Pediatric Center News

Sorry to disappoint some of the folks who will Google their way here:  It’s not about the connection, it’s about lack thereof.  Just wanted to let everyone know that, for the first time in my career, I saw an unvaccinated child with clear features of Autism Spectrum Disorder — between high-functioning Autism and significant Asperger’s syndrome.  Now, considering that I have far fewer than 150 unvaccinated children in my practice, and that 1 in 150 is the commonly accepted figure for ASD prevalence, this argues for at least as high a rate in unvaccinated as in vaccinated children.

Which brings me to, why do people think it’s the vaccines?

Sorry again; you ain’t gonna like the answer.

ASD is, for all practical purposes, a learning disability limited to interpersonal relationships.  Among other things, people with even mild  ASD cannot tell when someone is lying to them.  We responsible physicians tell them ASD is about genetics and parent age.  Translation: your children are growing up just like you but more so.

It’s as if we were saying: It’s all your fault.
From the other side, they are bombarded with another message.  Whether it’s MMR, mercury or microwaves, absence of evidence of connection is not interpreted as evidence of absence.  The more myths are debunked, the more fervently they are cherished, for at their core is this:

Someone did this to your child.

And what parent would not cling to that?

My own concerns with vaccines have nothing to do with either their safety or their efficacy.  I am concerned with the recent trend to require universal vaccination against diseases that are not significantly dangerous but rather unpleasant, which require school or work absence and medical care but are not likely to result in death or lasting damage.  I suspect that, as more children are crammed into day care for longer periods of time, other viruses will take their place — Norwalk and enteroviruses for Rotavirus,  Adenovirus for flu — negating the improvement from the vaccines.  Only if the current trend to place more and more children in day care is reversed will we see fewer sick children — and then the vaccines will really help.

We had our first clearly positive flu patient, a 2 year old who had one dose of injectable vaccine, with a 102 degree fever and no other signs. The rapid flu test was clearly positive for Flu type B.

Take home message:

(1) CDC recommends 2 doses of flu vaccine, 1 month apart, for certain patients, such as those under 9 years of age receiving the vaccine for the first time;

(2) Injectable vaccine is less effective than the nasal vaccine in preventing flu, but it is highly effective at preventing complications and hospitalizations;

(3) We have both, and will be happy to help you to select the right one for your needs.

(4) Two resources to find out about flu activity in our area:

http://www.google.org/flutrends/

http://cdc.gov/flu/weekly/

Stay healthy!

both VFC and non-VFC, injectable (Fluzone) and intranasal (Flumist).

For those of us who have a driver’s license, education is what we got to pass the written exam; training is the actual lessons in a dual-control car.  And the difference is that we can drive after being trained, but not after being educated.

What this has to do with a pediatric blog is to understand why we don’t have all the answers.

This lesson was recently driven home to me in a most impressive fashion.  I drove my son to a weight-reduction camp, and returned a month later to pick up a much different person.  16 pounds lighter, yes, but that’s the least of it.  I picked up someone who learned responsibility, self-respect, self-reliance, confidence, and strength.  I picked up someone who was trained in all the values I had tried to teach, by precept and by example.  And I picked up a lesson in what pediatricians can and cannot do.

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A long time ago, in a journal far, far away, an intrepid urologist ran a contest I cannot name for copyright reasons. It did, however, ask for medically relevant relapses od old and familiar works of art. I won a few, lost some, been baffled occassionally (I still cannot fathom why, in a contest of medical remakes of nursery rhymes, this one of mine won:

As I was going to St Ives

I met a man with seven wives

All on their way to Inverness

To find a cure for PMS

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A while ago I wrote of my small bit of civil disobedience – disobeying, for all of a minute and a half, the letter of the law governing the reporting of suspected child abuse. Here, in contrast, is a report of someone who obeyed the law perfectly. I will leave to the reader any judgement on whether this is a law sometimes best honored in breach and not the observation.

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As of today, both injectable and nasal flu vaccine is available for both VFC and non-VFC patients.

I generally stay out of politics for the same reason I don’t fly airplanes: I will not mess around with things I don’t fully understand where someone may get hurt.  Laws, as they apply to medicine, tend to run with a steamroller over problems best attacked with a scalpel, and the fewer of those we have, the fewer patients will suffer the consequences.  I have a story of a little girl who got better in spite of laws to the contrary.

 It was 10 minutes to seven PM.  The mother ran in, scattering tears, clutching her little 2-year-old daughter, upset beyond words.  She had just picked her up from day care, and as she started to change her diaper –

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As usual, it is a bit complicated:

Fluzone (injectable, dead, inactivated vaccine):

between 6 months and 3 years of age — available both VFC and non-VFC (comes in 0.25 ml syringes)

over 3 years of age — available non-VFC only

 reminder: the VFC program covers children and adolescents who are either uninsured or have a government-funded insurance or Medicaid, up to their 19th birthday.  VFC vaccines are supplied free of charge, but are often shipped later than commercially purchased vaccines.  Insurances do NOT pay for immunizations for VFC-eligible patients.

Flumist (live, attenuated vaccine administered as nasal spray, for persons ages 2 to 49 years who do not have a significant chronic illness)

We have non-VFC Flumist.  As usual, we expect a delay in the shipment of the VFC vaccine.

 Flu and flu vaccine will of course be in the news shortly; some news will be at least generally accurate while others will exhibit varying degrees of departure from reality. 

 On a different note, I would like to thank the military families who have joined our practice recently.  The response to my War and Peace editorial has been astounding, and the thought that they might see in our work a fleeting reminder of the dedication and professionalism their loved ones show daily in harm’s way is an inspiration. 

Anatoly Belilovsky, MD

Yes of course we are working on Columbus Day (Monday October 8, 2007) — both Brighton and Staten Island offices, usual doctors, usual hours.

As the NYC public school system now requires TDaP vaccine for all 11-year-olds entering 6th grade, we have plenty of both the VFC and the non-VFC TDaP.

Hepatitis A and second chicken pox vaccines are strongly recommended by the Health Department (first chicken pox vaccine has been required for a while).  There is, however, a nationwide shortage of the chickenpox vaccine, and we have run out.

The story is even more complicated regarding flu vaccine.  The popular Flumist (nasal flu vaccine, not a shot) may or may not be available this season at all.  The shots should be available, but the 6-to-36 months variety should be available first, followed by the 3-year-and-over variety, and as before, we may see big differences in VFC and non-VFC vaccine shipping times.  We have had a number of complaints about it last year, and would urge all parties concerned to call Health Department to make VFC vaccine available as early as possible, as they are ultimately in charge of it.

As the school season approaches, I would urge everyone to read last year’s posts, either at the bottom of this page, or on the next.  As nothing has changed in the school system, I expect to see the same problems this year as well.

In my work as a pediatrician, every once in a while I am privileged to be asked to see a child of a military or law enforcement officer. Even if sometimes they do not identify themselves as such, there is often a moment when their professional identity becomes apparent. It usually goes like this:

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There are many things in my practice which I prefer to leave to experts, and it isn’t just brain surgery. Psychological and behavioral issues are complex enough to need not one but many specialties in medicine: psychology, psychiatry, behavioral and developmental pediatrics, neuropsychology — and, being a general pediatrician, I try stick to what I know.

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