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Bill Klaproth (Host): As a parent, you may have questions surrounding the immunizations for your child and here to talk with us about pediatric immunizations is Dr. Nelson Branco, a pediatrician on staff at Marin General Hospital and a pediatrician at Tamalpais. Dr. Branco, thank you so much for your time. So, why are pediatric immunizations important?

Nelson Branco, MD, FAAP (Guest): Well, thanks for having me and good morning. Pediatric immunizations are important not only for the children who receive them but for the community at large, for their family members. We know that immunizations are safe and that they are effective. Children are exposed to many different illnesses, lots of croup and hand foot and mouth and ear infections etc. Fortunately because so many children are immunized; they are no longer exposed as often to serious illnesses like measles and mumps, chickenpox and whooping cough.in turn, children are very effective at sharing and spreading these diseases and so we protect their grandparents, we protect their parents, we protect you know other folks in the community including folks who may be immunocompromised.

Host: So, that’s why it’s important that all children get their immunizations because there are some parents who have heard rumors that vaccines can cause serious health problems. Can you please debunk this?

Dr. Branco: Well one of the things that we have learned is that vaccines are safe and effective and we’ve learned that through years and years of study, vaccines are actually monitored after their license as well as tested before more so than many of the medications that are given. There’s a system called the VAERS, the Vaccine Adverse Event Reporting System that collects stories, people who may have concerns about a vaccine or an illness associated with a vaccine and looks for patterns. And there have been you know different illnesses and conditions associated with vaccines that have been picked up by that system. There have been some that have been picked up and then studied and shown not to be associated with vaccines.

we could go into the history of Dr. Wakefield and his study which has been debunked Dr. Wakefield whose license was stripped in the UK because of his fraudulent work perpetuating the idea that vaccines have serious consequences, but the bottom line is that when parents or researchers bring up an idea that a vaccine may cause a serious illness; that is studied and in the case of MMR and autism and in the case of thimerosal; associations were studied extensively in many different ways, in millions of children across - across the globe and no connection was found. And that leaves us with the conclusion that the vaccines we are using today are as safe and effective as we can make them.

Host: Absolutely and diseases such as polio and mumps are rare. That’s because of all the vaccines that children have gotten over the last decades but there are people that may say well, why are vaccines necessary. We’ve almost wiped these out. Can you talk about that?

Dr. Branco: Yes. Polio is a great example. In our modern history, there’s only one disease that we have been able to eradicate and that was smallpox which we eradicated but with a worldwide vaccination campaign. Polio is similar in that we’re nearing the end, we hope, of a worldwide eradication campaign. And even though polio is rare; there are still pockets of polio in certain parts of the world Pakistan and some parts of Africa, Nigeria I had cases of polio and once we can eradicate these small pockets of polio; there’s a – a scientific model that says that if we see no wild type polio for several years; then we can stop doing polio vaccinations. Until that time comes; it’s not safe to stop polio vaccination because it really just takes a small pocket of susceptible individuals for one case of polio to then become an outbreak and to become widespread again and we saw that again, in rural Pakistan and in Africa where there were pockets of folks who had not been immunized and that kept the virus alive because there was still a place for it to go.

In the case of mumps; we have a vaccine that’s not 100% effective. It’s actually good at preventing mumps but not great and not perfect by any means and we’ve seen that there is still some mumps in certain communities most recently there was a pocket of students in a – in a boarding school situation in New York and the northeast and they started to get mumps and that spread very quickly through that community and then actually can also then affect even immunized children. So, it’s important to keep up vaccination rates so that these diseases don’t have easy access.

Host: Right so, it’s very easy to understand vaccines not only help the individual, but the population at large. But let me ask you this for parents who are concerned. We know that vaccines are safe but are there common side effects that a parent should know about?

Dr. Branco: Yes, I mean the vaccines will trigger an immune response. That’s the intention of the vaccine and I often will tell parents you know if your child is fussy or develops a low-grade temperature or some redness around the area that we give the shot or soreness; that means the immune system is reacting and responding. That’s actually what we want. All of those side effects are very common. There’s some discomfort and in many of us who had the experience of getting for example a flu shot and feeling a little fluey, feeling a little under the weather for 24 hours or so, that’s the immune system that does that. There are very rare fortunately, but more serious side effects many of the side effects that we see with vaccines are actually very common with the illness that we are trying to prevent. And you know one concern that comes up often for example with the flu shot is a condition called Guillain Barre Syndrome which can be associated with the flu shot but is much, much more common with the flu so even though we take a small risk of those conditions with vaccines; there’s a much, much larger risk we remain susceptible to the disease.

Host: Hmmm, and how many shots do children need and how should a parent keep track of those immunizations?

Dr. Branco: The immunization schedule is and updated every year by the – the CDC and the ACIP. And the CDC is the Centers for Disease Control and the ACIP is the Advisory Committee on Immunization Practices and that’s made up of pediatricians and family doctors and internal medicine doctors and researchers who all get together to look at all the research and decide on the schedule it’s hard to say exactly how many vaccines because every physician has a little bit of leeway in setting their schedule. In general, there are for infant’s vaccines or four vaccines at each of the early visits then as the booster doses become less as time goes on then that to be less.

Parents have lots of options for keeping track of which vaccines are needed. You can actually go onto the CDC website which is www.cdc.gov, GOV and there’s an immunization tracker and an immunization tool where you can put in your child’s vaccines and they will tell you what might be due. There’s a way to put in your child’s immunization dates and out or to keep it in the app. now many physicians’ offices who have gone to an electronic medical record will have a patient portal. In my office, my patients all have access to certain sections of their chart including an immunization record, so they can log in any time and print out a vaccine record whenever it’s needed for school or sports or travel. And then there also are immunization registries that physicians and hospitals will use to share information about individual patient’s vaccine records a wider scale.

Host: Well through technology, it’s easy to see how keeping records is easier. So, last question Dr. Branco, when preparing for a doctor’s visit, should a parent always bring the child’s immunization record?

Dr. Branco: You know it’s never a bad idea to have an updated copy of that immunization record. Most of us as I said are relying on these electronic methods for keeping track of vaccines. And also participate in these regional immunization registries. So, in my office, parents will sometimes bring their yellow card of the folks are familiar with the yellow card and we are happy to update that at any time, but they also have access to the online system with the records and have access to the immunization registry so that if they have gotten vaccines elsewhere, then those are kept.

And one interesting side note about vaccine registries – registries which are often statewide is that in cases like hurricane Katrina in New Orleans or the hurricane in Houston and I’m guessing the same thing is happening with the we’ve had here in California; children who had their vaccines recorded in the immunization registry were able to school and to get into schools in other communities much more easily because their vaccine records were available. They didn’t have to restart vaccines in order to make sure they were up to date. The doctors in the new community were able to access the old records for vaccines even if their pediatrician’s office had been flooded or burned down and you know all the records were not available right away.

Host: Well, that’s important information and really good to know and Dr. Branco thank you so much for your time today. For more information please visit www.maringeneral.org, that’s www.maringeneral.org. This is The Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.