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Importance Of Immunizations

In the midst of the current pandemic, when staying home is still the rule for most, keeping up with recommended immunization schedules can be challenging. Join the live discussion with Covenant Children's Pediatric experts to learn about why it's still important to get your children in for their vaccinations.

Amy Thompson

Good afternoon, and thank you for joining us on our Facebook Live broadcast. I'm your host, Dr. Amy Thompson. I'm the CEO at Children's in Lubbock, Texas. I just want to give a few reminders, and then I'm excited to introduce our guest today. So as a reminder, the information that's provided during this event is for informational purposes only. This event does not create a doctor patient relationship. And any questions or medical advice discussed is not considered guidance on what you should do. For any medical questions, please reach out to your primary care or health care professional. So we're so glad that you decided to join us today. It is my privilege today to introduce to you Dr. Jeremy Dalton. Dr. Dalton is a dear friend, a colleague and I'm so happy that he is here with us in Lubbock. And so I have asked him to come and talk with us today about child care immunizations and all of these great things. So, Dr. Dawson, thank you so much for joining us. And why don't you just start by telling just a little bit about yourself and what your role is here in Lubbock and, and what you do?

Jeremy Dalton

My pleasure Dr. Thompson. So I've been in Lubbock since about 2008. Actually, I grew up here and then went off to medical school in Houston for a while and then my wife and I moved back back a few years ago. I'm a pediatrician with our medical group here and have been doing that since 2008. We, my wife and I have a practice together and we also have six kids of our own. So we have a lot of kids at work and a lot of kids at home. So we at least have a lot of street cred I think and, and so I've also been pretty active in hospital, on the hospital medical staff have been chief of staff and serve a few other roles as well. So it’s my pleasure joining.

Amy Thompson

I'm so glad you're joining us. And he really does have a lot of kids. And so their office is a popular one here in Lubbock. People just talk about going to the Dalton's. And it's fantastic. So, obviously, you know, almost everything that we're talking about these days has to do with COVID. And so I just want to talk specifically about routine child appointments. When kids come in just to get that routine care, have you seen a change in that and you know, kind of what are your thoughts on those differences?

Jeremy Dalton

Yes, we definitely saw a change. I think when COVID hit back in the spring, really a lot of pediatrician and physicians in general were kind of just sitting around not doing much of anything because people were under stay at home orders and everyone was having quite a bit of anxiety about getting out, so routine well child care definitely suffered, and It's starting to pick back up. But I think there is still a lot of ground to make up. And not only do we notice that in our practice and in our community, but there was definitely a noticeable drop nationwide and routine childcare and immunizations.

Amy Thompson

I agree. And so specifically, I want to ask you a question about immunizations. Did you also with that routine childcare, you know, obviously, that's normally when kids will also get immunizations. And so have you seen that in your practice as well?

Jeremy Dalton

Yes, we're playing catch up on the immunization front right now because when people don't come in for well childcare, they don't come in for routine immunizations either. And as probably anybody who has kids knows, the kids get a lot of vaccines from birth until about two or so. So if they miss a well child appointment, they're going to miss shots too. So you can't make those up in one visit. Often it takes a little bit of time to make those up if they miss appointments.

Amy Thompson

Talk a little bit about what I would call an essential doctor. I have to remind patients all the time that they have to follow their PCP not just when they're sick, but for these well child exams and for immunization. So talk about those as, you know, essential doctor visits and kind of what you're hoping to accomplish in this visit.

Jeremy Dalton

So yes, that's a good question. Amy. There's a lot packed into these visits. So you know, people think about the sick visits as a time to go to the doctor, but well child visits are really important too. So not only do we give vaccines at well child visits, at certain increments, but there's a lot of things we look at as well. So you know, we plot kids out on the growth chart and we see how they're growing. We do a very thorough developmental assessment every time they come in, and a comprehensive physical exam too. We do things like check their hearing, check their vision. So, you know, sometimes parents don't exactly know everything that's going on because they're busy too. So it's really our job as pediatricians to make sure kids are completely healthy both physically and emotionally at well child visits.

Amy Thompson

Yeah, I agree. And, you know, when we were in residency - I joke that the last time I did clinic was those days - but my one of my favorite parts of those visits was called a guidance session, that you would look at each of those well child visits and it was an opportunity for you to answer questions for moms. And you know, exactly describe the guidance that you're going to need for that next developmental stage. And I often found that it was a great time to talk with the parents about what to expect, and what to look for if they didn't see some of those, you know, developmental things.

Jeremy Dalton

Yeah, we can always like, like you said, we can make sure things are going well during that visit time, but also tell them what to anticipate from that visit to the next one, because there's about two, oftentimes two to three months between visits. So I need to know what to expect over the next several months.

Amy Thompson

And it's been my experience, you know, you and I work together - where you guys will sometimes send kids to us, and there have been kids that we have picked up because they've come to well child visits that say, like you talked about, that have fallen off the growth chart or you know, various other things. We're actually able to bring them into the hospital and figure out what's going on with them. So we work closely with you guys in the outpatient setting to be able to identify kids that need to do more work in the hospital. Talk specifically about what immunizations are the most important, and why they are the most important, and what they should consider. Now, you know, I'm gonna be a big pediatrician and say, there's no most important - they all are.

Jeremy Dalton

Yes. Okay, I have this conversation a lot. And we talk about which vaccines are most important, if not every day, multiple times a week. And, you know, I do think I do think they're all important, and I'll talk about that more in a second. But I think the most important ones are the ones for illnesses that are still present in that community, so you can think about things like whooping cough and tetanus that if the child's not vaccinated, they could get that at any point. Because pertussis, which causes whooping cough and tetanus, are still alive and well. And also, I think that is probably the most important one, especially in infants, because if they get whooping cough, they could get very, very sick and they could come see you in the hospital very quickly and be there for a while. But then there's also other vaccines that we've seen to get to that period called strep pneumococcus that cause a lot of different problems. It can cause something as simple as an ear infection, but also it can cause pneumonia and bloodstream infections and meningitis, things that are really bad. So that's a bacteria that is present in that community. We have a vaccine now that covers 13 strains of this bacteria so it's very effective at preventing a lot of illnesses that we were not able to prevent in the past. So I think those are the two that come to mind. Also, I think there are vaccines against meningitis, especially for kids that are going to middle school and college. I think it's especially important for college aged kids because they're going to be going to a dorm and being in close contact with many other college-aged kids. Meningitis can spread very easily amongst college-aged kids who are close together. So there are illnesses like that that are still alive in the community, but it's important to vaccinate against other things as well. Because think about something like polio, people don’t consider the polio vaccine anymore because it's been gone for a long time. And that is true, although in places where vaccine rates are lower, polio still exists. So I always tell patients, you know, polio, if you're not vaccinated, polio is just a plane ride away. And so we need to get vaccinated against that just to keep our vaccination rates up. Herd immunity is present. So I'm sure everybody's heard lots about herd immunity with COVID. But herd immunity is important for other things as well. There's also another bacteria called demopolis influenza. So that vaccine came around in the 80s when kanopolis influenza was causing meningitis in lots of different kids and it was a very debilitating disease, but the vaccine works so well we don't ever see it. I've only seen it once or twice and in the last 15 years because the vaccine works so well. So that's one that you should also get even though we're not seeing anymore because it's important to keep vaccination rates up. So we can continue to have herd immunity against these illnesses. And then also you take something like the flu vaccine, I think that one is really important as well, because even though the flu vaccine is not 100% effective, it is one that is important to prevent complications from seasonal influenza. They can affect anybody but especially young kids and older people. And even if the vaccine isn't a perfect match to the strain from year to year, you'll still have some cross immunity to two different strains of the virus. Yeah, one other I might mention is the MMR vaccine. I think that one's really important.

They're all important. AB MMR is important, because there's still outbreaks of measles here and there, and just when we were getting over a measles outbreak COVID came along. I am concerned, just like a lot of pediatricians, that if vaccination rates dip something like measles can surface again. So it's really important to vaccinate against everything. So, again, I know that may not be what you're looking for, I want to talk about the most important ones, but I think they're all important.

Amy Thompson

I agree. I always laugh at this question, but I think that if you have to make a list about what the most important are, you've done a great job with that. But it is really true that the joke amongst pediatricians is, the real correct answer is, they're all important. Obviously this patient population that I see, since I just work in the hospital, you know, we oftentimes only the kids that are very sick from vaccine preventable illnesses. I started at a time when there were a lot of diseases that we had actually, in many cases, we were using the term eradicated because of those high herd immunity rates, and we certainly have seen those have come back in the last few years with decreasing immunization rates. So when people ask me the question about vaccines and immunizations, I always have to lead with, you have to keep in mind, all of the kids I see are the kids that have had very bad outcomes from diseases, and so we talk about strep pneumo. And for me, as a pediatric hospitalist, what strep pneumo means is usually very devastating meningitis, and as we've not neurologically the same, you know, as they came. I never want to use scare tactics or things like that. It's more that this is the reality when we allow these things to come back in. In the hospital, I have the privilege to take care of a lot of cancer patients. So for patients who are compromised, it is really important that we all as a community, even on things like flu, get flu vaccinations because the simple flu can be a deadly disease for a kid with cancer. And so my perspective is very much, I think sometimes it's skewed, because I can see the downsides. You know, of what happens when we don't do these. We do have a question that's coming in [from social media] and actually while we're on this topic, I'm going to ask this question about some of the adverse things that happen with immunizations. So, this is specifically about the risk of febrile seizures. And we've seen that some of these are seizures that just happened with fever - for those of you who are watching - the question is, “Is there a risk of febrile seizures with any of the childhood vaccines? My brother had a bad experience many years ago after a vaccine.”

Jeremy Dalton

So I think the one that they've probably had the adverse reaction to is the DTP vaccine. So I think one of the good things that we've done with vaccines in the last few years is we've substituted the pertussis component within an acellular component. So the side effects are much, much more mild. So whereas with the old one, there was a risk for febrile seizures, with the new one, they can have some low grade fever, but that's really the most common side effect. And they may get a little bit fussy. But the downside to substituting the pertussis component within an acellular component is it doesn't work quite as well as the old DTP vaccine. But side effect profiles much better. So I think what I always tell patients is, is the the main side effects of vaccines are ones that they need to be aware of is a low-grade fever, and they may be a little bit sleepy, but you know, that usually happens with most vaccines, they can get a little bit more fussy and run a little bit more fever. Six months and a year are usually better. After that, I think that the risk of side effects is pretty low. I think with the MMR vaccine - that's the one they get at 12 months - kids can get a rash a few weeks later, but that's really fairly uncommon. I think uncommon side effects will include a high fever, you know, more than 102. Does not happen very often but it can't happen occasionally. Anytime you have a fever that high, it can lower the threshold a little bit and the febrile seizures could be a side effect. But that is a very rare side effect and nothing I think that parents should, I think, should be too concerned about. They can always, of course treat fever and other systemic symptoms with Tylenol or Motrin, that can help. And I don't think that a very small risk of adverse side effects should prohibit parents from giving vaccines to their children.

Amy Thompson

Yeah, I agree with that. And I actually have this theory that because we had done so well in the past with, you know, immunizing, and we had in many of these cases really eradicated a lot of the disease, that the thing you hear about now is, you hear about the side effects from the vaccines, which, to your point many times are mild, that are very scary. As a pediatric hospitalist I take care of a lot of kids with what we call febrile seizures. And while it is not scary to me, I think because we have, you know, taken care of that so much, I can imagine my mom. So I can only imagine that sometimes the things that I hear myself saying to my patients, I'm thinking, these people must think I'm crazy. When I'm like, Hey, we see this happen, and it's going to be fine. It's really scary. But you know, the kids do really well with this. And I think sometimes it's that fear of, you know, these adverse events. And I think sometimes what has happened is because we have gotten close to eradicating these diseases, we see more of conversation about the adverse side effects than about the disease itself. And, you know, the truth is, mumps was a thing, even when the Brady Bunch was on. There were kids every year who died from those types of diseases and, and so, sometimes I think we have this view of these diseases. But I think sometimes the reason that this can be scary for parents is because they're reading more about the, you know, adverse effects of vaccines, rather than the things that can happen if we use things like to come back into our community.

Jeremy Dalton

Yes, yeah. Those are very good points.

Amy Thompson

Okay, so I'm going to go to kids coming in for well child visits. What are specific things that you guys have done in your clinic that are safeguards and that can help parents feel safe about bringing their kids in for well care?

Jeremy Dalton

Well luckily we had plenty of time to sit down and brainstorm in the spring while we weren’t seeing as many patients, and then they came in. So we're doing a few things. We basically have eliminated our waiting room. So that's probably one of the most helpful things, patients really aren't in contact with other patients. So we've had them wait in their cars and then we just usher them from their car to an exam room and then back out so they don't have to sit in a log, potentially with other sick kids. We've also separated well visits from sick visits. So we've been clustering well visits together and sick visits together. Keeping well kids in one part of the schedule and then sick patients in another's really helped as well.

Amy Thompson

Okay, good. Those are great things. And I encourage you, if your pediatrician's office is not doing those things, encourage them to create safe practices. There are really good things that are out now on the ways that you can make people feel safe. And yeah, we have the same thing in the hospital.

Jeremy Dalton

And then, of course, mask usage wherever we're at. Everybody's pretty well used to masking and everyone's required to wear a mask. So I think that's been helpful as well.

Amy Thompson

I have had some questions on things like, if I miss a routine visit for my kid, does that increase the risk that my kid could potentially get COVID? Or is the reason that you're telling me to come in, you know, a different reason than then just because of susceptibility to COVID?

Jeremy Dalton

Yeah, I think that's a good question. I think it totally could potentially increase the risk for COVID. I mean, I think that, thankfully, something I've been really happy with - I mean, most pediatricians have been - kids seem to be not as affected as severely as other segments of the population. But I think it's important to come in for well visits just to make sure that your kid is healthy, growing, doing well, and there's no underlying conditions that that we could potentially pick up in a well visit that would could make your child more susceptible to complications from COVID. Another thing if, say, if you missed a routine immunization visit like the 12 month visit, say where they get the MMR vaccine, if they miss the MMR vaccine, and then they're exposed to somebody with measles. Then if they got measles, one of the reasons measles is such a terrible illness is because it pretty much erases your immune memory. So you will not have as many immune cells to fight the coronavirus since you did get it. So, I know that is kind of extrapolating quite a bit, but that is one example of a reason it would be good to just stay as caught up on your well child care as possible.

Amy Thompson

And I'm always amazed. You know, every pediatrician has to have a pediatrician. And yes, I have been with the great Dr. Holly Hansen during my residency. She actually was a teacher for me in residency. And I'll have to say that one of the things I'm always amazed about is stuff that I have told my children 750 times and they roll their eyes. They go to Dr. Hansen, and she says it one time and we will get back in the car and they're like, did you know, whatever. I really do think that we have to remember that pediatricians have that relationship with people. And it has been amazing to me over the years to watch. When a pediatrician tells my kid something, they actually say well maybe I should go do that. They actually listen and it really makes a difference. And so I would expect, if you have a kid who is in a higher risk group for having some adverse effects from COVID, you have asthma if you have underlying issues, that's part of the reason we also want you to come in. Because Dr. Dalton will talk to your kid and be able to say some things to them about making sure that they understand how to protect themselves against COVID. And it's just that our kids sometimes listen to other people before they're going to listen to us. I've watched it. When you see patients in the hospital, these kids and their parents really trust their primary care doctor. And so I think that their primary care doctor can have real input into helping those kids make a decision.

Jeremy Dalton

Yes, that's an excellent point. A lot of times it just takes somebody who is not the parent to tell them. I think it helps if you have a medical degree - and a relationship with them. That's an excellent point.

Amy Thompson

Talk really quick about, if we have somebody who's watching and they are struggling with resources and different things like that, are there places that folks can go for vaccines at low cost or no cost? And where could they expect to go if they're worried about being able to afford a copay at a PCPs office or something like that?

Jeremy Dalton

Yeah, I think they have a couple of different options. First of all, they could always check with their primary care physician, because as far as I know, we all have VSP vaccines, which are vaccines for children. I think that the VSP vaccinates about 50% of the kids in America. So, you know that would probably be the first thing, those are inexpensive. I think they are $5 a vaccine. So pretty reasonable. You know, the health department's also an option. They do vaccines every day, so they'd be happy to help out. And then we have a children's clinic here that can see kids with limited or no funding. And I think that's the case in most communities? I think. So. There's a few options I think, especially during this time when so many people are struggling with funds just because of increased unemployment and prolonged unemployment. Hopefully it won't be prohibitive to getting up to date on vaccines.

Amy Thompson

Yeah, I agree and always, always in your community. I think calling the health department is usually the keeper of resources. They will know a place to tell you that's a low cost clinic where you can go for immunization. So I always say they're the keepers of many good pieces of information. All right. So this is your moment. Dr. Dalton, you're going to have one last opportunity to say anything that you want to say to our viewers about the importance of well child care and immunizations.

Jeremy Dalton

Please, if you haven't come in in a while for a well child care visit, now's the time because we - and there's a lot of grace here because I think a lot of us had anxiety around COVID and fear of exposing your child to COVID, understandably - because nobody wanted unnecessary exposure. So in the spring, I think a lot of people got behind on well child care. But now that schools are starting back up, I mean, most schools are in session already. A lot of kids are about to go to school. I know that New York City is getting ready to start after Labor Day. I think a lot of other schools are starting after Labor Day, and most kids are going in person. So they're going to be exposed anyway. And a lot of doctors' offices are taking precautions like we talked about. So I think the risk of picking up COVID at your doctor's office is low. So if you haven't come in for well child care, or you've gotten behind on vaccines, now would be a great time to get that started because every pediatrician that I know knows about catch up vaccine schedules. So if you've got behind, don't worry about trying to sort through it, that's our job. We can help them get back on track. And they haven't really missed that much time, it's only been about six months so we can get every kid caught up very easily. And now it'd be a great time to do it because if you're going to get a flu vaccine, I think September is a great month to do it. So I think now would be a very good year to get a flu shot. Because if we can eliminate one illness this year, I think that would be excellent. And the flu vaccine is a good way to do that. So that's what I would say as far as catching up.

Amy Thompson

Beautiful. I echo all of that. And I would just underscore, we have taken a lot of precautions at the hospital. I know you guys have clinics to make sure that your child is safe from COVID when they come visit us. But don't delay medical care. That's been my biggest message to people is, if you think your child is sick, bring them in to be seen. And for sure parents keep up with well child care immunizations. And I always feel like I should wear a T-shirt that says immunize, immunize, immunize. So to the ones that we know and are on the immunization schedule, I'm a big believer. Dr. Dawson. Thank you so much. It was fun to have you. Have a blessed Day.

Jeremy Dalton

Dr. Thompson, it was nice talking to you. Thank you. You too. Amy. Thank you.