Our March schedule is now open.
The best way to schedule your appointment is directly from our website at https://allpeds.com/for-parents/book-an-appointment/
If you are trying to schedule a double well child check and are unable to find consecutive spots with the same provider we ask that you please give us a call.
If your child needs a visit for ADHD, a Mental Health concern, or any other type of appointment, please call our office. These types of appointments require additional time.
Our February schedule is now open.
The best way to schedule your appointment is directly from our website
If you are trying to schedule a double well child check and are unable to find consecutive spots with the same provider we ask that you please give us a call.
If your child needs a visit for ADHD, a Mental Health concern, or any other type of appointment, please call our office. These types of appointments require additional time.
Our January schedule is now open.
The best way to schedule your appointment is directly from our website at https://allpeds.com/for-parents/book-an-appointment/
If you are trying to schedule a double well child check and are unable to find consecutive spots with the same provider we ask that you please give us a call.
RSV Vaccine/Antibody
Today, I will talk about RSV. RSV stands for Respiratory Syncytial Virus, the most common, but not the only, cause of wheezing and difficulty breathing in infants.
We do not have a specific treatment for this disease, which is why we often do not test for it routinely in the office when we suspect it; confirming RSV will usually not change management. I have been waiting for protection against RSV for a long-time. In my career, this has been the most common viral cause of hospitalization and serious illness, well above other diseases which had earlier vaccines developed, such as hepatitis A. However, there have been technical problems creating a vaccine. Similarly, we still do not have vaccines against other common diseases such as AIDS or malaria.
I don’t want to give ammunition for anti-vaxxers, but in the interests of historical accuracy, I must disclose that there was a vaccine against RSV released in the 1960s. However, that vaccine was not studied in anywhere near the number of children today’s vaccines are, and it caused significant side effects, and was withdrawn. The safety data on current products are orders of magnitude beyond those back then.
I am going to get technical yet again. Vaccines cause the body to produce antibodies, and we do have a vaccine against RSV, but that vaccine is only for adults. The current new product for children, Nirsevimab (Beyfortus), is actually a monoclonal antibody (which is why the name ends in mab). This is an artificial, but safe, antibody that helps fight off an infection even without support from the body itself. (People, include the staff at ALL Pediatrics, will no doubt refer to it incorrectly as a vaccine from time to time, if only from force of habit).
We already have an antibody product, best known as Synagis, against RSV for several years. It is effective, but expensive, requires five monthly injections, and is reserved for high-risk children who would benefit the most. The current monoclonal only requires one injection per season, and is more effective. It is recommended for children who will be 8 months of age or younger during RSV season, which is typically around September to March.
It is not given to older children, because they usually have some natural immunity from exposure in the real world, and the disease is typically mild, a nuisance rather than serious, with nowhere near the hospitalization/death rate seen with, for example, flu. In addition, as stated, this is not a vaccine. It provides antibodies, but does not stimulate the body to make them on their own, so once they are cleared from the body you are back to square one, without long-term protection.
Eventually, we will have an actual vaccine for infants; I am hopeful this will arrive in the next two years. In the interim, we have the antibody, but there is a major snag with its use this year: there is under-production. As a result, there is only antibody for children under 11 pounds, and supplies are limited. Furthermore, it is expensive, over $500 for a dose, and many insurance companies are dragging their feet about paying for it. As such, we will be able to offer a very small number of infants the antibody when we have it in stock.
In summary, this antibody will be a breakthrough, but for the vast majority of infants, it will have to wait until next year, when there will be new batches of antibody, and new batches of infants.
Lastly, there is one other way to protect newborns, and that is for a pregnant woman to receive the previously mentioned vaccine. She will then make antibodies, which can be passed on in the womb. If this is an option for you, please take advantage of it with your obstetrician.
As of 12/31/2023 we will no longer be accepting MultiPlan/PHCS insurance.
Should your child have a COVID vaccine, and associated boosters, even though it is relatively new? Categorically, yes.
Most vaccines take years, or even decades, before they can be released onto the market; they have to prove both safety and efficacy. COVID vaccines, in contrast, have been released under expedited protocols. Part of the reason for this was the enormity of the pandemic, and the need for a vaccine. The size of the pandemic, however, also allowed scientists to test enough people, and confirm the vaccine’s value. For example, we see almost no polio in the world anymore. It will be almost impossible to show that a new vaccine for polio would be superior to our current one; the disease is so rare you would need to test hundreds of millions of people to find out. Unfortunately, with COVID, we had these sorts of numbers (there have been over 100,000,000 reported cases in the United States alone, and over 1,000,000 associated deaths).
Is the COVID vaccine 100% safe? No; nothing in life is. Is it safer than being unvaccinated? The data here are overwhelming that it is. This applies even to worrisome side effects, such as the rare risk of teenage boys developing myocarditis after the vaccine. The chance of this happening is still less than that of an unvaccinated boy getting myocarditis.
In looking at the vaccine, we need to define what we mean by effective. As with the flu vaccine, many children who are vaccinated can still come down with COVID; protection may be around 50% or so. While I believe that reducing the COVID burden by half is valuable in and of itself, the real effectiveness of the vaccine lies in its ability to prevent hospitalization and death, and here it is over 75 percent effective. In this country, with the availability of vaccine, the vast majority of deaths from COIVD nowadays occurs in the unimmunized.
Children, for not well understood reasons, tend not to become that ill with COVID (‘only’ around 2000 deaths in this country so far). Why immunize them in this case?
First, children do die, or become hospitalized, from the disease. They can be quite ill and miserable feeling even if not hospitalized, and the chance of that happening is reduced with the vaccine. We are also just beginning to learn more about ‘long COVID,’ and its sequelae, and preventing COVID will prevent long COVID. Lastly, children with the illness can pass it on to others who are more likely to have serious consequences (grandparents often fall into this category); being vaccinated reduces this risk.
Why do we keep needing boosters? Does this mean there is something wrong with the vaccine? No; immunity seems to persist, but the virus mutates, rendering previous immunity less effective (but not absent), so the vaccine needs to keep up; each new mutation is, in some ways, a new disease. This is similar to what happens with the flu virus, and vaccine, each year. It would be great if COVID stopped mutating so rapidly, but that is unlikely.
You may be wondering why we don’t put the COVID vaccine and the flu vaccine in the same dose, so we only need one shot. I suspect this will happen in the future. However, it is not a given that you can just merge the two. It is possible that the components in one vaccine counteract the effects of the other, so that combination vaccines need to be carefully studied before doing this. This takes time. In a similar fashion, when the COVID vaccine first came out, we were instructed to wait three weeks on either side of it before giving a different vaccine. We now know that is not necessary, but it had to be proven first.
One last point to go over. There is a logistic problem with the COVID vaccine for children under age 5. It is being dispensed in a three-dose vial (most vaccines, by way of comparison, are unit-dosed), and once opened, the other two doses must be used within a narrow time frame, or discarded (and if not used, the practice has to pay the manufacturer for the vaccine anyway). As such, we will need to co-ordinate doses to make sure we do not waste them; for now, we will need to prebook giving the vaccine, and cannot automatically administer it at a check-up. The doses for children over age 5 are in unit-dose vials, and do not require prebooking, but there are shortages, and they will not always be in stock in our offices. As such, it may be more practical to have this done at the local pharmacy, which buys up the bulk of the vaccine
Bottom line, get the COVID vaccine for your children and yourselves. I don’t care where this is done; if the local pharmacy offers, and is more convenient, go there for it. All vaccines in the state are registered in the local database, so we will have a record if your child has received it elsewhere.
You can check our website and Facebook pages for updates on our supplies of vaccines.
Next up, RSV prevention.
Vaccines Part 1
This will be a three-part blog. I will look first at vaccines in general, and then subsequently COVID and RSV vaccines. I am not going to dwell on anti-vaccine sentiments; I will start with the premise, backed by countless studies, that they are valuable. Indeed, vaccines are probably the second most effective public health measure ever (good hygienic measures, such as a safe water supply, are far and away the most important).
We need to go over some basic science to start. Don’t worry, there won’t be a quiz.
When our body is invaded by germs such as bacteria and viruses, it makes antibodies, proteins which can fight off the invaders. The body is then, in most cases, able to ‘remember’ the invader, so that it can mount a future antibody response if attacked again by the same germ.
Vaccines stimulate the body to make these necessary antibodies. There are two main categories of vaccines. The first are inactive ones, usually containing only parts of the germ. As such, the body can make antibodies to these important components, and thus are capable of fighting off infection. However, since they are inactivated, the vaccines are incapable of causing infection themselves. Most vaccines fall into this category.
The other class of vaccines is live ones. The three most commonly used in pediatrics are for rotavirus, MMR (measles-mumps-German measles, German measles being the popular term for rubella), and chicken pox (varicella). These viruses have been weakened (‘attenuated’ is the technical term), so that they do not cause infection themselves unless given to a patient with a markedly abnormal immune system.
Most vaccines have to be given several times to build up a sufficient response. This is referred to as the primary series. The Prevnar and Pentacel vaccines we give at two, four and six months of age fall into this category. Immunity often wears off over time, hence the need for booster vaccines. One such vaccine, which requires boosting throughout the lifetime, is tetanus, which should be given every ten years. Other vaccines do not seem to require boosters as adults; the vaccines for hepatitis A and B fall into this category. I said ‘do not seem to’ because, while their efficacy and safety have been well established, they have not been around long enough to see if, for example, a booster will be needed after 60 years.
(Just to give a digression with a little bit of medical trivia. Although we often refer to the MMR and chicken pox vaccines given at age 4 years as boosters, this is inaccurate. The second dose of these is given because some children do not mount a response to the first vaccine, rather than being needed to boost immunity. While it is possible to do a blood test to see if a given child actually needs this second vaccine, we do not do this for several reasons. The blood test is expensive. It can be difficult to draw blood in young children, and doing so is often more painful than the vaccine itself. Lastly, it requires an extra trip, and associated time spent, to go to the lab to have this done. We are quite certain that the second vaccine is safe, even if your child is already immune, so that giving the vaccine rather than testing the blood is the more practical approach).
Now that you have a grasp of the science, next time I shall move on to discuss the COVID vaccine. In the meantime, please make sure you and your loved ones have had, or soon get, their flu vaccines this year.
Our December schedule is now available.
The best way to schedule your appointment is directly from our website at https://allpeds.com/for-parents/book-an-appointment/
If you are trying to schedule a double well child check and are unable to find consecutive spots with the same provider we ask that you please give us a call.
For the most up to date flu vaccine information please visit our flu page.
