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Observations about pertussis and vaccines from a peds RN

post #1 of 33
Thread Starter 

I know that MDC mamas mostly choose not to vaccinate, or they vaccinate on their own terms. Parents have rights and that's part of living in the U.S. I certainly would not want anyone telling me what to do with my child.

 

As a peds RN working on a respiratory unit  I have to say, pertussis is awful. If you go to youtube and google it or whooping cough, yes the patients are really that bad. It's beyond awful. To support a baby through endless coughing spells when they cannot eat, cannot breathe, cannot get a break, and cannot be comforted. I had one dad cry while watching his child suffer. He had several children and said this was by far the worst thing he had ever had to deal with as a parent because he could do nothing to help the baby. Some of our patients end up sedated and intubated until it's over. Some die. Luckily not many die but the suffering of the ones who survive is so very awful, there are no words for it.

 

Here's a little girl:

http://www.youtube.com/watch?v=AIVt3e5EVtc

 

Here's a baby-

http://www.youtube.com/watch?v=oYCkr3YxjIY

 

The nurse is helpless other than suctioning and some O2 and positioning. That's how I feel when I have these patients. The mom is helpless. And this goes on and one with no rest between the spasms. No one sleeps for days. 

 

Most of my patients are too young to get the vaccine. In some cases they are able to trace it to an adult who was around them, or to a daycare situation. Very few of my patients have families who don't believe in vaccination. They are adults who are not vaccinated or it ran out and is no longer effective in them. They get a cold and a small cough, the baby gets very very sick. 

 

I personally do vaccinate my kids. I have been to India and see polio victims. Thankfully they have pretty much wiped out polio finally but the victims are still there and cannot walk and there are few resources to provide for them like they have in the US. I found out when I was pregnant with my first child, when I had titres drawn, that I was not immune to rubella. Somehow my vaccine either wore off or never took in the first place. Thanks to herd immunity I never got it during the pregnancy. If I had my child could have been severely affected. 

 

I have seen a couple of kids harmed by bad side effects of vaccines. One boy I know his mom on-line, he suffered permanent brain damage from swelling in the brain. I have also had a young Guillain-Barre patient who got it from the live flu vaccine and needed months of therapy to recover. Vaccines are not without risk, but I guess I figure the bigger risk is getting the infections, statistically speaking. 


Edited by USAmma - 9/27/13 at 2:13am
post #2 of 33

I agree that these diseases are still really prevalent.  We personally have vaccinated for everything this far but will not do flu and are questioning varicella.  I think the reason parents choose not to vaccinate for pertussis is because it hasn't proven very effective against current strains.  I also agree that vaccines aren't for everyone especially those who have immune system problems which is why it is important for others to vaccinate.  There is also the theory that polio was going away before the vaccine.  I see both sides, but personally vaccinate. 

post #3 of 33

Thank you for posting this. Its really interesting to hear from the front line :)

 

I think the point you are making is a really good one. Vaccines have a small, statistical, chance of side effects. In that they are like any other medical procedure really. We are  playing the odds, but they are amazing odds.

 

I read once that the odds of being involved in a fatal car accident for the three doctors trips you'd make to get the MMR separates were greater than even the odds anti-vaxxers were giving for side effects. We play the odds every minute of the day. Driving is pretty dangerous really and yet most of us don't really consider the dangers of driving when deciding to make a trip.

 

One thing that complicates the issue with vaccines I feel is the herd immunity thing. Its easy to think "I'm healthy, I can fight off whooping cough.". It comes down to whether we see ourselves as owing responsibility to those in our society who cannot fight off disease as effectively. I happen to think that, in the main, those with depleted immunity-the sick, those with poor diets through poverty, young children, older people - are exactly the people I feel are owed protection by the rest of us, in every area, including herd immunity. 

post #4 of 33
Thread Starter 

We have had other things come through the hospital in the last year that also were preventable. We have members of certain communities come in who don't believe in vaccines for religions reasons, and some of them have contracted severe meningitis with brain damage or death. I don't know of a single nurse working on my unit who does not believe in vaccines. Some choose to have delayed schedules for their kids, but we all are very very sad when we see a child so sick and it possibly didn't have to happen. :-(

 

Flu shots are another story-- some nurses choose not to get them. I do every year but some years I get sick anyway. I have asthma so getting a virus requires a dose of steroids. It's a toss-up.

post #5 of 33

I am so torn about flu shots also.  My mother who is a nurse always gets them and gets sick every winter.  She insists that she would be more sick hadn't she gotten the shot.  I have never had the flu shot and am very rarely sick.  I know I will not get it myself, but am undecided about getting it more my almost 10 month old.  My instinct is not to get it even though he has every other shot.  

post #6 of 33

Since your mother is a nurse, she's probably exposed to all sorts of stuff at work, so that could be part of it. I usually get 3-4 colds per winter and I don't think getting the flu shot has anything whatsoever to do with it. I've only had the flu once, when I was 17, but it sucked enough then that I'll do what I can to avoid getting it again. 

 

The Cochrane Reviews said there is no efficacy greater than placebo for flu shots in kids under 2, so I felt fine about skipping it for my daughter. 

post #7 of 33

I've received it every year starting five years ago. I've never contracted the flu either before or after beginning to receive the flu shot, and I get 1-2 colds per winter, again both before and after starting to get the shot. 

 

Really my concern is all the elderly folks I work with. Doing my part to build the herd immunity is very, very, VERY important to me. 

post #8 of 33
Thread Starter 

The stuff at work I usually don't get-- even bad stuff like the pertussis MRSA and pseudamonas in the tracheostomies, staph infections, severe strep and Kawaksaki disease. I think I've built up an immunity to a lot of those and probably am colonized with MRSA like most nurses. I also am more careful at work about handwashing and wearing mask/gown/gloves. But if one of my kids comes home with a cold from school, I always get it, and it seems like I get it worse because it triggers my asthma. So far I'm on my second cold since school started in July.

 

I've had the actual flu and it's way worse than the side effects from the shot, and worse than a cold. I felt like I had been hit by a truck, I ached so bad, shivers and sweats, wished I could sleep until it was over. Both times I've had it in the last 10 years or so, I was in bed for several days and weak for several weeks afterwards. The one I got in India was the worst one I've ever had. So bad, they tested me for malaria (which it was not).

post #9 of 33

Thank you for your post.

 

I had a reaction to flue vaccine wen I was little . We did not know I was allergic to one of the preservatives. I get preservative free vaccines.

 

I had mums and it was far more horrible than my reaction to the flu vaccine.

 

It is true GB can be cause by  flu vaccines. I read a lot of  literature on it. The chance of getting GB from the actual flue are much higher.

 

You post shows that pertussis is not some sort of being illness but something that at best make someone suffer  and it worst, kills.

post #10 of 33

I just typed out a huge and emotional story but I just cant right now. But in short: my 4 week old preemie (born at 32 weeks so only 36 weeks gestation) contracted pertussis last year. We almost lost her, and I mean that in a very specific non-hyperbolic way. She stopped breathing and we did CPR on the side of the road until EMT turned up to resuscitate her. 

 

She contracted it (as did two other babies in that NICU- neither of them my triplets) from a vaccinated NICU nurse. My children, who are not vaccinated, did not give it to her and all their swabs were clear. As were mine and DH's. 

 

I completely agree with you that pertussis is incredibly serious and not to be taken lightly. We almost buried our daughter because of it. But it doesn't change my mind. Even if we were the most rabid vaccinators ever she still would have caught it because she was too young. I appreciate your first line experience but there is mine and I am on the other side of the 'camp'. 

post #11 of 33
Quote:
Originally Posted by momtoafireteam View Post
Even if we were the most rabid vaccinators ever she still would have caught it because she was too young. I appreciate your first line experience but there is mine and I am on the other side of the 'camp'. 

 

This is not a debate thread.  But I wanted to point out that if you were a "rabid vaccinator", you probably would have received TDaP during pregnancy.  Receiving the TDaP during pregnancy allows for transfer of antibodies against pertussis through the placenta.    http://www.ajog.org/article/S0002-9378%2810%2902286-6/abstract

 

Quote:

Results

 

Newborns born from mothers who received Tdap during pregnancy had significantly higher concentrations of diphtheria antitoxin (P < .001), tetanus antitoxin (P = .004), and antibodies to pertussis toxin (P < .001), filamentous hemagglutinin (P = .002), pertactin (P < .001), and fimbriae 2/3 (P < .001) when compared to newborns from mothers who did not receive Tdap. There was a significant increase in the odds that newborns from mothers who received Tdap during pregnancy have antibodies that may provide protection against diphtheria (P = .0141), pertussis toxin (P < .0001), and fimbriae 2/3 (P = .0146).

post #12 of 33
Quote:
Originally Posted by erigeron View Post
 

Since your mother is a nurse, she's probably exposed to all sorts of stuff at work, so that could be part of it. I usually get 3-4 colds per winter and I don't think getting the flu shot has anything whatsoever to do with it. I've only had the flu once, when I was 17, but it sucked enough then that I'll do what I can to avoid getting it again. 

 

The Cochrane Reviews said there is no efficacy greater than placebo for flu shots in kids under 2, so I felt fine about skipping it for my daughter. 

 

I've never had the flu and am, in general, quite healthy.  And I don't get the flu shot every year.  It's a mostly if I remember kind of thing.  Or if the university nurses were roaming campus with their needles.  Last year I got a cold every other week due to breastfeeding and sleep deprivation I think.  I probably got a flu shot since DS was still young and because DH works with kids and all their germs.  But I honestly don't remember.  I did get it while pregnant and I was very healthy that winter.  At any rate, I've never noticed a difference in illness between flu shot and non-flu shot years.

 

Have you decided on if you're vaccinating your daughter this year erigeron? DS will be 2 exactly at his next appointment.  I would like him to get the mist to better protect the next baby who is due 3 weeks later.  But I don't want him to get it until I get the shot myself.  People can be infectious after the mist, right? 

post #13 of 33

"She contracted it (as did two other babies in that NICU- neither of them my triplets) from a vaccinated NICU nurse. My children, who are not vaccinated, did not give it to her and all their swabs were clear. As were mine and DH's. "

 
It sounds like a dreadful experience and I am sorry you went through it. And I would agree this is not a debate camp. 
 
To me this is why we do need herd immunity-because vaccines are not 100%. No one says they are. That doesn't render them useless though. Just because something mainly works but sometimes fails is not a good reason not to use it at all.
post #14 of 33
Quote:
Originally Posted by cwill View Post
 

 

I've never had the flu and am, in general, quite healthy.  And I don't get the flu shot every year.  It's a mostly if I remember kind of thing.  Or if the university nurses were roaming campus with their needles.  Last year I got a cold every other week due to breastfeeding and sleep deprivation I think.  I probably got a flu shot since DS was still young and because DH works with kids and all their germs.  But I honestly don't remember.  I did get it while pregnant and I was very healthy that winter.  At any rate, I've never noticed a difference in illness between flu shot and non-flu shot years.

 

Have you decided on if you're vaccinating your daughter this year erigeron? DS will be 2 exactly at his next appointment.  I would like him to get the mist to better protect the next baby who is due 3 weeks later.  But I don't want him to get it until I get the shot myself.  People can be infectious after the mist, right? 

 

Well, I work in an establishment that gives the flu vaccine, and I give it myself, so it's definitely not something I'm going to forget about, and it's easy for me to get (from a colleague) if I want it. 

 

I probably am going to get her vaccinated this year. Someone mentioned something on another thread about FluMist being more efficacious in little kids than the inactivated vaccine, but I need to look at that before deciding which one to do. A spray definitely seems easier on her than a shot--I mean, not that a shot is such a terribly horrible thing, but if I can get the same results without a needle, why not? 

 

http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm123743.pdf

 

Package insert for FluMist has the transmission rate from one kid who got the mist to another kid who did not estimated at 0.58%, which doesn't sound like much, but compared to the general rate of contracting flu and adding in the issues with being pregnant and immune-compromised makes me think it is a risk worth considering and managing. 

 

But I'm still not super-crazy about the idea of getting the flu vaccine before the third trimester myself, so that would have me getting vaccinated at the beginning of November and then waiting two weeks to vaccinate her. Hmm. And I still have to bug my husband to go get his, as well. He is all in favor of it but tends to just forget to actually go do it. I can see why it's challenging... I mean, visiting his spouse at work? How difficult! :eyesroll

post #15 of 33
Thread Starter 
Quote:
Originally Posted by momtoafireteam View Post
 

I just typed out a huge and emotional story but I just cant right now. But in short: my 4 week old preemie (born at 32 weeks so only 36 weeks gestation) contracted pertussis last year. We almost lost her, and I mean that in a very specific non-hyperbolic way. She stopped breathing and we did CPR on the side of the road until EMT turned up to resuscitate her. 

 

She contracted it (as did two other babies in that NICU- neither of them my triplets) from a vaccinated NICU nurse. My children, who are not vaccinated, did not give it to her and all their swabs were clear. As were mine and DH's. 

 

I completely agree with you that pertussis is incredibly serious and not to be taken lightly. We almost buried our daughter because of it. But it doesn't change my mind. Even if we were the most rabid vaccinators ever she still would have caught it because she was too young. I appreciate your first line experience but there is mine and I am on the other side of the 'camp'. 

 

Your story sounds awful and scary! :-( I'm so sorry you experienced this. Usually at our hospital they don't test the nurses unless they've been exposed to something bad through blood or sputum. Your hospital must have been super diligent in finding the cause. Our hospital prefers not only proof of vaccinations but also titres to make sure they work.

 

Vaccines don't always work as you found out. And as I posted before, I was not immune to rubella even with vaccinations. I just think it gives us a greater chance at good odds. 

Hospitals are a great place to catch things, which is ironic because people go there to heal. We have some chronic and longer-term patients on our unit doing rehab after accidents and illnesses. I tell the parents to try to get them home before respiratory season arrives in full force, because I worry about these patients getting something. Even though the nurses are good about wearing protective gowns/gloves/masks, it can come in on the nurse's shoes, or on the family/visitors who pass through the main hospital and cafeteria on their way to the patients' rooms. The safest place for a vulnerable immune compromised child is at home. 

post #16 of 33

They started testing nurses when the other NICU babies got pertussis. 

post #17 of 33
Quote:
Originally Posted by Fillyjonk View Post
 
It sounds like a dreadful experience and I am sorry you went through it. And I would agree this is not a debate camp. 
 
To me this is why we do need herd immunity-because vaccines are not 100%. No one says they are. That doesn't render them useless though. Just because something mainly works but sometimes fails is not a good reason not to use it at all.

 

Everything Fillyjonk said. I'm really sorry you had that horrible experience. 

post #18 of 33
Quote:
Originally Posted by cwill View Post
 I wanted to point out that if you were a "rabid vaccinator", you probably would have received TDaP during pregnancy.  Receiving the TDaP during pregnancy allows for transfer of antibodies against pertussis through the placenta.    http://www.ajog.org/article/S0002-9378%2810%2902286-6/abstract

 

How did I not know that? Now I want a TDaP booster. Thanks, cwill

post #19 of 33
Quote:
Originally Posted by erigeron View Post

 

But I'm still not super-crazy about the idea of getting the flu vaccine before the third trimester myself

 

For what it's worth, I just got mine yesterday, at 14w2d. I'm entirely convinced of the safety: http://www.ajog.org/article/S0002-9378(10)02286-6/abstract and http://www.ncbi.nlm.nih.gov/pubmed/23262941, just off the top of my Google Scholar. 

 

'Course, what it's worth might not be that much! ;-)

post #20 of 33
Thread Starter 
Quote:
Originally Posted by momtoafireteam View Post
 

They started testing nurses when the other NICU babies got pertussis. 

 

Sounds like your babies went to a good nursery. I'm sure that nurse must have felt terrible!

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