On Friday, September 30, 2011, we hosted a live chat about vaccines on our Facebook page with experts from the Seattle Children's team. We have transcribed below the questions that were asked and the answers that wereprovided. If you'd like to learn about future live chats like this, please connect with us on Facebook.
Edgar Marcuse, MD, MPH, is professor of pediatrics and adjunct professor of epidemiology at the University of Washington and associate medical director of quality improvement at Seattle Children's. He is an academic general pediatrician with special interest in immunization (policy, practice, ethics, economics and vaccinology)
Doug Opel, MD, is acting assistant professor at the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Hospital.
Wendy Sue Swanson, MD, MBE, is a practicing pediatrician at The Everett Clinic, mother of two young boys and author of the Seattle Mama Doc blog.
Why is the pain from the HPV vaccine so intense? And why is fainting one of the side effects?
Dr. Wendy Sue Swanson: First of all, I hear about this a lot! Most teen girls report to me that the HPV vaccine really does sting more than many others. However, there is no specific ingredient that we know of that are more irritating than others. MANY girls report the more intense sting so I often mention this to my t (w)een patients prior to their 1st HPV shot so they have improved expectations. That sting doesn't tend to linger, but like all vaccines, we can all certainly have a sore arm for a day or so after an intramuscular immunization.
In regards to fainting, like any vaccine given during adolescence - fainting can be a side effect. However, fainting is most often a side effect to the experience of getting an immunization (more than a side effect to ingredient). Any shot experience can cause an emotional and/or "vagal" response which can lead to fainting.
Do vaccines have anything to do with population control, as quoted by Bill Gates?
Dr. Ed Marcuse: Vaccines save lives. In the developing world many children die in infancy. If parents can be confident their child will survive - because they won't die from a vaccine preventable disease like measles or whooping cough or be crippled by polio - they may have fewer children.
I know that I've always been told that one doesn't get the flu from a flu vaccine, yet our family's experience sure makes it look like we do get a milder case within 4-7 days of the shot. Is this really just coincidence, year after year? Are there things we can do to avoid this (load the kids up on vitamins or something)? And is the flu vaccine recommended for everyone this year? Shortages expected or no? Last thing - when is the optimal time to get the vaccine, assuming that we all should get it this year.
Dr. Doug Opel: You are right that you can't get the flu from the flu vaccine. Mild side effects from the flu vaccine can include fever and aches, though, so it is possible that this can be misinterpreted as getting a "mild case of the flu." Everyone 6 months and older should get the flu vaccine. No flu vaccine shortages are expected this year nationally. Since influenza season can start as early as October and last through May, the best time to get the vaccine is by October.
Wondering if our family should get flu vaccines this year - two healthy 40-year-old adults, and a healthy 12- and nine-year-old? We have gotten the vaccines about every 2-3 years in the past. Last year we skipped them and were all the healthiest we have ever been (less colds, etc.). I waver due to reading a lot of "negative" press on possible side effects and lack of research on long-term exposure to yearly vaccines. Does research support the possibility that your immune system is slightly suppressed for a couple of months following the vaccine resulting in more colds? This seems to have been my experience.
Dr. Wendy Sue Swanson: Absolutely, we recommend you and your children get flu vaccine this year. My entire family (two healthy adults and boys age two and four) will be getting our flu shots this weekend. Here's why: first of all, our immunity to flu can wane over seven to nine months, therefore our immunization against the three strains of flu in last year's shot (H1N1, H3N2, Influenza B) may not be as robust as it was immediately after immunization last year. Therefore, our dose this year will protect us for the Influenza season (2011-12).
Secondly, when we look at children who died from influenza in the year starting Aug. 2010 and ending Aug. 2011, 49% of the children who died from influenza were well, healthy children. Although we want to prioritize high-risk children (those with underlying health conditions affecting their lungs, heart or immune system) we want to protect all children. Immunizing well children accomplishes two goals: it protects the individual child from influenza and protects those high-risk kids and adults around them or those too ill (cancer patients, for example) to get the flu shot. Here's a video I published yesterday going over this info.
Dr. Ed Marcuse: Vaccines do not suppress the immune system - even temporarily. The reason we space giving different live virus vaccines by 28 days is because the first vaccine activates the immune system. If you give a second live virus vaccine a week later it may not be effective because the immune systems will fight it off. Therefore we give two live virus vaccines at the same time or space them by four weeks.
I know I'm not a child, I'm 21, but I'm diabetic and have a weak immune system. Should I get my flu shot? I've heard not to if you have a weak immune system and I've also heard a lot of people getting sick because of it. I'm a college student and can't afford to miss class.
Dr. Doug Opel: Yes, you should get the flu shot! Those with chronic illness such as diabetes are at higher risk for getting the flu, so it is highly recommended that you get the flu vaccine.
It seems like the flu vaccine is offered and promoted a lot sooner this season. Why is that and will it cover us through the entire flu season? Thank you.
Dr. Wendy Sue Swanson: We had flu shot avail in my clinic earlier than ever before. I've been immunizing my pediatric patients for over two weeks already. Getting a flu shot now and from here forward will do a great job protecting your child and your family for the 2011-2012. Your question comes from a spot of great knowledge: Influenza peaks in our part of the country often later in the season (Feb. and March) but the 2011-2012 flu shot given now will protect your child through the typical flu season.
I was wondering if the hospital has the flu clinic for the flu shot this year? Last year it was very convenient to get my daughter's flu shot!
Yes! Information our Flu Vaccine Room is open to patients and family members who live with patients. Information is available here.
I have a 10-year-old daughter who had a life-threatening reaction to a vaccine at six months old. Our family doctor, along with several doctors we've consulted with at Children's, have recommended that she continue to not be vaccinated for anything - since we can't determine exactly why she had the reaction she did. My question is this - is there ANY way to determine what vaccine she had the reaction to (aside from giving it to her and hoping for the best). They believe it was the DTaP - but they've also thought perhaps it could be something like the medium the vaccines were grown in. I ALWAYS worry that we're sending her "out there" unprotected… As an aside - she did contract bacterial meningitis though she'd been vaccinated for that - which makes me even more nervous (she was vaccinated and still contracted the disease so how much more at risk is she for those things she's not vaccinated for?).
Dr. Ed Marcuse: Without having detailed information about your daughter's medical history, knowing what vaccines she received and what reaction she had, I regret I cannot help you sort this out. Most often, if a physician concludes a serious reaction may be due to a vaccine, they would advise against administering that vaccine or perhaps others of that class, but not all vaccines, so I am puzzled. If she got the type of bacterial meningitis the vaccine she received was intended to prevent, then the vaccine failed to protect her. That could be because her immune system failed to respond because of a temporary or permanent condition, or because the vaccine was not stored or administered properly. Most vaccines are effective most of the time, but no vaccine is effective every time. Because this vaccine did not work I would not assume your daughter is more susceptible to disease or vaccine failure. It is really important you talk with your child's doctors about these questions.
Do physicians benefit financially (regarding pharmaceutical companies primarily) from giving vaccinations to children?
Dr. Doug Opel: This is a common misconception. Delivering vaccination services is really not highly profitable - it requires some cost to handle, store and administer vaccines correctly as well as to screen for contraindications and track the immunization status of patients. Some clinics and physicians actually lose money by administering vaccines. Regarding pharmaceutical companies, vaccine sales dwarf prescription drug sales, so here too, they are not high-profit.
I have friends that are highly anti-vaccine. Do you know of any resources that could counter claims made in anti-vaccination books such as "A Shot in the Dark"?
Dr. Doug Opel: I think one of the best non-biased Internet resources regarding vaccines is operated by the National Network of Immunization Information. I often send parents in my practice to this website.
Tell me more about the Gardasil vaccination. It seems to be getting a lot of bad press lately. I have serious issues with my daughter having the ability to consent for that (or any) vaccine without my permission.
Dr. Doug Opel: As a parent myself, I completely understand where you are coming from. We - parents - want to be there to discuss these things on our own terms with our children. In our community, however, we have decided that minors 14 years and older can consent for STD treatment primarily so that they will seek treatment.
Dr. Wendy Sue Swanson: I agree with Dr. Opel.... it's terrifying for me to take the training wheels of my 4-year-old's bike, let alone think about him making health decisions on his own. Or him one day having sex or getting exposed to STDs. HPV vaccine isn't STD treatment (as I'm sure you know) but 14-year-olds can consent on their own to get the shot series. I suggest you talk about your concerns with both your child's doctor/ARNP and also talk with your daughter. Talk about your thoughts and/or concerns and talk about her own. Then, return to it and keep the conversation going!
If my 14-year-old gets a Gardasil vaccine without my knowledge, and they have an adverse reaction (or worse), who's responsible then? I have no doubt the bills would fall to me. I know doctors have to comply with a lot of things they don't personally agree with, so I definitely understand the mixed emotions here.
Dr. Wendy Sue Swanson: Yes, I agree you'd be financially responsible for co-pays for additional visits with health concerns or side effects even if you didn't agree to her getting the immunization. I look at it kind of like your child driving a car on her own or going to a friend's home without your permission and then having a health complication/injury or illness as result of the choice. That's why keeping up an ongoing conversation about it with your daughter is likely the best way to feel like you keep tabs on her decisions and healthcare.
Dr. Doug Opel: I will also say that there is a process by which physicians are obligated to report vaccine adverse reactions to a national database called VAERS: Vaccine Adverse Event Reporting System. VAERS data is then continuously monitored to detect potential risk factors or safety issues. Any person who believes they were injured by a vaccine should consider exploring the National Childhood Vaccine Injury Compensation Program.
My son has had all vaccinations. With his first dose of MMR, he came down with the measles due to the vaccine (not just a slight rash). Also, with a few months his joint filled up with fluid, similar to what happens with JRA. Fast forward a few years to age 7 1/2. He was just diagnosed with bronchiolitis obliterans. Could this lung disease be connected to reactions to the MMR? He has no history otherwise to explain it. Thanks for your insight.
Dr. Ed Marcuse: You and your son have faced some really tough challenges. Measles vaccine causes a fever and often a rash in about 1 in 5 children who receive it, but both are mild. If a child got full-blown measles - severe rash, prolonged high fever, illness lasting about 10 days - after receiving the vaccine I would wonder if they were exposed before they got the vaccine. While pneumonia can complicate measles, I know of no relation between bronchiolitis obliterans and measles disease, much less the measles vaccine. It is really hard to face a serious medical problem for which there is no clear cause and even harder when it is your child who has the problem. I hope things go well for your son.
This year I notice that the shot is available early. Does the affects of the shot fade if given early in the season and would it be beneficial to give a booster in the later part of the cold and flu season?
Dr. Wendy Sue Swanson: We had flu shots available in my clinic earlier than ever before. I've been immunizing my pediatric patients for over 2 weeks already. Getting a flu shot now and from here forward will do a great job protecting your child and your family. And here's a video and blog post with 10 tips on influenza that I authored during peak influenza season earlier this year.
I feel puzzled about giving vaccinations for illnesses we survived as children such as flu and chicken pox and such. Besides preventing the discomfort is it necessary? Can these illnesses actually harm my children?
Dr. Wendy Sue Swanson: Great point. I had chicken pox, too. Survived of course, like most children (but remember it). However, we don't immunize against chicken pox (or influenza, for that matter) for mild cases, we immunize to protect children from the life-threatening cases and complications. Read this post about my story of chicken pox and recent data published about the incredible lives saved from the vaccine: "Varicella Vaccine: IT WORKS!"
Before the immunization was given in 1995, hundreds of people in the U.S. died every year from chicken pox and severe infections from chicken pox. That's the incredible thing, of the 77 total deaths since 1997, only 2 deaths occurred in children who had received 1 dose of the varicella shot. Both of those children (who died) were on steroid therapy (suppressing their immune system) and 1 of the children had cancer.
Dr. Doug Opel: There is a natural tendency too to begin perceiving the risks of vaccine-preventable diseases as less severe than they really are as vaccine do their jobs and make these disease more rare and distant.
I know several moms who are following a delayed/selective vaccine schedule, such as the one from Dr. Sears. Are there risks to spacing out vaccines?
Dr. Doug Opel: This a great question and one I am answering quite a bit lately. There are real risks to spacing out vaccines. Primarily, spacing out vaccines means that there is a longer period that children are left unprotected against diseases, and this leaves children at greater risk of both contracting and transmitting disease.
Do you think adults should get a booster for whooping cough?
Dr. Wendy Sue Swanson: YES! We recommend all adults and even grandparents get a Tdap (Tetanus diphtheria acellular pertussis) vaccine. ESPECIALLY when there is an infant at home. Whooping cough can be a frustrating and long-lasting illness for adults, but it can be far more dangerous and life-threatening particularly for young infants, under 2 months of age.
We recommend all adults get one dose of Tdap as their immunity to whooping cough or pertussis (the "p" in the vaccine) may have waned. Most infants and young children get whooping cough from adolescents and adults.
We know that some data suggests that about 80% of infants who get pertussis (whooping cough) get it from a parent.
We start to immunize babies between 6-8 weeks of life against whooping cough with the DTaP vaccine, then do a second dose at 4 mo., then a 3rd at 6 mo. of age and a 4th dose at about 15 months. Babies are still at risk for whooping cough until the vaccine series is completed.
Do our children need a Menactra booster? If so, when? Thank you.
Dr. Doug Opel: The CDC currently recommends a booster if your child received a first dose before age 16. If your child received their first dose on or after 16 years of age, there is no booster needed.
How many kids (0-18 yrs. old) die from the seasonal flu each year and how many die from getting the flu shot? And is it true that even if you get the flu shot, your chances of getting the flu didn't go down any because the flu experts often predict the wrong strain of virus??? Thank you!!!
Dr. Ed Marcuse: CDC has the statistics on flu deaths on their website: search www.cdc.gov. I am not aware of any deaths among children from getting a flu shot. How well the vaccine works varies from year to year depending on how good the match is between the virus circulating in the fall and the one experts predicted the previous spring that the vaccine was made to prevent. Fortunately often when the match is not ideal the vaccine still offers some protection, that is protects against severe disease if not all illness. Hopefully, in a few years, the science of vaccinology will have progressed and we will have flu vaccines that protect against a broad range of flu virus strains.
I've heard that it's better to spread the vaccines out rather than give so many at the 2/4/6 month visits. Is that a good idea, and if so, what are the benefits?
Dr. Wendy Sue Swanson: There are no studies that support spacing out immunizations. Often people space out vaccines because of concerns for side effects of number of vaccines given at once. I don't recommend spacing out: it leads to more office visits, more exposure to illness and MOST because we want to immunize as early as we can to protect infants as early as possible. Spacing them out leads to delays in getting immunizations and then delay in protection.
Here's a really rigorous article using science to explain why many pediatricians don't support the alternative-spaced schedule.
My son has juvenile idiopathic arthritis. We've been told that he and his siblings shouldn't get live immunizations. Can you tell me which ones are live?
Dr. Doug Opel: The standard live vaccines are MMR, varicella (VZV, chicken pox), and one of the influenza vaccines is live (the one administered by nasal spray).
I have two children who both have pretty significant health issues. For us, the question of vaccinations was never an "if" but a "when." My question for you is regarding pertussis. If my children are vaccinated, are they still at risk of coming down with whooping cough because of kids (people) who aren't vaccinated? Will the vaccine that they received protect them, or just make it less likely that they'll get sick?
Dr. Wendy Sue Swanson: Fortunately, having the series is VERY effective in preventing severe infection/death for your children. However you raise a good point. No single vaccine is 100% effective for all people. We depend on our community's immunity to keep us all healthy. Sometimes people call this "herd immunity" - we need the herd around us all immunized to protect us all! Here's a good link with a nice video at the bottom discussing "herd immunity."
Should my kids get the flu shot? Last year it made us all really sick. Is it safe should my kids get it? 12,6, & 2 yrs old.
Dr. Wendy Sue Swanson: Yes! We recommend flu shots for all children age 6 months to age 18 years every season. Here's a great link with information about influenza vaccine.