Back to School

It’s that time of year in NYC (I know other parts of the country already started) when buses are filled with children sporting back packs, tales of summer vacation are told and germs are spread.
In my office, it is also the time of year in which adults get re-exposed to germs they haven’t seen in years – the kids get a sniffle at best, and the adults (especially new teachers) feel like they’ve been hit by a Mack truck! Why is this?  What is it about “kid germs” that affect adults so severely?
The reason for this comes from our immune systems. The fevers we get and the aches we feel are a result of our bodies response to the infection. The more our immune systems get activated – the worse we feel!
Our immune systems develop memory. That’s why you only get certain diseases once. If you are exposed again later in life – the memory of the infection may have faded – and your body responds in full force.  When you are exposed to similar infections multiple times – or if you are vaccinated against a disease you body can respond faster and with less inflammation – and you don’t feel sick!  An MMR – measles, mumps, rubella – vaccine given in childhood and an adult booster gives enough immune memory to last a lifetime.
To help stop the spread of these infections basic hygiene is our best defense – HAND WASHING with soap and water or hand sanitizer.  Covering our mouths when we cough and sneeze; and taking our FLU SHOTS.
I wrote about flu shots last year.  Recent politics aside, there is no danger of getting the flu from the flu shot.  There can be side effects, depending on if you have an infection brewing or how strongly your immune system reacts to the shot, but there is no live virus in the vaccine to transmit disease.
The strains in this years flu shot are different from last year, and early reports show a good match between flu strains we are starting to see in the public and what is in the shot.  So get your flu shot, and feel better through the season!

Flu shots – Don’t Believe the Hype

It’s that time of year again – just after Labor Day when Flu Season begins! Flu shots are in stock in my office, most chain pharmacies and starting to make the rounds at companies that offer them to their employees. It is also the time of year when I explain to many a worried patient that you CAN NOT get the flu from the flu shot.

There are several myths about flu shots and vaccines in general – that persist because people with loud voices propagate falsehoods despite overwhelming evidence to the contrary. Perhaps it is, as was recently written in the Wall Street Journal  that people today, especially parents of young children, have never seen the consequences of the diseases vaccines prevent.

Some facts about the flu

  • Influenza is a virus spread like any other cold
  • You can be contagious about 1 day before you get sick, and for 4-7 days after
  • Anywhere from 5-20% of the US population gets the flu each year
  • About 200,000 people are hospitalized each year from the flu
  • In 2009, we saw the first new flu virus without a vaccine – H1N1 or “Swine Flu”
    • 60.8 million people in the US were infected
    • Almost 275,000 people were hospitalized
    • 12,469 people died from H1N1 flu that year – when no vaccine was available
    • Those most severely affected were pregnant women and children
    • When the vaccine was introduced the following year, rates returned to normal

Some facts about the flu shot:

  • You can not get the flu from the flu shot
  • Flu vaccines do not contain dangerous preservatives
  • Flu shots (or other vaccines) do not cause autism
  • Flu shots decrease hospitalization due to the flu by 70%

So where did the myths come from?

  • The flu shot is made from killed flu virus, and a mix of 3 or 4 different strains of the viral components
  • Because the viral components are killed, they can not cause an infection
  • The vaccine stimulates the immune system which can cause a mild fever, congestion and body aches
  • If you have a cold when you get the vaccine, this reaction can be stronger
  • Vaccines used to contain a preservative called thimerosal, but have not for years, which contained mercury, although the quantity was much less than your average can of tuna
  • No study of any vaccine has been linked to autism – the only study that showed that position was retracted for falsifying data and the physician who wrote the study stripped of his medical license.  I reviewed this information in an early post about the HPV vaccine

What do I advise my patients?

I offer the flu shot to all my patients. I highly recommend it for all my patients over 65, pregnancy women and those with young children in the house. In addition, anyone with a weaker immune system, such as diabetics, or asthmatics who are at higher risk of lung complications should get a flu shot every year.

The flu causes people to miss work (this is why employers have flu shots in the office), children to miss school, and unnecessary misery.  The flu feels worse than any cold – with fever, cough and severe body aches.  It feels like you’ve been hit by a Mack truck – and it can be prevented.

Don’t believe the hype, get your flu shot – I’m getting mine – and its much more pleasant in the office when you get your shot than when you come to see me because you are sicker than you’ve ever felt!  

The path to wellness begins with a proper diagnosis

Vaccines for HPV – Lies, Damn Lies and Statistics

In 2006, a new vaccine was introduced in the US – a vaccine for the Human Papilloma Virus (HPV).  This virus is responsible for most cases of cervical cancer, some throat, penile and anal cancers, as well as genital warts.  The vaccine is effective against the 4 strains of HPV that cause the majority of cervical cancer and genital warts.  It is given as a series of 3 shots over a 6 month time period, and is approved for females and males, ages 11-26.  There are two brands of vaccine, Gardisil and Cervarix, currently FDA approved in the US.  Recently, there has been a lot of media attention to HPV vaccines, leading to a lot of confusion about what the vaccine does and how safe it is.  As the father of a 12 year old girl, I thought I’d share my views and research.

What is HPV?

Human Papilloma Virus is the most common Sexually Transmitted Infection and responsible for most cervical cancer, as well as genital warts in both sexes.  It can also cause throat, penile and anal cancer.  The 4 strains of the virus that cause the most harm are 6,11,16, and 18, which are the strains in the vaccine.  HPV causes almost 34,000 cancers a year, with about 2/3 of them in women.  Almost 12,000 of the cancers are cervical cancer, which is usually treated by removal of the cervix and uterus (hysterectomy) which makes it impossible for a woman to have children.  Over 14 million people per year get infected with HPV.
HPV can be tested for in women during a PAP smear, hopefully identifying lesions before they become cancer.  However, there is no reliable test in men, other than doing a biopsy on a wart or other visible lesion.

What is the controversy?

Mark Twain once said, “There are 3 kinds of lies: Lies, Damn Lies and Statistics.”  All three have been used in the argument for and against vaccines.  Vaccines in general provoke very strong reactions from many people. Vaccines have been blamed for many conditions and reactions completely separate from the diseases the vaccines were meant to prevent.  There have been vaccines that have been recalled and discontinued because the risk of side effects was higher than the disease rate – a vaccine for Rotavirus and for Lyme Disease have both been discontinued.  There are immune reactions that are possible that can have serious health consequences, but these are not very common.  Allergic reactions to a vaccine are possible, just as they are possible with other medications or foods.  These reactions need to be considered and a good medical history obtained before they are administered.  However, I think that as medical science has progressed, we have lost sight of the devastation these preventable diseases  caused.  
I want to be very clear and state that there is NO LINK BETWEEN VACCINES AND AUTISM.  There was one scientist who made that claim and published research making that claim.  His research has been shown to be falsified, the journal that published the study issued a retraction and the scientist has had his medical license revoked.
Out of 57 million doses of HPV vaccine given through March of 2013, there have been 22,000 reactions reported.  Of those, less than 1800 have been considered severe reactions, mostly headache, nausea and fainting.  Enough people fainted that it is recommended that people wait 15 minutes after the vaccine before leaving the doctor’s office.  There have been about 30 deaths reported after the vaccine – but  none of those deaths have been shown to be directly related to the vaccine.  For example, if someone died in a car accident after receiving the HPV vaccine, it is reported.
Much of the recent controversy regarding HPV vaccine comes from 2 events in the past year.  In one, a physician submitted a case report of a 16 year old girl with irregular periods and eventual ovarian failure – with the symptoms beginning a few months after receiving the vaccine.  There was no evidence linking her condition to the vaccine, and it is known that in cases of early ovarian failure a cause is only found 10% of the time.  In addition, the reporting physician had strong personal beliefs that may have biased her reporting of the case.
The other event was when Katie Couric had a physician on her talk show who was involved in the development and testing of the HPV vaccine.  This doctor in several interviews did not question the safety of the vaccine or it effectiveness, but rather called attention to the fact that it is not yet known how long the vaccine lasts, and a booster may be needed.  She also questioned the need for the vaccine when PAP smears could detect the cervical cancer early.  However, HPV causes 20,000 cases of non-cervical cancer per year which would be missed.  Her statements also assume a much higher rate of women going for PAP smears than is likely to occur.  Ms. Couric did not give equal airtime to her own medical expert, her comments supporting vaccination were on the show’s website.  Ms. Couric did issue an apology after the show aired acknowledging that not enough airtime was given to talk about the benefits and safety of the HPV vaccine.

How does this affect us?

Our ability to treat disease has advanced tremendously in the past 100 years.  The rate of mothers dying during childbirth was reduced dramatically by having doctors and nurses wash their hands prior to delivering the baby… simply by preventing infection!  Today, it is accepted that by not smoking, maintaining a healthy body weight, normal blood pressure and cholesterol, we can prevent heart disease.  If we stop preventing disease, a healthy life and life expectancy would be very different from what it is today.  The CDC estimates that if we stopped preventing diseases with vaccines:
  • 13,000 – 20,000 people a year, mostly children, in the US would contract polio, requiring braces, crutches, wheelchairs and breathing machines
  • Almost everyone in the US would get measles, 20% of whom would need to be hospitalized, and 450 would die per year in the US, and 2.7 million worldwide
  • Haemophilous Influenzae (Hib) would cause 20,000 cases of meningitis or epiglottis in the US, killing 600 people per year.  About 1 in 200 children under 5 would be infected, and those that survive are often left deaf, with seizures or mental impairments
  • Almost all children would contract whooping cough, with about 9000 deaths per year
  • Pneumococcus would infect 63,000 Americans yearly, killing 10% of those infected
  • Rubella, while mild in most children and adults, causes birth defects in 90% of children whose mothers got infected while pregnant, causing heart defects, deafness, cataracts and mental retardation
  • Mumps would infect 300,000 people a year, and causes deafness in about 6% of cases.  It also caused miscarriages in women infected while pregnant
  • Hepatitis, Diptheria, Tetanus and Chickenpox are all diseases with potential long term consequences that we are preventing with vaccines
Vaccines are some of the most closely monitored treatments in medicine, both because the diseases they prevent are serious, and the consequences of not getting it right are real as well.  This is a great conversation to have with your physician during an Annual Physical.  My daughter will be getting her vaccination shortly.
The path to wellness begins with a proper diagnosis