Covid Shots for the little ones/Answers to frequently asked questions

 

Covid shots for the little ones!!

The Covid 19 vaccination is now approved for children who are 6 months and older. Many parents are celebrating this. Some have questions. Sadly most of us are not immune to the politicization of this issue. I am betting that many people are getting a barrage of strong opinions from either side. Uncle Frank is warning you that your child will be irreparably damaged from the shot, while cousin Harriet is prodding you to get it as soon as possible or you are a bad parent. Others agree that they want the shot, but aren’t sure of the timing, or how to choose which vaccine. Consider the following quote: “Statistics are like bikinis. What they reveal is suggestive, but what they conceal is vital.”― Aaron Levenstein I am not going to inundate you with slides that can be interpreted depending on who is looking at them. You can find statistics to validate your point of view in plenty of other places. If you are interested in learning more about my data, shoot me an email and I will be happy to share my sources. The purpose of this post is NOT to pressure you in any direction or to judge your decisions. My goal is to present up to date information that might answer some of the more frequent questions. Here are my takeaways, starting with the question “why should I get my child vaccinated for COVID?” Vaccination can protect your child from severe disease It is very fortunate that for the most part children have weathered the various strains of COVID much better than the adults. But some kids DO get quite sick and some can die. Deaths due to Covid are higher than from any other vaccine preventable illness. Ever since vaccinations have been approved for children from 5-17 the data has clearly shown that hospitalization, critical illness and deaths are all much more common among kids and teens who are not vaccinated than kids and teens who are vaccinated and boosted. I am guessing that we will see the same trend in the younger kids. Multisystem inflammatory syndrome in children (MIS-C) is another reason to avoid Covid. This is a rare but serious condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. They don’t know yet what exactly causes it but most children with MIS-C had Covid -19 or a strong Covid exposure. Kids do get long covid. Mt. Sinai in New York has been actively studying this and came out with some findings this week that even the youngest children can experience long covid. There was a study this week in the Lancet Child & Adolescent Health. It concluded that while long covid symptoms are generally ailments that kids might get anyway, headaches, fussiness, tummy issues and fatigue…etc., the kids in the study who had previously tested positive for Covid-19 were more likely to experience at least one of these symptoms for two months or more than the children who had never tested positive for the virus. The study also revealed that a third of the kids who had tested positive experienced at least one long-term symptom that was not present before testing positive. You might also have read that Israeli studies are linking the new and mysterious case of pediatric hepatitis to Covid. It is still too early to make a definite connection. The bottom line is, if you have a choice of having your child getting covid or avoiding it, I would prefer that they get some immunity from the shot rather than risk the unknowns that come along with this virus. Vaccination can protect others. Kids are an enormous vector of disease; in other words, they have cooties. Seriously, parents who send their kids to daycare for the first time can attest to the fact that kids bring home all sorts of colds and illnesses. Kids who are not showing signs of COVID because they have such a mild case can still be spreading the virus. Babies under 6 months, people who can’t get the shot, older vulnerable and immunocompromised people, need our help stopping the spread. I don’t know about you, but I am willing to take any steps that I reasonably can to move out of this pandemic. Would I put the young kids at risk in order to do this? Absolutely not. The vaccine is safe  During the trials, short term side effects from the shot were minimal. The most common ones were fever, headache, fatigue, body aches, chills and nausea with vomiting. It was interesting to see that across the board, the reactions from the placebo were remarkably similar to the reactions from the shot. This is because at any given time, kids tend to have those symptoms from other little illnesses that they tend to get. There were no reports of myocarditis in this age group. In fact, in the adolescent group where this was showing up, the incidences of myocarditis were 6 times higher in patients from having the Covid virus then from the vaccine. Every possible issue was reported. My favorite example of this was recounted by the awesome epidemiologist Katellyn Jetelina: In the Pfizer clinical trial, one potentially life-threatening adverse event occurred in an infant—coffee was spilled on them causing a thermal burn. Pfizer reported it to the FDA. This is an example of the rigor and comprehensiveness behind clinical trials. What about Uncle Frank’s warning about long term consequences? These shots have been given billions (yes, with a "B") times over the past few years. In addition, the Pfizer and Moderna vaccines were created using messenger RNA (or mRNA) technology, which has been used for about 10 years in cancer treatment, with no long-term effects detected. I am much more concerned about the future consequences of long covid that are still surfacing. What are the differences between the brands? The Moderna vaccine is a 2 dose series of 25 mcg each. The doses are given 4 weeks apart. The Pfizer vaccine is a 3 dose series of 3 mcg. The second dose is given 3 weeks after the first dose. The 3rd dose is 8 weeks after the second. Your child should get the dose that matches their current age, even if they started the series at a lower dose. Your child is NOT protected from one dose. Protection starts about 2 weeks after the completion of the series. The Moderna series has shown to give quicker protection, simply because the series is shorter. For those of you eager to get your kids protected, it would seem that the Moderna is an obvious choice. If you could get the Pfizer tomorrow and might have to wait 3 months for the Moderna, then that would be a consideration. Also, some parents might be inclined to go for the lower dose. You have been so careful for so long, another 3 months might be something that you are willing to put up with. I have heard some argue that starting the Pfizer series now would give peak protection right in time for fall illness season. The most important factor is probably which one you actually have access to! What if my kid already had COVID, do they need the shot? The quality of an immune response is relative to the severity of an infection. If a child had a mild infection (which many do), then they likely had a lower viral dose and broad protection is less likely.  The current recommendation is for you to wait 3-4 months after the first symptoms of a positive test, before getting the shot. Isn’t natural immunity better? Not necessarily. Dr Ted has some extra thoughts on this down below. I have seen some people, including kids get covid multiple times. Also, consider the case of varicella (chickenpox) .Once you get the disease it stays dormant in your body for years. In some unfortunate people this shows up as shingles. People who got the vaccine for chickenpox rather than that natural virus are LESS likely to have shingles. So in regards to covid, we really don’t know all the long term implications of the virus.  What side effects should I expect? Going back up to the trials, about one third of the kids had fever, fussy, aches and perhaps some vomiting. These were worse with the second dose (which makes sense). The symptoms also seemed to be a little worse on day two. If you child is still having issues more than 4 days after the vaccination, I would get them checked. My best guess is that they have something else going on. The most serious complication was febrile seizure . This was RARE. I added my link because all parents should know about them regardless. What are some comfort measures for after the shot? Once they get the shot, I like to apply topical arnica to the area. Baths, plenty of fluids, a lovely popsicle and maybe some extra screen time can help you all get through a day or two of not feeling quite right. Of course, have Tylenol and/or Motrin on hand for a really miserable kid. If the popsicle and watching a video of trains going in and out of tunnels (Elliot’s current favorite) don’t do the trick, go ahead and give them a dose. I wish I could tell you that getting the shot was going to completely protect your child and end this pandemic. Sigh, unfortunately the protection is not 100%. What we do know is that vaccinated kids are not getting nearly as sick. Think of it like a dart board. It is probably not a bull’s eye, but at least it is on the board. My grandson will be getting his shot shortly. Dr. Ted’s Tidbits Let me talk about natural immunity and COVID-19. The people who really know me know that I’m a surprisingly big hippie when it comes to medicine. If we can do something the natural way, I’m going to recommend it. So when it comes to kids and COVID-19, it might have been safe to assume that I would support relying on natural immunity.  I wish that were the case, but it’s not. The virus that causes COVID-19 changes shapes after it invades the body and attaches to cells. So the immune system is only trained on a shape that is not very helpful for long-term protection, and that’s what we see in the data. Natural immunity from COVID-19 wanes very, very quickly, much quicker than vaccine-induced immunity. It also doesn’t seem to protect as well from complications of COVID-19 on reinfection. When it comes to avoiding the complications that Nurse Judy lists up top, nothing is better than having the vaccine on board, as it trains your body in a more lasting way. Hybrid immunity, which is infection combined with vaccination, is the absolute strongest. If your child already had COVID-19, be happy that hybrid immunity is something you can achieve with the addition of the shot.

Hepatitis A 2022

 

Hepatitis A has been in the news recently. 

This is an inflammatory disease of the liver that is caused by a virus. It is the most common vaccine-preventable illness that people get infected with when traveling. 

Hepatitis A is certainly more common in countries with lower standards of sanitation, but this virus doesn’t care about borders. Even if you aren’t going anywhere, everyone over a year old should get the shot. 

As the recent finding of contaminated strawberries illustrates, there are plenty of cases right here in this country.

There are several types of Hepatitis. The ones most of you have heard of are A, B, and C. There are big differences in how you get them, how long they last and how sick you can get.

Hepatitis A is usually not chronic like the other forms.

Transmission of Hepatitis A occurs through:

• Close direct person-to-person contact 
• fecal-oral transmission (touching a contaminated surface and then putting your hand in your mouth)
• contaminated shellfish 
• water (Hepatitis A can only be removed from drinking water by boiling or chemicals. Filters aren’t effective because the viral particles aretoo small)
• Raw food (including fruit and vegetables..organic doesn’t make a difference, alas)
• Any contaminated food (Cooking foods at 185 degrees F for at least one minute will kill the virus, but cooked food can still spread the disease if contamination happens after cooking) It is essential for anyone who is preparing food to thoroughly wash their hands.
• Ice cubes

I actually have a funny story about ice cubes. Sandy and I were in Cambodia several years ago. We had been scrupulously careful about where and what we ate. But there we were in a lovely bar on Pub street in Siem Reap. We ordered some drinks. They came with ice and we each took a sip before I put my glass down, “Oops, ice cubes are off limits' ' Here is the difference between us, I opted out. Sandy just decided to drink it quickly before the ice could melt.

Hepatitis A is hardy and can live outside the body for quite a while. It is important to note that it can survive being frozen. If you are in the habit of freezing berries and have some of the tainted ones in your freezer, get rid of them!

This is a nasty virus. Hand washing is important and can stop you from spreading it, but won't necessarily protect you from catching it. Poor hand washing, and then handling food, is a common mode of transmission, but so is changing a diaper. Thus diaper age children, infected with the virus, are a large reservoir for spreading it. 

The incubation period averages 28 days (range 15–50 days). People are most infectious 1–2 weeks before the onset of clinical signs and symptoms, and can shed the virus in the stool for months and months.

Infection can be asymptomatic or range in severity from a mild illness lasting 1–2 weeks to a severely disabling disease lasting several months.  Most common symptoms include: 

• abrupt onset of fever, 
• Malaise (you feel tired and generally crappy)
• poor appetite,
• nausea, and abdominal discomfort
• Joint pain
• Dark colored urine
• stool is often clay colored or freakishly light. 

A few days after the first symptoms show up, many patients end up with jaundice (yellow skin and eyes). Although it is rarely fatal, adults with this can become very SICK!

The likelihood of having symptoms with a Hep-A infection is often related to the age of the infected person.  

It is worth emphasizing: In children aged <6 years, most (70%) infections are asymptomatic. 

Unless there was a known exposure, in an adult patient, jaundice is often the biggest clue that will lead a doctor to suspect Hepatitis. As I noted earlier, most of the time, young children don’t usually exhibit many symptoms at all. In the young children who are actually acting ill, jaundice is not a common symptom, so it might be a while until someone figures out what’s going on.

Unvaccinated caregivers are the ones who get walloped. I have seen it sweep through a daycare.

Here’s the thing. If you are vaccinated, you don’t need to worry! The shot is nearly 100% effective. It is also very safe.

The vaccination first became available in Europe back in 1993 and started getting phased into our vaccine schedule in 1996. It has been a routine childhood vaccine in the United States since 2005. Interestingly, although it is recommended, it is not one of the vaccines that are required for school entry. 

It can be given as soon as a child reaches their first birthday and should be followed by a booster six to twelve months later. 

If you are traveling, be aware that the protection isn’t instant. Protection against hepatitis A begins approximately two to four weeks after the initial vaccination. The recommendation for travelers is to get it at least 2 weeks before your trip, so plan accordingly. 

The vaccine comes only in preservative free form (no thimerosal concerns). I rarely see any side effects at all. Once in a while a baby post vaccine might be extra fussy, but that is rare and not necessarily shot related.

This one requires little thought. You should make sure that Hepatitis A vaccine is included in your child’s immunization schedule. Parents, also please check your own health records and make sure that you are protected. Adults are often quite clueless about their own vaccination status!

If your child is between 6 months and a year you can get the shot early if you are traveling to a high risk area. This early dose won’t count towards the routine 2 dose series. High risk travel zones include everywhere except Canada, western Europe and Scandinavia, Japan, New Zealand, and Australia.

If you are interested in resources that will alert you to outbreaks and recalls:

 FDA.gov safety recalls, alerts and market withdrawals

Food Safety.gov

Fightbac.org

This one has all sorts of education and activities for teaching your kids about safe food handling

Mothers Day 2022

 

Maternal - How would you define that word? I am fortunate that for me it evokes unconditional love, guidance and nurturing.   This Sunday is Mother’s Day. Most of these ‘hallmark’ holidays are somewhat of a mixed bag. Valentine's Day for example, is a day that many people who don’t have a partner might dread. Incidentally, it is the one day all year when Sandy celebrates my lack of romance. He is glad that I have no need or desire for overpriced roses.    Mother’s day has the potential to be even more triggering. I clearly remember five years ago when I lost my mom. That Sunday in May loomed for weeks like an impending shadow as what would be my first motherless Mother's Day. Every time I turned on the TV or the radio, there it was, Mother’s Day, Mother’s Day, Mother’s Day. What are you going to buy your mother this year? Where will you take your mother? Show your mother how much you love her. Newspapers, magazines, it was everywhere! It got me thinking. There must be so many of us out there. People who never had a mom, people who have lost a mom. Moms who lost a child, women who couldn’t have children, women who made the choice not to have kids but feel a twinge every once in a while. There are also so many wonderful families with no mommy but two amazing daddies. How about immigrant families who are forced to be separated? The list goes on and on. Ouch!    But for the lucky families who have a mama in their lives, I have some thoughts.   Make sure that you and the important people in your life know each other's love languages so that when celebrations and holidays come around, any offerings feel like they are nourishing rather than disappointing. Spoiler alert, a new vacuum cleaner might not be the best present.   For the children and partners looking for the perfect gift for mom, consider giving the gift of time.   Go on a special outing, take lots of photos. Have the kids cook a festive dinner. Memories are more valuable than jewelry. Okay go ahead and throw in some chocolate covered strawberries, but you get the idea.   Actually forget the strawberries - give mom a nap! Or remove the bath toys and set up the tub with candles, soft music and maybe some bubbles. Most essentially, the door is clicked shut and mommy has the option for a bit of solitude.   Make a new Mother’s Day tradition to tell your kids stories about your mothers, grandmothers, and great grandmothers. Did they have some favorite songs? Sing them! Did they have a favorite recipe? Bake it!   One of my best friends, Dee-Dee, flipped it and made it a tradition to write a mothers day note to each of her children. I love that! Take some time for introspection and think of some wisdom you got from your own mother or grandmother. I know that not everyone counts themselves as lucky as I am when it comes to their relationship with their mom. Nevertheless, I maintain that EVERYONE can find something positive to put on this list, even if it is to teach you what NOT to do or say. I try to live by some of the Lessons from my mom. Here are a couple that come to mind: Take the time to give positive feedback. If someone did a good job for you, write a letter to their boss and make sure they get to see a copy. These compliments can mean more than you can imagine. That grumpy person at the supermarket? Maybe they are having a terrible day. Show them kindness. Never stop wondering. For those of you in the middle generation, savor these years. You have your mom and your kids. If you are lucky, maybe there are some grandparents in the mix. Being the magic middle of the sandwich might present some challenges, but please TREASURE these years. My kids were fortunate in the grandmother department. Here is a post that I wrote about their other Grandma, my mother-in-law, who was quite remarkable in so many ways.   Let’s go back up to the word maternal at the beginning of this post. In my mind that word isn’t as tightly linked with gender or biology as one might think. The word mother is traditionally female, but the origin of the word is actually old Germanic meaning source. Anyone can mother!  Who are the maternal figures in your life? Reach out and give them a little acknowledgement (or a chocolate covered strawberry!) In that vein, Happy mothers day to everyone.