodies, we are able to protect ourselves before we even know we’ve been attacked. We currently have vaccines that not only prevent infection, but also help prevent selected cancers.

The good news is that technology is advancing rapidly, and vaccines are safer and more effective than ever before. Vaccines take full advantage of our body’s natural defenses. Getting immunized is one of the best things you can do for your health, and the health of your family.

The Invisible Success of the H1N1 Vaccination Efforts

2010-01-29T07:42:00.000-08:00

Sometimes, success is invisible. Everyone is in favor of prevention of disease and death – as the old saying goes, an ounce of prevention is worth a pound of cure. For most of the things we prevent, we can see the benefit. Seatbelts and child safety seats prevent death from car accidents much of the time - and we can see how smashed up the cars are and believe in the belts and safety seats when we hear that someone survived the crash.

Immunizations are different. No one sees the microbes all around us. When immunizations work, no one gets sick. Their success is invisible to us. We don’t even know if we’ve been attacked! The only way to measure success is to compare to historical information.

The Rotavirus vaccine is a great example. Rotavirus hospitalizations for diarrhea and dehydration have reduced dramatically since the introduction of the vaccine. The reductions in the first year included toddlers and older children who didn’t even get the vaccine because the infant siblings and daycare friends who were vaccinated weren’t spreading the illness (it is very contagious).

The absolute number of stool tests ordered by physicians declined from the pre-vaccine era, as fewer children were ill, and the absolute number of positive tests decreased from 48 to 72 percent in different regions of the country. Rotavirus season itself started later, peaked lower and ended sooner than in the previous decade. Did parents whose children did not get ill even notice? Most likely not.

Now I am hearing grumblings about H1N1 influenza and the vaccine program to combat it – was the pandemic overestimated? Did we really need to spend money to get the vaccine out there? Should everyone still get vaccinated? Was it all a scam?

The numbers of deaths and hospitalizations from H1N1 have been lower than was anticipated, and while the illness peaked in April, and again from August through October, things have quieted down for now.

This is the first pandemic in history for which we’ve had an effective vaccine out and available so quickly after the influenza virus began to infect large numbers of individuals. It is very likely that vaccination efforts to date have greatly modified the scope of the pandemic.

As with Rotavirus vaccine, H1N1 vaccine is doing its job. It’s decreasing the number and severity of cases, and thereby decreasing the number of people who are contagious and can spread it.

We won’t ever know who would have become ill without the vaccine… all we can do is compare to historical information. It is foolish to look at the result of this immunization effort and think that the threat was overblown.

It is clear to me that the limited severity of the H1N1 pandemic so far is a measure of vaccination’s success.

Protect Your Baby and Get Vaccinated

2010-01-22T09:25:00.001-08:00

Are you welcoming a newborn into your home? Perhaps you have a new grandchild, or are adopting a child from overseas? Babies bring so much joy into our lives, and so much responsibility! Because babies are vulnerable, and because they are newcomers to our homes, we adults need to take special precautions to protect them.

In addition to thinking about safe bedding, breastfeeding and finding the best pediatrician, family members need to think about preventing illness in themselves, so that they don’t give those illnesses to their new baby.

During the H1N1 pandemic, we all heard about the importance of getting flu vaccines for infants six months and older, and for the family members of those younger than six months who can’t be immunized. This applies to both seasonal influenza vaccine and the H1N1 vaccine. Most moms-to-be will be immunized while pregnant, but dads, siblings and grandparents – as well as other caregivers and other household members – need to be immunized too!

In addition, it is very important that everyone at home over the age of 10 get a Tdap booster, if they haven’t had one. This version of the tetanus booster came out in 2006, so if you had a tetanus booster since then, you’ve likely had Tdap.

Tetanus boosters (Td) now have pertussis (the “ap” in Tdap) vaccine added to them because pertussis, or whooping cough, is common among adults and teens, and infants are usually infected by a family member – most often mom or dad. Whooping cough is often fatal in infants under 6 months old and almost always requires hospitalization. Even in adults, it is not a mild illness – the Chinese name for it means “the 100-day cough.”

Finally, if the infant you are welcoming into your home is a foreign adoptee, be sure that everyone at home has been immunized for hepatitis A and for hepatitis B. Even adoptees who have tested negative for these viruses have sometimes later been shown to carry them, and you need to protect other household members from the possibility of becoming infected with these serious illnesses. Unfortunately, they are quite common in other parts of the world, though easily prevented with vaccines.

Congratulations on your new arrival, and getting off to a healthy start!

Get the Shot, Not the Flu

2010-01-08T08:03:00.000-08:00

It’s been awhile since my last post. I’ve been ill with a cold, followed by a sinus infection, followed by the usual side-effects of antibiotic that all women know about. Even with extra rest over Christmas and New Year’s, it has dragged on. I’m on day 14 of my overall illness, and finally almost well. It really is too bad that there are no immunizations for colds – I would be first in line!

I really have nothing to complain about. I felt feverish, but had no fever; runny nose and sore throat, but no tonsillitis or epiglotitis; sinus infection and cough, but no pneumonia, sepsis or meningitis.

This wasn’t the flu. There were no body aches, irritated eyes, or prostration. Even so, were there a choice between prevention or cure, a preventative vaccine would win hands down!

The risks, serious and non-serious, of side effects from any and all of our current vaccines are less than the risks, serious and non-serious, from any of our current antibiotics.

This experience has left me pondering even more about why many people have refused the H1N1 vaccine. Millions of doses have now been given, and the side effects and adverse events reported are no more or less than those for the seasonal vaccine – which is to say, a sore arm but rarely anything else.

The H1N1 virus isn’t causing much illness in Texas at present, but will likely circulate for several years. While it will be included in next year’s seasonal vaccine, waiting until next fall to be vaccinated will keep you at risk longer.

Seasonal flu vaccine is now back in stock, so if you missed your first chance to get it, now would be a good time. It is likely that we will have more influenza circulating this winter – sometimes influenza season hits as late as March!

Pneumococcal vaccine is a great idea for anyone with asthma, chronic illness, immune suppression from drugs or illness or overuse of alcohol, or those over age 65, and it can prevent not only pneumonia, but bacterial bloodstream infections and sinus infections from the types of pneumonia germs it covers. It is safe and reasonable to get the pneumococcal vaccine along with your H1N1 and seasonal flu vaccine.

Staying up to date with your immunizations is a great resolution for the New Year, and will help to keep you healthy to enjoy the new decade!

Vaccination Recommendations: Where We Are Now

2009-12-02T14:51:00.000-08:00

Now that the H1N1 pandemic seems to have peaked, and Texas no longer has widespread illness, what is the current recommendation about vaccination?

Vaccine supplies for H1N1 are finally adequate to meet the needs of the priority groups, and vaccination is now being offered to individuals at less risk. But is it still necessary?

Visualize, if you will, the plot of number of illnesses per week. The number starts at zero, and steadily climbs well above the usual number of influenza-like illnesses for a typical season.

Even now, when we are in the beginning of the downturn of the number of cases, there are still more cases than in a typical flu season. In fact, because we are barely past the peak, about half of those who will become ill from this virus haven’t become ill yet – the downslope covers as much territory, in general, as the upslope.

In previous pandemics, spring outbreaks were followed by bigger outbreaks in the fall (as occurred this year) and again by renewed activity in mid-winter and the following fall.
Immunizations were not widely available for prior pandemics, so it is possible that if we do a really good job getting the population immunized, we might be able to prevent history from repeating itself.

It is also important to remember that the reason a flu virus causes a pandemic because most of the population is susceptible, and the virus doesn’t really stop circulating until nearly everyone has caught it or been immunized. This process will take longer, and more people will become ill, if we stop vaccinating against H1N1 now.

While you are in getting your H1N1 vaccine, get a seasonal influenza vaccine as well if you haven’t already done so. Seasonal influenza illness is likely to ramp up following the winter holidays.

Individuals with chronic illnesses, such as diabetes, asthma, COPD and heart disease who haven’t had the pneumococcal vaccine should take the opportunity to get that as well. Pneumococcal pneumonia often attacks influenza victims just as they start to recover and can also lead to hospitalization and death.

Get the Facts About H1N1 Vaccine

2009-11-09T13:39:00.001-08:00

Concerns about the safety of H1N1 vaccines, especially the FluMist version, are hindering efforts to vaccinate vulnerable members of our community. I’m worried that fear of the vaccine will keep people from getting protected.

A common worry is that the vaccines were “produced too quickly” or weren’t tested thoroughly. In reality, both the injectable and nasal forms of the vaccine were produced in exactly the same way as the seasonal vaccine, using the same techniques and safeguards. The H1N1 vaccine was licensed in the same manner as the seasonal vaccine. In fact, additional studies not usually needed for seasonal vaccine were performed.

Since this new strain of influenza is not closely related to recent seasonal strains, there were concerns that more than one dose might be needed, and because large supplies were needed quickly, lower doses and doses with “adjuvants” – inert compounds added to improve immune response - were tested to see if they were effective.

It was determined that adjuvants work well, but they weren’t added to vaccines in the U.S. Two doses are needed for children under age 10, but not for adults. In those trials, and among people immunized so far, there have been no unusual or unexpected reactions.

Nearly every year, influenza vaccines contain new strains to keep up with the tendency of the virus to change its surface proteins, or “drift.” This year’s seasonal vaccine, in fact, contains new strains for all three of the influenza viruses it contains.

The bottom line – H1N1 vaccines represent a “strain change,” not a new or experimental vaccine, and are as safe and effective as the seasonal vaccine.

FluMist, the “live” version of the influenza vaccine, consists of a weakened, cold-adapted virus. This means that the virus has lost its ability to live in the warmth of the human body, and can only replicate or infect the nasal passages – where the temperature is much cooler. No instances of transmission of this virus from one person to another have been documented in the United States.

While it can cause a bit of a runny nose or sore throat for a few days, and even a mild fever in a few individuals, it cannot cause influenza because it can’t live in the warmth of your body. This vaccine has the advantage over the shot of inducing immunity where the infection starts – in your nose, as well as in your bloodstream.

It is not offered to individuals with chronic illness simply because they might experience a flare-up of their asthma or diabetes, or respond with less protection or more side effects to the immunization compared to a shot, if their immune system is compromised.

H1N1 injectable vaccine is in short supply in Texas and is the only vaccine that can be given to most of the people at highest risk from H1N1 influenza – pregnant women, children 6 months to 2 years, and those over age 2 through age 24 who have chronic illnesses.

Family members of infants younger than 6 months old who are healthy and less than 50 years old and children age 2-5 without asthma or other health problems should be vaccinated with FluMist vaccine so that the injectable vaccine can be utilized for individuals who have chronic illnesses or are out of the age range for the mist.

Either way, the time to be immunized for H1N1 is now!

The Vaccine Confusion

2009-10-23T13:08:00.001-07:00

Confused about flu vaccine and what you should do? You are not alone. My head is spinning!

Not only are there two different types of flu vaccine, seasonal and H1N1, but there are two different forms of vaccine, live (nasal) and killed (injection). On top of that, there are injections in multi-dose vials, with the preservative thimerosal, and those in single dose syringes, without it. Plus, the single dose syringes come in two strengths, one for infants 6 months through 35 months, and one for children age 3 through adulthood.

Injectable vaccines from different manufacturers have different age ranges for which they are approved, all of which are different age ranges than the age groups that can get nasal vaccine. Nasal vaccine is also free of preservatives, but isn’t used for pregnant women or infants – the populations which most often demand preservative-free vaccine (even though thimerosal has been shown to be safe in pregnancy and for infants.)

Seasonal and H1N1 vaccines are also both in short supply now, so getting them may also be a matter of whether you are in one of the high risk categories, at least until the supply improves. To really confuse things further, the high risk categories for the two vaccines aren’t the same!

We have limited supplies of vaccine for seasonal influenza in nasal form for healthy folks ages two through 49 and even less injectable vaccine for those with chronic diseases over age 50, or 6 months to 18 years.

We also have some H1N1 vaccine in nasal form. The high-risk groups that can also get the nasal form are health care workers, household members of babies under 6 months old, and children age 2 through 4. The limited H1N1 vaccine shots we have received are already allocated for the pregnant women we care for, though we won’t have enough for all of them, either.

We are working hard to direct vaccines to those who need it most and as soon as possible once we receive it. We will continue to update the information on our Web site as we receive more vaccine and, of course, appreciate your patience!

The Flu & You

2009-10-19T06:52:00.000-07:00

The Scoop on the H1N1 Vaccine

2009-10-14T15:02:00.000-07:00

Some H1N1 nasal flu vaccine has finally arrived at Kelsey-Seybold Clinic, as well as other immunization providers around town. This is the live virus version of the vaccine, which is great for healthy folks ages two up to 50, but not useful for those at highest risk from H1N1 – pregnant women, children under age two and those over age two who have chronic health conditions such as asthma, diabetes, COPD and immune suppression.

As the injectable vaccine becomes available in the upcoming weeks, it will be provided to pregnant women and children six months up to their 5th birthday, as well as to older, at-risk individuals with chronic illnesses. Once there is plenty of vaccine available, youth ages 5-24 will be a top priority to be vaccinated, with older individuals being offered the vaccine soon thereafter.

The good news for those over age 65 is that you already have a 50% chance of being immune to this virus – but if you do get sick, seek treatment with antiviral medications early in your illness. H1N1 flu is just as capable of putting you in the hospital as seasonal flu. Also be sure to let your doctor know if you aren’t getting better in a few days, as bacterial infections like pneumonia commonly follow any flu infection in older adults, especially those with chronic illnesses.

Flu Shot Myths

2009-10-02T14:27:00.001-07:00

It is incredible to me how many myths surround the flu shot. People have a real fear of shots in general. Health care workers are no exception. This month, I have been spending a lot of time talking to nurses and physicians who worry that they can get sick from the flu shot.

This fear is really quite understandable. Those of us who work in health care have a lot of experience not just in treating and preventing illnesses, but in catching them! Just like kids starting daycare or school catch many colds and stomach viruses in their first few years, physicians and nurses catch many infections when they start their clinical rotations or go into practice, even if they are meticulous about washing their hands. For many of them, the first time they ever received a flu vaccine was prior to those first patient contacts. Every fall when kids are going back to school congregating and sharing their germs, we get our annual influenza vaccine. At the same time, the office starts to see more with strep throat and a variety of viruses, including influenza. Often, we health care workers catch something. The close timing of vaccination with illness makes us blame that vaccine.

Coincidence is not proof of cause. However, I remember seeing a graph of two identical rising lines: one, the cases of measles in Greenland in the 50s and the other refrigerator sales in those same years, also in Greenland. Do refrigerators cause measles? No, but the shipping traffic to Greenland increased with sailors incubating measles arriving along with new refrigerators! Anyone can catch an illness in the doctor’s office the same day they get a vaccine, leading them to blame the vaccine. This year, it is particularly likely that you will get the flu around the time you get your flu shot. We’re vaccinating now for seasonal strains, but novel H1N1 (swine) flu is already widespread. When the H1N1 vaccine comes out, it will just about be time for the seasonal strains to start circulating. Talk about poor timing!

Can the flu vaccine cause the flu? No, that’s just a myth. Flu vaccine is made from dead virus, meaning it’s incapable of giving you the flu. You might get a sore arm, or a local reaction with some low-grade fever, but you won’t get billions of baby viruses throughout your system! Even the nasal flu vaccine, which is live and whole, is modified so it won’t cause the flu. It is “cold-adapted,” so that it can infect your nose, but dies in the heat of lungs and body, so the infections stop at the nose. Understandably, you can get a runny nose and mild sore throat, but nothing approaching the flu.

With four strains of influenza likely to circulate this year, it is well worth taking both seasonal flu vaccine and the H1N1 vaccine when it is offered. Even if you think you “got the flu” after a vaccine in the past, the risk of getting the flu this year is much higher if you don’t choose to vaccinate!

Who needs the flu vaccine?

2009-09-23T11:37:00.000-07:00

Are you due for the flu vaccine? Many folks believe that getting an influenza vaccine is not a priority for them because they consider themselves healthy and at low risk. It used to be that this vaccine was recommended mostly for those ages 65 and up or younger individuals with serious chronic illness.

In recent years, the recommended groups to receive the influenza vaccine have dramatically changed. Currently, over 80 percent of the US population is recommended to be vaccinated annually. Even individuals who are not themselves at risk often live with those who are and can help protect them by getting immunized.

So, who is at high risk of severe complications from influenza? Infants and children under the age of 5, especially those under two, are at just as high of a risk of being hospitalized as those over age 65 along with pregnant women and they should be immunized. Unfortunately, flu shots and nasal vaccine are not approved for infants under 6 months, so it is especially important to immunize family members when a young infant is at home. Daycare providers need immunization as well. Adults over age 65 are at the highest risk of death from influenza, so they and their household members need to be vaccinated.

Adults ages 50-65 usually have one or more chronic health conditions that put them at risk of complications from the flu. Asthma, diabetes, COPD, heart disease, immune system problems from medications or illness, neuromuscular problems that interfere with coughing or breathing and kidney or liver diseases are all considered chronic health conditions, even if the disease is in control. Unfortunately, we still do a poor job of vaccinating chronically ill individuals less than age 50 – only about a third get the shot. Again, household members of these folks should also be immunized.

Children in school are among the first to catch and spread influenza in a community. The close quarters at school, the large number of schoolmates each child is in contact with daily and the tendency of kids to share drinks and not wash their hands or cover their coughs all contribute to the rapid spread of germs, and heightens the chance of the child bringing the flu home. In Japan, the universal immunization of school children against the flu dramatically reduced the number of deaths among the elderly, simply by reducing the spread of disease. Now immunization of children up through 18 years is recommended annually in the US.

Health care workers need to be immunized because as anyone who has visited a doctor’s office in winter knows, where sick people congregate, infection can spread. Health care workers can protect themselves and their patients by staying healthy.

So who needs the flu vaccine? There’s a good chance that you do!

Flu Shot 101

2009-09-09T06:12:00.000-07:00

Have you ever had the flu? No, not “a flu”, or even “a stomach flu” -- THE flu. A fever of perhaps 103 degrees or higher, aches in every muscle, including the little ones that move your eyes, watery red eyes and nose, sore throat, cough and headache? Aches that are so bad that you can’t get out of bed? That stage lasts about a week and if you are lucky, you will feel back to normal by the end of a second week, when the billions of flu viruses that have been reproducing in your cells are finally being identified by your immune system and eliminated by the coordinated efforts of your white blood cells, spleen and liver. If you aren’t lucky, your immune system was so beaten down by the flu, the white cells so overwhelmed and depleted, that you might develop a sinus infection, pneumonia, and occasionally bacterial bloodstream infections or meningitis. The flu kills an average of 36,000 people per year and the H1N1 pandemic this year may add to that.

I’m always astounded when people tell me they don’t get the flu shot “because it gave me the flu.” Injectable vaccines for influenza are made from killed, split virus. Flu vaccine shots are incapable of causing an infection, even in the weakest person. Yes, your arm might get sore and you might have a low-grade fever for a day, but that’s probably going to be it. The nasal flu vaccine, however, is a live flu virus, but it’s one adapted to live in the relative cool of your nose, which dies when exposed to the warmth of your lungs or bloodstream. It might make you stuffy or have a mild sore throat for a day or two.

If you became ill after a flu shot or nasal vaccine, consider this: the flu vaccine is given in the fall and winter when respiratory viruses of all kinds are beginning to infect more people. All types of colds and flu, bronchitis and pneumonia increase in the fall and peak the winter because children go back to school and congregate and share their germs and adults stay indoors more as well. People also spread germs easily in close quarters, through coughing and sneezing or by touching shared surfaces like doorknobs. Your illness was likely coming on before your vaccine was given, and if you got the flu, it was because your exposure to the real thing occurred before the vaccine could build your immunity – about two weeks after the shot.

What can you do to avoid the flu? Get vaccinated every year. This year, I recommend getting the seasonal flu shot and the H1N1 vaccine when it becomes available. Those first to be given H1N1 vaccine will be those at highest risk – age six months to 24 years, pregnant women, adults with chronic illnesses and health care workers. Later, the vaccine may become available for everyone who wishes to receive it.

Always wash your hands or use an alcohol-based hand gel, especially if you are touching surfaces that others touch. Cover your cough with a tissue or cough into your sleeve and wash your hands if you have been coughing into them or rubbing your runny nose or eyes. Throw away your own tissues, too!

Immunizations: Through My Children's Eyes

2009-08-24T05:13:00.000-07:00

Children of pediatricians are experts in immunization, with lots of first-hand, real-life experience. They are always aware of the latest recommendations.

I remember telling my son at age four that "these are your last shots till you are 14, and then its only one shot every ten years." At that time in 1993, there were fewer immunizations required for children, and tetanus/diphtheria boosters were recommended every 10 years. He had completed the primary series and boosters for DTP (diphtheria, pertussis and tetanus), OPV (polio), MMR (measles, mumps and rubella) and meningitis. Vaccines for hepatitis B were at that time recommended for infants but no catch-up program was in place for older children. Flu vaccines were only for children with chronic illnesses.

Fortunately for my son and his younger sister, vaccine development was accelerating in an unprecedented fashion and new recommendations for the use of many vaccines and the development of many more turned my reassuring statement into a bald-faced lie.

The hepatitis B vaccine was expanded to adolescents and older children - a series of three shots. He was among the first in his class to get them. He missed out on Prevnar, for pneumococcal meningitis, due to being older than the recommended age, but received flu vaccine annually due to asthma. He did get his tetanus booster at 14, as promised, but had to get the Tdap (tetanus, diphtheria and pertussis vaccines), an improved version, in 2006 at age 17. Since he never had documented chickenpox, he got the vaccine before middle school entry and a booster this year at age 19 when it became clear that two doses were better than one. Then he received the hepatitis A in two doses last year. The meningococcal meningitis vaccine was given as an 18th birthday present. He knows when the HPV vaccine is recommended for men, he will be getting it. His sister already has. They are too old for rotavirus vaccines, but I made sure my great-nieces and nephews got it!

My daughter knows enough about vaccine safety and benefit, from listening to me talk to parents of my patients and from dinner table conversations, that she jumped at the opportunity to participate in a vaccine trial for CMV (cytomegalovirus), to prevent infection in her future children.

Even my nieces and nephews know the science behind vaccines, having heard their parents asking me over Thanksgiving dinner about the benefits of HPV vaccine - and set their health teachers straight when misinformation was being given in class.

Why are pediatricians such advocates of vaccines? When I was in training, Pediatrics was largely an infectious disease specialty. On call every third night, I could be pretty sure that I would evaluate at least one or two children for meningitis, and that at least twice a week I would admit a child who not only had it, but might either die or be permanently disabled from it. Bacterial sepsis was so common that every febrile child under age two got a blood culture and many got antibiotics by IV. Life-threatening infections of the eye or the throat or the skin were frequent and every trainee was guaranteed to see at least a few deaths among the many children treated for these illnesses. Now pediatricians in training may not see a case of bacterial meningitis or these other illnesses more than once or twice in three years of training - usually caused by germs not covered by the current array of vaccines.

Vaccines are safer than a course of antibiotics - and infinitely less painful than the serious diseases they prevent.