Joey Wahler (Host): They can create uncertainty for parents. So, we're discussing pediatric vaccines. Our guest is Dr. Kim Guida. She's a physician at Pullman Family Medicine. This is The Health Podcast from Pullman Regional Hospital. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Guida. Welcome.

Dr. Kim Guida: Thank you, Joey. Good to be here.

Host: Great to have you aboard. We appreciate the time. So first, when you're talking to parents about pediatric vaccines and they do have concerns, what sources of evidence or guidance do you rely on most and why?

Dr. Kim Guida: When parents are reluctant to vaccinate, rather than just giving them a handout, of which there are many, I really feel like we need to take extra time to find out what exactly they're concerned about and where their hesitancy is coming from. There's an astounding amount of misinformation on social media and many places on the internet where one single person can develop a large platform with lots of followers, but very little legitimacy behind the information they provide. So, figuring out where those parents' concerns are coming from is important.

And also, you know, it can range from things like minor side effects, like maybe they'll get a fever or things like are there preservatives in the vaccine that are going to be a problem to full-on conspiracy theories about vaccines. So, I try to reassure them that the pediatric vaccine schedule is based on solid science, decades of research regarding effectiveness and safety. I often refer to recommendations from leading medical organizations, of course, like the American Academy of Pediatrics, American Academy of Family Physicians; also the ACIP, which is Advisory Committee of Immunization Practices and the CDC, although these last two are a little less reliable recently than they used to be.

There's one more website that I wanted to promote, and that one is called Voices for Vaccines. That's another group that offers really good updated science-based information to parents. It's basically like a family sort of website that has a lot of personal anecdotes, as well as good science that families can look at.

Host: Gotcha. And you did a great job there, Doc, of answering what was going to be one of my subsequent questions about vaccine schedules. But especially since COVID first hit, how much do you need to address vaccine stigmas or misconceptions with parents, would you say?

Dr. Kim Guida: Most of my patients are pretty open to vaccines and believe in the science and want to have their children protected. But I will say there's definitely an uptick in distrust of the medical community, and vaccines in general. So, I do spend more time discussing with parents various concerns.

And it can be challenging because sometimes, if they don't have a good understanding of where the science comes from, they can be easily swayed by misinformation. So, it's hard to combat that.

Host: And speaking of which, from your experience, what do you wish more people understood about vaccines and pediatric health overall? Any misconceptions out there that you can clear up right here?

Dr. Kim Guida: I would say that some of the common misperceptions are that physicians are being paid or getting kickbacks, financial kickbacks for vaccinating children, which is absolutely untrue. Pharmaceutical companies doing it just for the money, which, although we have a capitalist system, we live in a capitalist society, and the medical system is no ,. That is not the primary reason for developing vaccines and promoting public health. So, those are the two big ones.

The others are things like dangers of things like, you know, "Is there mercury in vaccines and what type of mercury? And could it harm my child?" And so, we have to address a lot of those different topics when they come up.

Host: Now, the good news when it comes to vaccines is that many parents today, of course, have never even seen some of the illnesses we still vaccinate against. But the flip side is, which ones are still out there and why are vaccines still recommended for those?

Dr. Kim Guida: Right. That's really important. And I think that has made the discussions about vaccines even harder because parents really don't have any idea what they're protecting their kid from. Because for example, if I use measles as an example, many people have never seen measles, because of the effectiveness of the vaccine program. So, they feel like the vaccine could do more harm than the actual infection that it's preventing.

So, just to go off a little bit on measles, you know, this is one of the most contagious viruses known in the world. And if unvaccinated, 90% of people who are exposed to measles will become infected. And that's astounding. And it's not just a cold virus, right? While it can be mild in some cases, it can also make people extremely ill. Thirty percent of cases of measles are associated with complications like pneumonia or brain inflammation, which can cause long-term brain damage and even deaths.

So, the success of the measles vaccine, it was one of the biggest breakthroughs in public health, right? I mean, it was introduced in the early 1960s, and it's like 96% to 97% effective in preventing the disease. So, when you look at the graphs of measles cases over time, it's like 1965, it just falls off the cliff.

So, that's really cool, and that's why people don't understand what measles is. So when you try to explain that to them, that, "Look, if you get the vaccine, we're not going to see cases of measles," then they're like, "Well, measles isn't here anyway." And it's like, "Well, it is here." We have outbreaks now much more frequently than we used to, right? There's an outbreak right now in one of the Carolinas. I But it can be really scary when we do have outbreaks, and that's due to the declining vaccination rates.

Host: So, it's really a Catch-22 with that, right? Because on the one hand, you might have a parent that says, "Well, I haven't ever seen measles, nor do I know anyone that has. So, why do I need the vaccine?" And you're like, "Well, that's why, because people get vaccinated," right?

Dr. Kim Guida: Exactly. That's the idea about what we call herd immunity, where if all of the kids in somebody's kindergarten class are vaccinated, it's going to protect even the one kid who might not be vaccinated. So, it's like parents think, "Well, if I don't vaccinate my kid, it's not really a risk to my child because nobody's ever seen measles." And it's like, well, the reason it's not a risk is because everybody else's kids are vaccinated, right? And if we start to get a group of parents that start refusing to vaccinate, then we get a much greater risk of getting an outbreak in an individual situation.

Host: So, that being said, measles aside, what else is still out there that maybe parents have kind of forgotten about over time that really still should ideally be vaccinated against?

Dr. Kim Guida: Well, one of the big ones we've been seeing in the last decade or so has been whooping cough or pertussis. And that is part of the childhood vaccines. We start giving that to babies at two months of age. We also give it to the pregnant moms now. In the third trimester, we give a vaccine that will boost their immunity to whooping cough because some of those antibodies go through to the baby.

But when unvaccinated, whooping cough can be really dangerous for young babies. And so, we have had outbreaks of whooping cough where, usually for someone who's older with larger lungs and respiratory system, they can fight it off. But for babies, a lot of times, they end up on ventilators and can even die from whooping cough because of the overwhelming respiratory infection. So, that's a really scary one, especially for young babies.

Host: Now, switching gears a little bit here, even if a vaccine is in fact safe overall, there can of course still be common side effects. What would be some of those that aren't necessarily dangerous but nevertheless should be monitored if they pop up?

Dr. Kim Guida: Well, there really aren't very many. I mean, the common side effects are fever for like 24 to 48 hours, fussiness, fatigue, maybe an irritable baby. There might be a little redness at the site where the vaccine is given. And all of those symptoms or side effects, if you will, are really just evidence that the vaccine is working, it's revving up the immune system to protect that baby and develop antibodies. So, those are vaccines that I warn parents about. Like, "You don't need to call me if this happens. You can give Tylenol," or what have you.

You know, serious reactions are really rare, like one in a million for things like anaphylaxis or uncontrolled crying, screaming for hours at a time, to really high temperatures over 105 degrees Fahrenheit. Those would be things that I would tell them, "If something's really scary to you or if the baby has a seizure," which incidentally is not common. However, febrile seizures in kids can happen after vaccines, just like they can happen when a kid has a cold with a fever. They're not particularly dangerous, but they can be super scary for parents. So, if any of those things happen, I tell them, "Look, come in to see us. Go to the ER. Let us check your baby out."

Host: Absolutely. Couple other questions for you. First, how about tips for parents to help children, and I guess particularly babies, of course, feel safe when getting a vaccine?

Dr. Kim Guida: Well, first, it's important that the parents try to remain calm and positive, right, as even babies can pick up on parental anxiety And so, we try to say, "Look, just speak calmly to the baby, sing a song, maybe hold the kid on your lap, hugging them pretty firmly, but gently." And breastfeeding if possible or distracting the child with a book can help them feel safe. I also encourage parents not to tell, like when kids are a little bit older and they can understand that a vaccine's going to hurt, you know, don't tell them that it's not going to hurt, because it will hurt a little bit, but it's over pretty quickly.

The other thing that I recommend parents do not do is to use the shot as the threat to the kid, like, "If you don't behave, you're going to get a shot." Or conversely, promising them that they're not going to have a shot at a well-child visit if they're not sure if they're due for immunizations. Because the last thing you want to do is betray a kid and not be honest with them.

Host: I note that you mentioned one thing you can do to soothe your kid is sing. Of course, in the case of our three-and-a-half-year-old daughter, I often get, "Don't sing." So, it's on a case-by-case basis, isn't it, Doctor?

Dr. Kim Guida: Right. Exactly. You know your child best.

Host: And I'm just talking about when we're riding in the car and there's no vaccine anywhere in sight. Anyway, I'm hoping she'll outgrow that so that I can resume my singing. In any event, in summary, Doctor, when deciding whether to get their child a particular vaccine, what's the main thing they should consider? You've done such a great job of breaking down some of the details. But in a nutshell, what's the main thought you want to keep in mind as a parent when deciding whether it's the best thing?

Dr. Kim Guida: I try to emphasize that, look, to any individual parent, your kid is the world. You would do anything to protect your child, as would every other parent. And so, I try to frame it in terms of protecting your child, keeping your child safe from those diseases, but also keeping your community safe. I feel like it's a community responsibility for us to act in ways that are going to benefit the public health, not just the individual health of your child.

You know, like I mentioned earlier, if you don't get vaccines, but you're growing up in a community where most of the kids are vaccinated, you're going to feel like, "Oh, well, my kid did fine without vaccines." But it's really because others have done it. So, I emphasize that, and it's not really a guilt trip. But it's, like, we live in groups, we're human beings. We're social creatures. And we need to protect ourselves and each other.

Host: Great points. Certainly things for any parent to keep in mind. Folks, we trust you're now more familiar with pediatric vaccines. Dr. Guida, keep up all your great work, and thanks so much again.

Dr. Kim Guida: You're welcome. Thanks for having me.

Host: Absolutely. And for more information, please visit pullmanregional.org/primary-care. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of The Health Podcast from Pullman Regional Hospital.