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Talk to me about babies and the unvaccinated.

AmandaM

Critical Thinker
Joined
Jun 10, 2008
Messages
470
I went for my regular prenatal exam yesterday and some of the nurses were very upset over a case of whooping cough in the infant daughter of one of their patients. (My mom's little brother had it back in the 50s and she said it was one of the most frightening things she'd ever seen.)

Our community has seen several cases of whooping cough already this year and there is a certain unspoken accusation that it's due to parents not having their children vaccinated.


So paranoid mom asks this:

I looked at the CDC vaccination schedule and it seems that infants don't even start receiving vaccines for things like pertussis until 2 months old. Now I'm not planning on sending my 8-week old kid to the park to play with other kids, but is there a certain general "safe" age at which I won't be afraid to let my child be breathed upon by strangers who might be infected with who knows what? Should I keep her away from other kids/babies for 6 months? 12 months?

Apart from locking her away until she's twelve, what REASONABLE precautions can I take to prevent her from being exposed to a disease that can kill her before she's able to have the completed vaccine series?

I know this is me being uber-paranoid and ridiculously protective, but I hear parents all around me saying they didn't vaccinate, I'm I starting to view these people and their children as potential carriers of that one rare disease that will kill my child. (Okay that's me being dramatic, but the risk is there.)
 
It is true that infants can't receive the pertussis vaccine until a certian age, which is why herd immunity is so important! And the accusation is spot on! http://factsnotfantasy.com/vaccines.php has some good info to dispell many of the outright lies spread by the anti-vax pro-disease nutters.

As to precations, make sure that everyone you know is up to date on their shots. Follow the vaccination schedule. And educate people around you.
 
As to precations, make sure that everyone you know is up to date on their shots. Follow the vaccination schedule. And educate people around you.

But what about kids in the doctor's office? In public areas where I can't monitor what my kid is exposed to?

Or is this just me being overly paranoid? It took us 8 years to conceive this child, so I'm a tad bit nervous about someone else coming in and screwing something up.
 
Sadly you can't guarantee protection. :( Once your child is old enough, get the vaccines, and then it's pretty much a "hope for the best" scenario. I wonder if the parents of Dana McCaffery may have some advice? I haven't been to their web page lately: http://danamccaffery.com
 
Apart from locking her away until she's twelve, what REASONABLE precautions can I take to prevent her from being exposed to a disease that can kill her before she's able to have the completed vaccine series?

I know this is me being uber-paranoid and ridiculously protective, but I hear parents all around me saying they didn't vaccinate, I'm I starting to view these people and their children as potential carriers of that one rare disease that will kill my child. (Okay that's me being dramatic, but the risk is there.)

I don't think you are being over dramatic in viewing willfully unvaccinated kids and adults as potential threats to your child's health. They clearly are. And you should share that concern.

On a practical level you should avoid those families where you know that they are not vaccinating any of their children, but really you can't know everyone's record.

You should insist that your school and daycare require vaccination. Share your concerns and be very clear. They get a lot of pressure from the other side and need to know that you are just as concerned about your child's health, but have the science to back up your position.

Keep to the schedule recommended by your pediatrician.

That's about it. There is no perfect protection, so you do your best and hope that it works out. It likely will.
 
But what about kids in the doctor's office? In public areas where I can't monitor what my kid is exposed to?

Or is this just me being overly paranoid? It took us 8 years to conceive this child, so I'm a tad bit nervous about someone else coming in and screwing something up.

Well; you can't force people around you to vaccinate their kid and you can't even be sure that they are vaccinated, there isn't much that one can do against that although, as said, educating the people around you and increasing the awareness about vaccine will help. Or at least, it will make you unpleasant to be around for the anti-vax nutters, and that still help rising your odds...

Keeping your child vaccinated and being vaccinated yourself is the best you can do. It's not perfect, obviously, but it is the best you can do.

So, you are not being paranoid about it being a risk you have little control about. You might be a bit paranoid about the actual risk it represents. Pertussis is not benign, of course, but the risks of a life threatening prognostic are still pretty low.
At the end of the day, there will always be a level of risk you can't do anything about and have to learn to accept and live with.
 
Vets routinely advise that puppies and kittens should be kept secluded until they're old enough to be vaccinated. I've seen people carrying some quite big bundles of fur, because they were afraid to let them walk on the pavement!

This is the reason the GDBA give all their pups extra vaccines starting very young - to allow them to start socialisation training, which is vital if they're going to be guide dogs. The idea is that if their colostral immunity is poor, the vaccine will "take", and protect. Then subsequent doses are unnecessary but harmless. Conversely if colostral immunity is good, then the early doses will be ineffective (as the colostral antibodies will neutralise the vaccine), but that doesn't matter because the colostral immunity is itself protective. The the later doses will "take" and provide active immunity.

Most people don't want to shell out for the extra doses, so they don't let their puppies out of the house until the normal vaccination course has been completed.

Same thing probably applies to babies too I would think. Don't human-type nurses advise new mothers?

Rolfe.
 
Same thing probably applies to babies too I would think. Don't human-type nurses advise new mothers?

Rolfe.

Of course. There are loads of pamphlets, advice, and movies a mother is given at the hospital, and more to take home.

The problem as I understand it is over half of all cases of pertussis occur when the mother passes the disease to the infant and three quarters is from someone in the household; the mother often holds the infant near their face for most of the day. Further, the symptoms in adolescents and adults are pretty mild and people may not seek treatment at all, and people who haven't gotten their vaccine as adults can be non-symptomatic carriers.

So statistically, if your household is vaccinated the most likely cause of pertussis is eliminated.
 
I went for my regular prenatal exam yesterday and some of the nurses were very upset over a case of whooping cough in the infant daughter of one of their patients. (My mom's little brother had it back in the 50s and she said it was one of the most frightening things she'd ever seen.)

Our community has seen several cases of whooping cough already this year and there is a certain unspoken accusation that it's due to parents not having their children vaccinated.


So paranoid mom asks this:

I looked at the CDC vaccination schedule and it seems that infants don't even start receiving vaccines for things like pertussis until 2 months old. Now I'm not planning on sending my 8-week old kid to the park to play with other kids, but is there a certain general "safe" age at which I won't be afraid to let my child be breathed upon by strangers who might be infected with who knows what? Should I keep her away from other kids/babies for 6 months? 12 months?

Apart from locking her away until she's twelve, what REASONABLE precautions can I take to prevent her from being exposed to a disease that can kill her before she's able to have the completed vaccine series?

I know this is me being uber-paranoid and ridiculously protective, but I hear parents all around me saying they didn't vaccinate, I'm I starting to view these people and their children as potential carriers of that one rare disease that will kill my child. (Okay that's me being dramatic, but the risk is there.)
As a nurse practitioner specializing in infectious disease, I'm afraid I can't help you be less paranoid. It's just one of those things you'll have to work through. Of course as they get older, you just trade one fear for another. Wait till your baby is in the car riding/driving age. ;)

I kid a little and I'm also serious. All you can do is manage risk using the best available information, you cannot eliminate it. So here is some info on pertussis:

Infants under one year are at greatest risk, and vaccine only decreases the risk, it does not eliminate it. Children under age 5 are at greater risk than older kids and may end up hospitalized even if the fatality rate is lower. After that, the infection is very annoying (think 100 day cough) but not as serious.

One reason we are having current annual epidemics of pertussis is not because parents are not vaccinating, it's because adults all need a pertussis booster. That means the most important thing you can do for your infant in this case is make sure you, your husband, and anyone else who cares for your infant get a Tdap (tetanus diphtheria pertussis) vaccine booster if you have not had one. They have only been available since 2005. If you've had a tetanus booster in the last 6 years, you MUST CHECK to see if you had the one with pertussis and if not then get one. Until we get caught up vaccinating adults with this new vaccine booster, annual epidemics and outbreaks will continue.

The biggest group currently spreading pertussis is teens and young adults. Because there was not a vaccine booster available for anyone over age 7 until recently, the vaccinated cohort (everyone vaccinated for pertussis as kids) outgrew their protection. About 15-20 years ago, the pool of susceptible people reached the point where sustained transmission could occur. So don't let any teen or young adult with a cold near your child during pertussis outbreaks. And if you have teens and young adults around, such as siblings or another child, make sure they also get their boosters (due at age 15 if the child's vaccines are on schedule).

Pertussis begins as a mild cold and doesn't develop classic cough symptoms until 5-7 days later. So there is no way to recognize it in its early contagious phase except by a culture. It is, however seasonal, so one needs to be aware of the rate of pertussis in your community. If the rate is high, and you are able to keep your baby away for people with infection symptoms, do so, But when the community rates are low, you should not worry about everyone with the sniffles. Kids will get their usual upper respiratory infections (colds) as soon as they are around other kids. Studies show kids in day care get the colds at younger ages, but kids not in day care get the same number eventually when they start school. (GI infections are more frequent in kids in daycare).

It is droplet spread. That means it is not silently floating around in the air, people get it directly from each other, and from contact with the organism on surfaces. If one stays 3-4 feet away from a contagious person, and uses really good hand washing, one is unlikely to get pertussis. Pertussis lives a few days on surfaces. And there is antibiotic treatment for people exposed and who have the infection. A person with pertussis is contagious for several weeks or more UNLESS they are treated in which case they will still cough incessantly, but won't still be expelling organisms.
 
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The vaccine schedules we recommend out here in India are

at birth to 6 weeks - Hep B, Oral Polio zero dose, BCG (TB vaccine)
4 to 6 weeks - Hep B second dose
6/10/14 weeks - DPT I/II/III and OPV I/II/III

The lack of TB in the USA means you would not have to take that (TB vaccine works best if you are exposed to TB).

The recent nonsense regarding anti-vaccine parents has caused a few polio cases in the USA would make me suggest the Polio vaccine. It's worth it if you want to travel with the kids. Again take the TB vaccine if you plan to travel anywhere outside the USA. It's a godsend against preventing TB resurgence at the cost of a skin blemish.

BCG%20scar.jpg
 
... Again take the TB vaccine if you plan to travel anywhere outside the USA. It's a godsend against preventing TB resurgence at the cost of a skin blemish.
NO, do not take the TB vaccine if you plan to travel. And you shouldn't be giving medical advice you are not qualified to give.

Follow the CDC ACIP guidelines for all vaccines if you are in the US and the CDC's "YellowBook" for vaccines when you travel. For people in other countries, look for your own country's authority on vaccine schedules.

Here's the vaccine recommendations by country page for travelers from the US going to other countries.

Here's the current BCG (TB) vaccine information page.
 
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Apart from locking her away until she's twelve, what REASONABLE precautions can I take to prevent her from being exposed to a disease that can kill her before she's able to have the completed vaccine series?


The bad news: There is very little a doctor could or would do for a newborn under the age of two months.

The good news: Newborns have the best immune systems of anybody anywhere.

So, while you can't keep your child safe from sources of infections, you can rest a little easier knowing your newborn is heartier than she seems. In some ways, she'll be heartier than you.
 
The bad news: There is very little a doctor could or would do for a newborn under the age of two months.

The good news: Newborns have the best immune systems of anybody anywhere.

So, while you can't keep your child safe from sources of infections, you can rest a little easier knowing your newborn is heartier than she seems. In some ways, she'll be heartier than you.
While I agree it is helpful to reassure a new parent, babies under 2 months are not immune to everything and you are giving bad advice here. Newborns do not have the best immune system of anybody anywhere. What evidence are you basing that claim on?
 
Of course. There are loads of pamphlets, advice, and movies a mother is given at the hospital, and more to take home.
I didn't get any. There was one video on infant care, I believe, they had us watch. My son is almost 22 so this would have been 22 years ago. [politics sidetrack]A long time ago we had public health nurses who visited all new moms but the funding was cut for that decades ago, and now the latest cuts include cutting WIC programs as well. Those rich people need their tax cuts. :( [/politics sidetrack]

The problem as I understand it is over half of all cases of pertussis occur when the mother passes the disease to the infant and three quarters is from someone in the household; the mother often holds the infant near their face for most of the day. Further, the symptoms in adolescents and adults are pretty mild and people may not seek treatment at all, and people who haven't gotten their vaccine as adults can be non-symptomatic carriers.

So statistically, if your household is vaccinated the most likely cause of pertussis is eliminated.
The symptoms are mild in the first week for everyone infected, not just certain age groups. And adults and teens can get the typical spasmodic cough. One symptom is vomiting at the end of an incessant coughing spell. This pathogen does not spare adults the misery.

However, you are correct in that many people (probably due to partial immunity) have atypical coughs and remain unrecognized cases. And you are correct it is likely to be someone who has close contact with the infant that infects the child.
 
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Amanda, It's a difficult climate because of large pockets of anti-vaxxers or ridiculously delayed/selective vaxxers. I removed myself from a mothers' group due to their anti-vaxx stance, not so much for their unvaccinated infants but out of concern about older siblings, the mothers don't have the sense to keep their children home when ill and even actively seeking out disease to provide their special snowflakes with "lifelong immunity". They also lie about being unvaccinated to avoid becoming pariahs.

So, staying a hermit isn't an answer but you can take steps to minimise your infant's exposure by baby-wearing, washing your hands (general good hygiene), immunising eligible members of your family to cocoon your infant and trying to avoid mass gatherings with parents who you aren't sure or know they don't vaccinate.

Este
 
While I agree it is helpful to reassure a new parent, babies under 2 months are not immune to everything and you are giving bad advice here. Newborns do not have the best immune system of anybody anywhere. What evidence are you basing that claim on?


Here's one article that says what I was trying to express. Sorry if I overstated the case. However, I don't think I was giving bad advice: Don't worry too much about infectious diseases for your newborn, her immune system (especially if the baby is breastfed) will generally be able to meet the challenges she faces.
 
It is true that infants can't receive the pertussis vaccine until a certian age, which is why herd immunity is so important! And the accusation is spot on! http://factsnotfantasy.com/vaccines.php has some good info to dispell many of the outright lies spread by the anti-vax pro-disease nutters.

As to precations, make sure that everyone you know is up to date on their shots. Follow the vaccination schedule. And educate people around you.

And to add to this: if you find out any friends and/or family aren't up to date on their shots, tell them - point blank - that they're simply not allowed to visit or be around the kid. End of story. Your kid's health is more important than some hurt feelings of some goober who doesn't want to get vaccinated.

Btw, here's another good website on this: Hug Me, I'm Vaccinated!
 
One reason we are having current annual epidemics of pertussis is not because parents are not vaccinating, it's because adults all need a pertussis booster. That means the most important thing you can do for your infant in this case is make sure you, your husband, and anyone else who cares for your infant get a Tdap (tetanus diphtheria pertussis) vaccine booster if you have not had one. They have only been available since 2005. If you've had a tetanus booster in the last 6 years, you MUST CHECK to see if you had the one with pertussis and if not then get one. Until we get caught up vaccinating adults with this new vaccine booster, annual epidemics and outbreaks will continue.

Okay -- thank you for this. I'm sure I haven't had this (or my husband) since the last vaccines we got were in college, and that was long before 2005.

I was reading up on pertussis, and the CDC says you be a carrier, even if you've been infected or vaccinated. They also say the only way to accurate test for it is a nasal swab test, and most doctors don't do that routinely. My mom has had a persistent cough for the last year, but her doctor has never tested her for this. She freaked out when I told her and called to demand a test.

I'm forwarding this information to all of our immediate family. I'm giving them a grandkid -- the least they can do is get a shot!

Ginger - do you know if this booster is something I can get while pregnant? I have this all on my list of things to ask my doc at our next appointment, but I'm just curious now.

Also, is there anything else I should get? I haven't heard of a measles outbreak or anything, but is there a "new mom" schedule of vaccines? Do I need an MMR booster, just to be safe?
 
Ginger - do you know if this booster is something I can get while pregnant? I have this all on my list of things to ask my doc at our next appointment, but I'm just curious now.


I don't think they'll give you a booster while you're pregnant. Very, very few drugs have been scientifically tested on pregnant women for obvious reasons. Even if such a shot were safe, I doubt anybody would want to take the risk of finding that out.
 

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