pertussis, titers, breastfeeding

[Eos of the Eons]

Thing is, it would be better to vaccinate the baby rather than give a booster to the 12 year old right?
Barb seems concerned about the spread of disease from the 12 year old to the baby, but how likely is that...she seems to think 50% of the disease will spread from older age groups to babies, but I did not see that in the study.

Thing is, if the baby is vaccinated, then why worry about it? The 12 year old is not at much risk of any complications from the disease, unlike the baby.

Unless one is trying to avoid vaccinating the baby? Hmmm?

 

[IIRichard]

Re: Re: Re: pertussis, titers, breastfeeding

Hey, I have almost the exact same anecdote. Except my son was 7 months old, almost exclusively breastfed and he still got chickenpox. And yes, it was miserable. And then shortly after the chickenpox, he got Juvenile Rhuematoid Arthritis.

Unfortunately this is too late for you but a study published in NEJM in 1990, showed that Acyclovir (Zovirax) given to the siblings of chicken pox victims can dramaticaly reduce the symptoms of the disease. It must be administered before symptoms appear. It may also be of use if given to others exposed at the time in school or day care.

This might help Barbrae though.

The study did not get as much play as it should have because the vaccine had just been developed.

 

[Lisa Simpson]

Re: Re: Re: Re: pertussis, titers, breastfeeding

Unfortunately this is too late for you but a study published in NEJM in 1990, showed that Acyclovir (Zovirax) given to the siblings of chicken pox victims can dramaticaly reduce the symptoms of the disease. It must be administered before symptoms appear. It may also be of use if given to others exposed at the time in school or day care.

This might help Barbrae though.

The study did not get as much play as it should have because the vaccine had just been developed.

I called the doctor and asked about Acyclovir because my son had major surgery at 5 months old and was still on preventitive antibiotics at the time he got chickenpox. The doctor told me to just let him have the chickenpox--it wouldn't harm him. Of course, right after, he developed JRA. While in physical therapy for the JRA, we met a little boy who'd had an autoimmune reaction to the chickenpox as well, but he had a stroke! Yikes, that's scary.

When my sons had chickenpox, they gave it to their aunt and uncle, who'd never had chickenpox as children. Their doctor refused to give them acyclovir as well. This was 1994, BTW. They were lucky that they didn't have serious side effects.

 

[IIRichard]

Re: Re: Re: Re: Re: pertussis, titers, breastfeeding

When my sons had chickenpox, they gave it to their aunt and uncle, who'd never had chickenpox as children. Their doctor refused to give them acyclovir as well. This was 1994, BTW. They were lucky that they didn't have serious side effects.

I cannot understand why more Doctors are not aware of this use of Acylovir. The 1990 article in the New England Journal was peer reviewed. The study was a multiple center, double blinded trial and the statistics were good.

I've used Acyclovir for years for "cold sores" and Acyclovir has been as safe as water and very effective. Basically, I don't get facial herpes lesions any more.

 

[Barbrae]

Unless one is trying to avoid vaccinating the baby? Hmmm?

Oh, maybe I never mentioned it before, I do plan to vaccinate the baby and according to the regular schedule. Gee, I can't believe I forgot to mention that before - oh wait, I did, a million times.

I think the reason this is at all a concern is that this past year and last there were pertussis outbreaks at my oldests school so it has been on my mind.

 

[Lisa Simpson]

Re: Re: Re: Re: Re: Re: pertussis, titers, breastfeeding

I cannot understand why more Doctors are not aware of this use of Acylovir. The 1990 article in the New England Journal was peer reviewed. The study was a multiple center, double blinded trial and the statistics were good.

That's what was really frustrating about the situation. I had heard about the study, I was the one who told my sister-in-law to call her doctor and ask about acyclovir and yet the doctor didn't want to give it to them. And boy, were they sick from the chickenpox. It was far worse for the two 27 year olds than it was for the children.

 

[IIRichard]

Re: Re: Re: Re: Re: Re: Re: pertussis, titers, breastfeeding

That's what was really frustrating about the situation. I had heard about the study, I was the one who told my sister-in-law to call her doctor and ask about acyclovir and yet the doctor didn't want to give it to them. And boy, were they sick from the chickenpox. It was far worse for the two 27 year olds than it was for the children.

This is getting way, way, waaaay off topic but a lot of docs are worried about anti-virals, or were twenty years ago because of their mode of action.

I actually know the lead author of the study. If you need more info. or history of these trials (involved perhaps the first use of cell phones for investigators) email me privately.

 

[Skeptic Ginger]

Re: Re: Re: Re: Re: Re: Re: Re: pertussis, titers, breastfeeding

This is getting way, way, waaaay off topic but a lot of docs are worried about anti-virals, or were twenty years ago because of their mode of action.

I actually know the lead author of the study. If you need more info. or history of these trials (involved perhaps the first use of cell phones for investigators) email me privately.

Actually, a lot of doctors are poorly informed about both chicken pox and acyclovir. Like I said, I have lots of stories and they aren't all from the distant past.

First, any doctor not treating a 5 month old for chicken pox should be sued. Any child under age 1 with chicken pox is at a much greater risk than an older child, as are adults at much greater risk. My guess is that was the first mistake.

I have seen several doctors who were unaware acyclovir even worked because they only remember the studies of topical acyclovir on herpes which didn't work. I'm not so sure about fears of anti-viral risks doctors may have, it's possible but for acyclovir I haven't heard any such fears expressed. I have seen many doctors still treating shingles with prednisone when acyclovir is really the drug of choice. They just don't keep up to date on their medical knowledge.

There's an piece on NPR news today reporting on an Archives of Surgery article about surgeons not following current antibiotic practice guidelines. It's another example of what I find over and over again. These guys don't do it because they disagree with the guidelines, they do it because they are ignorant of the guidelines.
http://www.npr.org/templates/story/story.php?storyId=4508386

Surgeries Miss Mark on Antibiotics

Feb. 21, 2005 -- Doctors often fail to take a simple step that is well known to prevent infections from developing in patients getting surgery, according to a study published in the Archives of Surgery.

Doctors have known for almost half a century that using the right kind of medicine an hour before surgery can dramatically reduce the likelihood of developing a dangerous -- and possibly deadly -- infection.

But researchers were surprised to find out that doctors get this right in only 56 percent of surgeries. Patients almost always get the antibiotic drugs, but often not within the crucial hour before surgery, when the medication is sure to be effective.

Moreover, many patients continue to get the antibiotics long after surgery, which presents the danger of making infections resistant to the drugs.

The researchers said that when hospitals agree to track the way they use these antibiotics, they almost always do a better job. -- Joseph Shapiro

My doctor has come to trust my opinion when I say I would like xyz for something but the best way to deal with these guy's egos is just to bring them citations. I never argue with doctors, I give them references. That way, if I can't find a reference, I know I may be wrong and I learn something new. If I find the citations, the docs can't get into an ego match with a lowly nurse practitioner.

 

[IIRichard]

Re: Re: Re: Re: Re: Re: Re: Re: Re: pertussis, titers, breastfeeding

*****OK me and my guest were trying to put comments where they would be most most appropritate. Formatting got messed up read this carefully

Actually, a lot of doctors are poorly informed about both chicken pox and acyclovir. Like I said, I have lots of stories and they aren't all from the distant past.

***** I should have said that acyclovir was the first NUCLEOSIDE anti-viral. That said, this place is being vacated for the first author of the study.

First, any doctor not treating a 5 month old for chicken pox should be sued. Any child under age 1 with chicken pox is at a much greater risk than an older child, as are adults at much greater risk. My guess is that was the first mistake.

*****Sorry, the first author has, "...no Vehement disagreement with what was said."
So, we be goin to din din

I have seen several doctors who were unaware acyclovir even worked because they only remember the studies of topical acyclovir on herpes which didn't work. I'm not so sure about fears of anti-viral risks doctors may have, it's possible but for acyclovir I haven't heard any such fears expressed. I have seen many doctors still treating shingles with prednisone when acyclovir is really the drug of choice. They just don't keep up to date on their medical knowledge.

There's an piece on NPR news today reporting on an Archives of Surgery article about surgeons not following current antibiotic practice guidelines. It's another example of what I find over and over again. These guys don't do it because they disagree with the guidelines, they do it because they are ignorant of the guidelines.
http://www.npr.org/templates/story/story.php?storyId=4508386
My doctor has come to trust my opinion when I say I would like xyz for something but the best way to deal with these guy's egos is just to bring them citations. I never argue with doctors, I give them references. That way, if I can't find a reference, I know I may be wrong and I learn something new. If I find the citations, the docs can't get into an ego match with a lowly nurse practitioner.
****** First author agrees, bring cites. We be goin to din din.

email privqately for more

 

[Skeptic Ginger]

Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: pertussis, titers, breastfeeding

email privqately for more

Richard I can't figure your post out for the life of me.

*****OK me and my guest were trying to put comments where they would be most most appropritate. Formatting got messed up read this carefully

***** I should have said that acyclovir was the first NUCLEOSIDE anti-viral. That said, this place is being vacated for the first author of the study.

I didn't say anything about first antivirals, or second ones for that matter. I was only commenting on the story about the doctor refusing to use the suggested acyclovir on the 5 month old.

*****Sorry, the first author has, "...no Vehement disagreement with what was said."
So, we be goin to din din

***** First author agrees, bring cites. We be goin to din din.

????????????

 

[Rolfe]

Thing is, it would be better to vaccinate the baby rather than give a booster to the 12 year old right?

Hey, Eos, give the woman a break. She was specifically talking about the time before the baby was ready to be vaccinated.

Seems to me to be an easy thing to ask one's doctor, really. If the 12-year-old is being exposed to whooping cough, is this a danger to the baby, and how best to minimise this?

Thanks for all that good info, Capsid. The local effect of the IgA is no doubt not negligible, but would I be right in thinking that gut IgA isn't going to help much against a respiratory challenge by Bordetella?

Rolfe.

 

[Capsid]

Thanks for all that good info, Capsid. The local effect of the IgA is no doubt not negligible, but would I be right in thinking that gut IgA isn't going to help much against a respiratory challenge by Bordetella?

Rolfe.

You would think so but the abstract of this review suggests that

Protection against infections has been well evidenced during lactation against, e.g., acute and prolonged diarrhea, respiratory tract infections, otitis media, urinary tract infection, neonatal septicemia, and necrotizing enterocolitis.

However, I can't access the article and read the original studies to get the real details. Respiratory tract includes the nose and throat where colostrum would be present of course and thereby protect against an aerosol challenge. I'm not sure how it works for urinary tract infections and septicaemia though.

 

[IIRichard]

Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: pertussis, titers, breastfeeding

Richard I can't figure your post out for the life of me.

I didn't say anything about first antivirals, or second ones for that matter. I was only commenting on the story about the doctor refusing to use the suggested acyclovir on the 5 month old.

????????????

I was trying to insert my responses/comments into your quoted material and it just did not work.

As far as I know, acyclovir was the first nucleoside antiviral. Lots of docs might have been concerned because of that.

 

[Skeptic Ginger]

Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: pertussis, titers, breastfeeding

I was trying to insert my responses/comments into your quoted material and it just did not work.

As far as I know, acyclovir was the first nucleoside antiviral. Lots of docs might have been concerned because of that.

I don't doubt that but my first hand experience was with doctors who doubted its efficacy or weren't aware of the spectrum of organisms it covered.