Transcription:

Robin Kish (Host):  Welcome to the Health Care District of Palm Beach County’s podcast Hear for Your Health. I’m your host, Robin Kish. The Health Care District is a unique healthcare system located in Palm Beach County, Florida. We provide county residents access to primary care, hospital and school health services, skilled nursing and long term care and lifesaving trauma and aeromedical services. Through all of these programs, the Health Care District focuses on prevention. On this edition of Hear for Your Health, we’ll discuss a key form of prevention, childhood immunizations. Our guest today is Dr. Seneca Harberger, a Family Physician who cares for adults and children with the C. L. Brumback Primary Care Clinics. The C. L. Brumback Primary Care Clinics are federally qualified health centers, also known as FQHCs that provide primary care, dental and behavioral health services to adults and children at nine locations around the county. So, welcome Dr. Harberger.

Seneca Harberger, MD (Guest):  Thanks. Good to be here.

Host:  Doctor, why are immunizations so important for children?

Dr. Harberger:  Well a lot of people would say that vaccinations are like one of the most powerful advancements in modern medicine. Our bodies are pretty good at protecting themselves and they have the ability to create immunity but normally, before vaccines, for our body to have immunity to something, it would need to be exposed to the illness. So, vaccines allow us to get that immunity without being exposed to potentially dangerous or deadly illnesses or infections.

We start with children because when you start earlier, you are able to vaccinate more people and you are able to vaccinate and protect them for longer. And the more people you protect, the more likely you are to protect even the people who aren’t getting the vaccine. If the whole community isn’t going to get an illness, the people who aren’t protected from it are also protected by their neighbors. Even for infections that we can’t get rid of; like influenza or pneumonia, meningitis; vaccinating large portions of the population decrease the amount of people that have serious illness or have to be hospitalized or even die. But vaccines and childhood vaccines are the reason that we don’t have any diphtheria or almost don’t have any diphtheria anymore. We have virtually eliminated polio in the world, and they are likely going to be the reason that eventually we wont have any cervical cancer due to human papilloma virus.

Host:  And to illustrate your point, last year in 2019, the United States saw over 1200 individual cases of measles nationwide. And that was the highest number reported in the US since 1992. The majority of people contracting measles were unvaccinated and this according to the Centers for Disease Control and Prevention, the CDC. Recent research published in the Journal of Science and Science and Immunology shows that not vaccinating children with the measles vaccine poses a double risk. One like you said, it exposed a child to the severe and potentially deadly virus and two, the virus can cause what researchers call immune amnesia. Now this means that even after recovery, the virus can cause a child’s immune system to no longer be able to defend against other infections by erasing the body’s memory of previous illnesses that came and went like colds and flu, that it would otherwise know to attack. So, Dr. Harberger, in light of this research, and your expertise; what do you tell parents who are reluctant to get their children vaccinated?

Dr. Harberger:  That’s a good question. To be honest, and one thing I’ll point out, is when we have these conversations about people who don’t want to get vaccines, I think we ignore that most patients and most parents do get all the vaccines that they need. Most patients and parents are looking for everyway they can to protect their children. And for our population in particular, because we are treating a lot of patients who are coming from places that are underserved; I actually have a number of patients who were in places where there weren’t universal vaccine campaigns, so the children didn’t have the opportunity to get vaccines.

So, most of the parents and patients that I am working with are excited and happy to get all the protection they can. That said, when parents are deciding or asking not to get a vaccine; they are not doing it out of malice; they are trying to protect their child just like I am. So, most of the time, I try to understand why it is that they would not like to get the vaccine. I have conversations about what their concerns are. I try to allay those fears and I’ll go into detail with them in the same way that I hope to go into detail with you today.

Host:  Well, with that said, can you run down the list of immunizations and the corresponding childhood diseases they help protect by following recommended guidelines for vaccinations?

Dr. Harberger:  Of course. There are a lot of important vaccines and the vaccines come sort of from different companies and they are combined in different ways. So, I’ll run through many of them but because of our use of brand names sometimes in the office, and our use of combinations to reduce the number of needles that children get it might be that some of the names I say don’t sound familiar or some of the names you hear in the doctor’s office wont sound familiar. That said, there’s a lot. I’ll start off.

The meningitis vaccine or the meningococcal vaccine or MCV4 is a vaccine against a bacteria that causes an infection of the lining of your skull and the coating outside your brain. We give that early for babies to protect them but a lot of times, the risks that we are looking at for those patients is later in life like in teen years.

Hepatitis A and B vaccines are two vaccines to protect against viruses that infect the liver. The inactivated polio vaccine or IPV is a vaccine against polio which is a virus that initially affects the intestines but later moves on to affect the nerves and cause paralysis. What you’ve probably seen in older movies and history but is virtually eliminated now especially in the United States.

DTAP or TDAP shots are a combination of vaccines against tetanus, diphtheria, pertussis. Tetanus is a bacteria that causes muscles to clench uncomfortably, what’s known as lock jaw. And we think of it as an infection that you get if you step on a rusty nail or are exposed to a dirty cut. Diphtheria is a bacteria that produces a toxin also which initially causes a terrible sore throat but can progress to damage of the heart, lungs and nerves. And pertussis is an extremely contagious bacteria that causes whooping cough which for adults may not be super concerning but for babies, it can be deadly. That’s why we give it to moms every time they are pregnant.

Host:  And what if you have had a tetanus shot recently, would a pregnant mom still need to get one again?

Dr. Harberger:  Oh, that’s a great question. When moms are pregnant, we offer the vaccine a lot of times they bring up that concern. It’s very safe to get a tetanus shot early before – we talk about five or ten years for repeating those shots. But for pregnant moms, it is safe to get it every time they are pregnant, and it actually works better and protects the infant more if the mom gets the vaccine while they are pregnant.

Host:  Interesting. Are there any others?

Dr. Harberger:  Many. Haemophilus influenza type B or HIB is another bacteria that can cause meningitis but also severe other infections like very bad ear infections, sore throats, or bacteremia, infections of the blood. The MMR shots are a combination of vaccines against measles, mumps, and rubella which cause febrile illnesses in children and have a risk of progressing to a severe illness. Rubella can cause birth defects when they are contracted by pregnant moms. The pneumococcus vaccines protect against bacteria that cause pneumonia, meningitis or other serious infections. There are several versions of the vaccine, so some are given to children; the brand name for that one is Prevnar or PCV13 but then we also repeat that vaccine for people who have chronic illness and then again when people are elderly. And the later in life vaccine is called Pneumovax.

Varicella is a virus that causes chickenpox. Immunity from that vaccine is more long lasting that what I or many parents have. The immunity that we have from having chickenpox as a child was good; but having chickenpox as a child puts you at risk for having shingles as an older adult and the immunity to chickenpox that wanes over life is actually what gives you that risk of getting chickenpox later. So, we now give the vaccine instead of the illness to children so that they don’t have the risk of shingles later in life and also so that they have a longer lasting vaccination.

Rotavirus is a virus that causes serious intestinal infections in children. That vaccine is usually given as a drinkable liquid which is a little different from others. Human papilloma virus has been in the news a little bit more recently because it’s one of our more recent vaccines and because it has the potential to cure cervical cancer. The virus itself can cause warts or it can initiate changes in skin that can lead to cervical or other types of cancer. And so the vaccine that’s been created protects against the ones that are highest risk for causing cervical cancer.

And then influenza is a virus that causes flu symptoms which are uncomfortable for most people, but they can be deadly in certain vulnerable populations. So, even though we’re not going to get rid of flu and it changes very frequently; we try to vaccinate as many people as possible against the flu because if there are people in your neighborhood that have serious illness or are very young or are older; they have the prospect of getting the flu and then ending up in the hospital or getting a serious pneumonia on top of what they have already had.

Host:  Throughout all of the vaccines that you mentioned; what age is it best to start?

Dr. Harberger:  We start our vaccines as soon as possible. So, the first vaccine that children will get is the hepatitis B vaccine and they get that on day one or two of life. After that, we have a schedule of vaccines over the first few years to combine as many of the vaccines into single shots as possible and reduce the number of injections that kids are getting. Most parents thank us for combining the needles as much as possible. We have to think a little bit about how we combine them to make sure that the vaccines are as strong as possible and that we can separate the ones that need to be separated and give time between successive doses of single vaccines.

But following that schedule is the best way to ensure that your kids is immunized at the right time but for those patients and parents that are coming in a little bit late or weren’t able to access vaccines before; we have ways to catch up later and make sure that we are still safely giving all the vaccines that we need.

Host:  Who helps parents keep track of the schedule for the child’s vaccinations? Is it the doctor?

Dr. Harberger:  Yeah, it’s my responsibility and our office’s responsibility to make sure that the kids that come to see me get all the vaccines they are supposed to and get them on the schedule that they need to. So parents can always rely on the doctor to keep track of those things. Many states have good systems for making sure that the information is communicated between doctors so if – in Florida, if a child is seeing one doctor and then moves between cities and I need to find out the information; I can get that from the old doctor, but I can also get it from Florida Shots. It is good for parents to keep track of documentation especially if they are moving large distances. But we find ways to safely give all the protection that we can even if a parent isn’t keeping track of that information.

Host:  So, it also ensures you’ll be seeing the child on a regular basis, based on when those vaccinations are –

Dr. Harberger:  Absolutely. If we’re keeping track and following the normal schedule, in the first 15 months of a child’s life, I’ll see them eight times.

Host:  What can parents expect after their child receives a vaccination?

Dr. Harberger:  Well any medication has some potential side effects. The things that we think about for vaccines, most commonly is the distress that the child has when they are receiving a needle. That’s usually out of proportion to the actual pain that the child would feel. It’s scary to get a needle even though the needle is very small and doesn’t actually hurt that much. After you get a vaccine, we as adults, know that you have some soreness in the muscle that received the vaccine. Sometimes, the sort of ramping up of your immune system after you get a vaccine, will mean that you have some cold symptoms and maybe even a mild fever. What you don’t get is something like a small flu from getting the flu shot. Which is sort of a typical response that I get from patients a lot is I don’t get the flu shot anymore because the flu shot gives me the flu. That’s not true. What you might get is a little bit of cold like symptoms, some congestion, maybe a mild fever. But nothing like the debilitating stuff that an actual flu would give you where you are having nausea, and feeling aches all over your body and not able to go into work.

Host:  How would you recommend parents treat mild reactions to immunizations in children?

Dr. Harberger:  Well, there’s a lot of different things that you can do. Most of what we do and most of what parents do for kids that just got vaccines is just sort of TLC, just loving care for their child. The things that you can do if you are trying to avoid medicines, are things like cold compresses, a kiss and a Band-Aid on the spot that got the vaccine is very helpful for a parent to do. If you’ve noticed that after vaccines, your child often has that low grade fever or often has a lot of soreness; one thing that we recommend for parents it to premedicate. So, you can take over-the-counter Motrin, or Tylenol. You can talk to your doctor about dosing if you like to ahead of time and give a single dose about a half an hour before the vaccine. That can decrease some of the soreness and some of the potential side effects.

That would be safe to do but it’s also not necessary for parents that are trying to avoid medications.

Host:  So, there are medications a parent can use for fever or soreness after the vaccine.

Dr. Harberger:  Absolutely and another medication that sort of feel like we always talk about trying to get kids away from sweets but another medication so to speak, that kids can get is a lollipop or popsicle. I think that’s perfectly reasonable to give after you’ve gone through the experience of getting the needle.

Host:  What about aspirin, no?

Dr. Harberger:  Aspirin is not a medication that kids could get. It honestly, aspirin was a terrific medicine when it was the first medicine that we had but there’s enough side effects that I almost never use it for pain at this point. I do use it for adult patients who have cardiac conditions or we’re trying to protect them from clotting. But for children; we should never use it.

Host:  What are some of the more serious side effects that could occur and when should parents call their child’s doctor?

Dr. Harberger:  Well first if a parent is concerned for any reason, they should feel comfortable reaching out to their doctor. Some potential reactions that you could consider are things like local infection. So, at the area where the shot was given; if that muscle or skin became red, warm, inflamed, tender to touch; those would be reasons to come back. When I talked about fevers before; those are mild low grade fevers. This child feels a little bit warm to touch or has a fever in 100.0 or 101 maybe. But if you have a high fever or the child feels actually ill; that would be a reason to go back to the doctor.

Host:  Is it ever too late to get your child vaccinated?

Dr. Harberger:  So, too late is a funny word. Each year we have a flu season and we come out with a flu vaccine to protect kids from the flu during that time period. So, once the season is gone; then it’s no longer helpful to get that vaccine. So, that’s too late. There are some vaccines similarly for kids like rotavirus that apply at a young age, so once they are past that age, we no longer vaccinate children against that. For the vaccines where the disease is a potential risk for an entire life; you can get that vaccine at any time. But the longer you wait to get the vaccine; the more time you spend not being protected from it. So, it’s not really ever too late to get a vaccine that might apply and protect you but the longer you wait, the more time is missed, the more time you don’t have protection for it.

Host:  And even getting the vaccine, there’s time that you need to wait before it actually is effective?

Dr. Harberger:  Absolutely. And the way the you get the vaccines and the amount of follow up that you need changes. So, for instance, the first flu shot that a child receives needs a second booster shot. So, if a three year old is going to get a flu shot and they’ve never gotten one before; they are going to need to come back a month later. So, if they get that flu shot in February; they are going to get even less protection time than they would get otherwise. And they have the three years that they weren’t being protected. Similarly, HPV or the human papilloma virus, cervical cancer; if we try to protect from that as a child at say 11 years old; you need two shots of HPV but the later the longer you wait, the more likely it is that you’ll need a full three shot course and again, the less likely it is to protect against that virus.

Host:  For more information on vaccinations including when your child should get them and answers to frequently asked questions, parents can visit the CDC website www.cdc.gov/vaccines. At the top of the show, I mentioned that at the Health Care District we focus on prevention to keep our community healthy. Doctor, what is one top tip you’d like to share that helps keep your patients healthy?

Dr. Harberger:  Oh, that’s great. That’s a great question. We’ve been talking about vaccines and those are extremely important, but I think the thing when I see patients for their well visit and for preventative care; the thing I’m thinking about most for children because vaccines are so ingrained in us now; is making sure we talk about calories and care with things like sugary drinks. Parents and families and kids even, tend to think of things like soda, cakes, candy as being not great for their kids and they try to limit those things and think of them as treats. But a lot of parents are still thinking of things like fruit juice as a safe and healthy drink for kids. But it actually has a lot of sugar, as much sugar as something like a piece of candy or a soda. So, I spend a lot of time in my office educating my patients on trying to reduce the amount of fruit juice that their kids are drinking and think of it more like a treat. Not something you can never have, but something you’d have as a treat like you would as a cake or an ice cream or a popsicle.

Host:  Not so good for the body or the teeth.

Dr. Harberger:  That’s true, absolutely.

Host:  Well Dr. Harberger, thanks so much for joining us today and providing our listeners with such excellent in-depth information on childhood vaccinations.

Dr. Harberger:  Thanks for having me. It was a pleasure.

Host:  And thanks to all of you for listening. Please check in next time when the Health Care District explores another important health topic on our podcast Hear for Your Health.

Today’s podcast is brought to you by the Health Care District of Palm Beach County C.L. Brumback Primary Care Clinics. The C.L. Brumback Primary Clinics offer primary care, dental services, behavioral health and pharmacy services for adults and children as well as medication assisted treatment for patients with substance use disorders. The Brumback clinics have locations throughout Palm Beach County as well as a mobile health clinic for the homeless. For more information or to make an appointment, call 561-642-1000 or visit www.brumbackclinics.org.