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Issue 12013

Pediatrician’s Corner

Matthew William Wigder, M.D.

Photos by Allen Kramer

In 15 years of training and practicing in the Texas Medical Center, I’ve been able to treat a huge variety of diseases, from middle ear infections to childhood cancer. Thankfully, there are some diseases I have never encountered and hopefully never will.

Every day, I work alongside a pediatrician who has vivid memories of caring for children with polio and measles. I’ve heard terrifying tales of clinicians’ limited abilities to prevent the morbidity that these illnesses would cause — involving in one case the physician’s contracting measles, causing his wife to fear for his life.

Recently, I was fortunate enough to hear a lecture from Dr. Carol Baker, director of Texas Children’s Center for Vaccine Awareness and Research and one of the most qualified people in the world to discuss the science and history of vaccines. She explained that people have been questioning the safety and efficacy of vaccines for almost 300 years.

Benjamin Franklin, initially a skeptic about the practice of self-introduction of smallpox under the skin, became an advocate after the death of his 4-year-old son from smallpox, or as he called it, the distemper. During the Revolutionary War, George Washington inoculated his soldiers because smallpox was more lethal to his men than the English Redcoats. Later, in 1796, Edward Jenner created an oral vaccine that was at the time harshly scrutinized as unsafe. Now, thanks to his contributions, smallpox has been eradicated and no longer poses a threat to public health.

Although we mostly hear it in harmless pop-culture references, the phrase “going viral” has very serious origins — the lightning-fast spread seen by some viruses, like the measles. An outbreak of illness can sometimes be an international flight away.

Dr. Baker has co-written a remarkable book entitled Vaccine-Preventable Disease: The Forgotten Story. I recommend this book to anyone wanting to learn more about the devastating impact under-vaccinating can have on individuals and families.

In 2011, the United States suffered a massive spike of measles cases (222), including that of an 11-month-old at Texas Children’s Hospital. The national spread of the disease was traced back to 22 countries. Of those hospitalized, 97 percent were under-vaccinated against measles.

Newer vaccines have greatly impacted how we will practice pediatric medicine. One vaccine called Prevnar has greatly reduced the frequency of infections from Streptococcus pneumoniae, otherwise known as pneumococcus. This bacterium is the predominant cause of bacterial meningitis, severe pneumonia and other types of serious infections. With the adoption of Prevnar, the number of pneumococcal infections has fallen precipitously.

Gardasil, a vaccine directed against the human papilloma virus, aims to prevent 70 percent of cervical cancer, not to mention other oral and genital cancers in men and women.

Finally, vaccines targeting meningococcus, a cause of the meningitis cases in teens or young adults which often make the news because of its severity, are available in two forms.

The American Academy of Pediatrics’ Advisory Committee on Immunization Practices, chaired by Dr. Baker, recommends a revised vaccine schedule directed at 20 vaccine-preventable diseases every new calendar year. According to research, vaccines are the second-most cost-effective way to prevent disease, behind only the purification of one’s water supply. Immunizations, if provided to children as recommended, also provide “herd immunity” to those unable to receive certain vaccines. Unfortunately, of late, the protection that high vaccination rates provides has been diminishing here and abroad, exposing more of those at risk to vaccine-preventable disease.

Frequently Asked Questions About Vaccination

I heard there was a new vaccine requirement in Texas. What is it, and when does my child need it?

Teens have been encouraged to get the meningitis vaccine prior to going to college since the drug’s advent. However, several changes have been made recently to the recommendations regarding this important vaccine. When first released, Menactra was a vaccine offered to college- or military-bound seniors. In 2006, ACIP recommended the first dose of Menactra between ages 11 and 12 with the goal of protecting teens from meningococcus for approximately 10 years. Recent research indicated that immunity from the dose at this age is not sufficient for long-term protection through college age. Therefore, a new vaccine requirement was introduced.

It states that teens must receive a meningitis vaccine at age 16 or later. The current recommendation of vaccinating at 11 to 12 years has been maintained, as this is the age where meningococcus risk increases. Even if they received the first dose at an early age, they are still required to get another vaccine at age 16 or later.

I am concerned about the HPV vaccine from what I have heard in the news. And if my teen will not be sexually active for years, why is my doctor encouraging it?

Two HPV vaccines have been developed, and the one our clinic provides is Gardasil. Although it has been a political lightning rod ever since its introduction in 2006, Gardasil is the first vaccine introduced to actually prevent the development of cancer. The vaccine targets the four strains of HPV that cause the vast majority of cervical cancer. Imagine a breast or brain cancer vaccine that would prevent 70 percent of the cancer risk throughout a woman’s lifetime simply by getting three injections at the age of 11.

A day after discussing Gardasil during a Republican primary debate, Representative Michelle Bachman infamously linked the vaccine with “mental retardation” on national television. The vaccine has never been scientifically linked to such a claim, harming her credibility with the national and scientific media. The vast majority of the vaccine’s adverse effects are related to headache or dizziness, which resolve in minutes. We observe patients for 15 minutes following the administration of this vaccine to monitor for any such effects.

Additionally, there is no known evidence that receiving a shot at the doctor somehow makes a preteen or teenager more likely to have unprotected sex, as claimed by some. In fact, delaying vaccination until teenage years may in some cases lead to reduced vaccine effectiveness. As of 2009, statistics indicate over 50 percent of 10th graders were sexually active in the state of Texas — regardless of race, gender or religion. The bottom line is that as a teen or an adult, most people will eventually be exposed to HPV, and the potential cost of under-vaccination is what your pediatrician is trying to prevent.

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About Matthew William Wigder

Matthew Wigder, M.D., is a pediatrician with Texas Children’s Pediatrics. A native of Dallas, he attended The University of Texas at Austin and UT-Houston Health Science Center.

Before becoming a pediatrician, he served as an assistant professor of pediatrics at Baylor College of Medicine and as an attending physician in the busy emergency rooms at Texas Children’s Hospital and Ben Taub General Hospital. He and his wife have three children.

“I love my job because I get to help parents take care of their most valuable possessions and provide guidance based on my years of training and experience. I love to see children thrive.”