“Think Again,” When It Comes to Viral Hepatitis

Do you know which vaccine your baby received on the day he/she was born? Hepatitis B. The first dose is given to babies on their day of birth – so it must be pretty important, right? Right! But how much do you know about Hepatitis B…or the four other types for that matter? Monday is World Hepatitis Day, so we thought it would be appropriate to educate our readers about the dangers and prevention of this disease.

Let’s review the basics. There are five different types of hepatitis viruses: A, B, C, D and E. All of these viruses cause short term, or acute infection. However the hepatitis B, C and D viruses can also cause long-term infection, called chronic hepatitis. Here are the “cliff’s notes” about each type of hepatitis:

Hepatitis A: the most acute virus of the three, it often presents like a stomach bug. While the hepatitis A vaccine is part of the routine childhood immunization schedule, many adults have not been vaccinated.

Hepatitis B: a very hearty virus, can live outside of the body for at least seven days (and on household objects like toothbrushes and razors), an infected mother can pass it to her baby at birth, and when kids are infected, it is much more dangerous than adults because they can develop a chronic infection that can lead to liver cancer. Many people are infected with hepatitis B virus and don’t have any symptoms, but they can still pass it on to other people. The virus is transmitted through blood or other body fluids. Vaccination is part of the routine childhood schedule and is also available for adults.

Hepatitis C: a virus that the body is unable to clear by itself, so infection typically becomes chronic. It is mainly spread through blood-to-blood contact. There is no vaccination available.

Hepatitis D: found in individuals infected with Hepatitis B, this type is spread through contact with infected blood. There is currently no antiviral therapy or vaccination available.

Hepatitis E: spread through eating food or drinking water contaminated by the feces of an infected person. A vaccine exists but is not available in the United States.

So, you may be asking – how does this apply to me (and my child), and what can I do to protect my family from hepatitis? Well, first and foremost – you can make sure your family is vaccinated! This is the simplest and most powerful way to provide protection against Hepatitis A and B. The CDC recommends three doses of the Hepatitis B vaccine (given at birth, 2 months and between 6-18 months) and two doses of the Hepatitis A vaccine (given six months apart starting at 12-23 months.) Adults can get them, too!

And finally, because it’s much more fun to watch finger-puppets sing about hepatitis prevention than read about it…

Most people have no idea how prevalent viral hepatitis is (one in 12 people around the world are living with chronic viral hepatitis), and often because there is a stigma attached to the virus, it is misunderstood. In reality, it is a risk to us all. Thankfully, Hepatitis A and B can be prevented thanks to vaccinations. If you think your family is safe without a vaccination, please think again.

To visit the “Wall of Stories” where those affected by hepatitis have shared their personal experiences, click here.

Measles – Recognizing the Signs

MeaslesTravelFlyerMy husband and I just returned from a phenomenal trip to Mexico celebrating one year of parenthood – we survived! As much as we missed our baby girl, it was so great to get away together. We returned feeling relaxed and rejuvenated. As we made our way through customs after landing in Houston, I began to notice how many nationalities surrounded us. At a large international airport (like the one here), it’s not unusual to see a great number of countries represented as everyone debarks their planes and enters the U.S.

The lines were long, and as we slowly snaked along, something caught my eye. It was two large signs displayed very prominently. One asked “Do you know how to recognize measles?” and the other read “Get vaccinated against measles.” Trying my best not to be obvious, I began casually looking around to see if any travelers around me had a suspicious rash on their neck. (Yikes!) Simultaneously, I felt relief wash over me – I was so happy that my daughter wasn’t with us. Even though she received her MMR vaccine (Measles, Mumps, Rubella) a few weeks ago, I still wouldn’t want her to be exposed if someone in line had measles. As unlikely as that scenario probably was, the protective mother in me came out again.

Measles was not something I thought about much, until this past year. I thought it was a disease from the “olden days” that had pretty much been wiped out, thanks to vaccinations. But when my daughter was born, and I became hypersensitive to contagious diseases and germs, suddenly I began hearing about measles all the time. There would be a story on the evening news about an outbreak in Ohio, or a friend would post an article on Facebook about increased cases in California. Now, at least once a week, I hear something about the increasing problem of measles cases in our country. As I mentioned in this post, I counted down the days until Stella got her MMR vaccine, and felt so thankful to have easy access to it – sometimes we forget how lucky we are to live in a country where vaccines are readily available.

So, back to the signs at the airport. Do you know how to recognize measles? Symptoms generally begin about 7-14 days after a person is infected, and include:

• Blotchy rash
• Fever
• Cough
• Runny nose
• Red, watery eyes
• Feeling run down, achy
• Tiny white spots with bluish-white centers found inside the mouth

Three to five days after the start of symptoms, a red or reddish-brown rash appears. The rash usually begins on a person’s face at the hairline and spreads downward to the neck, trunk, arms, legs, and feet. When the rash appears, a person’s fever may spike to more than 104 degrees Fahrenheit. If you’d like to see examples of the characteristic rash, you can find images of measles here.

If you think your child might have measles, please (for the sake of those too young or too sick to be vaccinated) CALL your provider’s office or the emergency room before you go to let them know you suspect measles, so that they may prepare for you, and prevent it from spreading to other patients. The measles virus is spread through respiratory droplets (coughing, sneezing, kisses, talking, etc.), and can live in the air and on surfaces for up to two hours after an infected indiPrintvidual has left the room. It is one of the most contagious diseases to affect humans — so contagious that 90% of people who come into contact with the infected person will also become infected, if they are not vaccinated.

Sadly, measles is still one of the leading causes of death among young children worldwide, even though we have a safe and cost-effective vaccine to fight it. The CDC recommends the first dose (of two) of MMR vaccine be given one year of age for children, but can be administered as early as six months if the child will be traveling abroad.

We’ve been successful at significantly reducing the number of cases of measles we see here in the U.S., but we’re not out of the woods yet. Parents, please don’t let your child be without immunity from this highly contagious, dangerous (but preventable!) disease.

The Actual Risks of Vaccines (It Turns Out There Aren’t Many)

This article was originally published on the Huffington Post on July 8, 2014.


These days, we hear a lot about the risks of vaccines. As a pediatrician, I talk to many parents who are very frightened about those risks — and some choose not to vaccinate because of their fear.

Some of the risks we hear about are real, but some of them aren’t.

I absolutely support the right of every parent to make what they feel is the best decision for their child. The vaccination decision, however, isn’t a purely personal one. When people don’t immunize, it can lead to more cases of vaccine-preventable diseases — many of which can be deadly, especially for the young, the old and those with health problems.

And when people make the decision not to vaccinate based on misinformation, well, that makes it so much worse.

No medical treatment is 100 percent safe for all people. Heck, nothing in this world is 100 percent safe for all people. Crossing the street, eating a piece of hard candy, riding in a car and swimming have all been known to turn out badly — and yet those aren’t controversial.

I know, getting vaccines is different than riding in a car. There are lots of reasons, but one is that vaccines feel, well, more optional than riding in a car. Also, the risks of riding in cars are clear and well-known, and we know what we can do to prevent them (like using a car seat, and driving carefully). But the risks of vaccines seem a whole lot murkier.

That’s why the recent report about the actual risks of vaccines is so helpful. Researchers looked at hundreds of studies about vaccines and used statistics to figure out the most common “adverse effects.” These are the risks we need to really think about, as opposed to the mild fever and muscle soreness that goes away quickly, or the one-in-a-million risks that nobody can predict.

While it’s certainly good to know what the one-in-a-million risks are, if you are going to truly worry about those you should pack your child in a bubble right now — because the risks of playdates, playgrounds, going to school and taking most medications (as well as eating most foods) are higher. In saying that, I don’t mean to sound disrespectful of parents who worry about the rare risks of vaccines. It’s just that as a doctor, it’s frustrating to me when people only look at vaccines that way, vaccines that could keep their child and others from getting sick, and don’t pick apart the risks of everything else in their child’s life. And the illnesses vaccines prevent have risks that are much higher than one in a million, an important point that often gets lost.

Here are the risks that researchers found:

  • MMR vaccine: febrile seizures (while scary, these don’t cause long-term effects), and severe reactions in those who are allergic to the vaccine.
  • Hepatitis B vaccine: allergic reactions in people who are “yeast-sensitive” (people should check with their doctors to see if it applies to them)
  • Hepatitis A vaccine: can cause a bruising-type rash (purpura) although usually mild and short-lived.
  • Polio vaccine: the researchers found one study that showed an increase risk of food allergy in newborns who got the shot (they didn’t find it in older babies or children who got it), but only if they had eczema and a family history of food allergies.
  • Influenza vaccine: vomiting and diarrhea (for a brief period of time), febrile seizures
  • Pneumococcal vaccine (PCV13): can cause febrile seizures, especially if given with the flu shot.
  • Rotavirus: can cause intussception, a condition in which the intestine folds in on itself (while this can be dangerous, it can be fixed).
  • Meningococcal vaccine (Menactra): severe allergic reactions in people who are allergic to it.
  • Varicella (chicken pox) vaccine: can cause illness in children who have problems with their immune system (so they shouldn’t get it). It can also cause a much milder case of chicken pox in healthy children, and can cause purpura (that bruising rash again), usually mild and short-lived.

All of these are still rare — for example, intussception happens in between 1 and 5 out of every 100,000 children vaccinated. The risk of being allergic is very small too, which is good since it’s almost impossible to know about that risk ahead of time.

That’s it. They couldn’t find anything for the DTaP vaccine or the HIB vaccine. They couldn’t find any association with autism. And they couldn’t find any risk from giving a lot of vaccines at once; in fact, one study found that getting several vaccines may help protect children against leukemia.

Check out the report. Check out the Vaccine Adverse Event Reporting System, which is where information about events that happen after vaccines is kept. Ask your doctor every single question you have. We in the medical profession aren’t trying to keep anything secret, truly — and we rather desperately don’t want children or anyone to be hurt, either by the vaccines or by vaccine-preventable diseases.

Please, make your decisions based on the best information possible. There’s just too much riding on it.

Claire McCarthy, MD, is a pediatrician at Boston Children’s Hospital. An Assistant Professor of Pediatrics at Harvard Medical School, an official spokesperson for the American Academy of Pediatrics and a senior editor for Harvard Health Publications, she has been writing about health and parenting for magazines, newspapers, and the internet for more than 20 years. She and her husband are raising five children ranging in age from 23 to 8. She blogs for Thriving, the health and parenting blog of Children’s Hospital Boston, and for Boston.com as MD Mama; you can follow her on Twitter at @drClaire.

Vaccination Milestones

cupcakeIf you have children, you’ve probably heard the word “milestone” more than you ever did before you had them. Milestones mark each week and trimester of pregnancy. Milestones mark your child’s growth and development. Walking, talking, eating independently – all milestones in their wonderful little lives. My daughter reached a major milestone on Saturday. She turned one! It was a great weekend of celebrating (both her birthday, AND my husband and I surviving the first year) and it still surprises me how quickly time can fly when you’re having fun.

Yesterday we loaded up in the car for one more milestone – Stella’s “one year well-visit” and 12 month immunizations at her pediatrician’s office. We found a seat in the waiting room, and she was wonderfully oblivious to the shots that were coming. She loved watching the fish swim around in the aquarium, and giggled at the other kids around us. As the nurse brought us into our room, she bounced on her daddy’s lap and played with the paper on the table like a happy girl…until the nurse came in with the needles. Our happy girl turned into one big crocodile tear. Her immunizations included Hepatitis A, MMR (Measles, Mumps, Rubella), and Varicella (Chicken Pox), and before we knew it, they were over. Those nurses are amazingly quick! Although shots are never fun for kids, and Stella is probably a little sore today, I celebrated this milestone. We’d made it to our 12 month immunizations without contracting measles, mumps or chicken pox in the process! The nurse mentioned that she might have a slight fever today. A little fever is far better than the alternative, and she is finally protected. With outbreaks of several vaccine-preventable diseases on the rise – like measles and whooping cough – I was counting down the days until she could get vaccinated. Now I am able to breathe a sigh of relief.

Many of the diseases we vaccinate against are still common in other parts of the world. Measles, for example, is still a leading cause of death in children under 5 worldwide. In fact, 14 people die every hour from measles around the world. This is despite the fact that we have a vaccine that’s not only effective at preventing measles but also very, very safe.

A recent article published yesterday in the journal Pediatrics reviewed the available research on the safety of the MMR and other vaccines and found that side effects (if any) are mild, and severe adverse events are exceedingly rare. What is “rare”? Well, according to the CDC, the odds of having a severe reaction to the MMR is 1 in 1 million. To put that into perspective, Stella has a greater chance of being struck by lightning than having a severe side effect. And with measles cropping up all over the country, the chance of her getting exposed to measles is greater than it has been in roughly 20 years. Knowing that, I have no doubt the benefits of getting her vaccinated far outweigh the risks.

As a parent, we track our child’s development week to week. Additionally, it is our responsibility to keep up with their immunization schedule, and vaccinate them on time. Vaccinating is one of the best birthday gifts I could give to my child. It gives her the opportunity to stay healthy and be protected from diseases that can easily be prevented.