No doubt – the HPV vaccine (Gardasil) is the vaccine I hear the most hesitancy about. And yet I convince parents each and every day to get it – with patience, understanding, and some awesome, strong evidence that it works and is safe.

Little background: HPV (Human Papilloma Virus) is a nasty little virus that you get from other people – through intercourse, oral sex, or just heavy “making out” (yes: kissing can spread HPV).

The CDC states that at least 75% of the reproductive-age population has been exposed to HPV!

HPV lays dormant in most people, but sometimes it causes growth. Sometimes, uncontrolled growth.

Uncontrolled growth = cancer. Cancers of the cervix, vagina, anus, mouth, throat, head and neck in women and men. It also causes anogenital warts. Fun times.

HPV is one of the main reasons women get Pap smears – to see if this virus is causing trouble.

“The HPV vaccine? Isn’t that the new one? It seems like it hasn’t been out very long.”

• The first HPV vaccines were released in 2006.  That’s almost 17 years ago! 17 YEARS!
• The updated version (from the 4-strain to the 9-strain) came out in 2014. 9 years ago!
• It ain’t new! It’s been used for almost two decades and has been given safely to over 270 million people across the world!

“Isn’t this a little early to get a vaccine for something that’s transmitted through sex? My kids aren’t having sex.”

• The vaccine works BETTER when you are YOUNGER. Your immune system is SMARTER when you’re younger, and holds onto the “information” for longer periods of time!
• As evidence of this, you only need two shots if you get the series before age 15. After age 15, you need three shots.
• It is devastating to think about – but why not protect our kids from things that are out of our (and their) control as well? What if something happened to them, like sexual abuse?

“Are there any bad side effects or reactions to this vaccine?”

• In my 12 years of practice as a general pediatrician, I have never seen a severe reaction to an HPV vaccine.
• A sore arm, dizziness, and fainting can be common 15 minutes following the vaccine, so we often will watch them in the office for a while after they get the shot.

“Does it work?”

• Heck yes, it does. Like, really well. Better than most vaccines, actually.
• The longest studies done on these vaccines are at 10+ years, and they seem to be between 90-97% effective at preventing these cancers and warts.
• There is evidence nearly 99.9% of people who get the shot create some form of antibody to the virus.

“Why should boys get this vaccine?”

• Boys give HPV to girls. And vice versa.
• Boys can get anal cancer, anogenital warts, oral cancer, and throat cancer from this virus.

“Why should I believe you about all this? The internet says I shouldn’t get this vaccine.”

You don’t have to believe me. Though I am a pediatrician who has given thousands of HPV vaccines in my practice.  It’s OK. I know some vaccines just seem plain ole scary.

Maybe believe my cousin, though? She’s a cancer doctor. A gynecologic oncologist, to be exact. And what virus does she spend all day battling in order to save the lives of women? HPV.

My cousin is Mae Zakhour, and she practices gynecologic oncology at Spectrum Health Medical Center in Grand Rapids, MI. She treats HPV cancers in women, daily - some as young as 25!

Her exact words to me – to share with you – are:

“Timely HPV vaccination is the safest and most effective way to prevent cervical cancer and other HPV-related diseases. As a gynecologic oncologist, I see and treat young women with cervical cancer on a weekly basis, and even for those in whom cure is a possibility, it comes with a cost.

The treatment for cervical cancer, > 95% of which are caused by HPV, can have devastating effects on a woman’s fertility and quality of life. I want to do everything possible to prevent that for my children. They are getting the HPV vaccine.”

So there you have it. Two moms, who also happen to be doctors, sharing information with you to help you make a very important decision for your child.

And both letting you know we’re getting our kids vaccinated for HPV at age 9 without hesitation!

It’s normal to be nervous about vaccines. What I hope you take from this is more confidence in the HPV vaccine - by knowing it’s super safe, it’s been out a long time, it’s super effective, and it’s super important.

RELATED: New Study Says Boys Less Likely to be offered HPV vaccination (checkupnewsroom.com)

Vaccine and Immunization (cookchildrens.org)

‘We Have a Vaccine That Can Prevent Cancer' (checkupnewsroom.com)

Texas Ranks Near Last in HPV Vaccination Rate (checkupnewsroom.com)

And while I’m confident that we’ll get through it together, I need your help.

Ruling out COVID-19 for kids with symptoms (some mild, some more severe) has become the biggest reason for kids visiting our office. We’ve already seen kids getting sick as they go back to school and that makes me nervous about what the upcoming flu season is going to look like.

Because the symptoms of flu overlap with COVID-19 so much, it’s going to be difficult to tell whether flu or COVID-19 is causing your child’s flu-like illness. And, there’s no guarantee that a child can’t get both at the same time.

So with the flu season nearing, you probably have a lot of questions that need to be answered about this possibility:

• Does every child with flu-like illness need to be tested for both?
  • Probably.
• Does getting COVID-19 and the flu at the same time mean your child will be more at risk for severe illness?
  • Probably.
• Will we have enough COVID-19 testing available to continue avoiding unnecessary quarantines?
  • I hope so, but every time we test a child for COVID-19 because they have flu-like illness, we have fewer tests available.

Here are some things you can do to help your child and yourself (and me):

1. Get your child their flu shot. ASAP. The effectiveness of the flu shot does vary from year to year. It’s not perfect. But, it’s the best we have. And even decreasing the amount of flu by 60% this year will change the lives of those children: Avoiding not one but two tests. Avoiding the worrying during the waiting time and wondering if your child has flu, COVID-19 or something else.
    
2. Start practicing hand washing. Children need to be taught to wash their hands adequately and often.
    
3. Wear your mask, even in situations where you think it might not be necessary. It will not only protect against COVID-19, it will protect against the flu as well. We, as a health care provider and a society, cannot afford to have a terrible flu season this year.
    
4. Keep yourself and your child home if you are sick. This is important…every…single…year. But it is especially important this year. Don’t be the family that knocks over the first domino. Even if you aren’t seen by a doctor, waiting a day can be helpful to see if your simple symptoms progress or go away.

Let’s all do our part.

We can do this!

“We’ve seen gun sales increase significantly nationwide over the past several months,” said Dan Guzman, M.D., a Cook Children’s emergency physician. “Now, with many children being in the home for longer periods of time, curiosity and boredom are something we need to expect. We have to stay vigilant and make sure we’re doing everything we can to prevent a tragic accident.”

According to Small Arms Analytics and Forecasting, this year’s gun sales have already eclipsed 2019 by more than one million firearms.

“With the hunting season about to begin in earnest and the presidential election season about to start in earnest as well, 2020 will without doubt exceed the previous high of 16.6 million units sold in 2016,” SAAF chief economist Jurgen Brauer wrote in an emailed statement provided to FOX Business.

Last year, 41 children were admitted to Cook Children’s for injuries related to guns (including handguns, rifles, shotguns and other firearms such as BB guns.) With 23 children already injured in 2020, Dr. Guzman fears he could see more of these patients this year than last.

“I think most people think this ‘won’t happen to us’ because we’ve taught our kids to never touch guns,” Dr. Guzman said. “But if you aren’t taking the proper precautions as the adult and parent, it’s probably only a matter of when, not if, your life may be affected by an unintentional discharge involving someone you know, and maybe even your child.”

Building awareness for gun safety is a passion for Dr. Guzman. He’s the medical director of the Aim for Safety program at Cook Children’s, which promotes firearm safety for children. The program, which has been featured in several news stories, is a multi-step interactive experience that provides parental awareness and teaches children the steps they should take when they encounter a firearm.

“As parents need to feel comfortable having open-ended conversations with others where our children may play and stay,” he said. “That includes family members and close friends. Don’t be afraid to ask if there’s a gun in the home and if so, how it is stored. Keep the conversation focused on safety and not politics.”

Dr. Guzman offers these safety tips:

The 3 Ts of firearm safety and children

Talk – This includes your family, neighbors and friends. When your child visits other homes, ask the owners if there are guns in their homes and how they are stored. Dr. Guzman said this question is not to be insulting, but to keep your children safe from unsecured firearms.

Teach – Have a conversation with your kids about what to do if they see a gun:

• Stop
• Don’t touch the gun
• Run away
• Tell someone

Take – Dr. Guzman is asking gun owners to take action and store their firearms properly. And, to take personal responsibility for our children’s safety.

Dan Guzman, M.D., a Cook Children’s emergency physician, called the day gut-wrenching for the victims, their families, and the medical staff that took care of the kids, ranging from ages 3 to 14.

Gun awareness and gun safety is a passion for Dr. Guzman. He is the medical director of the Aim for Safety program at Cook Children’s, which promotes firearm safety for children. The program is a multi-step interactive experience that provides parental awareness and teaches children the steps they should take when they encounter a firearm.

“I think most people think this ‘won’t happen to us’ because we’ve taught our kids to never touch guns,” Dr. Guzman said. “But if you aren’t taking the proper precautions as the adult and parent, it’s probably only a matter of when, not if, your life may be affected by an unintentional discharge involving someone you know, and maybe even your child.”

Firearm-related fatalities are a top 3 cause of death among children in the United States.

Dr. Guzman said before the weekend, the medical center staff sees about one child per week. Already in 2019, three gunshot wounds treated at the medical center have been fatal.

“Unfortunately, the tragedy of children falling victim to unsecured firearms continues to happen daily,” Dr. Guzman said. “These preventable incidents and the pain and suffering they inflict can be reduced by properly securing your firearms.”

As part of the program, Dr. Guzman offers these safety tips to follow:

The 3 Ts of firearm safety and children

Talk – This includes your family, neighbors and friends. When your child visits other homes, ask the owners if there are guns in their homes and how they are stored. Dr. Guzman said this question is not to be insulting, but to keep your children safe from unsecured firearms.

Teach – Have a conversation with your kids about what to do if they see a gun:

• Stop
• Don’t touch the gun
• Run away
• Tell someone

Take – Dr. Guzman is asking gun owners to take action and store their firearms properly. And, to take personal responsibility for our children’s safety.

Dr. Guzman stressed that children are curious and impulsive which can be deadly when paired with a firearm. Storing a loaded firearm under the mattress, in a bedside table or a closet is placing your family at risk, Dr. Guzman added.

The most secure place for your firearm is in a safe with the ammunition stored separately. Unsecured firearms should always be in your possession. If you are unable to purchase a gun safe, then separating the ammunition from the firearm and using a cable or trigger lock will help reduce the risk of unintentional injury to your child.

“It’s important to assess and evaluate your home injury risk and find ways to reduce the hazards in your home whether it is related to firearms, water safety, poisonings or any other safety risks,” Dr. Guzman said. “Discussing with your children the importance of what to do when they encounter a firearm can help to reduce unintentional injury in your home.

More than 500 people spanning 20 states have been diagnosed with measles this year already. According to the Texas Department of State Health Services, 15 of those cases were in Texas.

For the rare remaining physicians who have treated measles, the news is like déjà vu.

“We learned a lot from the 1989 measles epidemic,” said Deborah Susan Hucaby, M.D., an emergency room physician at Cook Children’s Medical Center. “We got to a point where anyone who came into the pediatric emergency room or clinics with a fever was presumed to have measles until proven otherwise.”

Dr. Hucaby was a resident at Ben Taub Hospital in Houston in 1989 when the worst measles outbreak in recent history occurred. That year, 17,850 measles cases were reported in 47 states with 3,201 of those in Texas.

“At the time, the MMR vaccine was recommended for children at 15 months,” Dr. Hucaby explained. “Due to the high number of unprotected children we were seeing with measles, that recommendation was lowered to 12 months of age. We also started giving the single measles vaccine at 6 months of age.”

For this reason, Dr. Hucaby says a doorbell was installed outside of the pediatric clinic where she worked during the outbreak.

“Parents were asked to ring the bell if their child had a fever, with or without other symptoms,” she said. “A nurse would go out into the hallway to look at the patient. If they appeared to have a risk factor for measles, we would take them straight into an exam room. We didn’t sit them in the waiting room.”

In Houston alone that year, 1,434 children under the age of 5 were diagnosed with measles. Dr. Hucaby says it’s frustrating to interact with parents today who refuse to vaccinate their children against diseases such as measles, mumps and rubella.

“So many of these parents have never seen these diseases. I’m 40 years older than most of them and I have. I have seen kids die from them,” she exclaimed.

Dr. Hucaby says there’s one child she will never forget. The little girl was only 6 months old when she arrived at the hospital with measles and pneumonia. She was too young to have been immunized and died as a result.

“Parents who decide they are OK with their children becoming infected with diseases probably frustrate me the most,” added Dr. Hucaby. “We didn’t see that during the Houston epidemic. Truly, people were willing to vaccinate their children. I don’t remember a single parent saying ‘no’ to a vaccine.”

She said in the 1980s, children often weren’t up to date on their immunizations mostly because parents didn’t see the importance or they had difficulties with transportation or finances. Today, vaccines are more accessible than ever in the U.S. with programs providing low-cost vaccines in every state.

“Every place I worked before Cook Children’s had an infectious disease ward where patients could be isolated,” said Dr. Nelson. “But as infectious diseases became better controlled, particularly the ones that are so contagious like chicken pox and measles, we didn’t need to have a special ward anymore.”

The reason for the decline in such quarantined areas is simply vaccines.

“I have lived through the era where I’ve seen vaccines come and save children’s lives. I have stood in line to get the polio vaccine,” Dr. Nelson explained. “I grew up with a great deal of anxiety about all of these diseases. That’s the piece that is missing in our society now, no one is anxious about these diseases.”

Dr. Nelson had good reason to be anxious. Not only did he know people who fell ill with polio, he himself lived through infections of measles, mumps and chicken pox.

“I had measles when I was a little boy, before I even started school. I remember having to stay in a dark room for four days because they thought light might increase your chances of losing your vision, which was not true, but that was the belief back then,” he said. “I didn’t want to eat. I didn’t want to do anything. I just wanted to die. It was that horrible.”

“As a physician, I’ve seen a ton of children die when there was nothing I could do about it. There was nothing anyone could do about it. So it does make me incensed that a parent would put a child at risk for a disease that could kill them based on emotion,” he said. “A parent that has never lost a child doesn’t understand the emotion that they are going to feel if they do.”

Read More About Measles and Vaccines

Resources Available at Cook Children's

There's so much misinformation on the Internet and television about the dangers and risks of immunizations, that it can be hard for a parent to separate the facts from the fears. Visit our website to learn more about our recommmendations regarding vaccines and how to make the best decision for your family. 

The Centers for Disease Control and Prevention and the American Academy of Pediatrics are recommending against spray vaccines, such as FluMist, after finding it only 3% effective in preventing the flu in children. Instead, they're urging parents and pediatricians to opt for the shot.

If your child is like most, this is bad news because needles are often enemy number one.

The good news is, there are ways to make this undesirable trip to the doctor's office a little less traumatic. At Cook Children's Medical Center, Child Life Manager Janis Smith discusses ways to help kids cope with pain and stress. When it comes to needles, she says a little distraction can go a long way.

"An iPad, a book, or even engaging conversation can often be enough to take a child's mind and eyes off of the shot," said Smith. "We also encourage deep breathing and sometimes utilize a cold spray to help numb the skin."

A newer technique taking the pain out of shots is called Buzzy. This friendly-looking device comes in the form of a bee or lady bug and can trick the body's nerves with cold and vibration.

"Buzzy's wings are made of ice packs and its body buzzes. When placed above the injection site, these sensations knock the nerves off their game and help eliminate and/or minimize the pain from the shot," said Smith.

While many pediatricians provide tools like Buzzy in their offices, parents can also buy their own in Cook Children's onsite pharmacy.

Another way to ease the sting of the flu shot is comfort positioning. This means creating a secure hold, like hugging, that offers comfort to the child while immobilizing the extremity needed for the procedure (such as the arm). This minimizes anxiety as well the need to hold a child down, which can be traumatic.

For older children, it may help to ask them to do something, such as focusing on an iPad.

"Allowing children to play an active role during the procedure process can often minimize fears and encourage positive coping,'" said Smith.

Smith also suggests offering validation to a child who is afraid of shots.

"Try saying something like, 'I know that you don't want to do this, but it's a way we can help you from getting the flu,'" said Smith. "In the end, no one likes shots. But when children do need shots, we want to provide them with opportunities to cope successfully and help make them as painless as possible."

About the Source

Janis Smith is a Child Life Manager at Cook Children's Medical Center in Fort Worth, Texas. Child Life specialists work with children and families to help them cope with the extra challenges of living with chronic illness.

The first way is to prepare your child for the doctor’s visit. Studies show that children are less anxious for a doctor’s visit or medical procedure when they are informed beforehand. Honesty is the best policy when preparing a child for a blood draw, but it is important to use child friendly words.

Bringing a favorite toy or stuffed animal to the clinic can help. Familiar items help children feel safe and less anxious.

At the clinic it is important for you to stay cool, calm and collected. Children feed off of their parent’s emotions and an anxious parent could very easily make for an anxious child.

At Cook Children’s tips for preparation and comfort can be provided by the Child Life specialist on staff. Child Life specialists use their knowledge and background of child development to help practice successful distraction techniques and coping strategies. Comfort tips can be provided by the Child Life specialist to help with the blood draw such as comfort positioning, distraction and child friendly explanations.

Praise goes a long way. It is so important to support your child and provide encouragement during the blood draw and afterwards. Choose specific skills to praise such as, “You did a great job of holding still” or “You took good deep breaths.” Try to avoid any negative comments such as “Don’t cry” or “Be a good girl/boy” because it’s perfectly normal for a child to be nervous or anxious about a blood draw. Instead, validate your child’s feelings by saying, “That was hard, but you did a great job by holding your arm still.”

For more information on how you can help your child cope with blood draws, hospitals or clinic visits, you can read these resources:

http://childlife.org/files/PowerParentsTipSheet.pdf

http://childlife.org/files/ComfortMeasuresandTips.pdf

About the author

Laura Sonefeld is a Child Life specialist at Cook Children's. Our Child Life staff members recognize that hospitalized children still need opportunities to just be kids. They help children and families cope with a hospital experience by providing emotional and developmental support, giving honest information geared to the child's level of understanding and providing fun activities. The Child Life team works with medical and support staff to create a warm, child-friendly environment.

In the year 2000, measles were declared eliminated from the United States. This occurred because there was a 12-month period where no measles cases were contracted here, making the disease no longer native to the United States.

I hear this question often in my office and its logical based on the fact that measles was eliminated:

“We haven’t seen outbreaks of these diseases for years. Do we really need to continue vaccinating for them?”

The answer is yes and it's exactly because of what we've seen in the past two weeks. Measles are only a plane ride away. We live in a society with global mobility. People fly in and out of countries where measles continue to be a huge problem and then fly back to the United States. Measles are highly contagious via droplets from coughs and sneezes. In addition, people are contagious before they start to show symptoms. (Contrast that with another infectious disease we dealt with recently (Ebola) that requires blood or body fluid contact and is not contagious until there are significant symptoms.)

Continued vaccination programs protect our citizens when they travel abroad. It protects our citizens when travelers return to the United States. It helps to control outbreaks when they do occur.

Another common questions centers around the severity of these diseases.

I pulled this quote from an interview with The Today Show in Australia and Dr. Sherri Tenpenny:

“I don’t believe that measles, mumps, rubella or chicken pox are routinely fatal illnesses. If you ask any person over the age of 50…they had all those illnesses when they were children and growing up.”

There are so many false assumptions mixed in with this statement:

1. You cannot ask a person in their 50s that died from one of these diseases how serious it is.

2. Even if not fatal, the complications associated with these diseases can be very serious.

3. This completely discredits the suffering of any family member of someone who experienced complications from these diseases.

Just look at the stats. In the United States, prior to the introduction of measles vaccine in 1963:

• 3-4 million people had measles each year
• 400-500 died
• 48,000 were hospitalized
• 4000 developed encephalitis (brain swelling)

These complications don’t happen as much in the United States, but do continue to occur in areas where vaccination rates are not as high. There were 145,700 measles deaths worldwide last year. This is a 75-percent drop since 2000 due to efforts to make vaccinations available to children all over the world.

Continuing to vaccinate for measles is important because measles are serious and only a flight away ... and lately, even in our own backyard. 

This is part 2 of Dr. Smith’s series on measles. For more information about measles vaccination and herd immunity, click here.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. 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.