Why Vaccines Matter

[PinkyandtheBrains.]

I don't understand the "modified schedule" or delayed schedule, or all the talk of it being too many vaccines at once. I have read many times that even the times when a baby get 4 shots on one visit, the amount of immune challenge that this introduces is far less, scientifically speaking, than licking a shopping cart (all my kids did this a few times) or playing on a playground with germy kids. 

 

In our case it was to better manage the side effects.  By doing less jabs at one time we could identify which were causing side effects and not getting a double whammy of more than one contributing.  We still fully vaccinated and weren't too much behind schedule. 

[Kathryn]

In our case it was to better manage the side effects. By doing less jabs at one time we could identify which were causing side effects and not getting a double whammy of more than one contributing. We still fully vaccinated and weren't too much behind schedule.

This. My oldest had allergies. The rotavirus vaccine wasn't around for him, but if it was, he would have reacted to its ingredients. We spread out his brother's shots so we'd know what he was reacting to if he had a reaction.

[Guest]

From one controversial topic to the next.

 

This reminds me of the uncircumcised men having more of a risk of HIV. I did not circumcise my boys. I'm not concerned about it. My FIL isn't. They've never had issues, aren't concerned about it.

 

It's odd considering that the majority of males *are* circumcised, and if HPV is so common to be a problem?....

 

....That doesn't compute. Especially since the media and <ahem> industries that would promote sexual promiscuity do not typically hold up an uncircumcised male as the ideal.

 

I'd say multiple partners and unsafe sex is more of concern here than circumcised or not.

 

I'd also say that certain studies using third world countries as a basis for study are a problem (I've seen quite a few of those) Hygiene and access to medical care being a big factor as well.

 

Gardisil and other HPV vaccines are a big issue. Of all of them, I truly believe that one can cause more harm than good.

See, you are biased against thinking your sons are a "risk category" because of uncirc. HPV is very common, circumcised or not. Most people have it at least once at some point; it is frequently asymptomatic.

 

I have read numerous times that uncircumcised males ARE more likely to contract STD and STIs. There is more hiding and breeding area for viruses. It bugs me when mothers who have chosen not to circumcise are unwilling to consider that this statistic does actually apply to their son(s).

[Upennmama]

In our case it was to better manage the side effects.  By doing less jabs at one time we could identify which were causing side effects and not getting a double whammy of more than one contributing.  We still fully vaccinated and weren't too much behind schedule. 

But if each vax has preservatives and other things which some might consider dangerous, then combining as many vaxes as possible into one shot makes sense. Then you get the biggest bang for the smallest risk. The actual diseases themselves- the bit of CP virus or the pertussis or whatever, is actually not a big immune challenge, and yet I hear person after person talking about how much of a huge immune challenge it is to have 4 shots on one day, and that's why they're spacing them out. Makes no sense. 

[PinkyandtheBrains.]

But if each vax has preservatives and other things which some might consider dangerous, then combining as many vaxes as possible into one shot makes sense. Then you get the biggest bang for the smallest risk. The actual diseases themselves- the bit of CP virus or the pertussis or whatever, is actually not a big immune challenge, and yet I hear person after person talking about how much of a huge immune challenge it is to have 4 shots on one day, and that's why they're spacing them out. Makes no sense. 

 

I think you are misreading why we spaced them out.  This is not the reason.

[DesertBlossom]

Also, I think it is ironic that the crunchy crowd speaking out against circumsising their sons has unwittingly placed their sons in the "risk factor" category. I can't be certain, but I'm guessing more of the young men amongst homeschool populations are uncircumsized than in the larger public, just given the tendencies of homeschoolers to be iconoclastic.

 

 

 

This probably needs it's own thread, but I'll address it anyway.  This idea that circumcision increases one's "risk" is hotly debated.  Circumcision is not a guarantee that a person will not contract an STD. Condoms and safe sex practices are far more effective at preventing STDs than simply cutting off a child's body part. (And even a circumcised man should be wearing a condom)   Nevertheless, the only reason we can bring up circumcision as a preventative measure against STDs is because in the US we have been led to believe that the foreskin is an "extra" piece of skin that doesn't do anything except cause problems and that it can removed without consequence. That is simply not true. The foreskin is highly erogenous tissue that is important during intimacy, not only for the man, but also for his partner. Removing it absolutely has consequences.  Ask me how I know!  If a grown man believes that being circumcised reduces his risk of STDs, fine. But we should not be permanently altering our children's genitals when we have no idea what their future sexual practices are going to be anyway. Leave it for them to decide.

 

 

I have read numerous times that uncircumcised males ARE more likely to contract STD and STIs. There is more hiding and breeding area for viruses. It bugs me when mothers who have chosen not to circumcise are unwilling to consider that this statistic does actually apply to their son(s)

 

It bugs me when mothers think they have the right to permanently alter their child's genitals. My husband is really upset that he didn't have a say about his own body.  Whether or not circumcision reduces ones risk doesn't matter. The only person who can give consent to removing a healthy part of their body is the person undergoing surgery. 

 

ETA: And I apologize for further derailing the thread. While I think a lot of the same people who question circumcision also question vaccines, they are two totally separate subjects.

 

[Crimson Wife]

As you can see from my post above, I am/was on the fence about the Gardasil vaccine, so I am not a gung-ho defender of it.  But your young adult could be raped and infected that way, and that has nothing to do with the girl's personal sexual choices.

 

Which is why regular gynecological care including Pap smears is so important. The overwhelming majority of cervical cancer deaths occur among women who either lack access to healthcare or who choose for whatever reason not to regularly see a gynecologist/midwife/PCP. Gardasil may provide some level of protection (though it appears to wear off after only 3-5 years), but it's no substitute for good healthcare.

[barnwife]

I don't understand the "modified schedule" or delayed schedule, or all the talk of it being too many vaccines at once. I have read many times that even the times when a baby get 4 shots on one visit, the amount of immune challenge that this introduces is far less, scientifically speaking, than licking a shopping cart (all my kids did this a few times) or playing on a playground with germy kids. 

We do a delayed schedule. One reason for us is that if a child were to have a reaction it would be easy to identify the cause.

[Guest]

It bugs me when mothers think they have the right to permanently alter their child's genitals. My husband is really upset that he didn't have a say about his own body. Whether or not circumcision reduces ones risk doesn't matter. The only person who can give consent to removing a healthy part of their body is the person undergoing surgery.

 

ETA: And I apologize for further derailing the thread. While I think a lot of the same people who question circumcision also question vaccines, they are two totally separate subjects.

I find that a bizarre statement, because parents do routinely affect all aspects of their children's future life and body by the decisions they now make based on available evidence. Strangely enough, not circumcising and not vaccinating both could impact the child's health. Circumcision and vaccination could both impact the child's health.

 

P.s. I don't think it is a thread derailment. Both issues are important and connected.

[MomtoCandJ]

 

This probably needs it's own thread, but I'll address it anyway. This idea that circumcision increases one's "risk" is hotly debated. Circumcision is not a guarantee that a person will not contract an STD. Condoms and safe sex practices are far more effective at preventing STDs than simply cutting off a child's body part. (And even a circumcised man should be wearing a condom) Nevertheless, the only reason we can bring up circumcision as a preventative measure against STDs is because in the US we have been led to believe that the foreskin is an "extra" piece of skin that doesn't do anything except cause problems and that it can removed without consequence. That is simply not true. The foreskin is highly erogenous tissue that is important during intimacy, not only for the man, but also for his partner. Removing it absolutely has consequences. Ask me how I know! If a grown man believes that being circumcised reduces his risk of STDs, fine. But we should not be permanently altering our children's genitals when we have no idea what their future sexual practices are going to be anyway. Leave it for them to decide.

 

 

 

 

It bugs me when mothers think they have the right to permanently alter their child's genitals. My husband is really upset that he didn't have a say about his own body. Whether or not circumcision reduces ones risk doesn't matter. The only person who can give consent to removing a healthy part of their body is the person undergoing surgery.

 

ETA: And I apologize for further derailing the thread. While I think a lot of the same people who question circumcision also question vaccines, they are two totally separate subjects.

And this is why I'm glad I have girls (sorry), I don't have to worry about such decisions :)

[JessReplanted]

Just anecdotal evidence, but I personally know of two babies that died suddenly of unknown causes the night after being vaccinated. (Not SIDS) I did decide to vaccinate my kids, but I deliberated long and hard about it.

 

How scary. Do you know which vaccines they had? We delay vaccines, and even though my daughter only had one shot at her last appointment, she was still sick with a fever the next day. I hate the whole topic of vaccines. It's scary to vax and scary not to.

[Reefgazer]

However, by the time HPV causes cytological effects or cancer/pre-cancer is discovered, a woman *already* has a problem that requires invasive and painful procedures (at the very least, a biopsy).  Gardasil is preventive against the 2 strains that cause more than 70% of the disease, and another 2 that cause more, and can prevent cervical cancer deaths even in the absence (for whatever reason) of PAP screenings.  In the long run, if it works as touted, it will reduce health care costs and painful procedures.

Which is why regular gynecological care including Pap smears is so important. The overwhelming majority of cervical cancer deaths occur among women who either lack access to healthcare or who choose for whatever reason not to regularly see a gynecologist/midwife/PCP. Gardasil may provide some level of protection (though it appears to wear off after only 3-5 years), but it's no substitute for good healthcare.

 

[umsami]

 

 

When it comes to Gardasil, I think that safe sex practices and regular check ups do more good than the vaccine.

 

Sorry, but that's simply not true.  Why? Your daughter can't determine her future partners' histories.  Pap smears can diagnose an anomaly but they surely don't prevent it.  When I was 30 or so, I had an abnormal pap.  It was CIN I.  I had gotten paps every year since I was 18…even before I was sexually active.  (Maybe overkill…but I did.)  I had been with one person.  I ended up going through a colposcopy…which is the most horrific pain I've ever experienced, and I've had two of my kids without anesthesia.  Little pinch my #UI@#.  I also needed a LEEP procedure.  

 

Your daughter can be a virgin when she marries.  She can be faithful to one person.  You have no idea what the sexual history of her partner will be.  Even if he tells her that he was a virgin, you really have no idea.  Also, in some circles, they go by quite technical terms (meaning vaginal only)….and they can still have HPV.

 

Cervical cancer still kills 4000 women each and every year in the US.  

Oral cancers still kill 8,000 per year.  The mortality rate for oral cancers is high because they are diagnosed late.  

These are real deaths that far surpass even the most paranoid anti-Gardasil website estimates of death from vaccines. These are only in the US.  The deaths worldwide are far greater.

 

I will encourage my daughters and sons to get the HPV vaccine when possible.  If it reduces their chance of not only cervical, but also oral cancer, great.  The study I posted on nearly 200,000 people showing no fatalities, etc. is not the only study.  The Danes (love socialized medicine) looked at how it is impacting HPV lesions among vaccinated and non-vaccinated people.  "“Our study reveals a reduction of between 40 and 80 percent of cervical precursor lesions in vaccinated women compared to non-vaccinated women. We assume that this figure also applies to the risk of subsequent development of the disease.â€

 http://sciencenordic.com/hpv-vaccine-effective-danish-women

 

That is pretty darn great.

 

I would not wish a colposcopy on my worst enemy.  I would never want to hold my daughter's hand through one, knowing that there was a vaccine that could have reduced her risk of having it by 40-80%.

[Reefgazer]

There are only 4 strains of HPV that cause the vast majority of cervical cancers, and strains 16 and 18 are responsible for upwards of 70% and have the highest mortality rates.  I worked for the company that did the original research on HPV (it was my department, in fact).  To test the early immunoassays, we went to the hospital and got cone biopsies and screened them for 16 and 18 and rejected the rest.  It's the most cost effective way to prevent cancer by targeting the most virulent strains. 

But there are over 100 different strains of HPV and 30 of them affect the reproductive organs. Gardisil and Cervarix only protect against type 16 and 18. Also to really protect against a tumor which can be slow growing, they would need to be affective for up to 15 years and right now they seem to only be good for 5 years. Right now I don't know of any long term studies having been done on either of those vaccines. Regular pap smears are a more sure fire way of protecting ones self as early detection of cervical cancer puts the cure rate at 92%.

 

The Cancer Society says the biggest risk for HPV is having multiple partners, having sex young (16 or earlier), and or having an uncircumcised male partner.

 

[Reefgazer]

This makes no sense.  A parent is the guardian of their minor child and charged with making all health care decisions for them.  That includes circumcision, pulling of wisdom teeth that may cause mouth problems in the future, altering their brain chemistry with ADHD drugs, amputating a leg in the case of bone cancer, as well as things like removing the ovaries and breasts of an adult daughter who has the gene for ovarian cancer and is mentally disabled/incompetent and who in their parents' permanent custody.  Would you also suggest that parents have no right to make decisions about wisdom teeth and leg amputation?  Until my children are 18, I  and my DH make those decisions.

 

This probably needs it's own thread, but I'll address it anyway.  This idea that circumcision increases one's "risk" is hotly debated.  Circumcision is not a guarantee that a person will not contract an STD. Condoms and safe sex practices are far more effective at preventing STDs than simply cutting off a child's body part. (And even a circumcised man should be wearing a condom)   Nevertheless, the only reason we can bring up circumcision as a preventative measure against STDs is because in the US we have been led to believe that the foreskin is an "extra" piece of skin that doesn't do anything except cause problems and that it can removed without consequence. That is simply not true. The foreskin is highly erogenous tissue that is important during intimacy, not only for the man, but also for his partner. Removing it absolutely has consequences.  Ask me how I know!  If a grown man believes that being circumcised reduces his risk of STDs, fine. But we should not be permanently altering our children's genitals when we have no idea what their future sexual practices are going to be anyway. Leave it for them to decide.

 

 

 

It bugs me when mothers think they have the right to permanently alter their child's genitals. My husband is really upset that he didn't have a say about his own body.  Whether or not circumcision reduces ones risk doesn't matter. The only person who can give consent to removing a healthy part of their body is the person undergoing surgery. 

 

ETA: And I apologize for further derailing the thread. While I think a lot of the same people who question circumcision also question vaccines, they are two totally separate subjects.

 

 

[Artichoke]

In our case it was to better manage the side effects. By doing less jabs at one time we could identify which were causing side effects and not getting a double whammy of more than one contributing. We still fully vaccinated and weren't too much behind schedule.

Yes, this is us. We have one out of our four children who had negative reactions to vaccines. Thankfully, the reactions were mostly just vomiting and somewhat high fevers. We began to delay ( which really was just spreading out vaccines ) after these reactions. Now as an adult, ds is a world-traveler who still chooses to vaccinate before going to less developed areas.

[hillfarm]

 

A lot of things change, often for the better. Sometimes not. I hear all kinds of arguments about vaccines and people can have their own opinions even if I disagree but this attitude is the hardest for me to understand. Yes, the shot recommendations have changed. We've learned new things. We'll probably learn more. Some of the shots may go away (like smallpox which I'm just old enough to have gotten). Some new ones may get recommended. Maybe in 20 years the current crop of doctors will all look at what we are doing now the saw way we look at leeches (which are actually making a comeback). But it always surprises me that people are surprised that medicine, which is at least in part a science, changes. 

 

I think the reason many are surprised by this is that our physicians often tend to present themselves to us as infallible and all knowing. They react poorly when questioned and presume that we, as mere parents, could not possibly know what is best for our children. Particularly when it goes contrary to what the hallowed APA recommends.

 

So why is it hard to understand that parents who are told with 100% certainty that X is true find it hard to believe that medicine changes and that next week/month/year/baby these immutable "truths" have been changed? A doctor, who made it clear that he knew more than they did, assured them X was true and ridiculed them for questioning it. So they find it hard to imagine that it has now been determined that X is not true.

 

Yes, science and medicine changes. But the medical profession can't have it both ways. Either they are the gods/experts so many claim to be and their every utterance is true and should never be questioned, or things change and they are just as human as the rest of us and may unwittingly be making mistakes right and left. And therefore deserve to be closely scrutinized and questioned.

 

We have chosen to selectively vaccinate on our own schedule based on likelihood of disease exposure, severity of the disease, possible side effects of the vaccine, and the reactions observed in our dc. We were very fortunate to have an excellent pediatrician who was willing to discuss with me which vaccines he thought were important and why, but who left the final decision up to me, with absolutely no pressure. Our current physician is more "typical;", but still a pretty decent guy even though a bit too enamored of the APA for my tastes.

[swellmomma]

I don't understand the "modified schedule" or delayed schedule, or all the talk of it being too many vaccines at once. I have read many times that even the times when a baby get 4 shots on one visit, the amount of immune challenge that this introduces is far less, scientifically speaking, than licking a shopping cart (all my kids did this a few times) or playing on a playground with germy kids. 

In our case we did a delayed schedule for dd6 because when she went for her 2 month shots she had a severe reaction and there was no way to know for sure which of the 3 jabs she got caused it.  Yes it was reported and taken seriously enough that we were told by the person from the CDC that was in contact after our report had been filed via the health nurse (that is who gives the shots here) not to vax dd again unless the risk of infection was higher than the risk of the vax itself-meaning if measles hit the local area she would be vaxed).  Anyway, when she was 2 I had been contact with the health nurse and she with our ped and the CDC because there was in fact a measles outbreak.  While the 3 of them were conferring back and forth about the risk to dd, she was attacked by a cat in the neighborhood.  In addition to the regular medical treatment we felt this was a time with the risk of infection was worse than the risk of vax.  She was given tetanus globulin in her leg and a week later when she did not have an adverse reaction to it we continued with the regular DTaP-HiB shot.  Again no reaction.  We proceeded to continue vaxing her 1 vax at a time, with the health nurse, ped and cdc person conferring to track how she was doing.  Now at 6 she is up to date with the ones we did.  She has never had a pneumococcal vax, her risk of getting sick were miniscule at the ages she would have started the series so it was advised we don't bother.  She has never had the CP vax at my decision.  She has never had a flu shot.

 

Out here the school forms just have a check box "are your child's vaccines up to date" you check yes or no, no formal exclusion needed.  Homeschools generally don't even ask.  Camps and such do but again it is just a check box question.  While some parents I have spoken to have felt the health nurse or dr judged them for not vaxing I have never found that.  Even with my kids that did not have issues with past vaxes, I am selective in what they have had, and even stopping a series part way I have never felt judged or pressured to do vaxes we did not feel confident about.  It is possible that they tend to push families that seem wishy washy in their stance towards vaxing but not those that stand firm in their decisions to do what is best for their kids, I don't know.  But really I have never really noticed a push one way or the other from the health nurses (the ped will sometimes asks at well baby checks about them and is more likely to push but like my other parenting decisions that are not mainstream I remind him I am the one making those decisions, he isn't)

[swellmomma]

Sorry, but that's simply not true.  Why? Your daughter can't determine her future partners' histories.  Pap smears can diagnose an anomaly but they surely don't prevent it.  When I was 30 or so, I had an abnormal pap.  It was CIN I.  I had gotten paps every year since I was 18…even before I was sexually active.  (Maybe overkill…but I did.)  I had been with one person.  I ended up going through a colposcopy…which is the most horrific pain I've ever experienced, and I've had two of my kids without anesthesia.  Little pinch my #UI@#.  I also needed a LEEP procedure.  

 

Your daughter can be a virgin when she marries.  She can be faithful to one person.  You have no idea what the sexual history of her partner will be.  Even if he tells her that he was a virgin, you really have no idea.  Also, in some circles, they go by quite technical terms (meaning vaginal only)….and they can still have HPV.

 

 

Snipped for brevity. 

 

The bolded is so true.  My gramma was a virgin when she married, she was faithful to her husband, he was not.  They ended up divorcing and she remarried.  Her 2nd husband was her 2nd partner, she was his 2nd.  She ended up dying from cervical cancer.  The dr's told her that she likely contracted HPV from her first husband we was a drunk, abusive asshole in the navy with a skirt in every port and several close to home.  

 

As well though I hope my dd waits until marriage, being a young lady she is at risk of sexual assault. Like dealing with rape isn't enough, what if she contracted HPV from that assault. The stats have said 1 in every 17 Canadian women will be raped at some point in their life time. Teaching her to wait until marriage before she consents isn't enough to ensure she makes it there unscathed.  I may not be always there to protect her from a monster that does that, I can at least try and protect her from HPV that can be contracted that way.  I can only wish there was vaxes against the predators in the first place. 

[DesertBlossom]

I find that a bizarre statement, because parents do routinely affect all aspects of their children's future life and body by the decisions they now make based on available evidence. Strangely enough, not circumcising and not vaccinating both could impact the child's health. Circumcision and vaccination could both impact the child's health.

 

P.s. I don't think it is a thread derailment. Both issues are important and connected.

 

 

This makes no sense.  A parent is the guardian of their minor child and charged with making all health care decisions for them.  That includes circumcision, pulling of wisdom teeth that may cause mouth problems in the future, altering their brain chemistry with ADHD drugs, amputating a leg in the case of bone cancer, as well as things like removing the ovaries and breasts of an adult daughter who has the gene for ovarian cancer and is mentally disabled/incompetent and who in their parents' permanent custody.  Would you also suggest that parents have no right to make decisions about wisdom teeth and leg amputation?  Until my children are 18, I  and my DH make those decisions.

 

But you can't compare circumcision to any other health related decision that we make for our children.A foreskin is not a birth defect. A normal penis statistically is not ever going to cause problems for the boy or man. We don't cut off any other healthy tissue from our babies' body as "preventative" medicine. My grandfather remembers being lined up AT SCHOOL to undergo a tonsillectomy along with all of his classmates. He said one kid lost so much blood he didn't come back for a long time. Nobody would suggest doing that today. We don't remove body parts from children unless absolutely necessary.

 

The problem with circumcision is that despite whatever health benefits you think it may provide, you are removing tissue that will (and not just "might" it WILL) affect sexual function later on (whether or not even those circumcised men realize it). There is a reason boys are born with a foreskin. It's not extra. It serves a purpose. We should not be removing part of child's genitals without their consent unless it's absolutely medically necessary-- as in, there is an immediate problem that needs to be addressed. Statistically, a child is actually more likely to suffer from a complication from their circumcision than to ever have a problem with their foreskin. For example, one in 20 will develop meatal stenosis. Many will suffer from painful adhesions. Many adult men suffer from painful erections because too much skin was removed as an infant. Many women will think something is wrong their bodies when sex hurts, not realizing that it's because their partners lack the mobile skin and natural lubrication of their foreskins.

 

There are many decisions that we make for our children that can not wait until they are able to weigh the pros and cons for themselves. I have one child born with a birth defect that would have been crippling had it not been addressed immediately. I have another child with Type 1 diabetes who doesn't get a say in whether or not she has to test her blood sugar or receive insulin. She knows she just has to do it.  But I don't have to make a choice about any of my children's genitals. I can leave it alone and they will not be affected in any way. At some point we will teach our sons what the research says, and at that point he can make the choice for himself. Of all the choices I make for my children's health, I do not believe that cutting  off part of their genitals is one of them. 

[NASDAQ]

Re: Rotavirus. My third child had rotavirus as an option but it wasn't on the MSP (b. 2010). My fourth had rotavirus on the regular schedule (b. 2012). So rotavirus was introduced somewhat later in Canada than in most of the US, but it's standard in BC now, as of 2012.

 

ETA: According to the CBC, rotavirus vaccine is recommended but is not covered by MSP in provinces other than BC, Quebec, Ontario, and PEI. But it appears to be a funding issue rather than a safety issue. This was from an article in late 2012 so other provinces may have changed their policies since then.

[mommymilkies]

I also don't think it's fair to say that because someone doesn't vaccinate, they aren't looking at the science. Overall the science for vaccines seems convincing, and maybe it is (although there are ample statistics showing a huge drop in many of those diseases BEFORE the vaccines were introduced, likely due to improved medical care), but many aren't willing to take the risks of side effects. Yes, the risks are small (smaller with some vaccines than others), but they are REAL. The CDC website lists them all, so it isn't tainted, biased information. I think everyone is entitled to make an informed choice based on what works for their family.

 

Thank you.  I worked in healthcare and my dh worked in pharmaceuticals (QA).  It was partially his work experience and professional research which led us to stop vaccinating.  Now that my kids are older, I am researching the safest possible options out there and titres to check where they should be for what they are not likely to get exposed to (like rubella).  But it really angers me that people stereotype those who do not/delay/recombine vaccinations to be ignorant.  Most of the people I know who are on alternative schedules are in the sciences or healthcare professions or had children who were personally injured by their vaccinations.  A little more respect for parents making decisions for their children would be nice.  

 

FWIW,  my dh,  kindergartener, and 2 yo caught pertussis in 2007.  All had had vaccinations for it, but I think the 2 yo was due for one.  Her case was the most mild (she was also breastfeeding).  I had titres showing my immunity from my last job in a medical lab.  Dh needed abx for a secondary infection, but none of their cases were severe. 

[mommymilkies]

See, you are biased against thinking your sons are a "risk category" because of uncirc. HPV is very common, circumcised or not. Most people have it at least once at some point; it is frequently asymptomatic.

 

I have read numerous times that uncircumcised males ARE more likely to contract STD and STIs. There is more hiding and breeding area for viruses. It bugs me when mothers who have chosen not to circumcise are unwilling to consider that this statistic does actually apply to their son(s).

So what about circumcised vs. uncircumcised women?  Would you support that for a lowered chance of HPV?  First of all, those studies are faulty.  They compared two different cultures.  

 

Either way, this discussion will probably end with a lot of hurt feelings.  My son's TWO corrective surgeries (so far) on his urethra as part of the 10-20+% of circumcised males makes me more than a little sensitive about this.  I think I would be willing to trade a simple shot for not having had to manually rip his urethra open every time he urinated because it was closing.  Or you know, teach him about safe sex and testing. I think he would agree.  

[kubiac]

I can and will testify that it is terrifying to have an HPV infection and the accompanying monitoring and/or treatment to prevent cancer or remove precancerous lesions is both physically stressful and emotionally arduous.

 

I wish very much that I'd had access to an HPV vaccine before I was infected and I promised my then-unborn children that I would vaccinate them against HPV if such a vaccine ever became a reality--and so it has.

 

Please consider that in getting the HPV vaccine you are saving your kids the shame of a sexually transmitted disease as well as the fear of succumbing to a preventable cancer.

 

In short, this vaccine may also protect your children's mental health. Just something to think about.

[NASDAQ]

I circumcised for religious reasons and I can't for the life of me understand why I wouldn't get the HPV shot for my daughters as well. Belt and suspenders, eh?

 

Safe sex practices have never been particularly good at preventing HPV. Am I the only one who remember the pre-Gardasil days? It's one of those nasty skin-to-skin infections. It's not AIDS. It spreads really easily.

[Laura Corin]

However, by the time HPV causes cytological effects or cancer/pre-cancer is discovered, a woman *already* has a problem that requires invasive and painful procedures (at the very least, a biopsy).  Gardasil is preventive against the 2 strains that cause more than 70% of the disease, and another 2 that cause more, and can prevent cervical cancer deaths even in the absence (for whatever reason) of PAP screenings.  In the long run, if it works as touted, it will reduce health care costs and painful procedures.

 

Whilst I was lucky in getting my pre-cancerous status identified (because I had regular smears) it was a distressing and alarming procedure getting the patch excised with a loop of hot wire.  I was also very lucky that it did not result in incompetent cervix, affecting my ability to carry my two subsequent pregnancies to term.

 

L

[Jasperstone]

How scary. Do you know which vaccines they had? We delay vaccines, and even though my daughter only had one shot at her last appointment, she was still sick with a fever the next day. I hate the whole topic of vaccines. It's scary to vax and scary not to.

After having adverse reactions (both my DH and eldest dd), we have stopped vaccinating altogether.

 

For us personally the vaccines are WAY scarier!

 

My dd 11, ds 9 and ds 4 are all very healthy, and totally vaccine free. My sons have had some common childhood diseases, but their strong natural immunity fought them off. And the effects were so mild that they didn't even need doctor for treatments. My dd has had nothing except a common cold.

 

So for us, its give us the disease rather than the shots, and we will deal with it then and if it happens. I don't want to trivialize diseases, and saying it lightly to show that's where our fear lies or lays.  :confused:    I still don't know how to use those two- good ole Aussie public schooling to blame, lol! :D  Please someone enlighten me there!

 

It all depends on your *own* experience at how you view this issue.

 

 

[Laura Corin]

I have read numerous times that uncircumcised males ARE more likely to contract STD and STIs. There is more hiding and breeding area for viruses. It bugs me when mothers who have chosen not to circumcise are unwilling to consider that this statistic does actually apply to their son(s).

 

I think that it depends what you are used to and what seems normal to you - at least that is where my bias comes from.  I live in a country where circumcision is only practised for minority religious/cultural reasons, or for very specific and severe medical reasons.  Routine circumcision, even if it were to confer some health benefits, seems as strange as the old practice of taking out all of someone's teeth to forestall future dental issues.

 

L

[sewingmama]

I don't understand the "modified schedule" or delayed schedule, or all the talk of it being too many vaccines at once. I have read many times that even the times when a baby get 4 shots on one visit, the amount of immune challenge that this introduces is far less, scientifically speaking, than licking a shopping cart (all my kids did this a few times) or playing on a playground with germy kids.

Dang I lost my whole long post...so I'll just say I agree with you and that the reason why vaxes are scheduled as they are is because those are the ages the child is most at risk.

 

MMR is given at 12 months because it is thought they get immunity from being breasfed till then however since so many babies are now bottle fed they might want to rethink that. Just my own opinion.

[Guest]

I think that it depends what you are used to and what seems normal to you - at least that is where my bias comes from. I live in a country where circumcision is only practised for minority religious/cultural reasons, or for very specific and severe medical reasons. Routine circumcision, even if it were to confer some health benefits, seems as strange as the old practice of taking out all of someone's teeth to forestall future dental issues.

 

L

Yes, I agree. In my demographic, circ. is normal. I briefly considered whether or not my sons should be circumcised, but DH felt that it was normal. He is the one with a pen!s, so I assume he knows. As a woman, I would have some reservations about a partner who was uncircumcised. I am influenced by the culture in which I grew up.

[Guest]

So what about circumcised vs. uncircumcised women? Would you support that for a lowered chance of HPV? First of all, those studies are faulty. They compared two different cultures.

 

Either way, this discussion will probably end with a lot of hurt feelings. My son's TWO corrective surgeries (so far) on his urethra as part of the 10-20+% of circumcised males makes me more than a little sensitive about this. I think I would be willing to trade a simple shot for not having had to manually rip his urethra open every time he urinated because it was closing. Or you know, teach him about safe sex and testing. I think he would agree.

Female infant circumcision is not done here, so no, I've never considered it and would not consider it. Are you assuming the studies are faulty or do you know that factually?

 

Of course your son's outcome will influence your opinion. We all assess risk based at least partially on our own experiences. Whenever we are discussing vaccines, I always imagine my grandmother and how she must have felt about vaccines as they were developed. At that time, she would have known people who were maimed or killed by diseases that someone my age or younger have never witnessed. What a miraculous blessing vaccines no doubt seemed.

[Guest]

I think the reason many are surprised by this is that our physicians often tend to present themselves to us as infallible and all knowing. They react poorly when questioned and presume that we, as mere parents, could not possibly know what is best for our children. Particularly when it goes contrary to what the hallowed APA recommends.

 

 

Personally, I have not had any doctors who present themselves as infallible and all-knowing. I think we parents sometimes forget that a pediatrician has witnessed all kinds of bad scenarios. They may have had an infant in their care who died from Pertussis, for example. Pediatricians are scientists, so it will make sense for pediatricians to pay close attention to the science.

[Guest]

So for us its give us the disease rather than the shots, and we will deal with it when and if it happens. I don't want to trivialize diseases, but saying that lightly to show that's where our fear lies or lays. I still don't know how to use those two in sentences- good ole Aussie public schooling to blame, lol!

"...where our fear lies." ;)

 

I do understand, as I have been saying, that one's own experience colors what one fears. I'm assuming you never visited a classmate in an "iron lung," from contracting Polio. You probably have never contemplated how horrifying it would be to contract Small Pox, because it was eradicated before your lifetime. Why was it eradicated? Because thousands upon thousand of people world-wide, perhaps millions, were vaccinated against it. I owe a debt of gratitude to the millions of parents around the world who have vaccinated their children; it is because of them we can even have a debate such as this. My grandmother, as I have said, would find this conversation unspeakably bizarre, because she no doubt witnessed the harm of these diseases.

[Jasperstone]

 

"...where our fear lies." ;)

 

Thank you! :thumbup:

 

 

You probably have never contemplated how horrifying it would be to contract Small Pox, because it was eradicated before your lifetime. Why was it eradicated? Because thousands upon thousand of people world-wide, perhaps millions, were vaccinated against it. I owe a debt of gratitude to the millions of parents around the world who have vaccinated their children; it is because of them we can even have a debate such as this.

 

 

This is where it gets even trickier, depending on *who* you believe. I have read charts that say that hygiene, and nutrition is the real reason that diseases that you mention have been eradicated.

 

All I can go by is what happened to us as a family. And the vaccines didn't produce a positive effect. My husband has Lupus from the Hep. B shot he was forced into getting by his employer etc...

[Trish]

 

 

 

Yes, people who like to think that their children would NEVER do anything like that are just sticking their head in the sand and ignoring what might be happening. I would hope my kids wouldn't be putting themselves at risk but I would rather be safe then sorry. Unfortunately, the vaccine doesn't seem to be a very good long term solution and carries some pretty hefty risks, so until there is more study behind it, we are going the route of regular pap smears and safe sex education as well as instruction on abstinence which is what we think is best. Kinda along the lines of, "this is what we think is best, but if you choose to do different, this is what is necessary to keep yourself safe."

 

I think your approach to Gardasil is a good one.

 

I think I read somewhere that the majority of people get the HPV virus in their lives, and clear it from their system without every knowing it?

 

"Better safe than sorry" can apply to GETTING the Gardasil vaccine (which I guess is only good through your mid-twenties if you get it as a teen) and also to NOT getting it.

 

I'd rather have a PAP smear than a Gardasil shot.

 

 

[Reefgazer]

Yes, you can compare the two.  All personal and health care decisions are the parents' domain.  Wisdom teeth are not birth defects, either, but they are often removed because they "will cause crowding problems later" (mine were because they would have prevented floss from accessing between my teeth - a cleaning problem).  The preventive removal of breast/ovary decision would be mine if I had a daughter in that position, also.  For all the hysterical flapping by activists with an agenda, the men I've known have no issues with circumcision.  If you don't want to circumsize your DS, great, but don't push falsehoods by saying such men will have sexual problems, because that is very far from a universal, or even common, truth.

But you can't compare circumcision to any other health related decision that we make for our children.A foreskin is not a birth defect. A normal penis statistically is not ever going to cause problems for the boy or man. We don't cut off any other healthy tissue from our babies' body as "preventative" medicine. My grandfather remembers being lined up AT SCHOOL to undergo a tonsillectomy along with all of his classmates. He said one kid lost so much blood he didn't come back for a long time. Nobody would suggest doing that today. We don't remove body parts from children unless absolutely necessary.

 

The problem with circumcision is that despite whatever health benefits you think it may provide, you are removing tissue that will (and not just "might" it WILL) affect sexual function later on (whether or not even those circumcised men realize it). There is a reason boys are born with a foreskin. It's not extra. It serves a purpose. We should not be removing part of child's genitals without their consent unless it's absolutely medically necessary-- as in, there is an immediate problem that needs to be addressed. Statistically, a child is actually more likely to suffer from a complication from their circumcision than to ever have a problem with their foreskin. For example, one in 20 will develop meatal stenosis. Many will suffer from painful adhesions. Many adult men suffer from painful erections because too much skin was removed as an infant. Many women will think something is wrong their bodies when sex hurts, not realizing that it's because their partners lack the mobile skin and natural lubrication of their foreskins.

 

There are many decisions that we make for our children that can not wait until they are able to weigh the pros and cons for themselves. I have one child born with a birth defect that would have been crippling had it not been addressed immediately. I have another child with Type 1 diabetes who doesn't get a say in whether or not she has to test her blood sugar or receive insulin. She knows she just has to do it.  But I don't have to make a choice about any of my children's genitals. I can leave it alone and they will not be affected in any way. At some point we will teach our sons what the research says, and at that point he can make the choice for himself. Of all the choices I make for my children's health, I do not believe that cutting  off part of their genitals is one of them. 

 

[kiana]

This is where it gets even trickier, depending on *who* you believe. I have read charts that say that hygiene, and nutrition is the real reason that diseases that you mention have been eradicated.

 

While there are definitely charts that purport to prove this, they virtually always show the graphs of the *mortality* rate versus graphs of the actual incidence rate. Occasionally they will show cherry-picked data -- there will be natural fluctuations on a year-to-year basis, and it is easy to construct what looks like a downward trendline by choosing years which are statistically anomalous whilst omitting discordant data. The charts of the actual *incidence* rates show a sharp decrease at the introduction of vaccination.

 

It is very natural that as sanitation, medical care, and nutrition improve we should expect to see a decrease in the mortality rate from these diseases. However, it is not what has caused the virtual elimination. Leaving out smallpox (because it apparently HAS been eradicated), look at the recent resurgence of polio in Nigeria after the uptake of vaccines decreased. Look at the recent resurgences of measles and pertussis in the US and elsewhere after the decrease in vaccination uptake. If it were due to sanitation and nutrition rather than vaccination, we should expect that there had been a tremendous breakdown in one or both to precipitate these outbreaks, which has not happened. (Nigeria certainly is no picnic as far as sanitation and nutrition go, but it hasn't dramatically decreased recently).

 

I am not telling you to vaccinate your children (that is a decision for you to make, and you are certainly correct that complications from most of these diseases are rare), but you should not rely on misinformation to assist you in your decision, nor should you assist in spreading it.

[Dory]

The first 4 people in this province to have measles during this last outbreak, were all up to date with their vaccines.

 

For the record, in case I am coming across hugely against vaccines, we do selectively vaccinate.

[Guest]

Thank you! :thumbup:

 

 

 

This is where it gets even trickier, depending on *who* you believe. I have read charts that say that hygiene, and nutrition is the real reason that diseases that you mention have been eradicated.

 

All I can go by is what happened to us as a family. And the vaccines didn't produce a positive effect. My husband has Lupus from the Hep. B shot he was forced into getting by his employer etc...

This is somewhat difficult, as I am working from an ipad and cannot include the charts and links I could on my computer. If I have time later today, I will try to add those, but, doing the best I can with those limitations:

 

Hygiene and nutrition has *helped* to reduce the spread of disease, but no disease has "gone away in its own." Think of it in terms of influenza, or the common cold. Certainly, it is good to wash your hands, to use a tissue, to stay at home if you are sick. But, have these viruses disappeared because of hygienic measures? No.

 

I am 43 years old. When I was a child, I and my siblings all got Chicken Pox. Everyone one of my schoolmates got CP. 11,000 children a year got CP. Hygiene did not eradicate CP. In fact, most mothers were pretty blasé about it, because getting it eventually was pretty much inevitable, so most felt it was best to get it over with. In 1997, the vax was available. Since then, rates of CP has drastically reduced to very, very few. One of my kids did not have the vax, but we have not encountered a single person with CP in his life. At this point, I am getting the vax for him. Evidently, the vaccine does work. Evidently, hygiene and nutrition - though always good things - are not enough to eradicate any disease.

 

For another example, look at Rabies vaccines for pets. Undomesticated mammals still have high rates of Rabies infection, yet domestic pets rarely do. Why? Because the vaccine works. Also, Rabies is such a HORRID disease that people frequently recognize it isn't a risk they are willing to take. So Fido is vaccinated and, most probably, you and your children will never need to go through the Rabies vaccines.

[Lady Florida.]

 

 

I will encourage my daughters and sons to get the HPV vaccine when possible.  If it reduces their chance of not only cervical, but also oral cancer, great.  The study I posted on nearly 200,000 people showing no fatalities, etc. is not the only study.  The Danes (love socialized medicine) looked at how it is impacting HPV lesions among vaccinated and non-vaccinated people.  "“Our study reveals a reduction of between 40 and 80 percent of cervical precursor lesions in vaccinated women compared to non-vaccinated women. We assume that this figure also applies to the risk of subsequent development of the disease.â€

 http://sciencenordic.com/hpv-vaccine-effective-danish-women

 

That is pretty darn great.

 

 

 

My son needs one more course of the HPV vaccine, which he will be getting later this summer. He is not yet sexually active but after researching and discussing it with his doctor, I felt the time to get him this vaccine is before he "needs" it.

[kiana]

The first 4 people in this province to have measles during this last outbreak, were all up to date with their vaccines.

 

For the record, in case I am coming across hugely against vaccines, we do selectively vaccinate.

 

Yes. Vaccines in and of themselves fail at a certain percentage.

 

For example, let us assume a specific vaccine is 95% effective. (I am not using specific examples of diseases, because my point is the mathematics). In this case, if 100 vaccinated people are exposed,  5 of them will be vulnerable to the disease. If the proportion of non-vaccinated people is low enough, this may result in some rather counterintuitive results. For example, suppose (hypothetically) that 1000 vaccinated and 10 non-vaccinated people are exposed. This means that 50 vulnerable (but vaccinated) people are exposed and 10 vulnerable, non-vaccinated people are exposed. With that in mind, we should not be at all surprised that the majority of the people in this hypothetical population who caught the disease were vaccinated.

 

In order to show the vaccine is ineffective, what we would need is *similar* proportions of vaccinated and non-vaccinated people getting the disease. For example, if 1/3 of vaccinated people and 1/3 of non-vaccinated people who were exposed caught a given disease, we could easily conclude that the vaccine was completely ineffective.

[BrookValley.]

The first 4 people in this province to have measles during this last outbreak, were all up to date with their vaccines.

 

For the record, in case I am coming across hugely against vaccines, we do selectively vaccinate.

 

And this is one of the reasons why it is so important to vaccinate (not just singling out your post; there were post(s) a page or so back saying many pertussis cases were in children/people who had been vaccinated). Nothing is 100%, including vaccines. There will always be some people for who a vaccine may not be entirely effective. There will always be some people who, for whatever reason--adverse reactions, allergies, other health issues--that cannot vaccinate. So when everyone vaccinates, we help protect those people, and we help reduce the instances of these diseases.

 

I'm not saying you are saying this, but I've heard this as reasoning for not vaccinating. "Oh, these diseases would pop up anyway, look, those people were vaccinated." That is simply not true, and it's just furthering the spread of non-vaccinating for non-medical reasons--which puts a lot of people in danger.

[Dory]

And this is one of the reasons why it is so important to vaccinate (not just singling out your post; there were post(s) a page or so back saying many pertussis cases were in children/people who had been vaccinated). Nothing is 100%, including vaccines. There will always be some people for who a vaccine may not be entirely effective. There will always be some people who, for whatever reason--adverse reactions, allergies, other health issues--that cannot vaccinate. So when everyone vaccinates, we help protect those people, and we help reduce the instances of these diseases.

 

I'm not saying you are saying this, but I've heard this as reasoning for not vaccinating. "Oh, these diseases would pop up anyway, look, those people were vaccinated." That is simply not true, and it's just furthering the spread of non-vaccinating for non-medical reasons--which puts a lot of people in danger.

 

I kinda chuckled with this. Out of my family of 9 growing up, 7 of us had whooping cough. 2 people were not vaccinated at all and they were the only people who did not get it.

 

I get what you are saying, I am not 100% agreeing with it, but I understand your point I think.

[Lady Florida.]

Hygiene and nutrition has *helped* to reduce the spread of disease, but no disease has "gone away in its own." Think of it in terms of influenza, or the common cold. Certainly, it is good to wash your hands, to use a tissue, to stay at home if you are sick. But, have these viruses disappeared because of hygienic measures? No.

 

I am 43 years old. When I was a child, I and my siblings all got Chicken Pox. Everyone one of my schoolmates got CP. 11,000 children a year got CP. Hygiene did not eradicate CP. In fact, most mothers were pretty blasé about it, because getting it eventually was pretty much inevitable, so most felt it was best to get it over with. In 1997, the vax was available. Since then, rates of CP has drastically reduced to very, very few. One of my kids did not have the vax, but we have not encountered a single person with CP in his life. At this point, I am getting the vax for him. Evidently, the vaccine does work. Evidently, hygiene and nutrition - though always good things - are not enough to eradicate any disease.

 

For another example, look at Rabies vaccines for pets. Undomesticated mammals still have high rates of Rabies infection, yet domestic pets rarely do. Why? Because the vaccine works. Also, Rabies is such a HORRID disease that people frequently recognize it isn't a risk they are willing to take. So Fido is vaccinated and, most probably, you and your children will never need to go through the Rabies vaccines.

 

 

:001_wub: This post needed repeating.

[Pippen]

This is somewhat difficult, as I am working from an ipad and cannot include the charts and links I could on my computer. If I have time later today, I will try to add those, but, doing the best I can with those limitations:

 

Hygiene and nutrition has *helped* to reduce the spread of disease, but no disease has "gone away in its own." Think of it in terms of influenza, or the common cold. Certainly, it is good to wash your hands, to use a tissue, to stay at home if you are sick. But, have these viruses disappeared because of hygienic measures? No.

 

I am 43 years old. When I was a child, I and my siblings all got Chicken Pox. Everyone one of my schoolmates got CP. 11,000 children a year got CP. Hygiene did not eradicate CP. In fact, most mothers were pretty blasé about it, because getting it eventually was pretty much inevitable, so most felt it was best to get it over with. In 1997, the vax was available. Since then, rates of CP has drastically reduced to very, very few. One of my kids did not have the vax, but we have not encountered a single person with CP in his life. At this point, I am getting the vax for him. Evidently, the vaccine does work. Evidently, hygiene and nutrition - though always good things - are not enough to eradicate any disease.

 

For another example, look at Rabies vaccines for pets. Undomesticated mammals still have high rates of Rabies infection, yet domestic pets rarely do. Why? Because the vaccine works. Also, Rabies is such a HORRID disease that people frequently recognize it isn't a risk they are willing to take. So Fido is vaccinated and, most probably, you and your children will never need to go through the Rabies vaccines.

 

I know an individual that had chicken pox as a child and who had the virus reactive when he was severely immune compromised following a transplant. The young doctors all were flooding in to get a look because they'd never seen a chicken pox rash outside of a textbook.

 

I'm a mom of a kid who has almost no immune system following a stem cell transplan,t and I'm solidly in the vaccines matter camp. I always took the middle road with vaccines--did the majors, passed on some, delayed others (ie meningitis until 16 so only one dose would be required). But I'm glad sibs and we parents were current on vaccines when the cancer diagnosis hit.

[BrookValley.]

I kinda chuckled with this. Out of my family of 9 growing up, 7 of us had whooping cough. 2 people were not vaccinated at all and they were the only people who did not get it.

 

I get what you are saying, I am not 100% agreeing with it, but I understand your point I think.

 

The vaccine is effective in something like 7 out of 10 people throughout the entire population, IIRC. Also, if you've had the vaccine and you still get whooping cough, you are much more likely to have less severe symptoms, less long-lasting health issues, etc. The vaccine may still have helped those 7 family members that did get whooping cough.

 

The other thing is kids aren't fully protected until they've had the full round of doses, however many that is. Kids that get the whole course are likely to be fully protected, but they're higher risk for contracting whooping cough until they've finished that number of doses.

 

So people who look at anecdotal evidence such as your story here (or even the factual evidence, as not 100% will be fully protected by the vaccine), and then use that as further "proof" that the pertussis vaccine isn't a good idea (again, not sure exactly where you stand on this, so I'm not saying this is your point--just using your story as an example), are really putting that high-risk population in danger, i.e., babies and children who haven't finished the full amount of doses, those who cannot vaccinate, etc.

 

My whole point being, using that logic as some sort of proof that the pertussis vaccine isn't necessary is really a logic fail. Pertussis kills babies, rather horrifically.

 

(I'll point out again that I'm not picking on you or trying to argue with you, you just bring up stories similar to those I've heard as an argument against vaccines, so I'm just using your post as a jump-off point. :) )

 

[LMV]

You can get a tetanus booster 5-10 years after your last tetanus. If you have a dirty wound the recommendation is to get one if it's been more than 5 years. You can get them closer together if you have to (someone traveling overseas who will be gone for many years or a pertussis outbreak in the community) it just makes your arm more sore and is more likely to cause a mild reaction (aches, fever, etc). The recommendation currently for pregnant women is to get a TdaP with every pregnancy, and they are being given several years apart. 

 

Tetanus immunoglobin is rarely if ever given. You wouldn't give it for a dirty wound. Immunoglobulin in general is more of a risk than vaccines since it's a blood-product and it's much more expensive. Immunoglobulin is typically given in cases when an immunocompromised person is known to be exposed to a disease or when someone isn't vaccinated ahead of time (rabies immunoglobulin, or varicella immunoglobulin for a person with cancer exposed to chickenpox). 

 

Tetanus immunoglobulin should be given to those individuals who:

-have dirty wounds and have not received at least 3 prior lifetime doses of DTaP/DT/Td/Tdap

-have dirty wounds and have significant immunodeficiency states (i.e. HIV, agammaglobulinemia etc) regardless of immunization status

 

The area I practice in has a large pocket of individuals who opt out of vaccinations so as a physician I never presume that they have completed a primary series prior to showing up in our ED with a dirty wound.  I actually gave TIG and Tdap to a child while working yesterday.  I suspect that you practice in an area with better immunization rates.

[Alice]

Tetanus immunoglobulin should be given to those individuals who:

-have dirty wounds and have not received at least 3 prior lifetime doses of DTaP/DT/Td/Tdap

-have dirty wounds and have significant immunodeficiency states (i.e. HIV, agammaglobulinemia etc) regardless of immunization status

 

The area I practice in has a large pocket of individuals who opt out of vaccinations so as a physician I never presume that they have completed a primary series prior to showing up in our ED with a dirty wound.  I actually gave TIG and Tdap to a child while working yesterday.  I suspect that you practice in an area with better immunization rates.

 

Interesting! You're right, my area does have a pretty high immunization rate. Plus, I probably overreached when I said TIG is rarely given, even here. I don't work in the ER so I have the benefit of having the shot record for all the kids I see with dirty wounds. However, I think my original point was that you can give a Td or TdaP less than 10 years (and even less than 5 years if you have to) away from the last tetanus. There had been a previous post suggesting that they had to be 10 years apart. 

 

Thanks for the correction. 

[LMV]

Interesting! You're right, my area does have a pretty high immunization rate. Plus, I probably overreached when I said TIG is rarely given, even here. I don't work in the ER so I have the benefit of having the shot record for all the kids I see with dirty wounds. However, I think my original point was that you can give a Td or TdaP less than 10 years (and even less than 5 years if you have to) away from the last tetanus. There had been a previous post suggesting that they had to be 10 years apart. 

 

Thanks for the correction. 

 

We are assisted some in that our state immunization registry syncs into our EHR (and our EHR syncs into the registry) so sometimes we have shot records for some of our patients.  I agree with you that you can give Tdap or Td early with most patients. The only time there is a concern with this is if they had a prior Arthus reaction with Tetanus toxoid and then ACIP recommends not decreasing the immunization interval below 10 years, even in the event of a dirty wound.  If they had an Arthus reaction to the diphtheria component then that is the role for Tetanus toxoid (and why we stock it in our ED, we also give it to the children of parents who are adamant that they can have Tetanus only even if there isn't a medical basis for their viewpoint).

 

For the record, I thought your post overall was great.

[swellmomma]

Tetanus immunoglobulin should be given to those individuals who:

-have dirty wounds and have not received at least 3 prior lifetime doses of DTaP/DT/Td/Tdap

-have dirty wounds and have significant immunodeficiency states (i.e. HIV, agammaglobulinemia etc) regardless of immunization status

 

The area I practice in has a large pocket of individuals who opt out of vaccinations so as a physician I never presume that they have completed a primary series prior to showing up in our ED with a dirty wound.  I actually gave TIG and Tdap to a child while working yesterday.  I suspect that you practice in an area with better immunization rates.

 

That's why dd6 was given the TiG.  Didn't have the 2 prior lifetime doses, many deep wounds from cat scratches/bites and cats have filthy mouths.  She didn't get the Tdap until a week later to see if she would react to the TiG due to past reaction history.  

 

Thankfully when ds10 stepped on a nail in the garage last week he was already up to date in his vaxes.  I wouldn't want him to have lockjaw and given his terror of needles he would flip out at the size of the TiG needle.  So much bigger than a standard vax needle.