Baby 411 Blog

Flu shot update and AAP vax website

What's going around? The U.S. has seen a steady drop in H1N1 infections in the past few weeks. In fact, I have not diagnosed a child with H1N1 in about 10 days. Yippee!!! Of course, the usual germ suspects have made their annual trek into town— viral croup, RSV bronchiolitis, and Strep throat. And oddly, kids in my community are also coming down with Hand, Foot , And Mouth (coxsackievirus) which we usually see in the spring and summer. So, there is no rest for the weary.

Is it too late to get the H1N1 vaccine? Should you bother getting your child the H1N1 vaccine at this point? Yes, we still think your child should get the H1N1 vaccine. No it isn't too late! I don't think we are done with H1N1, particularly with the holiday travel season upon us. My practice has a decent amount of both H1N1 shots and nasal spray now, so I assume other practices who have ordered the vaccine have more now too.

What about seasonal flu vaccine? More good news, the seasonal flu SHOT supply is also much better than it is was a few weeks ago. So, now kids over two years of age can get seasonal flu shot and H1N1 nasal spray or shot at the same time (there is a 4 week interval required between H1N1 and seasonal flu nasal sprays). The U.S. seen virtually no seasonal flu yet this year. Those viruses usually show up in late December/January/February. So, if you or your kids have not gotten seasonal flu vaccine yet, now would be a good time to get that done!

More vaccine info: The American Academy of Pediatrics just launched a great new website for vaccine information (not just for flu). Bookmark this page: http://www.aap.org/immunization/

I'm blogging for WebMD!

Hey everyone,

I've teamed up with WebMD to keep parents up-to-date with the latest news in child health. I've been blogging about the major crib recall and H1N1 disease this week. Take a peek: http://blogs.webmd.com/child-health-411/

I'll be posting the WebMD blog links on the Baby 411 site going forward. So, be on the lookout for new posts on the way.

Happy Thanksgiving!

H1N1 shot update for my patients

For my patients and Capital Pediatrics: Based on the extremely high demand for the H1N1 shot and the limited availability (we have many more doses of the nasal spray), we are asking (for the time being) that the shot be reserved for children ages 6 months to 2 years of age and those who are high-risk and not eligible to receive the nasal spray form of the vaccine. But, anyone who is eligible to receive the nasal spray may book a vaccine appointment.

We expect to get regular shipments of vaccine, so I promise to keep you posted on this rapidly evolving situation!

Baby 411 now available on Kindle!

Great news! Baby 411 is now available as a Kindle e-book! 

Yes, now you can download Baby 411 for your Kindle! And if have an iphone and the free Kindle for iPhone app, you can also read Baby 411 on your iPhone!

Amazon is selling the Baby 411 Kindle-book for just $9.99.

H1N1 vaccine supply—How it all works

We've received quite a few questions from blog readers about how H1N1 vaccine supply is being distributed. I'm happy to share what I know about it. In my own state, each medical practice wishing to administer H1N1 vaccine had to apply for it through the state health department. My office had to provide specific information on the ages of our patients, the number of high risk patients we cared for, and the total number of active patients in our practice. The vaccine supply we are starting to receive is based on that information and what vaccine is available. All states are handling this situation in their own way, and they are doing what they can to get vaccine to everyone as soon as possible. I know it's a frustrating situation for everyone!!!

We've also received requests from blog readers who are not patients in my practice to get H1N1 vaccine at my practice. I wish I could offer it to everyone, but unfortunately, our supply is limited (since it's based on numbers we've given to the state) and so I can only give it to existing patients. But the good news is, if my practice is starting to receive regular shipments of H1N1 vaccine now, your child's pediatric office should be starting to see it soon as well.

H1N1 Shot arrives!

Here is an update and revision from my post from yesterday. My practice just received our first shipment of the H1N1 SHOT. It is Sanofi brand and they are multi-dose vials (which means several doses of vaccine are contained in each vial). This vaccine is approved for use in children ages 6 months old and up. This version does contain a small amount of thimerosal as a preservative. Despite that, I still encourage families to get their kids vaccinated with this shot.

If you are concerned about thimerosal, here are some key stats:

Children 6 months to under 3 years old, Sanofi multidose flu vaccine: 0.0125 mg ethyl mercury (thimerosal)

Children 3 years old and up, Sanofi multidose flu vaccine: 0.025 mg ethyl mercury (thimerosal)

By comparison, 1 liter of breast milk contain 0.015 mg methylmercury and a 5 oz can of tunafish has 0.115 mg of methylmercury. Both contain more mercury!

Here are some other key points:

• The H1N1 shot can be given to anyone who is 6 months and older.
• If your child received seasonal flu shot or Flumist, there is no time interval required between that vaccine and this one. In fact, the H1N1 shot can be given at the same time as the seasonal flu shot or Flumist.
• Kids under 10 years of age need 2 doses given 28 days apart for best protection.
• It takes about 2 weeks to mount an immune response to the vaccine.

Who cannot get this vaccine?

• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to an influenza vaccination.
• People who developed Guillain Barre Syndrome within 6 weeks of getting an influenza vaccine previously. 
• Children younger than 6 months of age
• People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)

I just got the H1N1 shot and I'm feeling pretty good! For patients at Capital Pediatrics: We have 320 doses of the H1N1 shot and just received another 500 doses of the H1N1 Nasal spray. Anyone who wants to get the vaccine can set up an appointment.

H1N1 vaccine news for Capital Pediatrics

Hey CPG patients,

Effective Wednesday, October 28, our practice will be offering the H1N1 Nasal Spray vaccine to anyone who wants it and is eligible to receive it (see prior blog posts on those restrictions). Please check it out to avoid frustration by showing up for an appointment and then being told your child is not eligible. We expect to receive another 750 doses of the nasal spray in the coming days so we should have enough to get rolling!! Please call the office to schedule a nurse visit appointment for each child who will get the vaccine.

We are still waiting to receive the H1N1 Shot (injectable form). We are told that we will receive 500 doses of the Sanofi brand--which is approved for children ages 6 months of age and older, and is thimerosal-preservative free. As soon as it arrives in the office, I will let you all know. In short: We do NOT have the shots yet.

H1N1 vaccine is here!!

It’s here!!

 

The first batch of the H1N1 vaccine is arriving at doctors’ offices and clinics around the country (including mine). I want to give all of you the 411, but I also have specific information for patients in my practice. Here are 12 things you need to know about H1N1 vaccine.

 

Tip #1. What version is coming? The first batch of vaccine being distributed is the live-attenuated H1N1 nasal spray (just like the Flumist for the seasonal flu strains).

 

Tip #2. How much is coming? Doctors’ offices will only receive a small batch on the first distribution (my office will only have 500 doses), but medical providers will get more shipments and the injectable (shot) H1N1 vaccine in the coming weeks.

 

Tip #3. Who can get it? There are only certain people who are eligible to receive the nasal spray form of the vaccine. Here are the people who qualify:

---2 years old to 49 years old

---Healthy (no medical problems like asthma, heart disease, neurologic disease, etc)

---No history of wheezing in the past 12 months

---Normally functioning immune system (no immune deficiencies)

---Not currently ill with a moderate to severe illness (yes, it is okay to get the vaccine with a minor cold or mild fever)

---Not pregnant

---Not allergic to eggs

---No prior history of Guillain-Barre Syndrome

---Have not taken any antiviral medication (Tamiflu, Relenza) in the past 48 hours

---Is not taking aspirin or aspirin-containing medication

---Have not received any other live attenuated vaccine (MMR, chickenpox, or Flumist) in the past 4 weeks*

 

*WORTH REPEATING: THERE MUST BE AT LEAST 28 DAYS (4 WEEKS) BETWEEN RECEIVING FLUMIST (OR MMR/CHICKENPOX) AND H1NI NASAL SPRAY TO ENSURE AN EFFECTIVE IMMUNE RESPONSE.

 

Tip #4. Who should get it first? The first children who should get the nasal spray form of the vaccine are healthy 2-3 year olds (especially if they have a younger sibling who is less than 6 months old in the house, a pregnant mom, or family member with an underlying health issue). Since the vaccine is in very short supply initially, the Centers for Disease Control recommends that those most in need of the vaccine get the vaccine first. I would bet most practices will simply ask patients to follow the honor system.

 

Tip #5.  When should everyone get it? As more supply becomes available, anyone who wants to get the vaccine should be able to get it. It will also be easier when the injectable (shot) form is available because that can be given to anyone 6 months of age or older who does not have an egg allergy.

 

Tip #6. How much will it cost? There is no charge for the vaccine itself, but there may be an administration fee that most insurance companies will cover.

 

Tip #7. How many doses are necessary? Kids under age 10 need two doses of H1N1 vaccine (either nasal spray or the shot form) to mount an effective immune response. The recommended interval between the first dose and the booster dose will probably be 4 weeks, but I will let you know if that changes.

 

Tip #8. Is there any red tape? Yes. All patients who receive the H1N1 vaccine are required to read the vaccine information statement and fill out a questionnaire before receiving the vaccine.  And, medical staff must record each H1N1 vaccine given in a special tracking system for the state health department. (In English: this may take a few minutes!)

 

Tip #9. For Dr Brown’s patients and patients of Capital Pediatrics Group: How will it be administered? We will begin offering the H1N1 nasal spray vaccine on Monday, October 19, 2009. Due to the anticipated high demand, we will offer H1N1 or seasonal flu vaccine by appointment only during weekday office hours. Starting on Friday, October 16, 2009, we will begin scheduling nurse/vaccine appointments for Monday, October 19, 2009 and beyond. We only have 500 H1N1 doses to start, but we’ll be receiving shipments regularly. We will book appointments for children to receive the doses that we have on hand. Each child in a family needs to have an appointment to receive the vaccine. Please review Tip #3 above to see if your child qualifies to receive the nasal spray vaccine.

 

Tip #10. Should I/my child get it? Yes, you should get this vaccine. No, I’m not worried about it at all.

 

Tip #11. Where do I get more info? For more info on the H1N1 vaccine, go to the Centers for Disease Control website at cdc.gov. And, the state of Texas offers flu updates if you call 211.

 

Tip #12. Why is the seasonal flu vaccine in short supply? Because flu vaccine manufacturers are prioritizing the distribution of the H1N1 vaccine, many medical practices have not received the bulk of their seasonal flu vaccine supply yet. The good news: The U.S. is really only seeing the H1N1 strain of flu virus right now and the “usual suspects” (our seasonal flu virus strains) have not arrived yet. Understanding that may help lessen your frustration with your doctors’ office! When it is available, you should get this vaccine, too.

 

Stay well!

Dr B and Denise Fields

Baby 411

H1N1 vaccine update

Just an update for my own patients who have asked when we will receive our first shipment of the H1N1 vaccine. We have been approved to get 500 doses of the live-attenuated vaccine nasal spray in the first shipment. We have no idea when it will come in, but it will most likely be within the next 14 days. The Centers for Disease Control recommends that there are 5 high priority groups who should get the vaccine first:

• Pregnant women
• Household and caregiver contacts of children younger than 6 months of age (e.g. parents, siblings, and daycare providers)
• Health care and emergency medical services personnel
• Persons from 6 months through 24 years of age
• Persons aged 25 through 64 years who have medical conditions associated with a higher risk of influenza complications

But, remember that the live-attenuated vaccine nasal spray is only for healthy kids ages 2 years and up. So, those first 500 doses will probably be best for healthy 2-3 year olds (the highest risk group who is eligible to receive it).

I promise to keep you posted as more information comes available.

Swine flu vaccine: What you need to know

AVAILABILITY

Q. Does your office have swine flu vaccine yet?

No. Medical providers have not received their shipment of swine flu vaccine yet. We anticipate getting the first shipment in mid-October. The U.S. plans to have 195 million doses of H1N1 (swine flu) vaccine, but it will be distributed in several batches on a weekly basis.

 

Q. Will the vaccine be a shot or a nose spray?

Well, there will be both forms of the vaccine. The FDA has approved three flu shots from three manufacturers and one nasal spray from another manufacturer.

 

Q. What is the difference between the three H1N1 shots?

All three vaccines protect against just one strain of influenza—H1N1. They will NOT protect against the other flu strains we typically see in the fall and winter season. They are all inactivated vaccines. And like the seasonal flu vaccines, these vaccines are created with egg product, so people with egg allergies need to steer clear.

Here are the key differences:

CSL Brand: FDA approved for people who are 18 years and older.

 

Novartis Brand: FDA approved for children four years of age and older. Kids under ten years old will need a series of two doses, given one month apart.* People ten years of age and older need one dose for protection. There are two forms of this shot:

-Single dose in a prefilled syringe: uses thimerosal in the manufacturing process but then it is extracted before the final production.

-Multidose vials: uses thimerosal as a preservative

 

Sanofi Brand: FDA approved for children six months of age and older. Kids under ten need a series of two doses, given one month apart.* People ten years of age and older need one dose for protection. There are two forms of this shot—a single dose in a prefilled syringes and a multidose vial. Both products are thimerosal preservative free.

 

*The dosing interval may be shortened if studies show adequate protection with shorter spacing between doses.

 

Q. What do I need to know about the vaccine nasal spray?

The nose spray is similar to the Flumist vaccine used for seasonal flu vaccine. It is a live-attenuated vaccine. Because it is a live vaccine, there are certain people who cannot get this vaccine. It is also made with egg product. It does not have any preservative.

Medimmune makes the H1N1 nasal spray. It is FDA approved for healthy people two years old up to 49 years of age. It will be a series of two doses, given one month apart for kids under 10. It will be one dose for people 10 years of age and up.

 

Here are some specific people who should NOT get the nose spray version of the vaccine: pregnant women, people with asthma, people with immune deficiencies, and those with underlying medical conditions.

 

Q. If my child is taking Tamiflu, can he get the H1N1 nose spray?

Not while he is on the medication. If someone is taking an antiviral (such as Tamiflu), he should not receive the nasal spray until it has been at least 48 hours after completing the medication. And, if a person receives the nasal spray, he should not take an antiviral (such as Tamiflu) for two weeks after being vaccinated unless it’s medically necessary. That’s because the medication will reduce the ability for the vaccine to work.

 

Q. Will doctors’ offices get all forms of the vaccine?

It’s possible we will get different forms as the distribution progresses. My practice has not received any specific information yet. But, we think the first batch we receive will be the nose spray. That means that we will be able to offer that vaccine only to children at least two years of age.

 

Q. Can my child get both the seasonal flu vaccine and the H1N1 vaccine?

Yes, it’s a good idea to get both vaccinations. The seasonal flu vaccine (both shot and Flumist nose spray) is available now. The H1N1 vaccine will be available in a few weeks.

Key Point: Live-attenuated flu vaccines (the nose sprays) must be given at least four weeks apart so you have an adequate immune response to the vaccinations. So, if your child gets Flumist over the next few weeks, he has to wait a full four weeks to get the H1N1 nose spray. Consider that before getting Flumist right now.  You will also need to wait four weeks between the H1N1 nose spray, Flumist, and other live-attentuated vaccines like MMR or Varicella.

There is not a special time interval to receive seasonal flu shot and H1N1 shot.

 

SAFETY CONCERNS

Q. Are these new vaccines safe?

Yes. Think of it this way—every year the seasonal flu vaccine is a “new” vaccine because manufacturers take their cookbook recipe for the vaccine and add the flu strains that are predicted to be the ones we see in the annual flu season. That is the same way the H1N1 vaccine is made. The only difference this time is that H1N1 is the strain they are using in the recipe.

If it makes you feel any better…as a healthcare provider on the front line, I will be one of the first to get the vaccine. I have no worries about it! In fact, I can’t wait to get it—since I am seeing a ton of kids everyday with this illness.

 

Q. Should I worry if my child can only get a flu shot that uses thimerosal preservative?

            No. There will be a priority for pregnant women and children to receive the preservative free version of the flu vaccine. But, if the only flu vaccine available is one that uses thimerosal in the manufacturing process or has a tiny amount in the final product, it is still a good idea to get the vaccine. Despite all the hype, there is not any substantial proof that thimerosal is harmful in any way.

 

Q. Does this vaccine contain aluminum or any adjuvant?

No. Adjuvants are products that increase a body’s immune response to a vaccine. Other countries have used (since 1997) and will use flu vaccines that contain an adjuvant, but the U.S. never has done this and the four FDA approved H1N1 flu vaccines are adjuvant-free.

This has been a bit of a debate because using an adjuvant makes it easier to create more vaccine to meet the demand.

 

Q. Is there a risk of getting Guillain-Barre Syndrome from the vaccine?

Guillain-Barre Syndrome (GBS) is a very rare disorder that causes the body to damage its own nerve cells, resulting in temporary muscle weakness. Most people recover completely. The risk of getting it is about 1 or 2 in 100,000 whether or not you get a flu vaccine. The risk of getting GBS specifically from the flu vaccines are about 1 in one million.

 

Stay tuned to baby411.com for updates. We will send out a note when the vaccine actually arrives in doctors’ offices.

 

And, check out the CDC website for the nitty-gritty details on swine flu vaccine.

http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm181950.htm