Marin Pediatric Associates - News from The Practice Marin Pediatric Associates

Our New website !

Welcome to our new website. Hopefully you've found valuable information here, and will return frequently if you need to access important facts about the practice, reliable online medical links for the health of your children, or just to check in with the latest news.

Our practice continues to thrive and grow. As part of our efforts to better serve you and your children, we have planned and implemented this new website. We have put together a site where you can easily find information about our practice and providers, trustworthy links to useful medical and parenting information, our latest news, and much more.

And now, we need you to help build our site. You may have noticed that our Home page displays artwork created by some of our patients. If you'd like to contribute, just submit a colorful picture, in portfolio orientation(up and down), on a white background - Your picture might get chosen for our site!

Updated guideline for Tdap Vaccine

Tdap vaccine

This vaccine protects against Tetanus, Diptheria (bacterial croup) and Pertussis (Whooping Cough). Changes in the indications for this vaccine include:

• expanded age range: age 7 to 100+
• recommending the vaccine for pregnant women
• eliminating any restrictions based on
  a Td (tetanus and diptheria only) vaccine given in the past

These recommendations were added to the existing indications of:
• Age 11-12, and older teens if this booster was missed
• All adult caregivers of infants

In 2010, Whooping Cough was epidemic in California at rates not seen for over 50 years, and resulted in 10 infant deaths. Marin County had the second highest rate of infection in the state! We believe this was largely due to the high rate of "personal belief exemptions" causing especially low vaccination rates. NO vaccine provides a 100% guarantee of protection and the effectiveness can wear off in time. To counter this, we rely on "herd" immunity: the more people out there who are vaccinated the less chance of an infection finding traction in a community of susceptible individuals and starting an epidemic.

In September 2010, then Governor Schwarzenegger signed into law AB354, which requires all 7th through 12th graders to get the Tdap vaccine before entering school in the fall. Each student will need to submit proof of their Tdap booster before entering school for the 2011-12 school year. Marin County Office of Education is requesting that you submit this proof by April 1st though the absolute deadline is before the start of the next school year. (In subsequent school years, only entering 7th graders will need to provide this "proof") We can provide you with an official copy of your child's vaccinations that will fulfill this requirement.

Tdap has been available since the end of 2005 to everyone age 10-64. This vaccine is typically given between the ages of 11 - 12 as a booster to the DTaP last given around kindergarten entry, and to any adult caregivers of young infants.

In response to the epidemic, 10 year olds were encouraged to get the booster last year. In addition, pregnant moms are advised to get the vaccine to protect themselves and to provide "passive immunity" or antibodies to the fetus that will continue to protect the child into early infancy.

What we don't yet know about the Tdap vaccine is just how long the immunity it provides lasts. We know from recent experience that the 5 dose DTaP series given from ages 2 months to 5 years wears off 5-8 years from the last dose, which is why we recommend the Tdap booster at age 11. We also know that immunity from the actual illness wears off in a similar time frame. Will we come to recommend a Tdap booster every 5 years? Every 10 years? Since the Tdap vaccine is only 5 years old, we will only now be able to study how long its effectiveness will last. So stay tuned!

Updated guideline for MCV4 Vaccine

Meningococcal (MCV4) vaccine

MCV4 protects against meningococcal disease, a serious bacterial infection that can cause meningitis or serious blood infections. Changes in the indications for this vaccine include:

• A booster at ages 16 -18 or 5 years after the initial vaccine

This recommendation was added to the existing indications of:
• Age 11-12, and older teens if this dose was missed
• Any person age 2-55 at high risk due to:
• travel to areas where meningococcal disease is common
• exposure during an outbreak
• living in a dormitory
• military recruits
• certain types of immune deficiencies

Meningococcal disease, though rare (1,000 -2,600 cases/yr in the US) is a very scary disease. Even with antibiotic treatment, the disease is often fatal and survivors may require amputation(s) and suffer from permanent neurologic damage. Anyone can get this disease but it is seen most commonly in infants, teens, especially college freshmen, and people with certain medical conditions affecting their immune function, such as lacking a spleen.

At the present time, we don't have a vaccine that has been shown to be safe and effective against this disease for infants. We do currently vaccinate this age group against other causes of meningitis and serious blood infections by providing the HiB and Pneumococcal (Prevnar13) vaccines.

Updated guideline for HPV Vaccine

HPV vaccine

This vaccine protects human papilloma virus, the most common sexually transmitted virus in the US. Changes in the indications for this vaccine include:

• offering this vaccine to males (licensed for ages 9-26)
• expanding the conditions that the vaccine protects against
  to include anal cancer

These recommendations were added to the existing indications of:
• females: suggested ages 11-13 or by high school entry, and older teens if this series was missed (licensed for ages 9-26)
• protection against:
• most cases of cervical cancer
• vaginal and vulvar cancer
• genital warts

In the United States, an estimated 75 to 80 percent of males and females will be infected with HPV in their lifetime. For most, HPV will clear on its own. However, for those who don't clear certain types, HPV can cause cervical, vaginal and vulvar cancers in women and anal cancer and genital warts in men and women. There is no way to predict who will or won't clear the virus.

In our office we offer the HPV vaccine called GARDASIL™ which helps protect against the four types of HPV, specifically types 6, 11, 16, and 18, that cause the most disease. It is estimated that HPV types 16 and 18 account for approximately 80 percent of anal cancers, 75 percent of cervical cancers, 70 percent of vaginal cancers and 40 to 50 percent of vulvar cancers. HPV types 6 and 11 cause approximately 90 percent of all genital warts cases.

Anal cancer affects both men and women, with approximately 60 percent of cases occurring in women. According to the American Cancer Society, it is estimated that approximately 2,000 men and more than 3,000 women will have been diagnosed with anal cancer in 2010. There is no standardized screening recommended for the general population for anal cancer and many people are diagnosed when the disease is more advanced.

School Immunization Requirement for Pertussis (Whooping Cough)

In September 2010, then Governor Schwarzenegger signed into law AB354, which requires all 7th through 12th graders to get the Tdap vaccine before entering school in the fall. Each student will need to submit proof of their Tdap booster before entering school for the 2011-12 school year. Marin County Office of Education is requesting that you submit this proof by April 1st though the absolute deadline is before the start of the next school year. (In subsequent school years, only entering 7th graders will need to provide this "proof")

This vaccine protects against Tetanus, Diptheria (bacterial croup) and Pertussis (Whooping Cough). In 2010, Whooping Cough was epidemic in California at rates not seen for over 50 years, and resulted in 10 infant deaths. Marin County had the second highest rate of infection in the state!

This vaccine is typically given between the ages of 11 -12. In response to the epidemic, 10 year olds were encouraged to get the booster last year. The vast majority of our patients have had their Tdap vaccine and we can provide you with the proof needed by the school. For those who have not yet received their Tdap, (~25% of our 11 year old patients) we are contacting you to let you know your child needs a check-up and this vaccine can be given at that time. But fee free to call us to verify your child's Tdap status.

We can provided you with a copy of your child's immunization records which will constitute "proof" of having received their Tdap booster.

(Our practice does not participate in the Vaccine Registry (PC based) due to the fact that our computer system is Mac based. Unfortunately this means your School Nurse will not be able to get your immunization records off the registry).

2010 Pertussis (whooping cough) Outbreak

As kids get older, protection from some childhood vaccines can begin to wear off. Teens also develop risks for different diseases as they get older. Help your child transition into adolescence in a healthy way by staying up-to-date on pre-teen vaccines.

Currently there is a Pertussis, or Whooping Cough outbreak happening in California, with very high rates of infection in Marin. You may have gotten information about a case of Pertussis in your child's preschool, school or camp.

Pertussis is caused by a bacteria (Bordatella Pertussis) that is spread by coughing or sneezing. Infants under the age of 1 and the elderly will suffer the most from Pertussis, and often need to be hospitalized due to the disease and its complications. In very small infants, Pertussis can be deadly (as of 8/31/10, 8 California babies have died).

A typical case of whooping cough may appear similar to a common cold, and starts with a cough and runny nose for one to two weeks, followed by weeks or months of rapid coughing fits that sometimes end with a whooping sound, or by vomiting from the severe cough. Fever is rare.

Children are immunized against Pertussis (the DTaP vaccine) at 2, 4, 6, and 15 - 18 months, and are given a booster dose before starting kindergarten. Another booster (the Tdap vaccine) is given to middle school students (age 11 - 13 years). The reason so many booster doses are needed is that Pertussis immunity (from both the vaccine and illness itself wears) off after 3 - 5 years. This is why so many adults, teens and 8, 9 and 10 year olds are susceptible to Pertussis. Moms delivering at Marin General are vaccinated for Pertussis after their delivery if they have not already been vaccinated. Pertussis vaccination for dads, and all household contacts is urged as a way of cocooning newborns against exposure to this disease.

Because infants, especially newborns, are at such high risk, the State of California is now recommending a Pertussis vaccine in the third trimester to boost mom's immunity in time for delivery. In addition, they are recommending that the "middle school booster" be given at 10 yrs of age and all children catch up their pertussis vaccinations if they are not up-to date.

The Pertussis vaccine itself is not 100% effective at protecting your child against Pertussis so "herd" immunity is a very important part of reducing the potential for community outbreaks. Marin has one of the state's highest rates of personal belief exemptions, parental waivers that allow children to enroll in kindergarten without receiving vaccinations against diseases such as measles, polio or whooping cough. We believe the large number of cases in Marin may be linked to the growing number of parents who refuse vaccinations for their children.

If your child has been exposed to Pertussis, please call us so that we can help you decide if your child needs to be seen, tested, or to take antibiotics to prevent the disease and keep it from spreading further in the community. In general, children who have been at the same school or in the same classroom as a child with Pertussis do not need antibiotics or testing unless they develop a cough, or truly have a close contact to the infected child. If there has been very close contact, or someone in your home has Pertussis, then you should be treated even if you do not have a cough.

For more information visit these web sites:

Marin County Health Dept

CDC

McNeil Product recall
(4/30/10 and 7/8/10)

What products are affected by this recall?

The products include certain liquid infant, children and adult preparations of Tylenol Motrin, Zyrtec, and Benadryl products. For a complete list of recalled products, please see

     http://www.mcneilproductrecall.com

McNeil Consumer Healthcare is initiating this voluntary recall because some of these products may not meet required quality standards. As a precautionary measure, parents and caregivers should not administer these products to their children. Some of the products included in the recall may contain a higher concentration of active ingredient than specified; others contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles.

While the potential for serious medical events is remote, FDA advises consumers who have purchased these recalled products to discontinue use. Please check the McNeill web site for info on specific lot numbers affected by this recall.

Flu Vaccine - New for 2010-2011!

The CDC is now recommending flu vaccines for ALL people 6 months and older.

We recommend flu vaccine for ALL our patients 6 months and older, and parents and caretakers of infants or kids at higher risk from complications of influenza.

We offer flu vaccination to all our patients.

We offer flu vaccination for parents and caretakers (as supplies permit). We offer this service as a convenience to our patient's families. Payment is expected at the time of service and we will not bill your insurance for the service. We will provide you with the necessary paperwork to submit to your insurance if you would like to try to get reimbursed, but we cannot guarantee your insurance will cover the service.

We are currently offering the new, 2010-2011 seasonal flu vaccine. At the present time, we have all types of flu vaccine available:

* the nasal spray preparation which is used for healthy individuals
               aged 2 – 49.

* injectable flu vaccine for children ages 6 - 35 months.

* injectable flu vaccine for people ages 36 months to 64 yrs.

* injectable flu vaccine for pregnant moms

Please call to schedule your child, and household members for their flu vaccine. If you are just interested in flu vaccines, you will be scheduled during one of our flu vaccine clinics. If you would like to get other vaccines as well at this visit, or have questions about the best vaccine for your child and family, we will schedule a brief visit with your PCP.

Why we recommend influenza vaccination:

Influenza results in close to 40,000 deaths a year and 300,000 hospitalizations per year. H1N1 seemed to have particular affinity for the pediatric age group and pregnant moms with slightly higher than usual complication rates in these groups. Though most of our patients will experience the "flu" as no worse than a particularly bad cold, the children under age 2 and those kids with underlying medical conditions are especially vulnerable to complications. Even healthy individuals with no risk factors can have surprisingly severe illness or complications from influenza. To protect all our patients, and especially the most vulnerable, both individual immunity and "herd" immunity works best. For more information please visit the links section, flu information web sites.