Pediatric Immunizations - Facts and Fiction

Hayden Pasco, MD
Primary Health Group - Short Pump

Children will be heading back to school soon, and while it’s hard to believe that this time is once again upon us, September is right around the corner! Because August is National Immunization Awareness Month, I have compiled a list of the most common misconceptions about vaccines, and the facts behind them.

Fiction: Vaccination Causes Autism

Fact: There is no scientific evidence linking vaccinations with autism. In fact, the initial report originally published in England describing the link between the MMR (measles, mumps, and rubella) vaccine was refuted by large-scale studies and eventually retracted by the journal. The notion of the link arose from the coincidental timeline of autism development. The disease tends to emerge around the timeline that the MMR vaccine is given, thus creating a link. The absence of this link has been confirmed by meta data, which is an aggregation of major studies over a period of time, effectively closing the case on this misinformation.

Fiction: Vaccinations Contain High Levels of Mercury (Thimerosal)

Fact: Almost all routine childhood vaccinations are now mercury (thimerosol)-free, in response to a US Public Health Service and American Academy of Pediatrics request to manufacturers in 1999. Thimerosal is a mercury-containing organic compound preservative that had been used in some vaccines and other products since the 1930s. There has been no evidence of harm caused by the low doses of the ingredient that used to be in some vaccines and other treatments, but it was removed as a precautionary measure, regardless. The only vaccines that may still contain this preservative are inactivated flu vaccines, which only make up a small part of the flu vaccine spectrum.

Fiction: I Should Wait to Vaccinate Until My Child is Older

Fact: Because their immune systems have not fully developed, children under the age of five are especially susceptible to disease. Although approximately 80% of all children in the United States receive the appropriate vaccinations on schedule, delays in vaccination have been linked to infectious disease outbreaks (specifically whooping cough/pertussis, which can be fatal) among young children. In 2013 in Wisconsin alone, 300 children under the age of one were diagnosed with pertussis, and 177 of them were under the age of six months. Half were hospitalized, and three of them died. By vaccinating early and on-schedule, you can protect your child and other children from disease.

Fiction: Partial Immunizations Will Protect My Child from Disease

Fact: Partial immunizations will leave your child, and others around him, at risk. Full immunity is not achieved unless your child is vaccinated according to schedule and dose. The good news is that it’s never too late to get vaccinated – catch-up immunization schedules are available for those who have missed or skipped doses.

Fiction: My Child Doesn’t Need Vaccines Because Herd Immunity Protects Him

Fact: Community, or “herd,” immunity is defined as a small critical portion of a community being protected against diseases because the majority is immunized, resulting in little opportunity for an outbreak. At-risk groups who sometimes are opted out from vaccines include infants, pregnant women, and otherwise immunocompromised individuals. In order for herd immunity to be effective, eligible individuals need to adhere to the recommended vaccine schedule, thus protecting the entire community.

Fiction: There are Very Few Deaths from Vaccine-Preventable Diseases

Fact: Globally, 1.5 million unvaccinated children under five years of age die each year from vaccine-preventable diseases. This is a much higher number than any of the risk factors for vaccine side-effects, which occur at virtually undetectable rates. Unfortunately, while the United States has low rates of vaccine-preventable diseases, the global population does not fare as well. If the United States population begins to relax on vaccine standards, the risks for an outbreak of a dangerous disease increase as these pathogens are just a plane ride away.

For even more information, there are several very helpful online resources available to you. The CDC has a very informative website at cdc.gov/vaccines, which includes vaccine schedules for all ages, the latest news and reports, and disease-specific information. Another site with fun infographics is vaccines.com/why-vaccinate.cfm. There is information about most major vaccine-preventable diseases, as well as population risk factors.

If you have any questions about vaccines, vaccine-preventable disease, wellness, or would like to schedule a consultation with Dr. Hayden Pasco, please call Primary Health Group – Short Pump at 804.217.9091.

Clinical Depression - Basic Facts about an Underdiagnosed Disease

Mary-Colleen Millage, NP
Chippenham Family Medicine

Clinical depression, affecting approximately 19 million people in the United States alone, is a vastly underdiagnosed condition that, with the tragic passing of Robin Williams last week, has been catapulted back into the national conversation. When a person has clinical depression, they are not “sad” and they cannot “snap out of it” as it is not a situational emotional reaction. Depression is caused by chemical changes in the brain, which, like heart disease or diabetes, cannot be willed away. There is significant stigma still associated with mental illness, and seeking help for depression should be noted as a very courageous act.

People experience clinical depression in various ways, with no two cases being alike, although many exhibit common symptoms. Some of the most common signs of depression include a loss of interest in previously enjoyable life activities, general hopelessness, lethargy, anxiety, and trouble accomplishing normal daily activities.

Energy-zapping fatigue is one of the most prominent symptoms someone experiencing depression faces, causing withdrawal from the productive activities crucial to daily life. Depressed individuals may find themselves feeling like they can’t get out of bed, or sleeping longer than normal with no clear explanation. Even in the presence of overwhelming fatigue, depression sufferers can also experience insomnia. This can be a side effect of certain medications, but also puts a person at risk for more intense health issues up to and including the consideration of suicide. Restorative sleep is crucial to the treatment of depression, and should be reviewed seriously with your healthcare provider.

Anxiety is both a symptom of depression and a condition on its own, and can make depression relapse much more likely. It requires complex treatment and can amplify the effects of depression in the afflicted individual. People who suffer from both depression and anxiety disorders may take longer to respond to treatments (both through medication and psychotherapy).

Suicidal thoughts are the most dangerous depression symptoms. More than 90% of those who attempt or commit suicide are depressed or suffering from a serious mental health disorder. Those in the 65 and older age group have the highest suicide rate, with men being more vulnerable than women. Suicidal thoughts are not the same as daydreaming about harming oneself – they become obsessive and inescapable mental images, often against the will of the afflicted. If you find yourself or a loved one discussing or contemplating suicide, seek immediate help from a mental health specialist, or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

More than 80% of those suffering from depression respond well to a variety of available treatments. Once a person has worked with their healthcare provider to diagnose depression, they will collaborate on a course of treatment, including medication, psychotherapy or a combination thereof.

Many questions abound about antidepressant therapy, but it remains one of the most successful long-term solutions from those suffering from depression. Used as a stand-alone treatment or in combination with psychotherapy, antidepressants work by altering brain chemistry to alleviate mood disorders. While this can seem scary, it is targeted to modify only the chemicals in the brain affecting the depressive symptoms, without changing one’s personality. The intent is to reverse the debilitating effects of depression while allowing the person to feel normal again.

Antidepressant therapy does have some notable risks. It’s not always effective on adolescents, and can trigger more severe reactions in that age group. It should be monitored carefully, but not ruled out as a treatment option. Also, after a course of antidepressant therapy, one should not quit cold turkey as it can trigger major withdrawal symptoms, including flu-like symptoms, dizziness, and worsening depression. Just as it takes several weeks to build up to therapeutic doses with antidepressant medication, you should wean off the medication at a mutually agreed upon interval with your provider.

For further inquiries about depression, anxiety, treatment options, and mental health resources, contact Mary-Colleen Millage, NP, with Chippenham Family Medicine at 804.560.0490 or visit chippenhamfamilymedicine.com.

If you or someone you know is experiencing thoughts of suicide or self-harm, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Immunizations and Pregnancy - What You Need to Know

Marijan Gospodnetic, MD
Richmond Women's Specialists
Johnston-Willis Hospital

August is National Immunization Awareness Month, and with it, a need for education not just on the importance of immunizations as a whole, but specifically during the delicate months of pregnancy. Vaccines help keep pregnant women and their growing families healthy, and are necessary for the protection of your children and those in the community from vaccine-preventable diseases. Many terms are used when discussing this segment of preventive medicine, but the three main ones are: vaccines, vaccinations, and immunizations.

Vaccines are the products that produce immunity from a disease and can be administered orally, via injection, or through an aerosol spray. There are two types of vaccines, inactivated and live, and these present different indications after administration. Vaccinations are the act of administering the vaccine that produces immunity in the body against the organism. Immunization is the process by which one becomes protected from a disease. Vaccines cause immunization, and sometimes diseases can also trigger immunization after the individual recovers from the disease.

There are three distinct stages to a woman’s pregnancy, prenatal (before), perinatal (during), and postnatal (after). All of these have specific vaccine and immunization recommendations that should be followed.

Before Pregnancy

As you consider expanding your family, you should ensure that you are current on all routine vaccines as indicated by age and individual health factors. The vaccine statuses of which you should be aware are: Hepatitis A, Hepatitis B, Human Papilloma Virus (HPV) if you are age 26 or younger, Influenza (flu shot), Measles, Mumps, and Rubella – MMR (live), Tdap (Tetanus/Diphtheria/Pertussis), and Varicella – Chicken Pox (live). If you receive a live vaccine, you should refrain from conception for at least four weeks while establishing immunity.

During Pregnancy

Congratulations – you’re now expecting! Among all the health questions that arise, one of the biggest is: what medicines and vaccines are safe during this time? The most important vaccine during pregnancy is for influenza. The “flu shot” is given annually to combat the anticipated strains of flu circulating in that given year, and it is of paramount importance for pregnant women to receive the inactivated flu vaccine. Contracting the flu during pregnancy puts you at serious risk for complications and hospitalization, and symptoms can be detrimental to the pregnancy. You should also get the Tdap vaccine for tetanus, diphtheria and acellular pertussis during each pregnancy. Ideally, this will be administered between weeks 27 and 36 of your pregnancy, in your third trimester.

Some of a woman’s immunity to disease is passed along to their baby during pregnancy, protecting them from some diseases during the first few months of life, before the baby’s 2-month checkup, when initial vaccines are routinely administered. In addition to boosting your immunity during pregnancy, you should be cautious about travel to areas known to be common locations for vaccine-preventable diseases. Talk to your physician about any planned international travel and work together on a care plan if the trip is unavoidable. More information about travel vaccines can also be found at Centerfor Disease Control’s traveler health website: www.cdc.gov/travel.

After Pregnancy

It is safe for women to receive routine vaccines immediately after giving birth, even while breastfeeding. This is also an important time to begin educating yourself on childhood vaccination schedules for your new addition. If you haven’t received your Tdap vaccine during pregnancy, you should have it administered right after delivery. Also, women should receive the pertussis (whooping cough), MMR, and varicella vaccines to reduce risks to both her and her infant.

For further inquiries about immunizations, vaccines, pregnancy, obstetrics, or general gynecology, contact Marijan Gospodnetic, MD, of Richmond Women’s Specialists at 804.267.6931 or visit richmondwomens.com.

Breastfeeding 101 - Frequently Asked Questions for New Moms

Courtney Legum-Wenk, DO
Commonwealth Ob/Gyn Specialists
Henrico Doctors' Hospital

In honor of World Breastfeeding Week 2014, it seems appropriate to discuss this very charged and often misunderstood topic in the world of women’s and infant health. Historically, breastfeeding has been the standard way to provide infant nutrition, and although there was a gap in the mid-20^th century in breastfeeding rates, it has resurged as a dominant first choice for feeding by most families. Extensive information is available regarding breastfeeding from your OB/GYN, your pediatrician, and trusted official resources, but much misinformation also abounds. I’d like to take this opportunity to answer some of the most frequently asked questions about breastfeeding, and encourage you to talk to your healthcare provider in detail about anything not covered here.

What are the specific health benefits of breastfeeding for my baby?

The American Academy of Family Physicians recommends six months of exclusive breastfeeding for infants. Breastfeeding provides vital nutrients to your infant that change and develop as he or she gets older. Studies show that infants who are breastfed have less frequent instances of otitis media (ear infections), gastroenteritis, atopic dermatitis (eczema), lower respiratory infections, and SIDS. There are also links to obesity, type 1 and type 2 diabetes, and asthma for children who were not breastfed in infancy.

Are there additional health benefits for the mother when exclusively breastfeeding?

Breastfeeding is associated with reduced instances of postpartum depression, type 2 diabetes, breast cancer and ovarian cancer for mothers. Many women have always heard that the “weight will fall off” during the postpartum period for those who are breastfeeding, but that link is unfortunately minor when compared with other factors. Breastfeeding can be one of the most unheralded difficult parts of the transition in becoming a new parent, but you will find that through all of the challenges, this is one of the best ways to bond with your new baby. This sense of accomplishment, both in providing exclusive nutrition for your child, and for persevering through the challenges posed by breastfeeding, is immensely beneficial to both mental and physical health.

Are there any dietary restrictions for breastfeeding mothers?

Many restrictions that existed during pregnancy still exist, to some degree, when breastfeeding. A good rule of thumb about alcohol consumption when breastfeeding is that if you’re sober enough to drive, then you can breastfeed. Alcohol affects infants in a magnified way because of their underdeveloped liver function, so consumption should always be monitored with care. Caffeine intake is another common concern, although most mothers can have it in moderation. Some infants are more sensitive than others to a mother’s caffeine intake, particularly if the mother avoided caffeine entirely during pregnancy. Cigarette smoking is universally unhealthy for both mothers and infants, and should be avoided. Babies who are exposed to cigarette smoke have higher incidences of respiratory distress, ear infections, eye irritation, croup, colic, and SIDS.

What if I have trouble breastfeeding, or am not able to produce enough milk?

Although most breastfeeding-related problems can be corrected by addressing a few simple procedural issues, a small subset of the population can experience Primary Lactation Failure (PLF), a condition occurring when the mother’s body fails to produce enough milk to supply her infant’s nutritional needs. PLF can be due to various factors, notably previous thoracic or breast surgery severing vital nerves or ducts, hormonal imbalances, and/or insufficient glandular tissue (IGT), which can also be referred to as Hypoplasia or Tubular Breast Syndrome. Many options exist for proper infant nutrition outside of breast milk, including many different types of formula. Your pediatrician can best guide you on which type of formula will work best for your infant, and can help you adjust if you experience issues transitioning.

What are some resources online where I can find more information?

The best medical resources for individual research are the American Academy of Family Physicians (aafp.org) and the American Congress of Obstetricians and Gynecologists (acog.org). La Leche League International (llli.org), KellyMom (kellymom.com), and BabyCenter (babycenter.com) are also excellent online resources.

For further inquiries about breastfeeding, pregnancy, obstetrics, or general gynecology, contact Dr. Courtney Legum-Wenk of Commonwealth Ob/Gyn Specialists at 804.285.8806 or commonwealth-obgyn.com. For more information about Henrico Doctors' Hospital, visit hcavirginia.com.