Category Archives: Wellness Blog

Wellness tips from Dr. Mays

How To Keep Your Child Healthy This Season

My toddler has been sick once in his life.  Once.  And he was under circumstances of high emotional, chemical, and physical stress and in a location of high germ exposure that one time.  He has not been in a bubble or isolated in any way from germs.  At 4 months he was on a cross-country plane trip during cold & flu season, he’s chewed on community toys at the library, he’s kissed other little kids.  I don’t do anything special or make fancy herbal concoctions.  What I do is follow the advice I give my patients in addition to washing his hands with soap and water before meals and a bath at night.  Maybe I have been lucky, but I believe increasing health really can make a child disease resistant.  What follows is everything I do for his health.  It may be one, a few, or all of these things, or just plain luck that keeps my child from getting sick; but if your child is the one who always catches the bug, you might try something different.

The germ theory of disease is well accepted, it has two parts:  A) a ‘germ’ is the agent that makes you sick & B) the ‘germ’ will only be successful in a specific environment.  If you do not want your child to live in a sterile bubble forever, you cannot put all your effort into part A.  Reasonable efforts in sanitation are important, such as washing your hands, and supporting a clean water supply.  Besides these simple preventative measures, you should put the bulk of your efforts into making your child a terrible environment for germ survival.

  1. Chiropractic Adjustments.  My son has had chiropractic care since day 2.  If the nervous system is working optimally, it can focus on other problems, like fighting sickness.  My son had lots of adjustments as a baby because his birth wasn’t easy and he had lots going on.  Once he was ‘up and running’ he was doing better.  His spine is checked at least once a month, more if he’s doing crazy stuff like taking big falls or seems to be having a rough time emotionally.
  2. Breastfeeding.  Entire books have been written on the immune system benefits of breastfeeding.  Breast really is best.  Not all babies have this advantage for one reason or another, this is not a mom failure, this is a society failure.  We need to do better for our moms & babies.  That aside, my son is a toddler, and I still nurse on demand.  Some research suggests that children should nurse until the immune system is fully developed at age 6.
  3. Love.  You didn’t expect to see this on this list, especially at #3.  The more I learn about emotional health, the more I believe it to be one of the most important and most neglected pieces of health.  Love your child.  Hug them.  Kiss them.  Snuggle them.  Support them emotionally.  A child needs to know they are loved in order to truly thrive.
  4. Happiness.  Yes, happiness counts, see #3.  I don’t mean give them what they want to make them happy, but I DO mean give them what they need:  love, snuggles, food, water, your attention.  Teach them approach the world in a way that it’s not so scary or hard.  Help them find happiness in their life, in the simple things.
  5. Parental contact.  Yep, skin-to-skin is powerful stuff.  For little kids and babies literal skin to skin with a parent is appropriate and necessary to hit the reset button sometimes, it can help regulate their nervous system and the rest of their physiology.  Hug your kids of any age often.  Wear your babies and toddlers.  Having a parent in physical contact can be huge.
  6. Physical Activity.  Kids should play often and hard.  Let your child run around and explore.  Little kids do this for lots of really good innate reasons.  Hopefully you can preserve this and you won’t have to twist their arm later in life to get off the couch.  Your child doesn’t NEED and organized sport to get exercise, but many parents find this a good way to make sure their little ones are moving their bodies.  Bikes, parks, etc. are your best friend.
  7. Fresh air.  I don’t care what the weather is; dress for it.  Babies in Norway are put in strollers to nap outside year round for good health.  My son naps indoors, but he gets outside every day for at least an hour.  Stale air is the worst and it’s almost always stale inside.  Bonus:  humidify your indoor air when it’s dry, dry air is irritating to the respiratory system.
  8. Sleep.  If you are doing all of the above, your child will naturally want to sleep and they should.  Sleep is when your body repairs itself and it’s vitally important for your whole health.  Sleep is a basic need, right up there with oxygen, food, water, and shelter.
  9. Microbiome care.  Everyone has a microbiome, these are the bacteria, fungi, and viruses that coat our entire body and digestive tract.  You want this to be a diverse, health-promoting group.  They fight off all the bad guys for you, digest your food, and generally help us survive & thrive.  Some people take probiotics, and I gave my son some as a newborn, but I believe probiotic supplements to be a stop gap measure.  It is far better to nourish your microbiome through food and proper exposures.  Proper exposures to acquire a healthy microbiome include:  a vaginal birth, breastfeeding, playing in dirt, having pets-especially dogs, eating fermented foods (yogurt, kefir, kimchi, sauerkraut, fermented pickles, etc).  Caring for your microbiome includes: avoiding processed foods, eating plant foods (fruit, veggies, beans, nuts, seeds, whole grains), avoiding antibiotics when possible (especially in soap!), and not sterilizing things-soap and water work just fine in daily life.
  10. Healthy, whole foods diet.  Processed food isn’t food, it is a stressor.  Eat real foods that have been around for generations:  fruit, veggies, whole grains, beans, nuts, seeds, meat, fish, dairy.  Sugar is not good for anyone, but it is part of our modern life.  It impairs immunity.  Try a ‘sugar budget’ for added sugar to not overwhelm your body (naturally occurring sugars, e.g. fruit, is free):  4 grams=1 tsp of sugar.  Kids 12 and under should only have a maximum of 3 tsp/day.  (Adults:  women 4 tsp, men 9 tsp.)  My child doesn’t know processed foods: no puffs, cereal, fruit snacks, etc.  He’s always eaten what we do once he started having solid food.  His current favorite snack is grape halves.  He eats pretty much everything, even Brussel sprouts.
  11. Vitamin D.  We are all deficient if we live north of Arizona.  Supplements are necessary.  How much?  More information at Vitamin D council.  Drops are typically easier to give kids.  My son has been taking Vitamin D since infancy and likes his drops that are in organic olive oil.
  12. Avoid Toxins.  You can’t avoid them completely and live on this planet.  I like it here, so I do what I can.  We use non-toxic cleaning and personal care products.  We eat lots of organic foods, but we aren’t perfect, but do make an effort to observe the Clean 15/Dirty 12.  Tap water is plentiful, but has it’s issues.  We use a Britta filter, but I am considering putting in a reverse osmosis system under the sink, they are more affordable than you think.  When we choose fish we make lower mercury choices.  I try to live lightly on the planet, because everything counts when it comes to polluting our planet.  If you haven’t clicked on any of these links, the Environmental Working Group is where I go to get help on lowering our toxin load.

This is a lot, try one new thing from this list at a time and slowly build a healthier child this season.

Chiropractic and the stress response

Stress is a big component to what ails us, hardly anyone in healthcare will debate this fact. The biggest killers of Americans, heart-disease and cancer, are stress related. If we could reduce stress and more importantly, it’s effects, we could live longer and better lives. Chiropractic care may be the key!

Stress of any type, chemical, physical or emotional will trigger the nervous system to unleash a body-wide chemical response including inflammatory chemicals, adrenaline (fight or flight hormone) and cortisol (stress hormone). Long-term elevated levels of these hormones will decrease the ability of your digestive, immune, and reproductive systems to operate at an optimal level as well as raising your blood pressure and glucose levels which can contribute to hypertension, diabetes, and heart disease. Your sympathetic nervous system is on alert, negatively impacting your ability to have rational thinking and interact with others in a sociable manner.

When you get adjusted, the positive proprioceptive information is sent to your brain through your spinal cord. It effectively hits the reset button in your brain. The stress hormone production decreases. Serotonin (happy hormone), dopamine (reward and motivation hormone) and oxytocin (love hormone) are released. This explains that relaxed and happy feeling that you sometimes get post-adjustment. Your parasympathetic and social Vagus nervous systems can now function at their appropriate levels, allowing you to rest, digest, and socialize in your best way. You can feel like yourself again!

When your brain is functioning in a less stressful way, you may find yourself more easily making healthier choices like drinking more water, craving healthier foods, and wanting to exercise. You might even consider quitting a nasty habit too!

No one is immune to the stress response, especially in modern society. The best ways to mitigate the impacts of stress in your life are regular spinal checks by a chiropractor, drinking water, appropriate sleep, eating a healthy diet, moving your body regularly, and spending plenty of time in nature.

Chiropractic Care in Pregnancy

As a Webster technique certified chiropractor, I specialize in perinatal chiropractic care. 

Under my care during your pregnancy, my goal is to support you in your journey into motherhood by decreasing stressors you will undergo while your body changes to accommodate your growing baby and prepares for a healthy birth for both of you.  The ultimate goal during this precious nine months is to optimize your health so you can care for your baby now, during birth, and postpartum.

In my care of pregnant mothers I utilize the Webster technique during all three trimesters.  According to the official definition of the Webster technique by the International Chiropractic Pediatric Association, the Webster technique is a chiropractic analysis and adjustment to restore proper neurobiomechanical function of the sacral/pelvic region.  Improper function in your pelvis may contribute to difficult labor for the mother by decreased nervous function, pelvic misalignment, and tightening and torsion and ligaments and muscles. All of these problems may also prevent the baby from comfortably assuming his/her optimal birth position.  

In addition to Webster technique I will also adjust other portions of your spine so that you may function optimally in all areas of your life.  (No one wants to go into labor with a neck that’s not quite right either! Relaxation of your whole body and mind is a critical piece of birthing.)  

Under my care you will also receive other support for your pregnancy in addition to the adjustment.  You can expect over the course of your pregnancy to get advice on proper nutrition and exercise, get answers to your questions about pregnancy and birth, and advice on newborn care and nursing.  When your questions or concerns fall outside my knowledge or scope, I can refer you to other resources in our community that can help you.

Chiropractic care for pregnant women is safe and comfortable.  If you are looking for a safer, easier birth and more optimal function in your pregnancy, call us today.

Update:  New research has shown that the Webster technique utilized in prenatal chiropractic care has the following benefits for mamas-to-be:  decreased fatigue, decreased pain, improved sleep, improved social satisfaction!

Informed Consent: Pneumoncoccal conjugate

Pneumococcal Conjugate Vaccine (PCV13)

What is this disease?

Pneumococcal disease is an infection by Streptococcus pneumoniae bacteria, aka “pneumococcus”. Although the name of this bacteria suggests that is the cause of pneumonia, pneumonia can be caused by many different things. S. pneumoniae is the most common cause of bacterial pneumonia. The most common cause of pneumonia in children under 5 years is viral; viral pneumonia cannot be treated with antibiotics and this vaccine does not prevent it. Viral pneumonia is typically mild. Many people (up to 90%) are carriers of S. pneumoniae and are not infected by the bacteria. Most infections of this bacteria are mild that may prompt the child to see a doctor if a fever is involved. This bacteria has been known to cause ear infections (about half of cases), sinus infections, pneumonia, meningitis, and blood infections.

This bacteria is spread through respiratory fluids, although it is uncommon for someone to contract an infection from an infected individual. This disease seems to be more prevalent in the winter and early spring. Children that are more susceptible to S. pneumoniae infection include those that are: missing spleen function, immunocompromised, in childcare and under the age of 2, have cochlear implants, and from these groups-Alaska Native, African American, American Indian (Navajo and White Mountain Apache).

Statistics

In the US, 90% of serious cases, and >95% of the deadly S. pneumoniae infection are in adults.

Annual Burden of Pneumococcal Disease in in US Children*

Syndrome Cases
Bacteremia 13,000
Meningitis 700
Death 200 cases
Otitis media 5,000,000 cases

*Prior to routine use of pneumococcal conjugate vaccine

The first vaccine for S. pneumoniae in US was cleared in 1977. The first conjugate vaccine in the US was in 2000, PCV7. The current vaccine PCV13 was cleared by the FDA in 2010, it vaccinates against 13 types rather than 7 but is otherwise the very much the same vaccine. The blue bars in the graph below are for invasive infections from all strains of the bacteria, the gray bars are those covered by the PCV13 vaccine.

In 2000, there were 14.5 million pneumococcal cases worldwide, in children under 5 years. 735,000 of those were fatal. The following maps depict the distribution of these cases.

How do you treat this disease?

Most mild cases will resolve without treatment. If infection with S. pneumoniae is suspected as sample will be taken to confirm infection. Treatment will be initiated with antibiotics once the infection is diagnosed from the sample, usually these will be taken by mouth and care is in the home. Antibiotic resistance is present in 3/10 of S. pneumoniae strains and specific antibiotics will be able to be chosen to fight these tougher infections from a sample. Antibiotic resistance is a serious problem we are facing today. Always finish a course of antibiotics prescribed to you. Do not pressure a physician to prescribe antibiotics as they are not appropriate for all infections, including viral infections.

Preventative measures include breastfeeding for up to two years of age, keeping your child out of big daycare centers, good hygiene & health habits, and avoiding smoking in the home.

How effective is this vaccine?

A large clinical trial comparing vaccinated and unvaccinated children showed that PCV7 reduced invasive infection by 97%, pneumonia by 20%, and ear infections by 7%. See the above bar graph.

Side-effects of vaccine

Children that have reacted to prior doses of this vaccine or the DTaP vaccine should not receive this vaccine. (Diphtheria toxoid is part of this vaccine.) If your child is ill, you should reschedule any vaccination appointment.

Adverse reactions to the conjugate vaccine: apnea (more common in premature infants), hypersensitivity reaction including facial edema, dyspnea, bronchospasm, anaphylactic/anaphylactoid reaction including shock, angioneurotic edema, erythema multiforme, injection-site dermatitis, injection-site pruritus, injection-site urticaria, and lymphadenopathy localized to the region of the injection site. These severe reactions occur at a rate of 8%.

In general, reactions tend to be more intense with subsequent boosters of the injection. Local reactions occur in up to half of children (e.g. swelling, redness, tenderness). Fever and body aches occur in a quarter to a third of children. Decreased appetite and/or irritability occur in 80% of children. Febrile seizures occur in up to 14% of children with this vaccine alone; however, in combination with the flu vaccine this increases to nearly 50%. (I am in general making no recommendations for/against vaccination in these blog posts as they are only intended for educational, informed consent purposes. However, given this data, if you choose to vaccinate your child against S. pneumoniae AND influenza my recommendation is to not have these vaccines administered to your child on the same visit).

Vaccine injuries listed by the National Vaccine Injury Compensation Program include: shoulder injury and fainting. To date (current July 2017), 7 cases have been compensated in vaccine injury court.

Vaccine Schedule

Standard US schedule is: 2 months, 4 months, 6 months, and 12-15 months.

Canadian schedules are by province/territory, most are 2, 4, and 12 months; some have the last dose at 18 months, and two have a 4 dose schedule much like the US.

Alternative schedules place this vaccine in a separate month as other aluminum containing vaccines and therefore recommend it be given at 3, 5, 7, and 12-15 months.

As with any decision to give your child a drug, you should read the insert to this vaccine before having it administered. There is only one version of this vaccine, Prevnar 13, made by Wyeth/Pfizer. You can find it before your appointment with a simple internet search. Do not give your child Tylenol before this vaccine as it can decrease the antibody response, which is the primary measure of effectiveness to vaccines.

References:

CDC Website

Mayo Clinic Website

National Vaccine Injury Compensation Data accessed 7/17/17.

Pediatrician websites (alternative schedule data only)

Prevnar 13 Insert, FDA website

Public Health Agency of Canada

WHO Website

Informed Consent: HIB

Haemophilus influenzae type b (Hib)

What is this disease?

Haemophilus influenzae is a bacteria. There are several types (a-f) and many untypable varieties. These bacteria have been found in the microbiome of humans. They can be benign or cause infection. Infection occurs almost exclusively in children under the age of 5 (85% of infections). It is a spread from respiratory tracts of infected people coughing or sneezing near susceptible people which then breathe in the bacteria. The bacteria does not survive in the environment. Peaks of the disease are September-December and again in March-May.

Infections include mild ear infections right up to serious infections called ‘invasive infections’. The most common non-invasive infections are ear infections and bronchitis.

An invasive infection is one that is in an area that is in an area where bacteria should not exist in your body such as your bloodstream, pleura (space around your lungs), or spinal cord. The most common invasive infections for Haemophilus influenzae are: pneumonia (lung; only invasive if infecting pleura or blood), bacteremia (blood), meningitis (brain & spinal cord), epiglotitis (throat), cellulitis (skin), and infectious arthritis (joint). Symptoms of the disease vary by organ that is infected. All will typically include fever.

Recurrent infections can occur in those under the age of 2. Those over 2 who have been exposed to Hib will likely develop immunity.

Morbidity & Mortality Stats

Fatal cases of Hib infection are at 3-6% in the United States. In 2015, the CDC estimates that the US had 1,600 cases of invasive infection in children under 5 years. In 2015, 1,015 deaths were attributed to Hib in children under the age of 5. Of note, these statistics are much better than the 2020 goal. Non-b and nontypable cases and deaths were higher than type-b in 2015. There were 23.9 million children in the US under the age of 5 in 2015.

Pre-vaccine incidence of Hib meningitis under the age of 5 in the majority of the US was approximately 50-60/100,000 per year, except in the southwest closer to 90/100,000 and in Alaska over 100/100,000. Pre-vaccination northern Canada, Alaska, and northern and central Australia had some of the highest rates worldwide. Pre-vaccination there was a 5% case fatality rate. Before vaccination (stats from 1985), it was estimated that there were 20,000 cases of invasive HIB infections in children 5 years and younger annually in the US. The U.S. population from 0-5 years in 1985 was 21.4 million children. Two-thirds of those children with invasive infections were meningitis cases. 15-30% of those meningitis cases had permanent effects from the infection and 4% of the cases were fatal. Other causes of bacterial meningitis in this age group include Group B Streptococcus, Streptococcus pneumoniae, Listeria monocytogenes, Escherichia coli, and Neisseria meningitidis. Vaccinations began in 1986 in the US. Vaccines at that time was a version known as the PRP which was shown in a trial in the 70s to have no efficacy in kids under 18 months.

Conjugate vaccines (which is used today) started in 1991. The conjugate vaccine job is to prevent nasopharyngeal Hib colonization. Before these vaccines, Hib could be isolated in 0.5-3.0% of all infants and children. Pre-conjugate vaccination it is estimated that there were 88 cases/100,000 children under 5 per year. Post-conjugate vaccination 1.6 cases/100,000 children under 5 per year.

How do you treat this disease?

Diagnosis is accomplished by testing the appropriate body fluid. It is treated with antibiotics, typically a 7-10 day course. Non-invasive cases may not require antibiotic treatment. Invasive infections are treated with antibiotics and typically require hospitalisation. Invasive infections can result in serious complications such as loss of limbs with blood infections and with meningitis loss of hearing and brain damage, even as severe as death. Successful treatment of meningitis leaves approximately 30% of children with some sort of permanent challenge, usually hearing loss.

Because fever is the only sign that is common in all of the invasive infections, here is a good review on how to manage fever. Most of the time fever (body temperature over 100.4 degrees Fahrenheit) is a healthy response that shows your child’s immune system is working properly to fight infection. Rectal thermometers are the best kind. Use these in smaller children. Use oral thermometers in older kids if rectal is not tolerated after they have not had anything to eat/drink for a while. Seek care if any of the following apply to your child:

  • Your child’s behavior changes dramatically, they have no interest in usual things such as food and play. In a baby they cry excessively and cannot be soothed.
  • Baby under 3 months rectal temperature is over 100.4 degrees Fahrenheit
  • Baby under 2 years with a fever lasting more than 24 hours
  • Child is over 2 and the fever lasts more than 3 days
  • Child of any age repeatedly spikes over 100.4 degrees Fahrenheit

Treat fevers in children at home with hydration, taking off their clothes/blankets, & giving them lukewarm baths. If any of the above apply, please call your healthcare provider.

How do you prevent meningitis infection?

The CDC recommends prevention by avoiding cigarette smoke, getting plenty of rest, and avoiding close contact with sick people in addition to the vaccination according to their standard schedule. They state on their site that the healthy lifestyle factors are especially important for young children, the elderly, those with weak immune systems, and those without a functioning spleen.

How do you prevent Hib invasive infections?

Current thinking is that a respiratory infection from a virus or a mycoplasma preceding the Hib infection may predispose a child to an invasive infection.

Breastfeeding is protective.

Pre-vaccination most children acquired immunity by age 5-6 from an asymptomatic infection of Hib.

How effective is this vaccine?

Since vaccination has been standard with the conjugate vaccine cases have dropped 99%. Clinical efficacy is stated to be 95-100%.

However, 36% of confirmed cases of invasive Hib infection in children aged 6 months-5 years, the child is fully vaccinated. The cause for this is unknown.

Side-effects and adverse events from of vaccine

Redness & swelling

Shoulder injury

Vasovagal syncope (fainting)

To date (6/26/17) 41 injury cases and 3 death cases have been filed with VAERS.

As always, before administering this or any vaccine to your child, please read the current insert of the particular version your child will be receiving. This can be obtained from the healthcare provider or the internet, different versions of the vaccine may be more appropriate for your child than others.

Different versions of this vaccine

PRP-T versions require 3 doses at 2, 4, and 6 months. These include: ActHIB, Pentacel, Hiberix, & MenHibrix

PRP-OMP versions require only 2 doses at 2 & 4 months. These include: PedvaxHIB & COMVAX.

Hib vaccines should never be given to a child under 6 weeks, a child who is currently ill, or a child who has had a reaction to a previous injection of Hib vaccine.

Boosters are also given at 12-15 months.

Alternative Schedules

Canadian schedule is 4 doses at 2, 4, 6, and 18 months.

In Europe 2-3 doses are given.

Alternative schedule A) 2,4,6,& 12 months with the ActHIB version recommended

Alternative schedule B) Aluminum-free version recommended at 3, 5, 7, & 15 months.

References:

  • CDC Website
  • Heikki Peltola. 2000. Worldwide Haemophilus influenzae Type b Disease at the Beginning of the 21st Century: Global Analysis of the Disease Burden 25 Years after the Use of the Polysaccharide Vaccine and a Decade after the Advent of Conjugates. Clin Microbiol Rev. 2000 Apr; 13(2): 302–317.
  • Hopkinsmedicine.org
  • Immunize.org
  • Pediatrician Websites for alternative schedule information.
  • Vaccine Injury Compensation data, accessed 6/26/17.
  • WHO website

Informed Consent: DTaP

In my efforts to help expedite your research on pediatric vaccines, here is one of the month 2 vaccines.

DTaP:  Diphtheria, Tetanus, & acellular Pertussis

Diphtheria

Diphtheria is a bacterial infection caused by Corynebacterium diphtheriae.  Once attached to the respiratory lining, the bacteria produces a toxin which kills healthy tissue.  This creates a gray buildup of dead tissue that create a pseudomembrane within 2-3 days that can block the throat or other passageways making breathing and/or swallowing difficult.  Toxin can also get into the bloodstream and cause problems with the heart, kidneys, and nerves.  Other symptoms include:  weakness, sore throat, fever, swollen glands.  Severe cases lead to coma, paralysis, and death.

Diphtheria is spread via the air (cough/sneeze) or contact (toy/clothes/wound).  It is typically spread in the winter and spring months.  Without treatment, the person is contagious for 2-6 weeks.  Risk factors for susceptibility to the disease are:  overcrowding, poor health, substandard living conditions, incomplete immunization, and immunocompromised people.  Infants are not typically susceptible to diphtheria as they care some immunity from in utero for 6-12 months, at which point this natural immunity wanes.  

Tetanus

Tetanus is a bacterial infection caused by Clostridium tetani.  The bacteria enters your body as a spore through a deep wound, incubation is 3-21 days (average of 10 days).  The wound can be a puncture wound, burn, etc.  This bacteria produces a toxin that bonds to your nerve endings and causes body wide muscle spasming.  The toxin cannot be removed from your nerve endings and you need to grow new ones which can take several months.  Complications of this disease are broken bones, pulmonary embolism, respiratory failure, and death.  

Tetanus is found in soil, dust, and manure and is not spread from person to person.  Although the bacteria is found world-wide, it is most prevalent in densely populated regions in hot, damp climates with soils rich in organic matter.  

Pertussis

Pertussis is a highly contagious bacterial infection caused by Bordetella pertussis.  The bacteria enters your body from contact with another person or respiratory droplets.  An infected person is contagious for about 2 weeks after the cough begins.  Even vaccinated people may be infected.  Incubation is 5 days to 3 weeks.  This bacteria produce a toxin that damages the cilia and cause airway swelling.  

This disease looks very similar to a cold.  In babies, the disease can cause apnea, or a pause in their breathing.  This disease can be serious in babies and 50% of those that catch it will need to be hospitalized.  After two weeks of infection that looks like a cold, the next 1-10 weeks are filled with terrible coughs that may be worse at night, make you have a ‘whooping’ inhale due empty lungs, vomiting and exhaustion are common after coughing fits.  After this stage, there is a 2-4 week ‘recovery’ stage where there is less severe coughing and the symptoms are cold-like again; during this final stage people may be more susceptible to other respiratory infections.  Primary natural immunity gained through infection lasts 4-20 years.

Statistics

Diphtheria

Before treatment and prevention methods were available, 50% of those infected died.  In 1921, there were 206,000 cases and 15,520 deaths.  Currently the case-fatality rate is 5-10%, up to 20% in those under 5 and over 40.  Between 2004-2015 there were thankfully only 2 cases in the US.  Worldwide, there were 4,778 cases in 2015.  Since 1980, there has been no greater than 5 cases in the US annually.  In recent times there have been outbreaks of the disease in eastern Europe and Russia.

Vaccination began in the 1920s in the US.

Tetanus

29 US reported cases 1996-2009.    Tetanus is more of a problem in undeveloped areas of the world.  

Vaccination began in the 1940s in the US.  

US Tetanus cases and deaths from 1900.

tetanus-incidence-1900-2009

US Tetanus cases and deaths from 1947 per million people.

tetanus-incidence

Pertussis

According to WHO, pertussis is a world-wide problem for infants, especially those in developing countries.  Worldwide,  they estimated 16 million cases in 2008, 95% were in developing countries.  In 2008, 195,000 children died from pertussis.  In 2008, 82% of world infants had 3 vaccinations for pertussis; the WHO goal is 90%.  WHO states that “Although vaccination can prevent pertussis in adolescents and adults, there is insufficient evidence to support the addition of vaccine boosters in these age groups for achieving the primary goal of reducing severe pertussis in infants.”

Pertussis incidence was on a steady decline from the time reporting was mandatory in 1922.  In recent times there has been an increase of pertussis in the US.  Globally, there has also been a modern increase in incidence.  The following figure illustrates this as well as when various versions of the vaccine were introduced.   In 2014, there were 32,971 cases reported in the US.

pertussis-1922-incidence

The following graph illustrates the modern increase by age group in the US.

pertussis-1990-incidence

How do you treat this disease?

Diphtheria

Even with treatment, diphtheria currently kills 3% of those that contract it.  This rate is higher in those under age 15.  Treatment typically involves ICU care and involves antitoxin and antibiotic treatments as well as possible removal of pseudomembrane blockages to the airways.  

Tetanus

There is no cure for this disease.  It is managed by injecting an anti-toxin which can block un-bonded toxin from binding to nerves.  Antitoxins were discovered in the late 1800s and used in World War I.  Antibiotics will be given to kill the bacteria.  Sedatives and other drugs are given to decrease the spasming.  Lengthy ICU stays are common and necessary to provide supportive care.

In 1984 there was a study in Bangladesh that utilized 1 gram of IV ascorbic acid (Vitamin C) in tetanus treatment, which was effective.  There have been no follow-up studies on this.

Prevention is possible by thorough cleaning of wounds and leaving deep wounds open to the air.  Tetanus thrives in an anaerobic environment.  Neonatal tetanus is possible if birth occurs in a dirty environment.  Neonatal tetanus is typically fatal.  

Pertussis

Pertussis can be treated with antibiotics, but if you have been infected for over 3 weeks, they will not be helpful as a normal immune system will have already eliminated the bacteria from your body.  Aside from following prescribed antibiotic directions, there are several things you can do to aid recovery:  avoid airborne irritants such as smoke, chemical fumes, and dust, use a cool mist vaporizer, hydration, and good sanitary practices.

If a child is hospitalized, they may be given antibiotics and/or IV fluids.  Keeping the airways clear and the child well-oxygenated is the key goal of hospital treatment.

How effective is this vaccine?

Since vaccination began in the 1920’s, diphtheria has significantly lessened the impact of the disease in the US and worldwide.  A case-control study (conducted in 1993) in Russia during an outbreak demonstrated that 3 or more doses of the vaccine were 97% (94.3%-98.4%) effective.  This same study showed 5-6 doses to be 99.0% (97.7%-99.6%) effective compared to unvaccinated children.  

To date, there have been no studies done on the effectiveness of the tetanus vaccination.  

The effectiveness of the pertussis vaccine is short-lived in most.  A recent Canadian study on the acellular vaccine shows that those that are up-to-date with the pertussis vaccination have an 80% (71-86%) effectiveness within one year.  From 1-3 years post vaccination (when up-to-date) the vaccine is 84% (77-89%) effective.  After that, effectiveness drops dramatically as time passes.  In those that are partially vaccinated, effectiveness is even lower.  

Contraindications, Complications & Side-effects of DTaP vaccine

The CDC recommends postponing vaccination if your child is ill until after they recover from a current infection.  

Children who have had a serious side effect or allergic reaction to a previous DTaP should not have another dose.  

Any child who suffered a brain or nervous system disease within a week of prior vaccination should not be given further DTaP.  

Special consideration should be taken before booster shots if with a previous DTaP injection, the child had a seizure, collapsed, cried non-stop for 3 hours, or had a fever over 105 degrees.  For those children, having a version without pertussis may be better.

Side effects of the DTaP vaccine include: fever (25% of kids), redness/swelling in injection site (25% of kids), soreness at injection site (25% of kids).  Swelling of entire extremity happens in later doses in 14% of kids.  Other problems:  fussiness (33% of kids) fatigue/anorexia (10% of kids), vomiting 2% of kids.  All of these problems are common and occur within 1-3 days of the shot.

Other, more uncommon though more serious problems:  seizures, 3 hours or more of constant crying, fever over 105 degrees, serious allergic reaction.  Rare, severe long-term problems that have been reported include long-term seizures, lowered consciousness, coma, and permanent brain damage.

You are encouraged to go to the FDA site and read the inserts for the DTaP vaccine your child will be receiving.  

Vaccine Injury Data:  October 3, 2016  

Data for DTaP only, not other versions or combination vaccines.  Please go to http://www.hrsa.gov/vaccinecompensation/data/index.html for current data on various vaccines.

Claims filed:  494

Deaths: 80

Compensation Awarded:  205

Of note:  to date, 39% of all compensated claims for vaccine injury were for versions of diphtheria, tetanus, and pertussis vaccines, including combination vaccines.

Adverse Reaction and reporting interval for VAERS:

  • Anaphylaxis or anaphylactic shock (7 days)
  • Brachial neuritis (28 days)
  • Encephalopathy or encephalitis (7 days)
  • Any acute complications or sequelae (including death) of above events (interval – not applicable)
  • Events described in manufacturer’s package insert as contraindications to additional doses of vaccine (interval – see package insert)

Different versions of this vaccine

There are 6 branded versions of this vaccine and one generic.  I will list the two that are actually DTaP here, the others add in other vaccines.  The generic does not protect against pertussis.  

Daptacel from Sanofi Pasteur.  This version contains less aluminum and formaldehyde than the Infanrix.

Infanrix from GlaxoSmithKline.  

I highly recommend you read the inserts of these on the CDC’s website when choosing the appropriate version for your child:  http://www.cdc.gov/vaccinesafety/vaccines/dtap-tdap-vaccine.html

Timing of vaccination

The US recommended schedule is 5 doses at:  2 months, 4 months, 6 months, 15-18 months, and 4-6 years.

The Canadian recommended timeline varies among provinces, and includes 6 doses.  They also use several different combo vaccines at different times.  Children in Canada are recommended to have their doses at 2, 4, & 6 months, 18 months, age 4-6, and in 7-11th grade.

Alternative schedules:  

2,4,& 6 months, 18 months, 4-6 years for DTap and then Tdap at age 10 with boosters every 5-10 years.

OR

2, 4, & 6 months, a Tetanus booster at age 7, and another Tetanus booster at age 17.

References:

Bisgard, KM, et al.  2000.  Diphtheria toxoid vaccine effectiveness:  a case-control study in Russia.  The journal of infectious diseases, 181:  S184-S187.

CDC

Clark, TA.  2014.  Changing pertussis epidemiology:  everything old is new again.  Journal of infectious diseases, 209:  978-981.

Jahan, K, et al.  1984.  Effect of ascorbic acid in the treatment of tetanus.  Bangladesh Medical Resource Council Bulletin, 10: 24-28.

Mayo Clinic

Medscape summary of Diphtheria, by Bruce Lo et. al.

Schwartz, K.L.  2016.  Effectiveness of pertussis vaccination and duration of immunity.  CMAJ, published online September 2016, early release.

WHO

Alternative schedule information from pediatrician websites.