Saturday, April 12, 2008

Recommendations for vaccines to prevent seizures and more...

It seems that each year we add another vaccine to the schedule of shots babies need, making it feel like babies are little pincushions. Efforts have been made to combine as many vaccines together as possible to minimize the number of pokes a baby gets at one time. Unfortunately, one of the new combinations-MMRV, which combines vaccinations for measles, mumps rubella, and varicella-is no longer recommended, and we are going back to giving MMR and varicella separately.

This change is due to the fact that fever-related seizures are seen more often in children who receive MMRV instead of the two separate shots. The Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention updates its vaccine recommendations from time to time to keep them in line with the latest research.

Here's what my colleague, Dr. Henry Bernstein, wrote about the change recently:The ACIP used to recommend that children receive a combination vaccine rather than separate shots. Why? Well, as any parent can tell you, children don't like shots. However, a recent study has found that children who receive MMRV are almost twice as likely to have febrile seizures-fever and shaking-7 to 10 days after the vaccine than children who receive MMR and a separate varicella vaccine. That sounds worrisome, but don't be alarmed.

The risk for febrile seizures due to these vaccines is very low: 9 children for every 10,000 who receive MMRV, and 4 children for every 10,000 who receive two separate shots. Moreover, these seizures more often occur outside of the context of vaccine. One in every 25 young children will have at least one febrile seizure, usually before the age of 5. Febrile seizures can be scary for the baby's caretakers, but they usually do not lead to any problems down the road for the baby. I hope that parents don't misunderstand the findings and become needlessly alarmed.

This updated recommendation does not mean that your child should not receive the MMRV vaccine. It just means that the MMRV is no longer the clear favorite over giving the MMR and varicella vaccines separately. Here are some suggestions:

· Remember that vaccines are safe. All vaccines are studied in large numbers of children for many years before they are licensed for routine use. Then, they are monitored for safety and effectiveness after they are licensed.

· Make sure that your child receives all recommended vaccinations. The benefits of immunizations outweigh the risks. No one likes to see their child receive an extra shot, or, as sometimes occurs, get a fever or possibly have a febrile seizure. Still, things are much better today than before the introduction of vaccines. Many childhood diseases are now rare because of immunizations, but outbreaks can and do occur. With proper immunization of all healthy children, there hopefully will continue to be fewer and fewer cases of these diseases each year.

· Stay informed about vaccines. There is currently a lot of misinformation about vaccines. Make sure you know where to go to get the most accurate information. For reliable information about vaccines, it is always best to consult trusted sources, such as your child's pediatrician or the Web sites of the National Immunization Program or the American Academy of Pediatrics.

In addition, don't just read or listen to the headlines - these are designed to capture your attention, but may be slightly misleading. Read the details of the article or listen to the whole story, so you can have all the facts. There have been many celebrities who have latched on to the "vaccines cause autism" movement as a result of having a child with autism or a friend who has one.

While this type of testimony can be compelling, the data do not support the conclusion that vaccines cause autism. So be a savvy reader and observer and be sure to read the less sexy material generated by scientific work.Dr. Victoria McEvoy graduated from Harvard Medical School in 1975 and is currently an Assistant Professor of Pediatrics at HMS.

She is the Medical Director and Chief of Pediatrics at Mass General West Medical Group. She has practiced pediatrics for almost thirty years. She has been married to Earl for thirty six years and raised four children. She currently enjoys writing, traveling, reading, almost all sports, and spending time with her two grandsons.


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