Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the recommended shots, the pertussis vaccine often raises questions.

Hospitalist Laura Romano, D.O., explains the key facts about pertussis (whooping cough) and the vaccine that prevents it.

What is pertussis?

Pertussis, a highly contagious bacterial infection, causes a severe, long-lasting cough which can sometimes end in a "whooping" sound when a child breathes in. The illness is also known as whooping cough or the “100-day cough.”

In older children and adults, pertussis typically causes only a low-grade fever and a prolonged cough. However, the disease can be fatal in infants. In babies, pertussis can cause difficulty breathing, apnea (when a baby stops breathing) due to coughing and respiratory failure. The infection can be fatal even when treated with antibiotics.

How can the disease be prevented?

Pertussis is very contagious. Vaccinating newborns is the best way to protect them. New parents, grandparents, or aunts and uncles should also receive a Tdap vaccine before welcoming a new baby home.

What would you like families to know about Pertussis or its vaccine?

As a medical community, we have watched pertussis vaccination rates steadily decline in recent years, leading to outbreaks in states like Kentucky. In that outbreak, three babies died from respiratory failure. Pertussis has proven to be fatal to at-risk infants and unvaccinated children.

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Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health service clinic for information on clinics.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the recommended shots, the Human papillomavirus (HPV) vaccine often raises questions.

Hospitalist Laura Romano, D.O., explains the key facts about HPV and the vaccine that prevents it.

What is HPV?

HPV is a viral infection that causes flesh-colored warts on certain mucous membranes, most commonly affecting the mouth, throat and genitals.

HPV infections can lead to cervical cancer in women, as well as head-and-neck and anal cancers in both men and women

Most people with HPV have no symptoms and don't realize they carry the virus, yet they can still pass it to others.

How can the disease be prevented?

Vaccinating older children and teenagers can provide lifelong protection against HPV and helps prevent several types of cancer as well.

What would you like families to know about the virus or the vaccine?

Vaccinating boys and girls offers lifelong protection against a virus that can cause warts but also against deadly cancers. The vaccine protects your child now and helps safeguard their future partners down the road.

Last year, for the first time, the United Kingdom announced zero deaths from cervical cancer among women under age 30. Australia and New Zealand have seen similar results alongside increased vaccination rates.

Other countries have also reported declines in cervical cancer among women, as well as head and neck cancer among men.

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Wellness

• Schedule a Check-up: The American Academy of Pediatrics (AAP) recommends annual checkups from age 3 through adolescence. Schedule early to secure an appointment before the school year starts.
• Mental Health: Have open and honest conversations with children about their concerns. Speak with the pediatrician on tools to help with anxiety.
  • Parenting & Back-to-School: Emotional Safety Starts at Home
  • Raising Joy Podcast: Back to School Anxiety
• Oral health: Children should visit the dentist every six months. Make sure kids brush twice a day for two minutes and floss daily. Make an appointment.
• Update child vaccinations: Navigating vaccines can feel overwhelming. Talk to your pediatrician. The Texas Department of State Health Services requires certain immunizations before children can attend school.
  • To schedule an appointment, visit Cook Children's website or your county's health department website.
  • If a child is not of school age but attends daycare, other requirements may apply.

  • College students are required to receive the meningococcal vaccination.

    

• Sport physicals: The annual UIL pre-participation physical evaluation form applies to middle school and high school students. Sports physicals give doctors the opportunity to check for a variety of concerns, from vision issues and asthma to a lingering sprain or even a serious heart condition.

Healthy Routines

• Sleep: Sleep fuels a child's memory and concentration. Without consistent rest, children struggle to focus in class and retain what they learn, impacting their academic performance.
• Key elements for building a bedtime routine:
  • Establish a consistent schedule by going to bed at the same time each night.
  • Limit screen time at least one hour before bedtime.
  • Keep bedrooms quiet, cool and dark.
  • Create a calming routine, such as reading together.
• Transportation safety:
  • E-Bike and E-Scooter safety: Always wear a helmet.
  • Driving: Drive slowly through school zones and watch for pedestrians.
  • Car Safety: Ensure your child is in the correct car seat or booster for their age and size.
• Nutritious meals: Plan balanced breakfasts and lunches to keep energy levels stable throughout the day.
• Screen time: According to the American Academy of Child and Adolescent Psychiatry, children ages 8 to 18 in the United States spent an average of 7.5 hours a day using screens in 2025. Set clear daily limits for non-academic screen use.

Make a Plan

• Virtual care: If school district offers it, sign up for the Cook Children’s School-Based Virtual Health Program.
• Allergy action plan: Provide updated emergency allergy plans and medications to the school nurse.
• Medication management plan: Submit required doctor authorization forms for any daily or emergency medications needed during school hours.

You've got questions? We've got answers covering everything about immunizations and vaccines. They each have a different role, but they both have the same goal. Learn more here: Immunizations and Vaccines Resources

Raising a child can come with a lot of questions, especially when it comes to their health and well-being. Vaccines, in particular, often spark a lot of conversation and curiosity among parents. It’s our priority to provide parents and caregivers with clear, reliable guidance. That’s why we asked Laura Romano, D.O., a hospitalist at Cook Children’s, to share the top 10 questions she receives from families.

1. Should my child receive the flu and RSV vaccines now? There seems to be so much confusion in the news, plus I’m not sure my insurance is going to cover all of this anymore.
Yes they should. Please get your seasonal vaccines as soon as possible!

Infants under 8 months whose mother did not receive an RSV vaccine while pregnant should receive their RSV immunization in October. If you did receive an RSV vaccination while pregnant, your child might still need their immunization. Please talk to your pediatrician to see if your child is eligible. RSV immunizations protect up to 90% of severe RSV infections.

Everyone in your house 6 months and older should also receive their seasonal flu vaccine. Ask your pediatrician whether your child should receive the COVID vaccine. These vaccines are recommended by the AAP among other organizations. Unfortunately, healthy children and adults can still have serious complications from the flu and COVID. 

I encourage you to have a conversation with your doctor and the financial representative in your primary care office. We all want to help your family and do what is best for your child.

2. Are vaccines safe and effective? 
Yes. Each vaccine is rigorously studied prior to its approval and is monitored even after it's approved to make sure it’s safe. 

Vaccines have saved nearly 200 million lives in a century, many of those lives were young children and babies. 

3. Do vaccines cause autism?
No. Decades of research have shown over and over again that there is not any link between vaccines and autism. The overwhelming majority of articles that have tried to show any association have been widely discredited by the medical community at large.

4. I heard vaccines contain things like aluminum and formaldehyde. Is that safe to put in my child's body?
Yes! Many of the ingredients found in vaccines are necessary to help the body produce an immune response, like aluminum, and can be found in nature. Aluminum is actually found in fruits and vegetables. It is also found in meat, dairy and produce in small amounts.

And yes, by itself, formaldehyde is dangerous and you wouldn’t want to ingest in any way. However, the amount contained in vaccines is so minimal, so it is very safe. The formaldehyde prevents bacteria from getting into the vaccine vial. 

These ingredients are necessary to make sure the vaccine is safe to give and that the body produces the best immune response. Think of these ingredients like baking cookies. You have to put baking powder and baking soda into the cookies for them to turn out delicious. 

5. Why are there so many shots these days? 
It is a good thing! Science and technology have allowed us to study more diseases and develop more vaccines to prevent children from getting sick! 

Also, many vaccines are now given in combination so there are less injections. 

6. Why don't you recommend a delayed vaccination schedule? 
We know based on years of study how the newborn’s immune system works and when the maternal antibodies begin to fade so vaccines are recommended at specific intervals to provide the most protection to the baby.

7. Will vaccines weaken my child's natural immune system?
Absolutely not! Multiple studies have shown that children who are fully vaccinated are not more at risk for other illnesses. 

On the other hand, certain vaccine-preventable illnesses like measles can cause complications like “immune amnesia” that damages their immune system and makes them more susceptible to other illnesses. 

8. Why does my healthy child need vaccines? Won't their immune system naturally protect them? 
Some vaccine-preventable diseases can cause serious complications including meningitis, seizures, blindness, hearing loss, loss of a limb, permanent brain damage, developmental delays, and pneumonias. Some diseases can be fatal. 

These are complications that we need to protect your child against. While their immune system might be able to fight off the disease, the complications would be devastating and life-changing. It is not worth the risk. 

9. Isn't Hepatitis B an STD? Why should my child get that vaccine? 
Yes, one of the ways that Hepatitis B is spread is through intimate contact but it can also pass from the mother to the baby and cause serious liver damage. Some mothers are not able to receive prenatal care and wouldn’t be tested for Hepatitis B prior to delivery so we vaccinate all babies to protect against liver damage. 

Hepatitis B can also be spread through blood transfusions, bites, lesions, certain sanitary habits, or contact with an infected person’s secretions. 

Vaccinating your child early against a potentially chronic disease is always a good idea! 

10. Are your kids vaccinated? 
Yes! I have two kids (a 7-year-old daughter and a 4-year-old son). Both of my kids are fully vaccinated for all the reasons listed above. 

Vaccines protect my children, my patients, my husband, and our community. Children who are fully vaccinated are less likely to spread disease to at-risk individuals, like my dad with diabetes, my daughter’s best friend who has a new baby sister at home, our friend who had a kidney transplant a few years ago, our neighbor who is undergoing chemotherapy, a co-worker whose daughter has congenital heart disease. 

Vaccines protect my kids and our friends and family. We vaccinate because it is the right thing to do and it is the safe thing to do.

Our goal at Cook Children’s is for our community, our patients and our patient families to stay as healthy as possible. If you have any questions, please contact your pediatrician. We’re here to help!

August is a chaotic month for any busy parent. Between back-to-school preparations and the last days of summer, it's easy to get overwhelmed. On top of that, August is also National Immunization Awareness Month—a perfect time to make sure your children are up-to-date on their vaccinations.

When people learn that I’m a pediatrician they often ask if my own two children are vaccinated and I always reply with a resounding yes. My children are vaccinated for several reasons: 

Vaccines are safe! 

• Every vaccine that is currently in use has gone through a rigorous testing phase to make sure that the vaccine is safe. Side effects and potential reactions are closely reviewed by multiple agencies at the federal level. Even after the vaccine has been approved, the Vaccine Adverse Effect Reporting System (VAERS) continues to monitor for additional side effects. 
• Millions upon millions of vaccines will be administered this year with minimal side effects. The most common side effects are low-grade fever, redness around the injection site or maybe some mild muscle aches. 

Vaccines are effective! 

• Vaccines have led to the eradication of previously fatal diseases like Smallpox. 

Vaccines save lives!

• Vaccines have saved the lives of nearly 200 million people in the past century. Many of those lives saved are of young children and babies. 
• Vaccines prevent diseases and illnesses that have serious consequences, even in healthy children. 
• Vaccines prevent diseases that can lead to hospitalizations, pneumonia, potential hearing loss, potential loss of an arm or a leg, brain damage, and even death. 

Vaccines do not cause autism. 

• Decades of research has shown again and again and again that there is no link between vaccines and autism. 

The ingredients in vaccines are safe. 

• Just as the individual vaccine is studied, the ingredients in vaccines are also rigorously studied. 
• Some vaccines contain ingredients like aluminum, which can be found in fruits and vegetables. Aluminum helps the body produce an immune response and is perfectly safe. 
• Vaccines can be preserved with very small amounts of formaldehyde, so small that it is not harmful at all. 
• These ingredients are like baking powder when you’re making cookies. By itself, baking powder does not taste good but in small amounts, it’s needed for your cookies to come out looking and tasting great! 

Vaccines are recommended by my children’s doctors.

• My kids’ pediatrician - along with the American Academy of Pediatrics, the American Academy of Family Physicians, the Infectious Disease Society of America, the American College of Physicians, the American Medical Association, and the American Nurses Association - all support routine childhood immunizations. 

Vaccines help keep my community safe. 

• My children are vaccinated because doing so protects them and our community. 
• Vaccines can help prevent your child from spreading illnesses to at-risk individuals such as your parents who have diabetes, your child’s classmate who has a newborn at home, your neighbor who is undergoing chemotherapy for cancer, your co-worker who just received a kidney transplant, or the cashier in the grocery store who has an autoimmune condition. 
• We rely on everyone to get their vaccines to keep the community safe. 

And the most important reason to me is that I want to protect my dad. My dad has type 1 diabetes and is immunocompromised. My kids will always get their flu vaccines every year so we can give him the BIGGEST hug without worrying about making him sick. 

So, this month, in between back-to-school shopping, meet the teacher nights and the ever-exciting first day of school, please call your child’s pediatrician and make sure that they are up-to-date on their vaccines. We would love to talk to you more and answer all of your questions and concerns! 

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Measles is highly contagious; one infected person can potentially infect 12 to 18 unvaccinated individuals. The virus spreads through infectious respiratory droplets and airborne transmission (from coughing or sneezing), where tiny droplets can remain suspended in the air.

 Measles symptoms typically appear seven to 14 days after infection. 

They can include:

• Rash
• Fever, sometimes over 104º Fahrenheit or 40 º Celsius
• Runny nose
• Cough
• Red, watery eyes
• Sore throat
• Tiredness

How do we stay safe?

The most effective prevention against measles is vaccination. The size of the virus makes it more contagious. Measles can live in the air in a room where an infected patient has been for two hours after that patient leaves.

This means that if ten unvaccinated children are in a room and one of them has measles, nine out of ten of them will likely catch the virus. 

In addition to getting vaccinated, the spread of measles can be mitigated by proper hygiene. This includes:

• Handwashing
• Covering your mouth and nose when you cough or sneeze
• Avoid sharing drinks or eating utensils
•  Disinfect frequently touched surfaces

What about other illnesses?

While Cook Children’s Medical Centers in Fort Worth and Prosper are not seeing an abnormal number of cases for RSV, COVID, and Flu, these illnesses can be prevented with proper hygiene as well.

It is important to speak to your primary care physician if you have any questions or concerns about vaccines. There are now vaccines to help prevent the severity of RSV, COVID, and Flu.

Where can you get immunized?
Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

If a parent suspects their child may have measles, they should call the primary care doctor before arriving at the office so arrangements can be made for safety and to minimize potential exposure in the waiting room.

As of Tuesday, April 8, the Texas Department of State Health Services (DSHS) reports 505 cases and 57 patients hospitalized. Of the 505 confirmed cases, 495 are either unvaccinated or their vaccination status is unknown. No cases have been reported at Cook Children’s Medical Centers in Fort Worth or Prosper.

Cook Children’s Health Care System, through Marc Mazade, M.D., medical director of infection prevention and control, and Alice Philips, M.D., director of ambulatory quality and safety, explained what this means and what families should know.

The measles virus is highly contagious and can remain in the air for up to two hours.

“If the children at Great Wolf Lodge (during the exposure dates) were vaccinated then only observation is needed,” Dr. Phillips said. “Vaccination provides excellent protection and these kids have little risk to develop measles.”

Dr. Mazade explained that if a child visited either of these locations during the exposure period and was not vaccinated, they should watch for symptoms related to measles.

“Parents should watch for fever, congestion, cough, and red eyes and development of a rash,” Dr. Mazade said.

There is a 21-day incubation period, which means a child could develop the measles during that time. Children who develop any symptoms during that period should contact their doctor.

Dr. Mazade explained if symptoms develop, the family should keep the child at home and call their primary care physician.

Cook Children’s primary care clinics and neighborhood health centers can do testing on site for existing patients. 

If a parent suspects their child may have measles, they should call the primary care doctor before arriving at the office so arrangements can be made for safety and to minimize potential exposure in the waiting room.

“Parents should not hesitate to call their primary care physician for any questions,” Dr. Phillips said. “We are here to answer them.” 

Cook Children’s Health Care System continues to work with county health departments where clinics, medical centers and urgent cares are located.

DSHS recommendations

DSHS released new guidelines Monday now recommending children living in Cochran, Dallam, Dawson, Gaines, Garza, Lynn, Lamar, Lubbock, Terry, and Yoakum.

Infants
Immediately administer an early dose of measles, mumps, and rubella (MMR) vaccine for infants aged 6-11 months.

Children
Administer a second dose of MMR vaccine for preschool-aged children aged 1 to 4 years who received one prior dose.

Children at least one year of age with no documentation of vaccination history should receive two doses at least 28 days apart.

Adults
Administer a second dose of MMR vaccine for adults who received one prior dose.

Adults with no documentation of vaccination history should receive two doses at least 28 days apart.

Dr. Phillips advised parents that while this does not include Tarrant County, families should watch for any updates to this recommendation and discuss any questions or concerns with their doctor.

Where can you get immunized?

Vaccinations and immunizations 
Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options. 
   

What are symptoms of measles?

Measles symptoms typically appear seven to 14 days after infection. They can include:

• Fever, sometimes over 104º Fahrenheit or 40 º Celsius
• Runny nose
• Cough
• Red, watery eyes
• Sore throat
• Tiredness

Following the initial symptoms, a rash will develop that starts on the forehead and spreads down the body and out to the hands and feet.

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It’s a dose of antibodies that works right away to help fight off severe RSV infection for at least five months. Getting the shot in October – just before RSV season -- provides an infant with extra antibodies to build their immunity during the fall and winter months.  

In November 2023, Cook Children’s saw a spike in RSV at our Urgent Care centers and Emergency Departments, the highest volume of cases in recent years.   

“RSV is one of the most common winter viruses. All of us catch RSV in the first couple of years of life," said Mary Suzanne Whitworth, M.D., Medical Director of Pediatric Infectious Diseases at Cook Children’s.

In older children, RSV typically causes cold-like symptoms such as cough and runny nose. But babies under 12 months don’t have fully developed immune systems, Dr. Whitworth said. They tend to get sicker with RSV, a leading cause for wintertime hospitalization in infants.

Severe RSV in infants tends to impact the lungs. Infants should be seen by a doctor if they’re struggling to breathe. If your baby is sick, Dr. Whitworth said, watch for rapid breathing, flared nostrils, airway congestion, wheezing or a rattle you can hear or feel in their chest. Other concerning signs are excessive sleepiness, lack of appetite and trouble feeding.

The Food and Drug Administration (FDA) approved the preventive medication, called nirsevimab, in 2023 after clinical trials showed it reduces the risk of hospitalization for RSV by 75%.

Every infant under age 1 needs the medication ahead of RSV season, Dr. Whitworth said. Some older babies need the shot too if they have certain underlying health conditions. Here’s the breakdown. 

Stopping RSV Two Ways

The first option Pfizer's Abrysvo, given during weeks 32-36 of pregnancy.  Maternal antibodies are passed to your baby and protect against RSV for about six months after birth.   

Infants who don’t have maternal antibodies should get a dose of nirsevimab shortly before the RSV season. Infants born from October to March should receive the medication within one week of birth, according to the U.S. Centers for Disease Control and Prevention (CDC).

The CDC also recommends nirsevimab for certain young children shortly before their second RSV season. This higher-risk group includes children who were preemies, or those with chronic lung disease, compromised immune systems or cystic fibrosis.

The injection delivers safe and effective antibodies, Dr. Whitworth said, and the most common side effect is soreness from the needle stick. She encourages parents to ask their baby’s pediatrician for the shot in October, before hospitalizations for RSV start climbing in infants.

“They are going to be exposed to RSV. It is a virus we are exposed to regularly all winter long.” she said. “The immediate benefits of the shot are huge.”

Cook Children’s has the RSV shot available at our seven Neighborhood Health Centers in the Fort Worth area and more than 40 pediatric offices from Aledo to Willow Park.

Additionally, the Tarrant County Health Department is offering this product to infants ages 2 – 8 months with state-funded insurance or no insurance and infants 8 – 19 months with a qualifying diagnosis.   

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National Infant Immunization Week amplifies a key point: Vaccines safely and effectively protect babies against various diseases.  

This campaign of awareness, which runs April 24-30, emphasizes the proven track record of shots that fight vaccine-preventable diseases such as polio, Hepatitis B and measles. Who benefits when an infant is immunized? The child, their family and the wider community.

Parents should know that vaccines work to stop the spread of infectious diseases at home, in daycare and school settings, and in the general population. Certain shots are needed before kids enter kindergarten, seventh grade and college. But babies and toddlers need shots too before they can be enrolled in a child care center or pre-kindergarten program.

In order to start or stay in daycare in Texas, state law requires proof of up-to-date records for eight vaccines, including periodic booster shots. Regular visits to the pediatrician’s office can help children and teens stay on track for their vaccines – or get caught up if they’re behind. 

The Texas Department of State Health Services (DSHS) ensures compliance during licensing visits by checking the immunization records that the daycare centers keep for each child. Records should include the child’s name, the date the vaccine was received (month, day and year), the provider’s initials or stamp to validate, and clinic contact information.

A conscientious exemption affidavit should be submitted if a child is following an alternative vaccine schedule. According to DSHS rules, a current record or exemption must be on file; otherwise, the child in daycare is considered “vaccine delinquent.”

The DSHS website lists the 2022-2023 minimum vaccine requirements in a chart, in English and Spanish. The chart covers:

• DTaP (Diphtheria, tetanus, and pertussis) – doses by 3 months, 5 months, 7 months and 19 months
• Polio – doses by 3 months, 5 months and 19 months
• HepB (Hepatitis B) – doses by 3 months, 5 months and 19 months
• Hib (Haemophilus influenzae type b) – doses by 3 months, 5 months and 16 months
• PCV (Pneumococcal conjugate) – doses by 3 months, 5 months, 7 months and 16 months
• MMR (Measles, mumps and rubella) – one dose by 16 months 
• Varicella (Chickenpox) – one dose by 16 months
• HepA (Hepatitis A) – doses by 25 months and 43 months

Flu and rotavirus vaccines are not required but may be recommended by the child’s health care provider.

Christina Sherrod, M.D. and the staff at Cook Children’s Pediatrics Southlake will make copies of the patient’s vaccine record and also fill out a health statement form for the daycare if requested. Dr. Sherrod said the vaccine requirements serve as a safety net to help families know when to bring in their babies and toddlers for shots. “That’s the practical side of it,” she said.

For instance … Kids' Place, located across the street from Cook Children's Medical Center in Fort Worth, sends reminder notifications to parents whenever a child is due for their next vaccines.

But the ultimate goal is preventing an outbreak of disease. “If you have a daycare full of 400 kids, and fewer than 95% are vaccinated against measles, that could easily lead to an outbreak in the daycare and in the community,” Dr. Sherrod said.

At Cook Children’s neighborhood clinics across Fort Worth and nearby cities, the medical teams also promote immunizations as recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. 

“Adhering to this vaccine schedule is the best way to protect children and keep them healthy,” said Sharhonda Ansley, M.D. at Cook Children’s Neighborhood Clinic Northside. “By keeping up with their child’s regular checkup visits, parents will help ensure they are prepared for daycare and kindergarten. And the healthier we will all be!”

Dr. Ansley and Dr. Sherrod both pointed out that the symptoms of some diseases can be mild for some patients but serious or even fatal for babies. 

Your Questions Answered

How do vaccines work? Dr. Sherrod puts it this way: “A vaccine injects a protein or molecule into your body that tricks the immune system to make your body think you're getting that disease. It makes your immune system ramp up and build antibodies and memory T cells to prevent getting ill in case you're exposed to the real disease later on.”

What's it like to immunize an infant? Some vaccines are given orally. If it’s an injection, the needle goes into the thigh, and a Band-Aid is applied. The baby usually cries. “You can't warn a baby that the shot is coming, and you can't explain to them why,” Dr. Sherrod said. “The truth is they do really well and they usually calm down very quickly.”

What are some tips to help with discomfort afterward? Breastfeeding or a bottle can be soothing. Don’t give Tylenol right away. “Usually if the baby needs Tylenol, it's that evening or maybe even the next day. I tell parents to go home and see how their baby does. A lot of babies get kind of sleepy the day after their shots. If they have a fever and they're fussy, go ahead and give them Tylenol. But a lot of babies never need it. They just go home, maybe sleep a little bit more, and are fine.”

Anything else? The bacteria that might cause an ear infection or sinus infection in an older child can cause brain damage or even death to a 2-month-old, whose immune system is more immature.  Vaccines benefit the babies who receive them as well as the bigger picture of public health in our country. “It's a privilege that we have these vaccines,” Dr. Sherrod said. “As a nation, we really don't know how bad it can be without these vaccines. I just hope enough people keep getting them that we can continue to see that disease prevention.”

But many people question the safety of a novel immunization for a novel virus, especially parents with young children. Moderna recently announced plans to begin testing its coronavirus vaccine in children between the ages of 12 and 17, while Pfizer and AstraZeneca began their pediatric trials in October.

We were able to talk to Jason Terk, M.D., physician at Cook Children’s Pediatrics Keller Parkway and a nationally known advocate for vaccines, who answered a few questions about the COVID-19 vaccine.

Tell us about the COVID-19 vaccine and why people should feel safe receiving it.

The vaccine is really showing a lot of promise because we've gotten data that shows that the efficacy (that's how well the vaccine works at protecting against COVID-19 disease), is much more effective than what we might've expected. We were hoping to get something around 70% and the two vaccinations that are being considered for emergency use authorization have efficacy of about 95%, which is really fantastic. I think that that bodes well for the potential of these vaccinations to make a real difference for us.

While trials in children are just beginning, should parents go ahead and get the vaccine?

Well, the quantity of vaccinations that we have available is going to be limited initially. The CDC, FDA and the state health departments are all working together to determine what priority groups need to be getting it first. The elderly nursing home population, healthcare workers, and first responders are going to be the first individuals recommended to get the vaccination. Obviously we need to protect the health care workers so that we can continue to do our jobs providing care to our patients. Unless you have some serious underlying health condition that makes you high risk for complications from COVID-19, you will not as a parent be among the first groups of individuals  recommended to get the vaccination. But once we have plenty of supply, I certainly encourage parents to get the vaccination for themselves.

When is the vaccine going to be available for children?

Trials in children are only just beginning. We need to prove that the vaccine is just as effective and just as safe in children because children are not little adults. We also need to make sure that it works as well for them too. I have no reason to expect that it will not be as effective for children. It's going to be important to stay tuned for that. Once the vaccine is available for myself, I'm definitely going to be in line to get it. And I am unreservedly optimistic about its impact for myself and for the rest of us.

What gives you that confidence that it is a safe choice for you to get the vaccine?

In medicine, we're data driven and we have really good data that shows its effectiveness, as well as what the safety profile is with the 30-40,000 individuals who were involved in the Phase 3 trials. Right now, what we've seen from a safety point of view, is that it is producing some side effects that are very similar to other vaccinations out there that are routinely recommended and they're fairly mild for most people. The two vaccinations that are currently under consideration for emergency use authorization require two doses. One of them requires two doses separated by 21 days. The other one requires two doses that are separated by 28 days. It appears that after that second injection, that maybe about half of the individuals have some side effects like achiness and, and maybe sore joints and, and some injection site soreness and things like that, but it doesn't last very long. It's generally gone after a few days. We've had the pandemic going on now for about a year. And we've had these vaccines that are under consideration now for about six months in the clinical trials. People in those clinical trials will be followed for at least 2 years to monitor for any problems. I have no reason to expect that there will be safety concerns.

Will children receive the same vaccine as adults?

Very good question. We won't really know the answer to that until the clinical trials are completed in children. Sometimes kids require lower doses of the same vaccination that we need to get as adults. And sometimes they get the same dose. What you're looking for is to get the desired therapeutic point of protecting against the disease at the lowest dose to minimize side effects. So that's what they'll be working on for kids too.

Should people who have already had COVID-19 get the vaccine?

So the current recommendations coming from the CDC is that prior COVID-19 disease should not be a determining factor about whether you should get the vaccine, because we do not know how long natural disease will give you immunity. It certainly gives you some protection for a period of time, but how long that lasts? We really don't know. Probably because of limited supply, individuals who were shown to definitely have had COVID-19 will probably not be the first ones that will be recommended to get the vaccination. That’s getting kind of ironed out right now and we'll get more specific information on those recommendations in the next several weeks I expect.

Where should people look for more information as they make the decision on getting the vaccine?

I think that it's important to talk about information and how people get information. Unfortunately, there is organized resistance against vaccinations generally, and against efforts to try to vaccinate the population against COVID-19 specifically. Consumers of this information need to know that that those sorts of agenda-driven organizations are working to prevent the end of the pandemic. We really need to be very careful and make sure that the things that we're reading or watching on social media are evidence-based. These vaccinations are going through the same – and even greater – rigorous processes and scrutiny that all the other vaccinations that we have gone through. I have every confidence that this is going to be a game changer for the human population. We all need to get vaccinated and support this challenging effort.

Are you hopeful that a COVID-19 vaccine can help end the pandemic?

Absolutely. This is our way forward to try to get back to normal. It's not going to be an immediate thing, but it's going to be a lot quicker now that we have such effective vaccinations. It will take some time for us to really get back to normal as we know it, but we're getting there.

For more information about vaccines and COVID-19, visit https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.

For the latest on how COVID-19 is impacting kids and Cook Children’s work to protect them, visit the medical center’s newsroom at checkupnewsroom.com.

Since the arrival of COVID-19, a desperate search for a vaccine to fight the pandemic has ensued worldwide. However, despite this present-day example of the importance of vaccination, immunization rates at Cook Children's have dipped.

From March 1 through May 31, 2020, 66,049 children received their vaccines at either a Cook Children's primary care office or a neighborhood clinic. That's compared to 81,984 in those same months in 2019.

While some of the decreases in numbers are due to families staying at home because of the pandemic, pediatricians want parents to know it's essential to get your vaccines, perhaps now more than ever. Data from Scientific American found that during March 2020, vaccination rates dropped to 44.7% in Texas, the second-lowest in the nation behind Washington D.C. (44.4%).

The Centers for Disease Control and Prevention (CDC) reported a 2.5 million decrease in non-influenza vaccines ordered from the federal Vaccines for Children Program between January 6 and April 19 of this year. The CDC adds there was a 250,000 drop in the number of measles vaccines ordered during that time.

"Immunizations are the safest, easiest way to protect your kids from unnecessary and sometimes fatal childhood diseases," said Jason Terk, M.D., a Cook Children's pediatrician in Keller and a national advocate for vaccines. "We all desperately want a vaccine to protect us from COVID-19. But I think it's important to focus on what we do have right now, and that's vaccines for 16 different diseases. These vaccines are tried and true. We have had many years of experience with them, and we know that they are safe."

Doctors stress vaccines to protect not only your child but other kids as well. Immune-suppressed people have a higher risk for the deadlier complications of measles infection, such as encephalitis and pneumonia. Vaccines protect your child and those who may come into contact with them.

Dr. Terk said, "the best course of action is to make sure that all persons in close contact with babies less than 6 months of age are properly vaccinated against measles and avoid situations where larger groups of unvaccinated people are likely to be."

While the overwhelming majority of parents do choose to give their children vaccines, some have decided not to, ignoring leading health care organizations.

"Vaccines are safe and effective," said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. "There are decades of sound scientific research to support this. We recommend that all children be vaccinated as recommended by the American Committee on Immunization Practices schedule to help keep them safe."

With so much misinformation online undermining the safety and importance of immunizations, it can be difficult for parents to separate the facts from fiction.

Pediatricians and other health care providers at Cook Children's are concerned about the potential rise in preventable diseases and even more concerned about the risks they pose to babies, kids, teens, and adults.

Alice Phillips, M.D., a Cook Children's pediatrician, welcomes a conversation with her patient families. She said her job is to listen to concerned parents in a respectful way to provide facts and calm their worries.

"I try to answer them with what my experiences as a practitioner have been. I tell them not only what I've seen as a physician and explain all the science supporting immunization, but what I've done as a mom," Dr. Phillips said. "My children are vaccinated. I believe in vaccines. Often, a parent needs kindness, compassion, and assurance that they are making the right decision for their child. I truly want them to know that receiving a vaccine is the right decision for your child."​​

Important Resources

• Immunization Schedule for Your Child
• Calendarios de vacunación
• Common Questions Answered About Immunizations
• Immunization Collaboration of Tarrant County
• Immunization Collaboration of Tarrant County - Schedule of Events

And only time will tell for sure, but some indicators lean toward a potentially severe influenza season.

Clinical experts in the U.S. watch the Southern Hemisphere of the world for signs of what might be in store for us in the north.

In Australia, where winter recently ended, the Department of Health reported the flu season arrived earlier than normal. Of special concern to the experts is the type of flu season seen in Australia – Influenza A (H3N2). H3N2 is a more dominant strain of the flu and causes more illnesses.

How effective the flu vaccine is depends on how well experts predict what strains of the flu will be circulating the globe that year.

“The vaccine strains are chosen about nine months before flu season, based on circulating strains from around the world by epidemiologists who are geniuses and do this for a living,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases.

Locally, the first case of flu (Flu B) was reported at Cook Children’s Medical Center two weeks ago. Last week, no one tested positive for either strain.

NBC News reports that one pediatric flu death has already been recorded in the U.S. – a 4 year old in California who had underlying health problems.

Jason Terk, M.D., a Cook Children’s pediatrician and a national expert on immunizations, adds his voice to other pediatricians and global health experts who say the flu vaccine remains the best way to prevent influenza.

“The great news about the vaccine is that even when it’s not always a perfect match for prevention, the flu vaccine can reduce the severity of the illness, even if you do catch the flu that season,” Dr. Terk said.

To make an appointment for your child’s flu shot, contact your Cook Children’s pediatrician. The vaccine is currently available in many offices and a second shipment will be delivered next week.

“It takes two weeks for the shot to become most effective. Because flu can hit as early as late October or early November, we recommend getting the flu shot as soon as possible and definitely before the end of October,” said Justin Smith, M.D., a Cook Children’s pediatrician.

More On This Topic:

• Flu Shot Appointments
• Influenza/Flu Information
• Let's Learn About ... The Flu
• How To Tell If It's Strep, Flu, Rotavirus Or Norovirus
• Comfort Menu to Ease Pain, Anxiety for Children Getting a Shot
• Is It a Cold or The Flu?
• Pediatricians Say Kids with Egg Allergies Should Now Get The Flu Shot

As a pediatrician, I have been lucky to practice medicine in the post-vaccine era. Although I have watched kids struggle with whooping cough, meningitis, mumps and pneumonia, I am happy to say I have never seen many of the vaccine-preventable diseases. I rely upon my education and training to know about the diseases and recognize them should the need arise.

I do frequently wonder, ‘What was life like for families and children before vaccines were introduced?’ How did people manage the illnesses and anxiety that came with the disease?

For a firsthand answer, I only had to talk to the person sitting at my dining room table during a typical weekend family dinner – my mom.

It was the summer of 1949. While other children were skipping rocks and riding their bikes, my mom was lying in a hospital bed as one of many children struck down by polio.

The illness began as a fever with trouble swallowing and weakness in her left leg. The doctors quickly admitted her to the hospital for quarantine and treatment. Her most vivid memory of the time has to be of the spinal tap used to aid in her diagnosis. At the time, there were no child life specialists to comfort her. She was told to hold still and if she moved the test might kill her.

After 3 months in the hospital with only her mother allowed to stay, her symptoms seemed to be worsening. Her kind physician came into the room one day to visit and cheer up the family. His kindness unfortunately, resulted in him contracting the disease and being confined to a wheelchair for the remainder of his days. After all, back then doctors did not even realize the value of handwashing.

I asked my mom what people thought about polio in the pre-vaccine era. “Everybody was scared to death of catching it! They did not know how they got it but knew it was prevalent in the summer months. They tried to avoid the sun and swimming holes since those seemed to be related.”

We now understand the transmission of polio much better. Polio comes from a virus that is highly contagious. It is spread person to person through sneezing, coughing or contact with human feces. Before the successful introduction of the polio vaccine in the 1950s, the disease resulted in the paralysis of 15,000 people per year. Since 1979, no cases of polio have originated within the United States but cases can be brought in by travelers with the disease.

My mom was one of the lucky ones. Just as a conversation with her medical team was turning to placing her in an iron lung to support her breathing she began to recover. The impact of the illness, however, continues to this day with residual weakness in her legs that makes walking for her a constant challenge.

I asked her what she thought about vaccines as a mom and a grandmother. She responded, “I experienced polio and its effect on my life. I want all my kids and grandkids protected so they don’t have to go through what I did.”

Vaccine-preventable diseases such as polio and the re-emerging measles and mumps are not historically that far away from us. We cannot forget the tremendous impact these diseases have had on the lives of so many before the introduction of vaccines.

If you want to learn more, you can check out the CDC website on polio. 

Better yet, just look across the table on a sunny Saturday afternoon and if you are fortunate to do so, ask the folks who lived it. Their stories and experiences are powerful.

More Information On This Topic

• 'I'm Worried Too.' Pediatricians Concered As Texas' Nonmedical Vaccine Exemption Rates Hit All Time-High
• 5 Questions We Get Asked About Vaccines Answered
• Vaccines for Your Children: 9 Facts Parents Need To Know
• Vaccines and Immunizations
• Information for Parents

Regardless of statistics, research or science, some parents will never change their minds.

But for the vaccine-hesitant parents who are truly trying to make the most informed decision for their child, let’s take a look at some of the most commonly asked questions and concerns we read on social.

The responses to these questions are based on extensive research conducted by the Cook Children’s Vaccine Clinical Guideline teams, comprised of primary care and specialists in their field. The team cited 99 different sources during their research and their work was approved by the Cook Children’s Medical Center’s Clinical Excellence Committee.

We hope this helps to answer some of your questions.

1. Do vaccines work?

Immunizations are considered to be one of the greatest accomplishments of modern medicine. Compared to pre-vaccine statistics, we’ve seen a reduction in the number of cases of measles by 99.9%, mumps by 95.9%, pertussis by 92.2% and rubella by 99.9%.

This is important because many vaccine-preventable diseases require high vaccination rates to maintain community immunity. For most of the vaccines that are currently available, there must be a population immunization rate for at least 90% to ensure consistent community immunity and some diseases that are highly contagious, such as pertussis or measles, require population immunization rates of at least 95%.

The maintenance of community immunity protects people who received the vaccine but were unable to generate a lasting immune response to the illness, as well as those individuals who are too young to receive a vaccine or have medical reasons that prevent them from receiving a vaccine.

2. Do vaccines cause autism?

This is a most difficult subject to approach because some parents make the direct link to their child’s autism to the vaccines they received.

Because MMR is one of the vaccines that is given to children between 12-18 months and signs of developmental conditions such as autism develop around the same time, it’s easy to see why families would perceive a cause and effect relationship between the two.

This argument was strengthened when Andrew Wakefield published an article in The Lancet in 1998 that claimed a link between the MMR vaccine and autism. Since his initial article was published, investigations have found that Wakefield’s study was flawed by research misconduct, conflicts of interest and lies. This ultimately led the Lancet to retract his original article. In 2010, Wakefield was barred from practicing medicine in Britain.

Dozens of studies have been conducted to look for any possible link between vaccines and autism and these studies continue to confirm no link exists, and that vaccines are safe and effective.

3. If children receive too many vaccines, can it overload their system?

While the number of vaccines that children are given has increased over time, children are actually being exposed to fewer antigens than they had been previously – thanks in large part to the increased purity of the pertussis vaccine.

Some parents may have concerns that vaccines can overwhelm a child’s immune system, but this simply isn’t true. When a child is born, they leave a relatively sterile environment and within hours their GI tract becomes heavily colonized with bacteria. They begin to produce what’s called a specific secretory IgA against these bacteria within the first weeks of life. A 2002 study, published in Pediatrics, states that an infant has a theoretical capacity for up to 10,000 vaccines at any one time.

Multiple studies have been done that show vaccines do not cause an increased risk of infection for children. One study even found that children who received vaccines had a lower rate of infections from vaccine-related and unrelated pathogens. There is also no evidence to support the idea that vaccines lead to increased risk of SIDS. Research has found that vaccines significantly reduced the risk of SIDS.

Children with severe immunodeficiencies who receive live viral vaccines may be at risk for developing an infection or disseminated disease. The biggest concern would be children with T-cell immune deficiencies receiving live virus vaccines. Fortunately these immune deficiencies are usually diagnosed around 6-8 months well before the first live virus vaccines are scheduled (12 months). 

With all that being said, many children with immunodeficiencies can receive vaccines safely, such as certain children with HIV or certain children with malignancies.

4. Is it really hygiene and better nutrition that caused disease reduction and not vaccines?

Statements like this are commonly found in anti-vaccination literature and it implies that vaccines are ineffective and unnecessary. While better hygiene and nutrition have certainly helped to improve the health of our population, it ignores the dramatic effects of vaccination.

If hygiene and nutrition were responsible for disease reduction, you would expect all disease incidence to decrease at around the same time, but this is not what we have seen. Instead, we have seen a recurrent pattern of disease reduction shortly after a vaccine against that disease has become available.

For example, while there was yearly variation in rates of measles, it wasn’t until a vaccine was released and widely distributed in 1963 that we saw a permanent drop in measles cases. Another example is Haemophilus influenza type b, which remained prevalent until the early 1990s when a vaccine that could be used in infants was developed.

Another way of debunking this myth can be to look at individual countries who saw a decrease in their immunization rates. Great Britain saw a dramatic drop in their immunization rates for pertussis in 1974, which was followed by a pertussis epidemic with more than 100,000 cases and 36 deaths by 1978.

In Japan, a drop in pertussis vaccine rates around that time from 70% to below 40% resulted in an increase of pertussis cases from 393 in 1974, to 13,000 in 1979.

5. If your child is vaccinated, why do you care if my child isn’t?

The increasing prevalence of vaccination acts to prevent the circulation of an infectious organism within the community provides benefit to everyone, even those who aren’t vaccinated. This is referred to as community immunity. Community immunity is an important means of protecting the elderly, the young and those with medical conditions that prevent them from receiving vaccines.

For most of the vaccines that are currently available, there must be a population immunization rate of at least 90% to ensure consistent community immunity and some diseases that are highly contagious, such as pertussis or measles, require population immunizations rates of at least 95%.

The maintenance of community immunity is important to protect those individuals who received the vaccine but were unable to generate a lasting immune response to the illness, as well as those individuals who are too young to receive a vaccine or have medical reasons that prevent them from receiving a vaccine.

More on This Topic:

• Vaccines for Your Children: 9 Facts Parents Need To Know
• Vaccines and Immunizations
• Information for Parents
• Immunization Collaboration of Tarrant County
• Childhood Vaccine Assessment Tool (CDC)
• American Cancer Society and HPV
• Centers for Disease Control and Prevention
• Vaccinate Your Family
• Voices for Vaccines
• Allied Vaccine Group
• Texas Department of State Health Services

It was also during this time that measles showed up in Texas and when I received my second MMR.

My sister had been in San Antonio with my mother for two months receiving care at a Bone Marrow Transplant center. While she had no memory of her twenty-third birthday, I saw pictures of the nurses and doctors surrounding her with a cake.

Later when she returned home, she commented on this nice shirt she had found in her suitcase as she had not seen it previously. I did not have the heart to tell her that it had been a gift from me for her birthday, she just had been so ill she did not remember.

As the number of measles cases in Texas were climbing, her doctors became fairly insistent that I receive a second MMR. They really didn’t want me to be around her without being protected.

Some may feel that wasn’t their decision to make. However, those doctors were not only scientifically correct but they cared deeply for my family. They knew me well enough to know that if I gave anything to my sister that would have hurt her, I likely would have never recovered from that guilt.

While measles can harm anyone, it likely would have been a death sentence for my sister. Initially, my mother was concerned about any possibility of me developing measles after the vaccine and giving it to my sister. The doctors reassured her and said the only way to protect her was to protect me. My mom had to make so many difficult decisions that year. Sometimes she did what the physicians recommended and sometimes not. Her goal everyday was to advocate and protect her daughter. So I was vaccinated based on the new two dose MMR policy.

Then I was able to be with my sister. I was with her when they told her that cancer returned. I was there to watch my platelets infuse into her weak body. I was there on the morning she died. Holding her hand. It would have been too risky during the measles outbreak for me to be around her that summer if I had not received that vaccine. While I grieve the loss of her beautiful mind and spirit still after almost 30 years, I realize that experience inspired me to enter medicine and advocate for children.

It is so unfortunate that the discussion around vaccination has become so volatile. Like my mom, parents are just trying to make the best and safest decisions for their children. They have to navigate a much more complex world of information available to them. At my clinic, we spend a good amount of time discussing questions and concerns regarding vaccines. While I try to work with families and guide them, in the final discussion, vaccinating children is the healthiest choice for them. Not just for their own disease prevention but for all of those who cannot receive certain vaccines through age or medical condition.

Honestly, I was a bit nervous writing this realizing potential backlash from those not agreeing with vaccinations. Yet as I was looking through my closet the other day, I saw that shirt I gave my sister. It made me smile remembering her wearing it and it reminded me of how all of us had to be brave in different ways that year. In her memory, I will continue to try and be brave.

Vaccinate. It saves lives.

Alice Phillips, M.D., a Cook Children’s pediatrician in Fort Worth – Cityview, hears the worry in the voices of many of her patient families. They’re afraid their child may contract measles or some other contagious disease.

“I like to reassure them,” Dr. Phillips said. “And currently, I can say there is no indication of a major outbreak threatening the health of their children in our area. But I understand their apprehension and I admit I’m worried too.”

Measles cases have hit a 25-year high in the United States, and Texas already has reported 15 confirmed cases of measles in 2019, six more than in all of 2018.

And yet as the number of cases have gone up, Texas vaccine exemption rates have reached an all-time high. According to a report in the Texas Tribune, “the number of individuals who have had at least one vaccine exemption affidavit requested on their behalf has grown more than tenfold, to more than 70,000 in the 2018 fiscal year.”

Texas is one of 16 states to provide vaccine exemptions for conscientious, philosophical and/or religious beliefs. In our state, kindergartners must have 10 immunizations to be enrolled in school. The Tribune found that since 2006, when Texas first started reporting data, the exemption rate for kindergartners has risen from 0.3% for the 2005-2006 school year to 2.15% for the 2018-2019 year.

“I’m very concerned by these numbers,” Dr. Phillips said. “I truly believe vaccinations are the greatest public health advancement seen in my lifetime. This trend toward opting out of vaccines threatens the health of all of our children.”

The Texas Tribune article allows readers to type in their school district and see the vaccine exemption rates for kindergartners, those who aren’t receiving vaccines by claiming a conscientious exemption (along with citing medical or religious concerns). The story mentions that Alliance Christian Academy had the second highest vaccine exemption rate by percentage in the state last year with 40.6% of their students (13 of their 32 kids).

In Fort Worth ISD, 1.39% of kindergartners (84 of 6,031) received non-medical vaccine exemptions. Dr. Phillips knows that some will say that’s only 84 kids in Fort Worth or 13 at Alliance Christian, but those numbers add up.

“You may say only 2% of the population isn’t vaccinated, but that 2% is often times happening in clusters,” Dr. Phillips said. “We have seen those areas with clusters of a population are where we are especially primed and ready for an outbreak. That’s what we’ve seen recently in New York City. There was a cluster of people who didn’t vaccinate. I worry that’s what we are at risk for in Texas.”

Dr. Phillips hopes healthy people who can receive immunizations take that responsibility seriously. Community-wide protection depends upon a high percentage of the entire population receiving vaccines in order to protect children who are immune compromised and or can’t receive vaccines for health reasons.

“Those children rely on us to protect them,” she said. “They can’t have the vaccine, so they rely on the rest of us to stand up and protect them and keep these illnesses from them. That’s the herd immunity. That’s simply not happening as much as it should in this country. The measles cases in this country are startlingly high.”

With so much misinformation on the Internet or even among their friends, Dr. Phillips welcomes a conversation with her patient families. She said her job is to listen to concerned parents in a respectful way to try to provide facts and calm their fears.

“I try to answer them with what my experiences as a practitioner have been. I tell them not only what I’ve seen as a physician and explain all the science supporting immunization, but what I’ve done as a mom. My children are vaccinated. I believe in vaccines. Many times, a parent just needs kindness, compassion and assurance that they are making the right decision for their child. I truly want them to know that receiving a vaccine is the right decision for your child.”

For more on this topic:

• The Texas Tribune Story: Texas vaccine exemption rates have reached an all-time high. Did Texas make it too easy for parents to opt out?
• Vaccines and Immunizations
• Common Questions About Immunizations
• Measles
• Immunization Schedule
• From Vaccine Hesitant to Pro Vaccines. Why This Mom Changed Her Mind.
• Pediatricians Remember Experiences with Measles
• What The First Measles Case in Tarrant County Means for Your Child
• 'Vaccines Are Safe and Effective'
• When It Comes to Your Kids It's Never Just a Virus
• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles In the Classroom
• MMR/thimerosal/mercury: What you should know

Although she wouldn’t call herself “100% anti-vax” at the time, Amanda Carroll declined to give her first-born son his hepatitis B vaccine at birth.

With the next group of shots scheduled at his 2-month checkup, Amanda and her husband weren’t so sure what they would do next.

Amanda met with her pediatrician, Justin Smith, M.D., who was then in Abilene, and expressed her concerns. She talked about spacing out the vaccines or delaying them. She was concerned about the sheer number of pokes, the number of vaccines her baby would be given and wondered about a possible pharmaceutical company profit motive.

She figured she had two months to make a decision and began to read Dr. Robert Sears’ book that promoted a vaccine timetable contrary to the Center for Disease Control and Prevention’s schedule.

Amanda only made it halfway through the book.

At 3 weeks old, her son was rushed to a hospital in Abilene for emergency surgery. He needed a bowel resection after he was diagnosed with a strangulated inguinal hernia. After a code blue, the baby was flown to Cook Children’s by its Teddy Bear Transport team.

The little boy received two more operations at Cook Children’s, including another bowel resection from  pediatric surgeon Patrick Thomas, M.D. In all, the Carroll family’s son spent three weeks in the Pediatric Intensive Care Unit and two more weeks on the surgical floor.

During that time, Amanda and her husband developed a rapport with Dr. Thomas and felt comfortable expressing their concerns about vaccines.

“We talked to him about delaying or spreading out his vaccines,” Amanda remembers. “Dr. Thomas was so nice and he was very polite. He didn’t actually say these words. But in the nicest way possible he basically told us, ‘Really? I put so much work into saving your baby, you cannot do that. He needs to be vaccinated.’”

Because of his condition, the Carroll’s son had developed a blood infection and needed to see a doctor from Cook Children’s Infectious Diseases department. Dr. Thomas found out the physician would be Mark Shelton, M.D. Dr. Thomas told Dr. Shelton about the parents’ concerns.

“We spent an hour with Dr. Shelton. He was able to answer all of our questions in detail. I wish everybody who had the concerns we had about vaccines could have a similar experience,” Amanda said. “I wish they could sit down and talk to someone as knowledgeable about vaccines as Dr. Shelton.”

One memory that sticks with Amanda was when Dr. Shelton addressed Andrew Wakefield, the discredited British doctor and leading anti-vaccine activist. Much of today’s misinformation about vaccines began when Wakefield erroneously published a report linking vaccines to autism. That report has since been debunked.

Amanda recalls Dr. Shelton’s emotion at the mention of Wakefield’s name. He spoke passionately about the harm that Wakefield’s study had caused many children around the world.

Amanda is a sociologist and an educated person. Even after talking to Dr. Shelton, she still wanted to make the decision whether or not to vaccinate her son, using science as her guide.

“I looked at four or five other countries from around the world and found they had remarkably similar vaccine schedules in almost all of the western nations,” Amanda said. “When you looked at the CDC, the World Health Organization and other equivalent organizations, they all stressed vaccination.”

Then during her studying, another thought occurred to Amanda that chilled her to the bone. She had made the decision to not give her newborn boy the vaccine for hepatitis B. She realized after three surgeries and a blood transfusion there had been a chance, although small, that he could have gotten the disease because he was not vaccinated.

Once their son was discharged and recovered enough from his surgery, Amanda took her son to Dr. Smith for his full vaccine schedule.

She has continued to do so with her other two children, now 3 and 17 months old.

Amanda would be the first to describe her parenting choices as a “bit granola or hippie,” and she has several friends who are like-minded. But where she disagrees with some of her friends is about vaccines.

“I respect my friends’ opinions who are against vaccines or are vaccine-hesitant, although I disagree with them,” Amanda said. “I think they are absolutely trying to do what is best for their child, whether they are against vaccines or choose alternate schedules. My husband and I believe in the scientific research that says vaccines are safe. After our experience at Cook Children's, we felt comfortable going ahead with the schedule as is, and we have no regrets.”

For more information on this topic:

• Vaccines and Immunizations
• Common Questions About Immunizations
• Pediatricians Remember Experiences with Measles
• What The First Measles Case in Tarrant County Means for Your Child
• 'Vaccines Are Safe and Effective'
• When It Comes to Your Kids It's Never Just a Virus
• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles In the Classroom
• MMR/thimerosal/mercury: What you should know

To identify the hot spots, researchers from the University of Texas at Austin and Johns Hopkins University looked at each area’s volume of international travel from foreign countries with large measles outbreaks and the prevalence of nonmedical exemptions from childhood vaccinations.

The same researchers previously predicted outbreaks in Washington, Oregon and New York which are all experiencing an influx of measles cases.

“For measles, most experts believe that there will be one to two deaths per 1,000 cases, most likely infants. We are set to see over 1,000 cases in the U.S. in 2019. So, for the first time since the 1980s, we may expect infant deaths from measles in the U.S.,” said the study’s lead author, Sahotra Sarkar, a philosophy and integrative biology professor at UT Austin and an expert on public health, in UT news. “We have long known that vaccine avoidance is a critical public health issue in the U.S. and Europe. Our results show how travel from regions elsewhere compounds this risk.”

The Texas Department of Public Safety has confirmed 15 measles cases in Texas this year, including one in each: Tarrant, Dallas and Denton counties and two in Collin County. Comparatively, Texas had nine measles cases in 2018 and only one in 2017.

Already this year, more than 760 cases of measles have been confirmed in the United States, the highest number in decades.

Physicians at Cook Children’s call this news frustrating because measles is a disease once thought to be all but gone from the planet. Texas has one of the highest rates of unvaccinated children in the U.S., partly due to a 2003 state law allowing parents to opt out of getting their children immunized for reasons of conscience.

“It’s not a coincidence that as we have seen more people hesitant to receive the vaccine, we have seen the number of measles cases increase nationwide,” said Justin Smith, M.D., a pediatrician at Cook Children’s. “The numbers are very concerning.”

Measles is a highly contagious respiratory illness spread by contact with an infected person through coughing and sneezing. Measles is so contagious that if someone has it, 90 percent of the people around that person who are not immune will become infected.

The Centers for Disease Control and Prevention (CDC) recommends children who are older than 12 months get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.

Two doses of the MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

"Populations who choose to not follow the recommended vaccine schedule are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," said Jason Terk, M.D., a Cook Children's pediatrician.

Other Texas counties to make the Top 25 were Harris at No. 9 and Travis at No. 22.

To learn more about where you can receive vaccines in the Tarrant County area, visit the Immunization Collaboration of Tarrant County website.

For More on This Topic:

• 25 U.S. Counties Identified as Most at Risk for Measles Outbreaks
• Vaccines and Immunizations
• Immunization Collaboration of Tarrant County
• Common Questions About Immunizations
• Why Children Like Olivia Need You to Immunize
• From Vaccine Hesitant to Pro Vaccines. Why This Mom Changed Her Mind.
• Pediatricians Remember Experiences with Measles
• What The First Measles Case in Tarrant County Means for Your Child
• 'Vaccines Are Safe and Effective'
• When It Comes to Your Kids It's Never Just a Virus
• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles In the Classroom
• MMR/thimerosal/mercury: What you should know

Olivia is 7 years old and has fought a battle that most 7 year olds (and 70 year olds) have never and will never face.

Olivia has spent the last two years in and out of Cook Children’s battling neuroblastoma. It was a cancer that started in her adrenal gland and had spread by the time it was found – around her spine, and all over her stomach.

She is a tough cookie. Olivia has undergone countless procedures, tests and chemotherapy. And in 2017, Olivia underwent something called an autologous stem cell transplant.

This means that before chemo, her own stem cells (which you can think of as neutral “beginner” cells) were taken from her bone marrow, harvested, and after the chemo wiped everything out, put back into her bone marrow as a “fresh start” for her immune system! It was a huge part of her cancer treatment.

This also means that all of the “memory cells” she used to have are gone.

And it means that the vaccines she got as an infant and small child are “forgotten”.

So Olivia now has no protection against vaccine-preventable illness. Her immune system is like a baby’s again.

When she came to see me for her checkup last week, I hadn’t seen her in two years! She was bouncing all over the room, and smiling, and happy. Like 7 year olds should be! She’s doing great! Her oncologist is watching her very closely, but her cancer seems to be gone!

I know that’s a lot of exclamation marks, but all deserved for this awesome little girl.

We now have to start re-vaccinating Olivia. This is a slow process that will take a few years. Until she is fully vaccinated, she is susceptible to illnesses like whooping cough, pneumonia, measles and others.

I’m telling you Olivia’s story (at the urging of her father, who wants you to know her story) so that you understand why everyone should be immunized.

Olivia CAN’T be immunized fully yet. Her body needs time to re-learn all of her vaccine protection.

If all of us AROUND Olivia get vaccinated, we are creating an impenetrable wall of protection. The disease cannot get into our community to potentially attack Olivia’s brand new immune system.

When you make a choice to vaccinate yourself and your child, you also prevent something devastating to those who cannot protect themselves – like Olivia.

And she’s fought too hard a battle to look back now!

Learn more by clicking the links below:

• Vaccines and Immunizations
• Immune Suppressed Children and the Measles: What Parents Need To Know
• From Vaccine Hesitant to Pro Vaccines. Why This Mom Changed Her Mind.
• Measles In the Classroom
• Pediatricians Remember Experiences with Measles
• 'Vaccines Are Safe and Effective'
• Cook Children's Hematology and Oncology
• Bone Marrow and Stem Cell Transplant
• Neuroblastoma

No topic triggers as much controversy on our social media sites or Checkup Newsroom as vaccines. When it comes to the HPV vaccine, people are especially passionate.

You may have seen the comments on Cook Children’s Facebook page after we announced an upcoming Facebook Live event. “Take The Shot. Prevent Cancer. A Conversation About HPV” will feature experts from Cook Children’s and Baylor Scott & White at 1:30 p.m. CST on Thursday, April 12.

We know there is a small but aggressively vocal group of people who have made their mind up on this issue. No amount of science will sway their firm stance against vaccines.

However, we feel it’s important as a health care organization to provide facts for our readers. That’s why we are taking this opportunity to discuss some of the arguments against the HPV vaccine and debunk many of the myths being spread on the Internet.

Myth 1: The HPV Vaccine is New

The United States currently has the safest, most effective vaccine supply in history. Years of testing are required by law to ensure the safety of vaccines before they are made available for use in the United States. This process can take 10 years or longer. Once a vaccine is in use, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) monitor any possible side effects (adverse events) through the Vaccine Adverse Event Reporting System and other vaccine safety systems.

The HPV vaccine – Gardasil^® 9 – went through years of extensive safety testing before they were licensed by FDA. Tens of thousands of people participated in studies for the HPV vaccines. No serious safety concerns were identified in these clinical trials. FDA only licenses a vaccine if it is safe, effective and the benefits outweigh the risks. CDC and FDA continue to monitor HPV vaccines to make sure they are safe and beneficial for the public.

Click here to learn more.

Myth 2: The HPV Vaccine Causes Side Effects

While no vaccine or medicine is completely without risk, the Centers for Disease Control and Prevention (CDC) & the Food and Drug Administration (FDA) review all safety info on HPV vaccines. Most reported adverse events following HPV vaccination are considered minor. Pain at injection site, headache, nausea, fever & fainting are the most common adverse events after HPV vaccination. Fainting occurs in some people because the vaccine stings a little more when it is given. Keeping vaccine recipients in a seated position for 15 minutes after the injection prevents fainting episodes. Click to learn more.

Approximately 79 million doses of HPV vaccine have been distributed since the vaccine was introduced, and no serious side effects have been linked to HPV vaccination. The most common side effects after HPV vaccine are mild and include pain in the arm where the shot was given, fever, dizziness, and nausea. For more information, click here.

Myth 3: The HPV Vaccine Could Cause Fertility Problems For My Child

Currently, there no legitimate data or any evidence that suggest getting the HPV vaccine will have an effect on future fertility for women. In fact, getting vaccinated and protecting against HPV-related cancers can help women and families have healthy pregnancies and healthy babies.

Not getting HPV vaccine leaves people vulnerable to HPV infection and related cancers. Treatments for cancers and precancers might include surgery, chemotherapy, and/or radiation, which might cause pregnancy complications or leave someone unable to have children. Click here to learn more.

Myth 4: A Child 11 Or 12 Years Old Is Too Young To Receive The Vaccine

For HPV vaccine to be most effective, the series should be given prior to exposure to HPV. Most of our kids (80 percent) will become infected with the types of HPV that can cause cancer unless they get vaccinated. Waiting increases the chance that they will become infected before the vaccine can protect them. Click to learn more.

Like all vaccines, we want to give HPV vaccine earlier rather than later. If you wait, your child may need three shots instead of two. More information on this topic can be found here.

Myth 5: HPV Vaccination Gives My Child Permission to Be Promiscuous

Research actually shows the opposite. According to a study published by the American Academy of Pediatrics (AAP), HPV vaccination among 11 to 12 year olds did not increase sexual activity-related outcomes such as pregnancy, STD infection or testing or contraceptive counseling. Click here to read the study.

Studies tell us that getting the HPV vaccine doesn’t make kids more likely to start having sex. However, HPV is a very common infection in women and men that can cause cancer. Starting the vaccine series today will help protect your child from the cancers and diseases caused by HPV as an adult. Intimate contact that is short of intercourse (making out) is sufficient to transmit HPV. Click to learn more.

Myth 7: I Heard The Shot Causes HPV

The HPV vaccine does not cause HPV infection or cancer. The HPV vaccine is made from one protein from the virus, and is not infectious, meaning that it cannot cause HPV infection or cancer. Not receiving HPV vaccine at the recommended ages can leave one vulnerable to cancers caused by HPV. Click here to read about the science behind this statement.

Myth 8: The HPV Vaccine Is Too Expensive

Are you interested in getting HPV vaccine for your child but concerned about the cost? The Vaccines for Children (VFC) Program may be able to help. VFC provides vaccines for children ages 18 years and younger, who are uninsured, Medicaid-eligible, American Indian or Alaska Native. Learn more by clicking here.

Myth 9: The HPV Vaccine Damages Women’s Ovaries

The CDC is aware of public concern about the safety of HPV vaccine. Since the vaccine’s introduction in 2006, vaccine safety monitoring and studies conducted by the CDC, FDA and other organizations have documented a reassuring, excellent safety record. There is no current evidence that HPV vaccines cause reproductive problems in women.

Myth 10: The HPV Vaccine Contains Dangerous Amounts of Aluminum

Small amounts of aluminum have been used safely in vaccines for more than 70 years. It’s added to help the body build stronger immunity against the germ in the vaccine. Aluminum is one of the most common metals found in nature and is present in air, food and water. The amount of aluminum present in vaccines is low and is regulated by the U.S. Food and Drug Administration (FDA).

Aluminum is present in U.S. childhood vaccines that prevent hepatitis A, hepatitis B, diphtheria-tetanus-pertussis (DTaP, Tdap), Haemophilus influenzae type b (Hib), human papillomavirus (HPV) and pneumococcus infection. Click here to learn more.

Myth 11: The HPV Vaccine Doesn’t Really Prevent Cancer

Every year, more than 30,000 people in the US are diagnosed with a cancer caused by HPV. That’s one case every 20 minutes.

More Articles On HPV:

• New Study Says Boys Less Likely to be offered HPV vaccination
• ‘We Have a Vaccine That Can Prevent Cancer'
• Texas Ranks Near Last in HPV Vaccination Rate
• Study Finds 1 in 9 Males Infected with Oral HPV
• Pediatrician Leads New Initiative To Improve HPV Vaccination Rates
• Protection From HPV Now Easier For Kids
• Early Evidence Shows HPV Is Working
• HPV Raises Risk of Head and Neck Cancer Sevenfold
• What's New With the HPV vaccine?

So why aren’t more people getting this vaccine?

According to NPR, a new analysis from the Blue Cross Blue Shield Association found only 29 percent of the teens its members insure receive a first dose of the human papillomavirus (HPV) vaccine by their 13^th birthday. The CDC found that nationally only 43 percent of teens are up-to-date on all the recommended doses of the vaccine.

Another recent study found that Texas ranks 47^th in the cancer-preventing vaccine. Out of the 50 states and the District of Columbia, Texas only ranked higher than Utah, South Carolina, Wyoming and Mississippi for HPV vaccination coverage.

“A simple vaccination can mean the difference between getting a deadly cancer or not. Unfortunately, not enough people are getting the importance of this message,” said Jason V. Terk, a Cook Children’s pediatrician.

HPV infection can cause cervical, vaginal and vulvar cancers in women and penile cancer in men. HPV can also cause anal cancer, throat cancer and genital warts in both men and women.

The HPV vaccine is recommended for preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. The CDC recommends that 11 to 12 year olds receive two doses of HPV vaccine at least six months apart.

Teens and younger adults who start the series later, at ages 15 through 26 years, will need three doses of HPV vaccine to protect against cancer-causing HPV infection.

The Texas System Offices of Health Affairs states that about 90 percent of men and 85 percent of women in the United States will contract HPV at some point in their lives. HPV is the most common sexually transmitted virus in the United States. Most sexually active people will have genital HPV at some time in their lives.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

Dr. Terk wonders if there’s a disconnect when parents think about their child receiving the HPV vaccination.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s what Dr. Terk wants parents to know: HPV infection can be prevented.

The vaccine is most effective when given in early adolescence.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends.”

More Resources:

• Vaccines and Immunizations
• HPV Vaccines: Vaccinating Your Preteen or Teen
• What is HPV?
• HPV Questions and Answers
• CDC approves 2-dose HPV vaccine schedule

“Should I even bother getting the vaccine,” I get asked.

“Yes. You should definitely still get your child’s flu vaccine.”

Here’s why.

Is it going to be a bad flu season?

Widespread influenza activity is present in 46 states, including Texas. Hospitalizations for influenza associated illness are on the rise, with nearly 4,000 reported. Children under 5 (as well as adults over 65) appear to be at the highest risk for hospitalization.

As of December 29, there were 13 pediatric deaths associated with influenza in the U.S. And it wasn’t just little babies either, six of those deaths occurred in children over 5 years of age. Only two of those children were known to have high risk conditions, which means that many of the deaths occurred in healthy children. 

One of the major concerns, regarding the severity of the season, is that much of the circulating Influenza A virus is of the type H3N2. In previous years where H3N2 has been common, we have seen increased numbers of cases and more severe disease. Last week, more than 237 children tested positive for Flu A at Cook Children’s. Two weeks ago, 380 kids tested positive for Flu by our lab.

Is the flu vaccine coverage going to be terrible?

Scientists often use the previous flu season from Australia to predict what type of flu season and vaccine effectiveness we are going to have. You might have heard early reports that suggested that this year’s vaccine might only have 10 percent effectiveness. But, the important point to remember is that meager 10 percent only reflected activity against H3N2 and truly predicting which strain will be most common is tricky.

Another important factor to consider is that flu activity is regional. Influenza A activity nationwide is showing H3N2 activity at 7,012 out of 7,754 overall cases, or 90 percent. But, in region 6 (of which Texas is a part), H3N2 was present in 466 of 589 or 80 percent of Influenza A cases. Still not great, but there’s plenty of vaccine preventable flu out there.

So, will the vaccine coverage be terrible? Maybe, but we won’t know for sure until the end of the year and I believe there is evidence to suggest that it will be better than the 10 percent estimates we were reporting earlier in the year.

Should I still get my child’s flu vaccine?

Flu vaccine is an important part of protecting our children from this terrible disease.

Your child will almost certainly be exposed to the flu this year, and probably multiple times. Flu causes serious illness, even death. Even if the coverage was only 10 percent (and I think it will be better), I would still recommend it. Flu vaccine has been proven, even in bad years, to prevent flu-associated death in pediatric patients.

Flu vaccine cannot cause flu. It is an injectable, killed virus which cannot cause infection. Side effects might include soreness at the injection site, low grade fever and mild body aches.

You still have time. We expect flu activity to be increasing over the next few weeks, possibly even into mid to late February. Once you get the vaccine, it takes about two weeks before your protection is up and going.

So, call and get the vaccine today…for you and your children.

Texas Department of State Health Services, which receives the information from schools of students who have declined vaccination  says, “Maintaining adequate immunization rates in schools is critical to preventing disease outbreaks and ensuring the health of Texas children.” 

Jason Terk, a Cook Children’s pediatrician and former president of the Texas Pediatrics Society, states that “immunizations are the safest, easiest ways to protect your kids from unnecessary and sometimes, fatal, childhood diseases.”

And yet, last year the number of conscientious exemptions in the state of Texas rose to 52,756 last year, compared to 44,716 the previous school year.

These numbers occur as more and more cases of diseases once thought to be wiped out have returned. Last year, mump outbreaks occurred in Johnson County, Texas. Almost 30 people, mainly children, were identified and health officials traced the virus to an outbreak in Arkansas, where several students from Keene, Texas visited.

In 2017, more than 300 mumps cases have been identified in the state. In April of this year, the Texas Department of State Health Services investigated multiple outbreaks of mumps, calling the recent resurgence the highest incidence of the virus in 22 years.

"At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high," said Justin Smith. M.D., a Cook Children's pediatrician. “My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together.”

Dr. Smith said private schools, for example, have a high likelihood of having people go overseas for mission trips or other opportunities. Traveling to countries where diseases are more common increases the likelihood of bringing a disease back to school. Waiting at school are their unvaccinated friends and their vaccinated friends who could even be at risk as the number of cases rise. Outbreaks are possible.

“I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation," Dr. Smith said. "Let’s pray we don’t get there.”

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

What can you do?

• Get the best start to protection by vaccinating your child.
• Be aware of the vaccination percentages of your child’s school, your church and your social community.
• Be especially cautious when your child’s unvaccinated friends return from overseas travel. If they are sick, stay away.

House Bill 2249 would require the Texas Department of State Health Services to provide reports every other year on vaccine-preventable outbreaks and the number of students at public schools who have vaccine exemptions.

“Parents want the choice about where to enroll their children to lessen the chance of their child contracting a vaccine-preventable disease from an unvaccinated child,” J.D. Sheffield, R-Gatesville and the bill’s author, said.

Lisa Pomeroy, a general pediatrician in Lubbock, spoke to the committee about this issue. Her daughter is in remission from leukemia, but remains immunocompromised because of the chemotherapy she must continue to receive.

“I don’t want to put my daughter in a dangerous environment,” said Pomeroy. “I want to keep her safe, and this information will let me decide what school is best for her.”

Jason Terk, M.D., a Cook Children's pediatrician in Keller and on the Committee on Federal Government Affairs for the American Academy of Pediatrics, says current school district information is not specific enough.

"The parent of a child with special needs, such as one with cancer or any disease which makes him or her more vulnerable to infections, needs to know if the school that child may attend is safe," Dr. Terk said.

"Currently the percentage of exemptions per district is available, but that information is not that helpful when you consider that many school districts cover large areas and may have a large number of individual schools," he added.

For example, the Keller ISD has 23 elementary schools, 6 intermediate schools and 4 high schools spread over a very large area.

"Knowing the district level exemption rate is not very helpful when the exemption rates may vary widely across all of the many schools," Dr. Terk said. "Risk is specific to the environment that your child learns in and that is what parents need to know about."

Since 2003, Texas has allowed parents to decline state immunization requirements for “reasons of conscience.” At the time, 3,000 kids were listed as exempt. In the 2015-2016 school year, the Texas Department of State Health Services reports 44,716 children from kindergarten to twelfth grade claimed exemption.

Of the state’s 10 largest school districts, three have vaccine exemption rates higher than the statewide rate of 0.84 percent:

• Austin ISD (Travis) – 1,582 students exempted (2.02 percent exempted)
• Katy ISD (Harris) – 866 students exempted (1.22 percent exempted)
• North East ISD (Bayer) – 657 (0.97 percent exempted)

Dallas ISD is eighth on the list with 497 students and 0.34 percent exempted, followed by Tarrant County as ninth with 197 students and 0.24 percent exempted.

Opponents of the bill say they fear families that opt not to have their children vaccinated will face harassment. Sheffield counters by saying no identifying information would be included in the information.

Keeping vaccination rates relatively high (somewhere around 90-95 percent) helps protect all children (vaccinated or not) from diseases, Justin Smith, M.D., a pediatrician at Cook Children’s, said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

“At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high,” Dr. Smith said. “My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together. What if an outbreak occurs in these schools?”

With the upcoming season, now is the time to get your child’s flu vaccines.

Only flu shots will be given this year to protect kids from becoming sick. This is due to recommendations from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) after last year’s FluMist was found to have failed against certain strains of the flu.

But parent’s shouldn’t worry, Cook Children’s has increased its doses of the Quadrivalent Influenza Vaccine (flu shot) for its primary care offices.

“Even in bad years, the flu vaccine continues to provide the best layer of protection against this deadly disease,” said Justin Smith, M.D., a Cook Children’s pediatrician. “Last year’s injectable flu vaccine was 50 percent effective in preventing disease which means thousands of people were protected.”

The AAP recommends children ages 6 months and older be immunized against influenza every year. Previously, the CDC and AAP had recommended either form of flu vaccine – the inactivated influenza vaccine (IIV) that is given by injection and is approved for all patients older than 6 months, or LAIV which is given by intranasal spray and was approved for healthy patients ages 2 through 49 years. But that is no longer the case. Only the injection is recommended.

To find a Cook Children's pediatrican in your area, click here.

After more than 56 years as a pediatrician, Dr. Rogers, a Cook Children's pediatrician at the Forest Park practice in Fort Worth, knows first-hand the devastation of infectious diseases on children. During his long career, he’s seen the life-saving advances that immunization has brought to children around the world.

“It really irritates me that parents will listen to people talk about the dangers of vaccines, but you hear very little about the dangers of diseases,” Dr. Rogers said. “It astounds me that anyone would not get their child immunized. It can be so dangerous for children who are immunosuppressed because they have a disease that won’t allow them to get vaccines.”

Nearly 90 percent of pediatricians say they have encountered a parent who refused to have their child vaccinated, according to a 2013 survey released this week by the American Academy of Pediatrics. The most common reason parents provided for their decision was that vaccines are no longer needed because the diseases they prevent are no longer prevalent in the United States.

Oddly enough, the high success rates of immunizations may be what’s driving this apathy. Most Americans alive right now haven’t seen diseases like polio or even tetanus, but Dr. Rogers has. He remembers the chilling scene of an entire ward of children suffering from tetanus, while he was in Thailand as a young man. 

He recalls seeing the end of polio and watching kids in iron lungs, paralyzed from the waist down or on crutches and in wheelchairs because of the disease.

“These were terrible diseases and they are all gone, nobody sees them anymore,” Dr. Rogers said. “I hope we keep it that way.”

Vaccines have had a huge impact all over the world:

• In 1980, smallpox was declared eradicated globally at the Thirty-third World Health Assembly. It marked the first time that a disease had been vanquished.

• The Centers for Disease Control and Prevention (CDC) states that polio cases fell from an estimated 350,000 cases in 1988 to 407 in 2013.

• The CDC estimates 15.6 million deaths from measles and rubella have been prevented from 2000-2013.

But what happens if the trend of parents shying away from immunization continues?

According to the Houston Chronicle, the number of Texas public school children “whose parents decline vaccinations for non-medical reasons rose nearly 9 percent last school year.”

Since 2003, Texas has allowed parents to decline state immunization requirements for “reasons of conscience.” At the time, 3,000 kids were listed as exempt. The Chronicle reports that number has since multiplied to 45,000 last year.

Justin Smith, M.D., a pediatrician at Cook Children’s, believes parents should look at current examples of what’s happening in the world when making the decision to get their child immunized.

“I don’t think there are many parents out there who would choose to skip a shot for Zika if it were available,” Dr. Smith said. “But that fear we have about Zika is the same fear our parents felt for many of the diseases for which we vaccinate today. I'm not sure that fear remains for parents today.”

Related articles:

• The Devastating Consequences of Meningococcal Meningitis

• Let's Learn About Whooping Cough

• Let's Learn About Tetanus

• The Flu Can Kill - Why We Vaccinate

• Chicken pox: Why we vaccinate

• Vaccines saves lives, maybe even your own

That’s the concern of Justin Smith, M.D., a pediatrician at Cook Children’s. The Houston Chronicle reported “the number of children whose parents decline vaccinations for non-medical reasons rose nearly 9 percent last school year.”

Since 2003, Texas has allowed parents to decline state immunization requirements for “reasons of conscience.” At the time, 3,000 kids were listed as exempt. According to the Chronicle, that number has since multiplied to 45,000 last year.

“If you look at the statistics, you see a lot of geographic clusters of people who choose not to vaccinate at all or to under-vaccinate their children,” Dr. Smith said. “I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation. Let’s pray we don’t get there.”

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

Dr. Smith points to an NBC5 report last year on vaccination rates in local school districts that he found not only enlightening, but a bit frightening to him. The news focused on the growing number of vaccine exemptions in three public school districts (Frisco, Plano and Lewisville).

“At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high,” Dr. Smith said. “My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together.”

In the report, what’s happening in our area includes:

• Thirty schools in the DFW area have vaccination rates below 96 percent.
• Five schools in the DFW area have vaccination rates below 90 percent.
• The highest unvaccinated rate in our area is around 13 percent. The highest in the state is near 50 percent.

Why does it matter?

“If you read the names of the schools, you’ll see a trend,” Dr. Smith said. “They are private schools. They are schools that have a high likelihood of having people go overseas for mission trips or other opportunities. Traveling to countries where diseases are more common increases the likelihood of bringing a disease back to school. Waiting at school are their unvaccinated friends and their vaccinated friends who could even be at risk as the number of cases rise. Outbreaks are possible.”

Do you think this is far-fetched?

Dr. Smith points to the Tarrant County measles outbreak from 2013 that basically had all the characteristics that he’s describing. A large group of unvaccinated people, grouped together based on their faith that contracted measles from a visitor who brought measles into the United States after traveling overseas.

What can you do?

• Get the best start to protection by vaccinating your child.
• Be aware of the vaccination percentages of your child’s school, your church and your social community.
• Be especially cautious when your child’s unvaccinated contacts return from overseas travel. If they are sick, stay away.

About the source

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the fall of 2016.

Tetanus is a nervous system disorder that causes severe muscle spasms. It is caused when a spore that is in the soil, known as Clostridium tetani, gets into damaged skin. It will not grow in healthy tissues, which is why things such as splinters and other puncture wounds, burns, and certain fractures put the body at risk for it. Once inside the body it produces a toxin that irreversibly attaches to the spinal cord and brain stem, and after a few days the symptoms begin.

I can’t imagine many diseases that would make me feel more helpless than if I watched my child in the grips of tetanus. It starts with restlessness, sweating, and rapid heartbeat. Later it progresses to the inability to open the mouth due to muscle spasms (lock jaw). They have episodes of intense and painful contraction of muscles and intense muscle spasms that can be triggered by stimuli such as physical touch, light, or sound. It would be so terrible to try to comfort my child and triggering an episode of them arching their back, clenching their hands, straightening their legs, and holding their breath. The worst part is that there is no change in their awareness, they know it is happening, and they know that it hurts.

The muscles surrounding the throat and lungs can even stiffen to the point that they may need help breathing as well. They are usually monitored in the intensive care unit due to this, and also for the need to control pain.

An intensive care doctor told us the story of a young unvaccinated child with tetanus: “She was walking outside with her parents in a large field, and cut her foot on something. Soon after, she started having muscle spasms in her calves. They got more and more intense, so her parents brought her to the hospital.” The child ended up needing intensive treatment, including numerous rounds of painful treatment injections. The parents finally realized how important vaccination was when she was transferred to the ICU because there was concern she would need assistance with her breathing.

How long can the symptoms last? A long time. The toxin attaches to the nerve and requires the new nerve growth until symptoms resolve, usually around 4-6 weeks. The main treatment is trying to control the pain, and ensuring they continue to breathe.

The bad news is that we can’t eliminate the element in the soil that causes tetanus, and we certainly can’t protect our children from open wounds.

But we CAN give them a vaccination that can prevent this terrible disorder!

Related stories:

• The Flu Can Kill
• It's only the flu that killed her
• Chicken pox: Why We Vaccinate

About the author

Sperry Binnicker is a nurse practitioner at Willow Park. Sperry joined Cook Children's in 2009 in the Pediatric Intensive Care Unit (PICU). In that role, she earned the Daisy Award, an award given to a nurse that is nominated and selected by the parents of patients for excellence in patient care. She continued her education while working full time and received her master’s degree from the University of Texas at Arlington in May of 2015.She is a Board Certified Pediatric Nurse Practitioner and a member of the National Association of Pediatric Nurse Practitioners. Learn more about the Willow Park staff here.

I want to go over some general information about the varicella virus and discuss complications that can arise. Chickenpox is highly contagious. When one individual in a household had it, there is a 90 percent infection rate for those in the same household who have not previously had it or been immunized. It is spread through droplets (think body secretions – runny nose, sneezing, coughing) and direct contact of lesions on skin when in the ruptured vesicular stage. This virus has a really long incubation period, which means there is a long period between the time you are exposed and the time you develop symptoms. The average time is 14 to 16 days! Just when you think you are out of the woods, you can develop symptoms!

Varicella generally starts with 1 to 2 days of fever, fatigue, sore throat, and loss of appetite, followed by a rash. The rash starts as tiny red bumps to the face, spreading to the torso and then extremities. There are three stages of a chickenpox rash: maculopapules, vesicles, and crusts. The maculopapular rash appears as tiny red bumps from pinpoint to pea sized. Vesicles are typically pea sized and are fluid filled (blister like) on an red skin base. One description I like is “dew on a rose pedal” appearance. After several days the vesicles will rupture and leave crusts. The crusts usually resolve in 1 to 2 weeks and can leave areas of lighter colored skin that will eventually disappear. As I mentioned before, it will usually start on the face and move down to the torso and then extremities. There will be several “crops” of new papules, which allows there to be rashes in different stages of healing. Start to finish, chickenpox can last anywhere from 7-14 days. I missed 10 days of school when I had it! You are contagious 48 hours prior to rash appearance (usually when fever starts) until all lesions have crusted over.

But if chickenpox is so mild, why do we bother with vaccinating? Varicella can have severe complications that can cause as little as discomfort or as much as death. The most common complication is secondary bacterial infections. Here is a list of a few:

1. Soft tissue or skin infections: It’s hard not to scratch when you’re itchy, especially if you’re a child! This can lead to secondary skin infections. The common culprit is strep, a common bacteria that lives on your skin. There are even cases of flesh eating bacteria post chickenpox!

2. Encephalitis: Before vaccinations, this neurological issue accounted for 20 percent of hospitalizations and 50 percent of the deaths related to varicella. Encephalitis is swelling of the brain that can happen after or with a virus. It causes delirium, stroke like symptoms, and seizures.

3. Pneumonia: This is a common complications with lots of viral illnesses, and possibly one of the most feared. The mortality rate with varicella pneumonia is estimated between 10-30 percent. Typically you develop high fever, after initial fever has resolved, and cough.4. Hepatitis: This is a liver condition that can occur in our patients who contract chickenpox and already have a low immune system. Kiddos with cancer or who have had organ transplants are at highest risk.

In my prior work in the ED, I have unfortunately witnessed all of these complications with the exception of hepatitis. Complications can affect any age, regardless of current health. I have seen some previously healthy children develop encephalitis and have permanent neurological and seizure disorders after!

With the development of the varicella vaccine in 1995, chickenpox cases decreased 90 percent! The American Academy of Pediatrics and the Centers for Disease Control recommend two doses of the varicella vaccine at 12 months and 4 years.

As always, if you have questions, please call the office. I am happy to discuss things with you. Our goal is to keep your kiddos happy and healthy while avoiding potentially fatal outcomes from preventable diseases!

Tara, NP

About the author

Tara Haraldson is a nurse practitioner at Cook Children's Willow Park office. To make an appointment for back-to-school vaccines, contact your Cook Children's pediatrician. To find a pediatrician near you, click the following link. 

The physicians, nurse practitioners, and staff at Cook Children's Willow Park Pediatrics have all fully vaccinated their children. Every single child. Every single vaccine.

August is National Immunization Awareness Month.

Vaccines save lives. It is a thankless accomplishment.. We can't know the good they have done, as they are arguably the greatest preventative invention in the history of modern medicine.

The vaccines you've received may have saved your life. You will never know. Think about that - a shot you got on a random day, in a random year of your life, may be the reason you're still alive.

We've watched children die of vaccine-preventable illness. We've watched parents cope with the horrific loss of a child, knowing that what happened was preventable. We never want you or your children to go through that.

Let's learn about them. Tune in this month as we teach about the diseases we vaccinate against. Sometimes knowing the other side helps us remember why they're so important.

‪#‎savinglivessilently‬

Hugs,Dr. Diane

We have said this before (many times), but a new study shows just how true this statement is.

A recent study published in the Journal of the American Medical Association (JAMA) looked at the combined data of 18 published measles studies on several measles and pertussis outbreaks.

Reviewing a total of 1,416 measles cases, 56 percent had no history of measles vaccination. This is way higher than you might expect given that most still choose to have their child vaccinated.

Still the study states that “a substantial proportion of the US measles cases in the era after elimination were intentionally unvaccinated.”

Intentionally unvaccinated?

As a pediatrician this concerns me. As a dad, it terrifies me.

In one outbreak the risk of contracting measles was 35 times more likely when parents had skipped the shots. A child who isn’t vaccinated is much more likely to spread measles than a vaccinated child.

We know that the pertussis vaccine is not working as well as we would like. The protection from the vaccine is falling off quickly. However, this study showed that despite this, vaccine exemptions continue to be a factor in the spread of pertussis outbreaks. Somewhere around 1 out of 3 kids who got pertussis during these outbreaks was unvaccinated.

Why are children not getting the vaccines? Not all studies had the information necessary to say. But, for those that did, most families skipped the vaccines for personal or religious reasons (70 percent for measles, 60-90 percent for pertussis).

This is further proof to something we’ve suspected for some time. Having even small pockets of unvaccinated children increases the risk to the whole community.

Each of these families who chose not to vaccinate gamble on 3 issues:

1.Their child would not be exposed to the disease (banking on herd immunity whether they know it or not).

2.If their child was exposed, that they would not contract the disease.

3.If their child contracted the disease, they would not suffer serious consequences.

These are consequences I’m not willing to gamble on.

In the case of measles, consequences could mean pneumonia, hospitalization and, later in life, neurologic complications.

In the case of pertussis, consequences could mean painful coughing, broken ribs and, in the very young, death.

This is further proof to something we’ve suspected for some time. Having even small pockets of unvaccinated children increases the risk to the whole community.

Don’t get me wrong, I’m glad he had his baby vaccinated for his baby’s sake, but I don’t want it to affect your decision to vaccinate at all.

I don’t want your vaccine decisions to be based on what a celebrity does, even if that celebrity is one of the most brilliant guys around.

Why?

Because some other really smart person will choose next week to skip vaccines and then where will we be? No better off than getting vaccine information from celebrities like Justin Timberlake or Jenny McCarthy.

If you vaccinate, you are not alone.

Studies show that over 95 percent of you have chosen to vaccinate your children.

Does it feel like that to you?

Does the media portray it that way?

Does your social media stream reflect that vaccination is the overwhelming majority?

The answer, I believe, is no.

But, why?

Maybe it’s not cool or politically correct to vaccinate you child, or at least to say that you do.

Maybe it’s because you are afraid of the comments you will receive if you support vaccines or report that your child just received some.

Maybe you worry what would happen if you question that thousandth share of some 2012 Italian court case. (P.S. That decision, which was made in some really low level court in Italy, was thrown out by a higher court so just stop already with Italian court decision memes.)

I promise you the world wouldn’t end if you do. If you get a comment that is rude, it’s OK to ignore it. If you have an answer, answer. If you don’t know, get advice from someone who might know. Tag me.

So, I don’t care that it was Mark Zuckerberg who chose to vaccinate his child. But, I do appreciate when anyone speaks up to say, “I vaccinate my child because I believe it is what is best for them.”

Let’s start something today:

Share this post that you are reading right now and say, “Thanks for sharing Mark. I #vaccinate too."

“Epic fail.”

A couple of years ago, this was the phrase that my teenage son used as I unsuccessfully attempted to beat him in a game we were playing. At the time, I thought to myself that it was a harsh but accurate assessment of my performance. And, I was certainly motivated to practice on my own so that the next time, things would be different.

That same phrase came to mind as I read through an alarming article of interest to physicians. The article, published in Cancer Epidemiology, Biomarkers & Prevention is titled Quality of Physician Communication about Human Papillomavirus Vaccine: Findings from a National Survey.

Bottom line: Physicians (primarily pediatricians and family physicians) do poorly in providing the Human Papillomavirus (HPV) vaccine to patients.

Another source, the most recent National Immunization Survey-Teen for the year 2014, reports another alarming trend. The survey shows the number of patients who start the shots – and also complete them – lags far behind what it should be. (The HPV vaccine is given as a series of shots.)

So, it came as no surprise to me that the first article clearly showed what I have suspected for some time and which has been hinted at by previous studies. The epic failure in providing what is essentially a cancer-prevention vaccine to the recommended population of 11-12 year old boys and girls lies not at the feet of the anti-vaccine movement or hesitant parents. Rather, the failure belongs to we physicians!

The article describes findings from an online survey sent to 2368 pediatricians and family physicians in 2014. The 776 respondents self-reported their own performance on strength of four criteria: Endorsement (how strongly they recommend the vaccine); timeliness (whether they recommend it at 11-12 years of age, which is the most beneficial age); consistency (recommending it routinely vs using a risk-based approach); and urgency (whether they recommend the patient receive the vaccination that day). More than a quarter stated they did not strongly endorse the HPV vaccine, and a similar number reported that they did not recommend it be given at 11-12 years of age. Amazingly, 59 percent said they used a risk-based approach versus a routine approach to recommending the HPV vaccine, and only half of the respondents recommended giving the vaccine then and there, while the doctor discussed the HPV vaccine with the patient and parent. And these results represent a best-case scenario because respondents would be unlikely to paint an unflattering picture of their own performance.

Clearly, we have a major problem with physicians struggling with their own discomfort in talking about the HPV vaccine and who erroneously believe parents do not value it. Physicians who can’t communicate the importance of this cancer-preventing vaccine in turn fail to recommend it, which is so important to protect our patients. We are at risk of being the generation of pediatricians and family physicians who collectively failed to protect our patients from a preventable cause of cancer. Only we physicians can fix what it wrong with us: Only we can reverse this epic failure!

Are we there yet? “No. 5 more minutes.”

Are we there yet? “No. I will tell you when we get there!”

Did anyone hear this or something like it last week?

We’ve been asking a similar question to our favorite Cook Children’s microbiologist, Morgan Pence, Ph.D.

Is it here yet? No.

Flu season should be just around the corner, but it’s not here yet. Currently, there are only two regions showing Influenza activity across the state of Texas. Tarrant County is not one of those regions.

Flu season usually starts sometime in late October or November but occasionally we have later seasons. It appears that we are going to (knock on wood) make it till December before we see our first case at Cook Children’s this year.

There are few theories about why flu follows a seasonal pattern:

1.As weather gets colder and people are trapped indoors, the virus can more easily spread from person to person.

2.Colder temperatures lead to drier air. Dry air causes our noses to be drier which may make their defense against flu weaker.

3.Cold temperatures may allow the flu virus to live longer on surfaces.

Based on these theories, it’s possible that our warmer fall has caused a delay in the onset of flu season. With the colder temperatures last week, we may be reporting our first case soon.

Dr. Pence reports that our lab tested 74 specimens last week but none were positive for flu. She states, “Currently we are mostly seeing children with rhinovirus and RSV.” Rhinovirus causes the common cold. RSV can cause cold-like symptoms as well, but can be more severe in babies, especially those who were born premature.

What does this mean for you and your child?

1.If you haven’t yet, there’s still time to get your flu shot. (Even if the year starts late, it could still be a bad one).

2.Continue to teach your children to cover coughs and to wash hands.

3.Be aware if your child tests positive with a rapid flu screen, it may not be correct until flu activity is higher.

For now, Dr. Pence will still have to play the role of lab-mom.

Is it here yet? “No.”

Is it here yet? “No, probably 2-3 more weeks.”

Is it here yet? “No, but you’ll be the first to know!”

The vaccine is only in the beginning stages and part of ongoing research, so it will not be available to the public any time soon. But if a vaccine does become available, it has the potential to be a lifesaver for children across the world.

NBC News reports that a team at the National Institutes of Health has genetically engineered a virus that should be safe and effective against RSV, which kills 200 U.S. children a year and hospitalizes 75,000 more. RSV can lead to several types of diseases, ranging from a cold to pneumonia.

So how big would this be? Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s says a vaccine that can prevent RSV will be a difference maker for all of us.

“In terms of preventing hospitalizations, emergency room visits and outpatient clinic visits, it would be huge for infants and toddlers,” Dr. Whitworth said. “Everyone has RSV at least once in the first two years of life. It may just be a minor cold or it could progress to involve the lungs and cause wheezing. We then acquire it regularly throughout our lives as some of our winter colds. In older children and adults, who are generally healthy, it is just a mild respiratory tract infection. But we are all impacted in some way by RSV.”

A new vaccine for RSV is the latest in a line of vaccines that have helped fight against diseases such as the flu and the whooping cough. Dr. Whitworth hopes that this latest medical breakthrough serves as a reminder of the importance of vaccines and why the medical profession seeks them out.

“Scientists all over the world dedicate their lives and careers to developing vaccines because they feel passionate about preventing disease and death,” Dr. Whitworth said.

In the meantime, Dr. Whitworth says families can help prevent the spread of RSV through good handwashing, cough hygiene (covering your mouth with your elbow), using tissues, etc.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

“Vaccinations are still the best answer to preventing the flu and protecting your children from the upcoming season,” Dr. Whitworth said.

The flu shot is recommended for children ages 6 months and older. However, the Centers for Disease Control says only 47 percent of the nation’s eligible population received a flu shot. The only age group that met the CDC’s coverage goal of at least 70 percent was children 6 months to 23 months of age with 75 percent getting their shot.

It’s important for babies to get their shots beginning at 6 months of age. Flu shots are not approved for younger infants,” Dr. Whitworth said. “Because these younger babies cannot be protected by getting flu shots, their caregivers and household contacts must get theirs. If those individuals who are around the baby don’t get infected with influenza, the baby is much less likely to be exposed. It’s especially important for pregnant women to get their vaccines in order to protect their newborns.”

Last year, a lot of talk focused on how ineffective the flu vaccine was, with the CDC saying it was less than 23 percent effective against the dominant strain. The CDC says the vaccine will be more effective this year based on data from early detected cases.

Dr. Whitworth says it’s too soon to predict what the flu season will bring as far as severity and it’s difficult to say how effective the vaccine will be because different strains circulate each year. But vaccines are still the most effective way to fight against the flu.

During the 2014-2015 flu season, 145 children died in the United States from influenza-related illness and the American Academy of Pediatrics says many of those children had no underlying medical condition. The AAP states that an estimated 90 percent of pediatric deaths have occurred in unvaccinated children.

Two types of influenza vaccines are available for children this year, according to the AAP:

• The inactivated influenza vaccine (IIV) is given by injection and is approved for children 6 months of age and older. It is available in two types, one which protects against three strains and one which protects against four strains of influenza.
• Also available is the live attenuated influenza vaccine (LAIV), which is given by intranasal spray. It is approved for healthy patients 2 through 49 years of age and protects against four strains of influenza.

 The AAP also recommends:

• Everyone who is 6 months of age and older should receive annual influenza vaccine.
• Children ages 6 months through 8 years need two doses this flu season, if they have had less than 2 doses of flu vaccine before July 2015.
• Special efforts should be made to vaccinate household contacts and out-of-home caregivers of children with high-risk conditions, and all children under the age of 5.
• Parents should not delay immunization in order to receive a specific vaccine formulation. It is more important to be vaccinated at the earliest opportunity.
• Pregnant women, who are at high risk of influenza complications, can safely receive influenza vaccine at any time during pregnancy. This also provides protection for their infants during their first 6 months of life.
• Mandatory influenza immunization programs for all health care personnel should be implemented nationwide.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

No.

So why are we discussing this issue again?

Because Donald Trump linked vaccinations to autism in last night's debate between Republican presidential candidates.

“Autism has become an epidemic, 25 years ago, 35 years ago, you look at the statistics, it’s not even close,” he said. “It has gotten totally out of control.”

He went on to say he had evidence of a relationship between autism and vaccinations.

I wish I had a voice in the debate last night, I would have been less political and more factual.

What can’t be debated are the facts on this issue: Multiple studies done by different people in different places have shown consistent results that vaccines do not cause autism.

There have been multiple theories proposed over time as to why vaccines might be a cause of autism. In my checkups and vaccine discussions, I generally address the issue of vaccine safety by answering three questions:

No. 1 - What does basic science say?

No. 2- Do studies of groups of children (vaccinated vs unvaccinated) show a problem?

No. 3 - What do you do with your own kids?

Basic Science

The basic science and scientific community has overwhelmingly supported the use of vaccines in children over time. Take a look at any major medical organization and they support vaccination. The overwhelming majority of pediatricians support vaccines according to the Centers for Disease Control schedule. Just so you don't think you’re in the minority, the overwhelming majority of patients have their child vaccinated according to the same schedule.

Over time, various concerns about vaccines have been brought up. Basically the way it happens is like this … someone comes up with a theory as to why vaccines might be a cause of autism. The scientific community starts to complete studies to determine if it could be a concern. Over and over, the theories have been disproven. Here are three specific examples of this pattern.

Population Studies

I believe that research has shown, through basic science, that vaccines are safe. But, there are studies that have looked at the problem from a different perspective.

In an example from 2010, two researchers from the University of Louisville, Dr. Michael Smith and Dr. Charles Woods, studied a group of over 1000 children to determine if delayed vaccination or on-time vaccination affected developmental outcomes. The study was published in Pediatrics (the journal of the American Academy of Pediatrics) in June 2010.⁵ The study compared children who were vaccinated “on-time” (received vaccinations within one month of the recommended schedule) with children who were not on-time.

The testing looked at multiple different tests, which included outcomes for speech, intelligence, memory and behavior control (among a few others). Results showed that children who were vaccinated on-time showed improved scores in intelligence and naming questions, all other testing showed equivalent scores. If delayed vaccines protected against autism or other developmental problems you would expect those vaccinated on time to show deficiencies in many of the areas tested.

Another study done in Australia, released in June 2014 looked at multiple combined studies totaling 1.2 million children. The findings were overwhelming supportive and showed no link to autism for any of the following: vaccination and autism, vaccination and autism spectrum disorders, and autism and MMR/thimerosal/mercury.

These are just two examples of many studies that have shown vaccines to be safe and not a cause of autism, even when looking at large studies of populations over time.

My Personal Practice

The science tells us that antigen load (and load on the immune system has actually decreased) and population studies have shown that children vaccinated on time do not have developmental problems.

But the real point I like to discuss with my families is this: I vaccinate my kids on time. Each of my children has been vaccinated on time without hesitation. I am confident that by doing so I have not harmed them in any way and I will continue to vaccinate them with all available vaccines according to the CDC schedule.

I am willing to have an open and honest discussion with any family about their choice to vaccinate, their choice to vaccinate on an alternative schedule, or any other issue surrounding vaccination but I do feel strongly that vaccines are safe and that I am not putting any child at risk by vaccinating and vaccinating on time.

In summary, I have studied this issue extensively and have seen no study that convinces me that vaccines are the cause of autism or any other concern. I consider them to be the most important thing that I do to prevent disease in my patients and will continue to vaccinate my children and my patients with confidence.

Vaccines work. Vaccines are safe. Donald Trump shouldn’t change your mind.

However, some moms and dads may not realize the harm they are doing their newborn by not getting themselves or their older children vaccinated for whooping cough, or pertussis.

Because the immunity of a newborn isn’t fully developed, babies are at high risk for contracting potentially fatal illness and disease.

A new study published in the journal Pediatrics stresses the importance of the entire family getting vaccinated, at least those old enough to receive the immunization. The study says babies who contracted whooping cough were now more likely to get the infection from a sibling than a parent.

The study states that pertussis “is poorly controlled” and that the incidence of pertussis in this country is on the rise.

In contrast to previous studies, data now shows that infants are contracting whooping cough more often from their siblings than from their mothers. Doctors suggest that this may be because of vaccine effectiveness wearing off over time in these older children. They then contract pertussis more easily and the younger siblings (including infants) are more likely to be exposed.

Five vaccine doses are recommended by age 6, with a booster shot at age 11 or 12. Booster shots also are recommended for adults.

Infants are at greatest risk for disease and death from whooping cough, especially during the first 2 months of life before pertussis immunizations begin. That means that everyone in the family should be vaccinated when a newborn is being brought into the family.

While the parents, adolescents and caregivers who will have direct contact with the baby should all be up-to-date on their immunizations, the two most important vaccinations for adults to receive are influenza and combination booster for tetanus, diphtheria and pertussis (Tdap).

“Tdap is recommended for all pregnant women during each pregnancy to prevent the baby from getting pertussis if coughed on in the first few months of life before the baby has time to get immunized,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “The mother makes antibodies that go into the baby’s bloodstream during the pregnancy. Those last until the baby gets his or her 2-month shots.

“It’s very important for everyone in the family, including parents, siblings and grandparents to have the vaccine. Pertussis can be deadly if a child contracts the disease in the first 3-4 months of life.”

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

So why did the Tarrant County Health Department just announce that there is a case of rubella in a Texas Christian University student?

Unfortunately, the student returned from a part of the world where rubella continues to be an ongoing concern. The World Health Organization states that rubella continues to cause infection in Africa, the Eastern Mediterranean and Southeast Asia. Despite the fact that rubella is no longer transmitted in the United States, an average of 10 cases of rubella are diagnosed here each year from travelers who bring it back from affected areas.

Don’t get me wrong, rubella is a big deal. Prior to the vaccination, it used to cause millions of cases per year around the world. The most severe complication from rubella is congenital rubella syndrome (CRS) which can affect the babies of women who contract rubella during the first three months of their pregnancy. Children born with CRS are at risk for growth problems, developmental delays and other birth defects.

We should definitely be aware that there is a case of rubella in our area, but I’m advising parents not to panic about their children getting rubella.

Here are the 2 main reasons why I’m choosing not to panic:

1. Rubella is a mild illness in children. It can start with a mild fever (but often doesn’t) and then causes a rash that starts on the face and spreads downward. Other complications from rubella are very rare and are more likely to happen in teenagers and adults.

2. Rubella vaccine works very well. After the first dose of the rubella vaccine (given at 1 year), 90-95 percent of children are protected. After the 4-year booster dose, protection gets much closer to 100 percent. If your child is vaccinated, they are most likely protected. As with anything, the vaccination is not perfect so we are relying on each individual person getting vaccinated to help protect their neighbors from an outbreak. Despite the fact that cases of rubella have been imported into the United States, no outbreaks have occurred, thanks to our relatively high immunization levels.

Children (or adults) who are infected by rubella can spread the disease via droplets spread by sneezing or coughing. We recommend all children be vaccinated against rubella. The vaccination helps prevent children from getting the disease and it also helps protect anyone they may come in contact with, including pregnant women.

Pregnant women with rubella run the risk of potentially having a baby with congenital rubella syndrome.

As always, if you are pregnant (especially in the first three months), use caution around sick individuals especially those with a rash. If you already have a baby, you were likely checked for rubella immunity at the delivery and your doctor should have the results of that test. If you are thinking about becoming pregnant, a doctor can check your immunity level now so that you can be vaccinated prior to getting pregnant.

Let’s not panic about rubella at TCU. If your child is starting classes there, feel free to send them on (I’ll be on campus for a meeting today if that gives you any peace of mind). Let’s be aware. We’ll follow the story and notify you if there are any updates or new reasons to be concerned.

More resources:

• Rubella
• Frequently asked questions about immunization
• Measles: Just a plane ride away
• Should you immunize?

Articles and news reports about infectious diseases and their impact on our children keep me up at night. Tonight, it’s not an article about an outbreak of disease that has me up typing away at 11:30 on the night before I come home from vacation.

Tonight, at least in the United States, there’s no large ongoing outbreak.

Tonight, my concern isn’t so much about those parents who choose not to vaccinate. I’ve been down that road before.

Tonight, I’m concerned about parents who are choosing to vaccinate their child, but then also choose (often unknowingly) to send them to a school where the low vaccination rates put even their fully vaccinated child at risk.

We know that families who choose not to vaccinate tend to cluster in geographic regions because studies have shown this. I have proposed the theory before that perhaps clusters of unvaccinated children in our area might be more based on ideology (faith-based or otherwise).

Why does this matter?

Herd immunity.

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases. In addition, when outbreaks occur (which is much more likely when herd immunity breaks down), even children who are vaccinated become at risk for contracting disease due to the number of possible exposures. (If you are about to say, “If your child is vaccinated, why do you care if mine is?” read the post above.)

NBC 5 Investigates released a really enlightening (frightening) report this week on vaccination rates in local school districts. They highlighted the growing number of vaccine exemptions in three public school districts (Frisco, Plano and Lewisville).

At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high.

My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together.

Take a look at what’s happening in our area:

• 30 schools in the DFW area have vaccination rates below 96 percent.
• 5 schools in the DFW area have vaccination rates below 90 percent.
• The highest unvaccinated rate in our area is around 13 percent. The highest in the state is near 50 percent.

Why does it matter?

If you read the names of the schools that fall into the categories above, you’ll see a trend. They are private schools. They are schools that have a high likelihood of having people go overseas for mission trips or other opportunities.

Traveling to countries where diseases are more common increases the likelihood of bringing a disease back to school. Waiting at school are their unvaccinated friends and their vaccinated friends who could even be at risk as the number of cases rise. Outbreaks are possible.

Do you think this is far-fetched?

The Tarrant County measles outbreak from 2013 basically had all the characteristics that I am describing. A large group of unvaccinated people, grouped together based on their faith that contracted measles from a visitor who brought measles into the United States after traveling overseas.

What can you do?

• Get the best start to protection by vaccinating your child.
• Be aware of the vaccination percentages of your child’s school, your church and your social community.
• Be especially cautious when your child’s unvaccinated contacts return from overseas travel. If they are sick, stay away.

The short answer is yes because your child is still more protected than without one.

Donald Murphey,M.D., medical director of Infectious Disease at Cook Children’s, was on a conference call with the CDC the morning of Thursday, Dec. 4, to discuss the advisory.

The dominant influenza strains at present in the US are influenza A, H3. There are two of these strains present this year:

• One is a good match for the vaccine currently in use.
• The second, accounting for about half of the samples tested, is a new flu A, H3 strain that was not seen until March 2014.

This new strain is not included in the current vaccine, but Dr. Murphey says it will likely be included in the vaccine for next year.

“This strain has drifted from other similar strains seen in the last few years. This new flu A could be associated with more severe influenza cases, and a more severe flu season in general, Dr. Murphey said.

But he stresses that parents and their children should still get a flu shot.

The CDC recommends:

• Treatment with antivirals for influenza more emphatically this season in hopes of preventing severe disease, hospitalization and death. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu in your body. Antiviral drugs are not sold over-the-counter. You can only get them if you have a prescription from your doctor or health care provider. Antiviral drugs are different from antibiotics, which fight against bacterial infections.

• Staying home if you have flu-like symptoms.

• Cover your cough.

• Frequent hand washing.

“We should still be using flu vaccine, as it is our best way to prevent this potentially serious illness,” Dr. Murphey said. “People's best chance of avoiding influenza and complications of influenza is to be immunized every year. That’s how we build up a community that can protect themselves from new strains, even when we did not have a vaccine for it yet.”

More resources:

• Six ways to protect your family from the flu
• The danger of the flu
• It's only the flu that killed her
• Fever, headaches and tummy aches: when you should be concerned
• Is your child afraid of shots?
• CDC's flu page
• What You Should Know for the 2014-2015 Influenza Season
• Seasonal Influenza Q&A

I respect that parents have the right to choose what is best for their children regarding their medical care. There are certain situations in medicine where these decisions truly only affect you and your family.

If you choose to turn your child’s car seat around at 6 months, I will argue adamantly that this is not safe and is unreasonable, but if you leave and decide to anyway, it probably will only affect you and your child should something happen.

If you choose that vaccines are not right for you family, I will discuss with you the benefits and risks of vaccines but ultimately, it only affects you and your child, right?

Wrong.

Let me just give you two hypothetical situations:

1. Your unvaccinated 6 year old has fever and a rash, but you have a planned visit with your old high-school friend who lives hours away. No big deal, you say, your child probably just has a virus so you plan to treat with home care, manage his fever and symptoms which would all be very appropriate, generally. Your friend comes for her visit but brings along big news … they’re pregnant. In fact, she’s 12 weeks along and has been waiting for this visit to reveal it to you.

Your friend leaves and the weekend passes … now your child is getting worse so you decide to go on in and you get a preliminary diagnosis of measles.

Fortunately, unlike some of the vaccine-preventable diseases, measles does not appear to cause birth defects. However, there are some risks of increased miscarriage and premature labor. If one of these things occurs, the percentage of moms who have a miscarriage and enter labor prematurely is so high, it would never be clear if the measles was the cause or if it would’ve simply happened anyway. Even if your child doesn’t have the measles after all, you should tell your pregnant friend and everyone will be pretty stressed for the next few days waiting for test results.

2. You travel with your unvaccinated 18-year-old college freshman on a mission trip to Africa during his first Christmas break from college. You have an amazing time there working in an orphanage, a school and volunteering to sit with people in a local hospital.

Everyone comes back to the United States feeling great so you load up your son and take him back to his college dorm to start the next semester. Two days after getting back to school (eight days after getting home from Africa), he develops fever which progresses over the next day to having a stiff neck. He is subsequently hospitalized and diagnosed with meningococcal meningitis. The average incubation period for meningococcal meningitis is four days, but ranges from 2-10 days.

Hopefully, because most of the dorm will be vaccinated against meningitis, your child’s case will be isolated but there’s no guarantee. Consider other children who used a religious exemption or exemption of conscious. Consider those that didn’t have a good response to the vaccine and remain vulnerable. Consider the next two weeks and how stressful it will be for the other students, their families and the school as they wait to see if anyone else develops symptoms of meningitis.

Medical autonomy does give you the right to choose to vaccinate or not; however, we all live in a social context as well. If you choose not to vaccinate, it's important that those around you are aware of your decision.

It's important that you consider that the illnesses your kids could contract could harm others around them. You need to make responsible decisions in accordance with this fact. We should use caution about having our sick children out at any point, but this is specifically important with children who are not vaccinated.

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Most of the concern today regards the vaccine for measles, mumps and rubella (MMR). A study, which has now been discredited, linked the vaccine to autism.

In her more than 22 years of private practice, Audrey Rogers, M.D., has had to calm fears about immunizations a few times. Dr. Rogers understands the hesitancy of a new parent because of all the misinformation out there, but her primary concern is the health of the children she treats.

“A lot of people tell me, I’m not sure if I should get my child immunized,” Dr. Rogers said. “But then you educate them and let them know the facts, and most of them understand and say, ‘Oh, OK. I get it now.’ The only reason we immunize is to treat these awful diseases. Most people have not seen a case of measles. I have. About two or three years after I started practice there was a measles outbreak here and one of the sickest kids I have ever seen, covered in this awful rash, came into my office. He was so sick, running a 105 degree fever. He was just miserable. It was awful. The 105 temperature lasted at least a week. That’s what can happen if you aren’t immunized. Kids really can die and there is really no treatment once the child contracts the disease for that either, except supportive care.”

“People aren’t scared anymore,” she said. “In the 1950s, people were scared of polio and they were lining up to get the vaccines because it was so scary. It’s been decades since anybody’s gotten polio in the United States. Polio caused permanent paralysis and during the acute phase, patients needed ventilation. No one knows what an ‘iron lung’ is any longer. Those things are hard to be afraid of when you haven’t seen it. I think that’s one of the growing problems that people are more afraid of the side effects of the vaccines than they are the disease. But those diseases are so ugly and so deadly.”

Recently, Dr. Rogers has met with parents who want to juggle the immunization schedule of their baby.

“If people are willing to get their child immunized, but they want to get them on a different schedule or space them out differently than what is recommended, then I am willing to work with them on that,” Dr. Rogers said. “I warn them that the disease that we immunize for at 2, 4 and 6 months, are serious and that babies can really die from them. I really try to encourage them to get those vaccines, especially for pertussis because pertussis is very much alive and can very much kill kids or cause brain damage.”

What Dr. Rogers won’t budge on are parents who refuse to get their children immunized at all.

“If we get them immunized eventually, I’m generally OK with that, but if the parents just say, “No, I don’t want any immunizations, I will not treat that family,” she said. “For one thing, this absolutely places all my other patients at risk and I’m not willing to take that risk. Frankly the other thing is medical legalities. If the child gets pertussis and dies, I can’t put myself in a position knowing it could have been prevented from happening and the parents say I didn’t talk to them enough about getting the vaccine. And there’s a third reason too. People who aren’t going to listen to me about immunizations, probably aren’t going to listen to me about anything. And if they aren’t taking my advice, we are wasting each other’s time.

Dr. Rogers said as a board certified physician, she relies on the facts and data supplied by research. But unfortunately, those who are against immunization do not have to rely on the same burden of proof, research, and the Internet can back up many opinions

“Every time you say you need to look at some real facts, they point to the thousands of people who have written that immunization has hurt their kids,” Dr. Rogers said. “There’s a lot of that on the Internet. Anybody can put up this stuff with absolutely no backing or proof. People read it and it seems just as legitimate as the AAP and Center for Disease Control Web sites. Parents really need to investigate, because there is a lot of unsupported information out there. There is no proof at all about the dangers of immunization. The only proof about immunization is that it’s the crowning achievement to the human race of the twentieth century.”