Transcription:
Back to School and Needed Vaccines

Caitlin Whyte: Back to school season has arrived. And one important item on every back to school list should be a well child checkup with your child's pediatrician. An important part of every child's checkup is to receive needed vaccines. Here to talk more about childhood vaccines is Dr. Sandra Arnold. The division chief of pediatric infectious diseases, the medical co-director of antimicrobial stewardship and the associate residency program, director of pediatric residency at Le Bonheur Children's Hospital.

This is the Peds Pod by Le Bonheur Children's Hospital. I'm Caitlin Whyte. So doctor to start us off today, why is the back to school season a good time to set up these general vaccine appointments?

Dr. Sandra Arnold: There are vaccines that are required for students to enter school at kindergarten. And then again at the seventh grade, although the requirements are somewhat different at those two time points. And so for this reason, getting caught up is essential in order to avoid delays in starting school, it's really important that families be prepared for this since everyone is going to try to see their doctor right before school starts, you should definitely not wait until the last minute to try to get your shots.

A good idea, I think is to take your child for their well child checks near the time of their birthday. So it doesn't have to be tied to the time you are starting school. And that's a good way to remember when you actually need to take your child for an appointment. And if you can't get into see your doctor, because you did leave it to the last minute, you can also take your child to the health department to get vaccines. And this year, the school system here in Shelby county and the health department and La Bon Heur Children's Hospital sponsored some back to school vaccine drives.

And we'll probably keep doing those, but we do recommend that you try to get these things done before. It's a better idea to go to your doctor than to go to the health department, because you also do need to get your child to check up so that they can make sure that they're growing and that they're thriving and have these other things done. But the clinics run through the health department can be helpful if you're in a pinch.

Caitlin Whyte: Absolutely. So, it's been a crazy couple of years. What trends have you seen with kids getting those general childhood vaccines?

Dr. Sandra Arnold: Unfortunately, we had a lot of doctor's offices being closed early in the pandemic, either that, or they were only seeing certain kinds of sick visits. And so a lot of children fell behind on their vaccines and we are really still seeing the effects of this many children. As I said, fell behind the state of Tennessee publishes reports on how caught up children on their vaccines.

And what they're showing was that in 2021, which is the most recent data we have fewer children were completely up to date on vaccines in 2021 compared to 2019 and 2020. And the only vaccines were children in Tennessee were meeting the goal set for 2020, what's called Healthy Children 2020, where the hepatitis B vaccine, which you receive when you are born.

And then in the first couple months of life and the pneumococcal vaccine, which is a vaccine that's given to prevent a particular kind of meningitis, a lower percentage of children were fully vaccinated for all the other vaccines compared to 2019 and 2020. So the trends are not good and we really need to get the word out there because if the rate of vaccination against certain diseases in the community falls, then we could see outbreaks of those diseases.

I think a lot of people know a lot more about the general population protection against infection and what we call herd immunity or the herd effect. And that's really important in vaccine preventable diseases like measles. Chickenpox and pertussis, which is whooping cough. And so we really need people to be getting these shots in order to keep these diseases out of our communities.

Caitlin Whyte: Well, let's dig into that a bit more. Can you tell us in even more depth, why we've seen an increase in vaccine hesitancy for children? I mean, why should I be getting these general vaccines for my child?

Dr. Sandra Arnold: So vaccines are really very safe. Most of the concerns that people have about vaccines are false. There was this study that's been since discredited that showed that measles or MMR vaccine measles, mumps, and rubella vaccine was associated with autism. That is untrue. It has been disproven many times over and a lot of dollars were spent on research to disprove that that was actually the case.

We do a very good job in this country. And in other countries of monitoring vaccine safety, typically vaccines go through years of testing, including. Preclinical testing, testing in animals and then very large clinical trials starting in adults, and then in children. I think the thing that always worries people of course, is that not every side effect can be detected in a clinical trial because you would have to study millions of people to see the very rare side effects.

And you have to balance that against the cost of doing such a large trial and also how long it would take to do such a large trial. That keeps really important vaccines off the market for longer if you have those sorts of requirements. But what is done is that after a drug, and this is the same for medications, it is for biologic products like vaccines. You have post-marketing surveillance, which is done by both the FDA and the CDC has many systems in place.

They have multiple systems. Where they monitor for adverse events after vaccines and these systems really work. And I can give you two examples of that. One was a vaccine called Rotor Shield, which was late 1990s, early two thousands. It was a vaccine to prevent roto virus, which is the most common cause of viral diarrhea in young children. And what they saw after this vaccine was released were reports of cases of a condition called intussuscqqeption.

Where some of the bowel telescopes in on itself, and it causes severe pain and bleeding. And children, if they're not treated quickly can develop, they can have lack of oxygen to that part of their bowel and they can lose a part of their bowel. It can be very serious, but it also can be dealt with very promptly. And they started to see that.

And studies were set up very quickly to determine whether this was just something that was a fluke or whether it really did seem to be associated with the vaccine. It was found to be associated with the vaccine and eventually the vaccine had to be withdrawn from the market. So the system worked because when we picked up on what was going on and we studied it and did something about it.

The same thing goes for the coronavirus vaccines, with the nature side effect that people have been concerned about being this heart inflammation that you get. That's seen in teenagers in young adults, mostly males following their second dose of an mRNA vaccine, either the Pfizer vaccine or the Moderna vaccine. And it is rare enough that it was not picked up in the clinical trials, where 30,000 people were studied instead of a million people.

But as soon as the vaccine was released and millions of people received these vaccines fairly quickly, the systems that the CDC had in place and also around the world, Israel started reporting cases. The European medicines agency systems all around the world picked up on this very quickly. It was studied. It was determined to be a real association and then people studied, well, what can we do?

What we did find out was that it was actually relatively mild. In the long run and that most people did just find the inflammation went away. But we also figured out that if you delay the second dose by a longer period of time, instead of doing it after a few weeks, you do it after a few months, that that drops the risk substantially. So medicine and science are self-correcting. We are constantly learning and nobody ever claims to know anything right at the beginning.

But we do know how to study and monitor for things and how to determine whether their associations are real and then what we can do about them.

Caitlin Whyte: Well, as we head back to school this season, what do you expect to happen with COVID 19 numbers?

Dr. Sandra Arnold: I think it's impossible to know for sure of course, but it would be surprising if we didn't start seeing more cases when we have school is the largest group gathering besides maybe rock concerts, right? We get thousands of children sometimes crammed into schools. So it wouldn't be surprising if cases started to go up again.

We also don't know what variant or sub variant is coming next, whether it will be better able to evade our preexisting immunity or not another variable in this will be whether there is a new vaccine that we can get a booster with that will provide better protection against the currently circulating Amicron sub variance, B4 andd BA5. So I think we need to be prepared that we will see a spike in cases.

Whether we'll know about them or not is another question because a lot of the cases that we're gonna see in children are gonna be mild. They may not even register on anybody's radar. People are doing home testing. A lot of people aren't testing at all anymore. So it may be difficult for us to know unless we start seeing a lot of older people or immunocompromised people getting sick and ending up in the hospital.

We're really much more accurately counting hospitalizations due to COVID than we are overall case numbers. Although, so the numbers themselves don't mean very much, but the trends in the numbers can be helpful in terms of whether cases are going up. You can look and see are the numbers going up, even though the numbers probably don't accurately reflect what's actually going on in the community, but the numbers from hospitals should be very accurate.

So I think that we'll be able to get an inkling of what's going on based on that. What we're also gonna see though, is we're probably gonna see a proper flu season again this year, since nobody is masking. And I think what we really need to enforce to people is that they need to be up to date on their COVID vaccines and they need to be up to date on their flu vaccine. I can't stress that enough.

We know that again, like the COVID vaccine, the flu vaccine does not prevent all cases of flu, but it definitely keeps you from getting very ill. And anyone can get very ill from the flu at any time. And unfortunately, every year, children die from influenza and we know that the influenza vaccine is protective against death from influenza. So there are really good reasons to get both of those vaccines.

And I hope that people. Make sure that they do everything they can to protect their children from these respiratory viruses. And we never know what else is coming down the pike as well. There might be, we're starting to see more cases of respiratory since social virus, which is less of an issue for school age children. More of an issue for younger children. Those seasons have been messed up by COVID and masking as well.

So I think it's gonna be really interesting for those of us who find these things interesting to see what goes on this winter. But the best thing that you can do is get all caught up on those respiratory virus shots and keep your hands clean. And if you're so inclined, certainly you can wear a mask. If you find that a lot of kids in your child's classroom are getting sick, wearing a mask for a couple weeks, might actually keep your child from getting.

There's no reason not to, if you're comfortable in it, I'm not telling people they have to, but it's another added what we call non-pharmacologic measure. It can keep you from getting sick. I suspect that I will be wearing a mask in crowded public spaces for a long time. I haven't been sick in two years and it's really nice.

Caitlin Whyte: Yeah. Well, as we wrap up here, doctor, what can parents do on top of all of this to help prepare their child for a healthy school year?

Dr. Sandra Arnold: So make sure you take your child to the doctor for their yearly checkup, you can check on their growth and their development. Make sure that they are ready for school deal with any health or learning related issues that they may have. Make sure they're up to date on all their vaccines, of course, including flu and COVID 19, make sure they're eating well, eating regularly, not eating too much junk.

And a really important thing is to make sure that they have regular sleep. Children need a lot more sleep than adults do. We're talking about 10 to 12 hours at night, and a lot of kids get up very early for school here. So make sure your kids have a good, solid sleep schedule. Cause that really goes a long way to helping them get through their days and keep learning.

And reading to your child, your young children. These are all really important things that we recommend when children come in for their well child checks. Make sure that your children are, that you're engaging your children. You're engaged in their learning. And in terms of health, obviously the vaccines keep your hands clean, consider wearing a mask. If they seem to be a lot of illnesses circulating in the moment.

But continue to enjoy things, enjoy the fact that we're able to get out there and do the things that we love to do again, because after a couple years ago it does seem like a real treat to be able to go to the movies, go to the theater, enjoy hanging out with friends without having to worry too much. All of those things.

Caitlin Whyte: Well, thank you so much, doctor for this critical information. It's just so important to keep our kids health in mind as we head into another school year already. And thank you for listening for more episodes. Be sure to subscribe on apple podcasts, Google podcasts, or wherever you listen to your shows and find more information online@lebonheur.org. If you found this podcast helpful, please share it on your social channel. This has been the Peds Pod by Le Bon Heur Children's Hospital. I'm Caitlin Whyte. Be well.