Why immunization is an important part of a child’s care

Transcript

Scott Webb: Despite what it feels like we’ve learned over the past few years about the importance of immunizing ourselves and our kids against viruses like COVID-19, there’s a growing trend of families deciding not to immunize their kids for chickenpox measles, and perhaps even COVID. And joining me today to stress the importance of immunizing our kids, staying on the recommended schedule by the CDC and maybe even dispel some myths about vaccines, is Dr. Anna-Kathryn Burch, she’s the division director for pediatric infectious diseases, and medical director of the pediatric antimicrobial stewardship program at Prisma Health Children’s Hospital–Midlands. And I’m also joined by Dr. Matt Grisham. He’s a clinical assistant professor in the department of pediatrics at Prisma Health Children’s Hospital.

This is Flourish, a podcast brought to you by Prisma Health. I’m Scott Webb. So I want to thank you both for joining me today. I have a couple of kids myself, and so this has come up over the years about immunizing our children. So that’s what we’re gonna focus on today. And as we get rolling here, Dr. Burch the all important one, the million dollar question. Why should we immunize our children?

Dr. Anna-Kathryn Burch: Immunization has gone back a long way and actually it is historically one of biggest things that happen in medicine to really kind of change the outlook of what goes on in the world, honestly. So when you go back and talk about Jenner and the first immunization that was against smallpox, and that definitely was something that saved a bunch of people during that time. And so once we began to have better immunizations over time we were able to be able to stop a lot of big diseases from happening.

And it seemed like in the very beginning when vaccinations were first around everybody was for vaccines because it saved you from those very deadly diseases that most people would die from, smallpox the really big one, but there’s other ones out there. So the easy answer is why do we vaccinate our children? It’s because we don’t want them to get viruses and other bacteria that can be harmful to them. I think that a lot of times vaccines have done such a good job with preventing these deadly infections that we don’t see them as often.

And so people continuously ask, why do I need to vaccinate my child from measles because we don’t have any measles in the United States? The reason why we don’t have measles in the United States is because we vaccinate our children. And so that’s one of the most important reasons why we need to vaccinate our children is to continue to keep that herd immunity up. So those deadly diseases don’t come back and start infecting people in the United States.

Scott Webb: That’s really interesting. It does feel like that sort of chicken and egg thing, when you try to explain this or get your mind around it, it’s like, we don’t have measles because we vaccinate people against measles. Right. Dr. Grisham, I’m sure there are some challenges, right? When we think about and hearing about through media and social media and word of mouth that families and parents. Are choosing not to immunize their children, whether that was COVID or anything else. So what are some of the challenges and what advice do you give to parents?

Dr. Matt Grisham: Dr. Burch made a good point about herd immunity. And that really is a reliance on everyone in the community or as many people as possible who can get vaccinated to get vaccinated. So that, if those diseases do decide to make an appearance, they don’t spread as easily. And especially for us, it’s about protecting those who potentially cannot be protected through a vaccine. So it may be someone who has a weakened immune system, like our little babies or someone who might be too young to get those vaccines.

And so as we know that with these diseases they’re often spreading these diseases sometimes even before they show signs of the illness. And so that horse may be out of the barn before you know it, and we may have unknowingly exposed someone like our family or our friends, or in the case of kids, maybe they’re friends at school or at daycare or otherwise, to that illness. And so as fewer individuals become vaccinated, we decrease that herd immunity, making it more likely to spread these diseases within a community.

And admittedly, as a physician who trained in the era where we’re highly vaccinated. I haven’t seen a good number of these diseases. I have seen a few, but not all of them. And so it makes it hard for us as physicians because it changes the way we think about what diseases may be coming into our offices. And so when I’m talking to parents, I know that at their heart, they want generally what’s best for their child. And they’re seeking information from a wide variety of sources and we don’t know about those sources. Are they family, are they friends? Are they the internet? And how accurate are those sources?

So I would encourage. Any parent who is looking for that additional information to ask their child’s healthcare provider, those questions, or for websites, for information that can be trusted, because unfortunately we can’t trust all of it that’s out there. And so personally I do like to refer families to website like healthychildren.org or the vaccine education center website, which is through the Children’s Hospital, Philadelphia. And those. Both very vetted information that can be helpful for parents as they’re trying to get that information, they need to help make this decision.

Scott Webb: Yeah, and those are some great websites, great resources. And Dr. Burch, I think you covered this earlier when we think about rare diseases, and immunizing our children against them, I guess the goal is to keep them rare. Do I understand that right?

Dr. Anna-Kathryn Burch: Oh, absolutely. Dr. Grisham hit the nail on the head about the herd immunity, if we get everyone vaccinated against diseases and they rare, but we keep up that vaccination status and new children coming up, born children, new people who come into this area from other countries that might not be vaccinated. The better we keep that herd immunity up. If somebody does bring a disease that the majority of the people are vaccinated against, then we won’t have what we call breakthrough diseases. And so one example of that would be, I don’t know if people will remember this or not, but some years ago there was a measles outbreak at Disneyland in California.

And that was able to occur because there are so many people these days, children is the majority who are not receiving the MMR vaccine. And I think that kind of goes back from some studies that were done in the nineties that kind of showed that MMR led to autism, which has totally been debunked since then, and actually that paper’s been retracted and the person actually gotten in trouble for that, who did that research. That being said that led to a lot of children not getting the MMR vaccine. And so it kind of left this dip and that hurt immunity against measles.

And when you have people coming into the United States who either are infected with measles, never got vaccinated for measles and brings to the United States, if that herd immunity is low, it allows for outbreaks. And that’s exactly what happened at Disneyland. And that’s exactly what happened in Minnesota a couple years, the two big measles outbreaks that we’ve had in recent times.

Scott Webb: Dr. Grisham, I remember when I was a kid, it was like, if you got chickenpox well, then you never worried about being immunized against it again, because, I don’t know if it was a wives tale or maybe I heard it from my grandma or wherever we got our information back then, but basically I’m asking, if that’s true, if you get chickenpox and you’re not likely to get it again, is there any point in actually being immunized once you’ve had it?

Dr. Matt Grisham: I like you, I can still find the scars on my skin. And I still remember my body looking like one big bottle of calamine lotion. My My brother and I had it at the same time after being at summer camp. And fortunately for us, we just had a fever and an itchy rash. And so it was a pretty uneventful tie. My parents may argue otherwise because they had missed a week of work to help take care of us for that week that we were sick.

But what we do know is that young babies who are often too young to get vaccinated for chicken pox those who have problems with their immune system who can’t get vaccinated for chicken pox, or they were previously vaccinated, but now medicines have decreased their immune system. Or even teenagers and adults who get chickenpox, they often will not fare as well as my brother and I, and hopefully you did when you had chickenpox as a child.

And we know that prior to routine immunization against chickenpox, there were numerous hospitalizations and even deaths each year from chickenpox, which again, we don’t hear a lot about, we just hear about the itchy rashes. But some of the complications of that disease can be a severe bacterial skin infection that can occur at the same time as chickenpox. Some people get pneumonia, some people are gonna have that same virus that infects their brain. And so it can be a very dangerous virus.

And so ideally again, our, with the goal of herd immunity, if we can protect our fellow. Community members who maybe are susceptible to these severe manifestations of chickenpox, that’s the goal. Because again, while most of us get just that fever and itchy rash, there’s some others who suffer far worse outcomes than the simple scars on our skin.

Scott Webb: I wanted to stick with you and ask you about the timing of vaccines. I know with my kids in the pediatrician’s office, they’re very good about tracking all of that, but sometimes you miss an appointment and you skip something and how does that work? If you don’t stay on track with our children’s immunizations, do we have to start over? Can we pick up along the way? Maybe you can explain that to all of us.

Dr. Matt Grisham: The current CDC recommended vaccine schedule is really based on a ton of research that looks at how effective is that vaccine when given at a variety of intervals at protecting the child from the disease. And that research has involved millions of patients. Whereas we have some folks who are wanting to do an alternative schedule. And so what we don’t know about those alternative schedules is do they have the same effectiveness in terms of protecting a child as the CDC recommended vaccine schedule?

And so ideally we would want to stick to that recommended routine schedule, because it gives us as physicians greater certainty that your child is truly protected. Additionally the timing of those vaccines is very intentional. So we know that moms actually give their full term babies a good number of antibodies to help them fight infections, especially for the first six months of life. But those are gonna go away. And so we really are intentional about starting that vaccine series around two months of age.

So that we can basically educate that baby’s immune system so that they can form their own antibodies that are ready if that disease were to try to infect them after the mom’s antibodies have gone away. And again, it’s about the body’s ability to develop a plan of attack. Should they come in contact with that disease? And life happens. Sometimes you get off track with those vaccines and that’s understandable. And some people will ask do I have to start over again with my vaccine series? You do not have to start back over with that vaccine series.

That said, though, our vaccines have only been studied up to a certain age. And so if we wait too long to get those vaccines, we can’t actually give those vaccines, cuz they’re not approved to be given in older children, leaving that child susceptible to the disease.

Scott Webb: Dr. Burch, I always get a little nervous when I’ve had my kids in and they’re gonna be vaccinating against more than one thing on the same day. That hasn’t come up very often, but it makes me a little nervous. Wondering from an expert, your perspective, is it safe to give multiple vaccinations on the same day? Or do we need a little buffer, a little time between?

Dr. Anna-Kathryn Burch: It is absolutely safe to give multiple vaccines at the same time. It’s very interesting when you go back from a historical perspective and look at this so basically there are. Proteins in a vaccine and we call those antigens and that is what your body sees and makes antibodies toward. It’s just a little piece of either the virus or the bacteria that we’re trying to vaccinate against. And so when vaccines were more in their infancy, there was a lot more antigen that were put in each vaccine itself to make antibodies.

Now that we have gotten so much better at making vaccines and making them more efficacious, meaning that they work just as well with lower amounts of those antigens in place. Those numbers of antigens have significantly decreased over time. So essentially, even though you’re getting multiple vaccines against different organisms, the total number of antigens is significantly less than what it was say in the fifties or the sixties when we were all, seventies when we were getting vaccinated over time. These vaccines are very well studied.

And the CDC actually has put plenty of time and research to look at the way that a body will respond to the vaccines. And I promise you if it was not safe, it would not be recommended to give multiple vaccines at one time. So I definitely recommend it. And that kind of goes into the previous question about keeping on schedule on time. The schedule is made to where you can get as many vaccines as you can at one time safely, to start covering that infant or that child appropriately. And to foster that immune system as quickly as possible to protect that child as best as it can. So the time trued CDC recommendation is the best way to go when it comes to vaccinating your child.

Scott Webb: Yeah. And hopefully we’re getting that messaging across today because yeah. We know things come up, you miss an appointment, whatever, but it’s best to get that rescheduled. Stay on track of course. And sticking with you, Dr. Burch, this is maybe a, sort of a third rail kind of area, but I know some people are afraid that vaccines can cause autism or SIDS or sterility or perhaps other things, why do people believe that? And what would you say to them?

Dr. Anna-Kathryn Burch: I think that, oh, the autism was that scare against the MMR vaccine and since that time, that research has been debunked and completely removed from the actual journal itself. And that’s the one that showed that MMR showed increase risk of autism in children. And so because of that I think it makes it easier for parents to not know who to trust, honestly, when it comes to vaccines and how to vaccinate your child. The same thing comes from sIDS or sterility. And really honestly, one of the biggest things has been this past two years with the COVID pandemic and whether or not we can trust messenger RNA vaccines.

This is the first time that this technology has been used to mass produce vaccines. And so I think. Things like that make people worried about vaccines, whether or not they’re safe or not. And, or is there unintended consequences that occurs when you vaccinate your child, i.e. Will they get autism? Is that easier for them to get, or can they get sterile or does the COVID vaccine interfere with infertility? All of those things have been proven not to be true, honestly. And so it’s our jobs as physicians and caregivers to try to educate the families out there to say, vaccines are safe. I promise you if vaccines were not safe, I would not have my children get vaccinated.

Being a pediatrician at heart, that’s one of the most important things is to get your child vaccinated. So just from those standpoints I would say, please listen to your primary care physician, your pediatrician, your family practice physician and really know that the data that’s out there that we currently have is the best data. And that it is safe and your child is not gonna get autism if they get the MMR vaccine.

Scott Webb: That’s really well said. And Dr. Grisham, when we think about side effects, the usual things like a sore arm. Sure. But are there other side effects we need to be aware of when it comes to immunizing our children?

Dr. Matt Grisham: Dr. Burch alluded to earlier the vaccines in previous times before they were clean up, had tons of antigens. And when we look back at those vaccines the more those that had more antigens seemed to have more side effects. Some kids even developing seizures related to their fever with that, however with that advance in technology, we’ve been able to reduce those antigens a ton. And so we have actually seen a decrease in those type of events related to the vaccine and its associated antigens, but at the same time still provide the needed protection.

And as you said, the most common side effects we see are a sore arm and then fever. But remembering that fever is a normal response by the immune system when it is getting to know that antigen that was just injected or just swallowed in the case of our rotovirus. And with that the body is already starting to develop its plan of attack, should that child come into contact with a real disease. And that redness and swelling that you might see at the injection site is primarily related to just increased blood flow to that area because the immune system.

The bigger pieces of it are carried in your bloodstream and they descend additional blood to that area so that the immune system again, can get to know that antigen, and mount an appropriate response. And those are the two most common side effects that we see, but those are easily addressed with acetaminophen after two months of age or ibuprofen after six months of age and while there’s discomfort and there’s a little bit of fever, those side effects are far outweighed by the benefit that comes with the potential severe consequences of getting one of these vaccine preventable diseases.

Scott Webb: Dr. Burch, I’m gonna end with you. And another one of those tricky ones, but I’m sure you have a great answer for us. Are there any reasons or times when a child or why a child shouldn’t be vaccinated?

Dr. Anna-Kathryn Burch: Yeah, there actually are times when children should not be vaccinated. Really two big categories. Number one, if your child is immunocompromised for any. In that could be because they’re on steroids for a long period of time, or they have a disease that makes them immunocompromised. They have cancer. They’re on immunosuppressive drugs because they have lupus or some other problem. Then there’s certain vaccines that you need to be careful against. And those big ones are live virus vaccines.

And the biggest two that you would know in routine children, childhood vaccines is the MMR and the varicella vaccine. Both of those vaccines are what we called live virus vaccines. That means that the child gets immunized with the whole virus, but it’s an attenuated virus, which means it’s very weak strain of the actual virus. So live virus vaccines should not be given to immunocompromised patients. And then also if you have certain side effects very rare side effects from vaccines, you want to always talk to your primary care either pediatrician or family practice medicine physician who can talk to you about those options.

And, for the most part, vaccines are very safe for any normal person who has a good immune system. Some vaccines obviously cannot be given to certain children under a certain age. So for instance, the MMR and varicella vaccines should be around one year of age. Can you get them earlier if you’re traveling? Yes, you can, but it doesn’t count for your school, age immunization. There’s special caveats out there. But that is something that your primary care physician can talk to you about individually, before you make your decisions about getting your child vaccinated.

Dr. Matt Grisham: And I would love to put a plug in and follow up to Dr. Burch’s comment, there’s the single most important thing that the members of that household who may have a child who cannot get vaccinated for them to protect that child, is for them to get the vaccines themselves. And ideally a whole community of vaccinated individuals that they might encounter at daycare or school or church or grocery stores, that’s the best way to protect that vulnerable individual who can’t be vaccinated.

Scott Webb: Well, It has been so great to learn from both of you today. It’s been a great conversation. Very educational again, thank you so much for your compassion, your expertise, all the learning. I loved it. So, thank you both. And you both stay well.

Dr. Matt Grisham: Thank you.

Dr. Anna-Kathryn Burch: All right. Thank you so much.

Scott Webb:

For more information and other podcasts, just like this one, head on over to PrismaHealth.org/Flourish. This has been Flourish. A podcast brought to you by Prisma Health. I’m Scott Webb. Stay well.