Pediatric Care

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This is a weekly dose of wellness brought to you by MemorialCare health system. Here's Melanie Cole.

Melanie Cole
August is National Immunization Awareness Month. My guest today is Dr. Linh Nguyen England when she's a pediatrician at MemorialCare Medical Group's primary care office on Bellflower Boulevard in Long Beach, California. Welcome to the show, doctor. When we're talking about National Immunization Awareness Month and people have a lot of questions about vaccines so that to start before the school year begins. Tell us about the safety and efficacy of vaccines.

Linh Nguyen England, M.D.
Good morning, thank you for having me on your show today. Yes, this is by far the hottest topic in pediatrics these days, and the most important question that parents have, like you said, is the safety. And the truth is, vaccines are safe. They're usually years, decades of extensive research and testing that goes into ensuring the safety and effectiveness before they can be approved and licensed. And also, they are continually monitored for any potential safety issues and adverse effects.

Melanie Cole
How important is it that parents stick to the vaccination schedule set out by the American Academy of Pediatrics?

Linh Nguyen England, M.D.
By far, vaccinating our children is the most important thing we can do to protect their health, and the schedule is set up so that we can protect our children as soon as possible before they can enter school or interact with society in a way that is safe for them.

Melanie Cole
Dr. Nguyen, when people hear about vaccinations, it's been such a hot topic, as you say lately, when parents ask you as a pediatrician, what are the benefits versus the risks of vaccinations? Will it cause autism? Are there all these problems? What do you tell parents? You're most important information?

Linh Nguyen England, M.D.
Yes, that is definitely the typical questions that they always ask me because parents care about their children, and especially when we're putting something new to the children's bodies, they have many questions. But benefits that we get from vaccines by far outweigh the risks and the nature of potential side effects that we get from vaccines. And what I tell parents is these days we are so fortunate as a society in the US that we do not see the devastating effect of diseases that we have prevented with the vaccine. And the symptoms can vary from severe sickness to paralysis, heart, liver issues and death. And because we do not see those effects as commonly these days, the fear kind of went away and we focus on confusing messages in the media. And if we stop vaccinating our children, those symptoms, diseases will come back and more children will get severely sick and die. So it's very, very dangerous thing to consider not vaccinating the children.

Melanie Cole
Tell us about the schedule a little bit, Dr. Nuguyen and why are some vaccines combined with others, such as DTaP and MMR? Does that increase any risk? So speak about some of the diseases that we covered today and why some of those vaccines are combined.

Linh Nguyen England, M.D.
Right. So. Because if we don't combine some of the vaccines, one, our children will get a lot of pokes at once, and that's not that pleasant for them. And too many of them are combined for scientific reason because together they can be in molecularly one vial that does not interfere with each other. And we can actually give them much less of the additives in the vaccine. And another reason, too, is because some of the vaccines need a longer period for our body to produce antibodies in order for it to work. That's why if we spread out the vaccines. It will take a very, very long and we'll take our bodies through a longer period to get that immunity and also to make sure that we recover from any side effects of the vaccine. So that's why some of them are given together so that the body goes through the potential side effects in a shorter period of time.

Melanie Cole
And are there certain vaccines that you would like to just point out and make sure to let parents know that there was a recent outbreak of measles? That's a nasty disease, Dr. Nguyen, so speak about some of these vaccines that we've heard about in the media lately and the importance of getting those. When do we get those in the importance of getting them on time?

Linh Nguyen England, M.D.
Yes. So measles is definitely very high up there as far as controversy in the media and the start of the controversy, the media was about potential risk causing autism, which has been disproven many, many, many times by scientific research and has not been any kind really proven link between it. So the studies have been disproven, however, that fear of measles is still out there because measles is given at right around the same time that autism could present itself. So the vaccine has been unfortunately falsely accused of causing it, but that has been disproven. And measles is given first and usually after the first birthday and then another booster before going to kindergarten. So I've had many parents will come with newborn babies who are afraid of the vaccine, and I do tell them that a vaccine is not given until one year old. However, that means that your newborn baby is potentially at risk of getting measles if our society continues not to protect themselves against the illness. And yes, it's devastating. It can get them very, very sick. They end up in a hospital with severe severe illness, needing fluids, needing medication, and we actually don't really have a cure for it. We kind of just help and support their body while they go through it.

Melanie Cole
So recently, with all of this media attention, some parents, anti-vaxxers, they're called as you as a pediatrician. What do you say to a parent that says to you, I am hesitant to give my child any of these vaccines? And even with all of the important information that I hear, what do you tell them about when they question you and they say, I don't want to do this? What do you say?

Linh Nguyen England, M.D.
So I always have very open communication with the parents, and I want to make sure that decision that they're making is an informed decision because it is their child and they're just concerned about their child's health and safety, which is absolutely understandable. And I see most of the time when we have open communication and I answer the question and eliminate any misinformation. I actually am able to convince many of the parents to vaccinate their children with the outbreak recently of measles. Many of the parents who have been vaccinated, their children at all have come back to me in order to vaccinate their children. So the most important thing is that open communication and the trust between the clinician and the parents. And I do tell them about the potential side effects because like any medications, vaccinations do have side effects. And after knowing how mild it usually is, many parents will decide to get the vaccine.

Melanie Cole
So many vaccines are given at the very beginning of life, hepatitis and rotavirus and the tap vaccine. So many of these are given in the first few months. And is it safe for the babies, the little babies to get these vaccines right away? Hepatitis in such?

Linh Nguyen England, M.D.
Oh, absolutely. And it's actually the little one that we want to protect as soon as possible because they're most at risk to be severely ill if they don't get these vaccinations. We do give the first big set of vaccinations at two months and we protect them against illnesses like whooping cough, which in adults it could be just like a cold kind of cough. But in a newborn baby, they end up stopping their breathing. They end up being on ventilators, end up being in the hospital for weeks, and they can potentially die. So with those children, particularly, we want to protect them as soon as possible. And there's always this fear that we're exposing the little children to too many vaccines at once. But the reality is children are exposed to many, many other viruses all the time. You know, if you forget to or they put dirty hands into their mouth, that is millions and millions of different viruses and potentially bacteria that put in their mouth and their right. So we absolutely don't have a fear of putting too many at once.

Melanie Cole
In just the last few minutes, Dr. Nguyen and it's such important information. I am very passionate about the vaccine situation and with the American Academy of Pediatrics, tell us where people can find more information about vaccine and immunization and why it's so important that they vaccinate their children.

Linh Nguyen England, M.D.
The most reliable source about the current state of diseases and vaccinations and side effects is the CDC.gov website. It also has a parent-friendly version of information about illnesses and vaccinations, and my other favorite one is healthychildren.org by AAP, which is also very, very friendly, but with the most reliable information.

Melanie Cole
Thank you so much for such great information. You're listening to weekly dose of wellness. For more information, you can go to MemorialCare.org. That's MemorialCare.org. This is Melanie Cole sitting in for Deborah Howell. Thanks so much for listening.

Announcer
This is the weekly dose of wellness brought to you by MemorialCare health system. Here's Deborah Howell.

Deborah Howell
Hi there. And welcome to our show. I am Deborah Howell, and today's guest is Dr. Linh Nguyen England. Dr. Nguyen is a pediatrician at Memorial Care and Medical Groups Primary Care Office in Long Beach, California. Dr. Winn believes in the power to change a child's well-being through preventive care and partnering with parents to achieve the best care possible for their child. Welcome, Dr. Nguyen.

Linh Nguyen England, M.D.
Hi, thank you, Deborah. Thank you for having me again.

Deborah Howell
Nice to have you back. Today we're going to be talking about ear infections and our kids. Oh, that can be so painful. How common are ear infections in children these days?

Linh Nguyen England, M.D.
They are very common. In fact, infections actually are the most common infections requiring treatment in children younger than five years old.

Deborah Howell
Wow.

Linh Nguyen England, M.D.
Yeah. About two out of three kids will get the first infection before they turn to.

Deborah Howell
It almost seems like every time they go into the kiddy pool or the pool, they get an ear infection.

Linh Nguyen England, M.D.
Yes, or the first few weeks after they entered daycare.

Deborah Howell
That's true, too. So what are the primary symptoms of an ear infection?

Linh Nguyen England, M.D.
Ear infections can be very tricky, and especially in little baby, because it can be as subtle as being very fussy and not eating well. Older children tend to be easier because they will have ear pain and fever. They'll tug on the ears and sometimes they'll tell you

Deborah Howell
That's the thing if they can't tell you.

Linh Nguyen England, M.D.
Yes, but, you know, unfortunately, not all the time. I think kids that don't have your pain and inspect them feel for a cold And there it is. So it's very tricky for parents to know.

Deborah Howell
Yeah, especially sometimes they think their kid is just teething, but maybe it's an ear infection.

Linh Nguyen England, M.D.
Yes, because the symptoms of teething overlap with symptoms of ear infection. Including even fever. Because sometimes baby, that are teething tend to have low grade fever. A little trick for parents. So is with teething babies tends to drool quite a lot, and they tend to get comforted with the teethers or gum rubbing. And that's when they feel a little bit better. And the fevers tend not to run as high as with ear infections. But it's always best to get checked in.

Deborah Howell
Sure. Sure. I mean, anytime your baby has a fever or your child has a fever, it never hurts to get them checked, especially if you have a primary care physician that's nearby.

Linh Nguyen England, M.D.
Right.

Deborah Howell
What causes all these ear infections?

Linh Nguyen England, M.D.
So vast majority of your infections are triggered by us having a cold or just having allergies with lots of nasal congestion. There's fluid that just stays in the back of our nasal passages and just in little kids can go towards the middle ear and bacteria attack. On top of that.

Deborah Howell
I never would have connected as my two ear infections. You learn something every day, right?

Linh Nguyen England, M.D.
Yes.

Deborah Howell
Wow. There's so many causes. So are they usually bacterial or always bacterial or sometimes fungal? Or maybe you can help us on that.

Linh Nguyen England, M.D.
So, yes, they can be all of those options that you mentioned. But in children, the majority of time it is a bacterial infection, especially in kids younger than five. And that's why we have to treat them with antibiotics.

Deborah Howell
Right. And probably keeping their fingers out of their ears, and they probably shouldn't be stuffing peas down their ears.

Linh Nguyen England, M.D.
Yes, I find the most random things in their ears, all the time.

Deborah Howell
I can only imagine. Okay, so let's get back to the treatment. Now, how are ear infections treated?

Linh Nguyen England, M.D.
So with simple infections, we always start with antibiotics, and it tends to treat the vast majority of ear infections really well. However, sometimes we do have the stubborn ear infections that are very hard to treat, one that we have to go through a few rounds of antibiotics. And at that point, we might refer the case to specialists to either drain the fluid out or even put tubes in.

Deborah Howell
Wow. OK. That can't be very pleasant.

Linh Nguyen England, M.D.
No, no. We try to avoid that fate as much as possible.

Deborah Howell
And then at that point, how long does it take for most ear infections to clear up?

Linh Nguyen England, M.D.
So the simple ear infections with antibiotics, the main symptoms of pain and fever going really fast, we're talking about few days. But the fluids itself takes about two to three weeks to clear up.

Deborah Howell
Two to three weeks?

Linh Nguyen England, M.D.
Yes.

Deborah Howell
How do you keep your kid happy during the two to three on, you know, your drains and antibiotics?

Linh Nguyen England, M.D.
Yeah, it's very hard once you have ear infections. As simple as it sounds, it's still like if they're dealing with antibiotics for seven to ten days. And most of the time I have to re-check that years if they're young and hope that we don't have to go another round.

Deborah Howell
Yeah, and I don't know about you, but my only really sensitive area when I go to the doctor where they really call me a wimp is the ear doctor because it's so sensitive inside there.

Linh Nguyen England, M.D.
It is and I always tell the kids that it's going to take a little bit and they find that funny. And it prepares them a little bit for that. But yes, it's a very, not a good feeling.

Deborah Howell
That's a very smart tactic, doctor England. What can parents do to help prevent ear infections? So we don't have to go through all this?

Linh Nguyen England, M.D.
So preventing the colds as much as possible, but that's very difficult in kids. Getting vaccinated is actually key because most of these bacteria, there's four main bacteria that causes ear infections, and the vaccine schedule actually prevents the majority of ear infections. But if they get vaccinated by the time they're two.

Deborah Howell
OK, wonderful.

Linh Nguyen England, M.D.
So that was the whole point of doing that vaccine schedule and staying with the schedule so that they don't get ear infections that can actually turn into meningitis or actually infection in the blood.

Deborah Howell
Where you really, really don't want it to go. That's right.

Linh Nguyen England, M.D.
Right, right. And we don't see that much anymore because we're vaccinated against the pneumococcal and the hip disease. What else parents can do is actually provide the smoke-free environment and also taking away the bottle as much as possible. Definitely after they turn one.

Deborah Howell
OK, I didn't know that was connected. How is that connected?

Linh Nguyen England, M.D.
Because of course, we allow babies to have bottles until they turn one. That's the only way they can get nutrition. But the moment they can use the sippy cup and also other sources of nutrition, we want to avoid that constant sucking motion that they do with the bottle. And that pulls the fluid back into the middle ear.

Deborah Howell
I see that makes sense now, OK? So if our listeners want more information on ear infections in children, where's the first place they that you would send them?

Linh Nguyen England, M.D.
The website, healthychildren.org is the most common one I spent my families to in cases like this. The CDC website is a pretty good source as well.

Deborah Howell
Okay, so CDC.gov or healthychildren.org. I want to thank you so much for taking time out of your day to be on our show today, Dr. Nguyen.

Linh Nguyen England, M.D.
Oh, thank you. It's always a pleasure.

Deborah Howell
Please come back and see us real soon, OK?

Linh Nguyen England, M.D.
OK.

Deborah Howell
For more information or to listen to a podcast of this show, please visit MemorialCare.org. That's MemorialCare.org. That's all for this time. I'm Deborah Howell. We will see you soon for another weekly dose of wellness brought to you by MemorialCare health systems. Have yourself a fantastic day.

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MemorialCare health system Excellence in Health Care presents weekly dose of wellness. Here's your host, Deborah Howell.

Deborah Howell
Welcome to the show, I am Deborah Howell, and today we'll be talking about asthma and the flu. Our guest today is Dr. Jen Jen Chen, a pediatric pulmonologist at Miller Children's and Women's Hospital in Long Beach. Welcome, Dr. Chen.

Jen Jen Chen, M.D.
Hi, Deborah. Thank you for having me.

Deborah Howell
Thank you for being on the show. So asthma triggers often are harmless to most people, but certain substances, like weather conditions or even other diseases like the flu can make life very, very difficult for a child with asthma. What can happen when a child with asthma gets a cold or the flu?

Jen Jen Chen, M.D.
So, I mean, when you and I have the flu, it kicks us probably pretty hard. And so you can imagine when a child, especially if a small child gets the flu on top of asthma. What asthma does. And this is just anecdotally to go into the little metaphor because my mom told me when I cook a patient report oil down the drain, right? Because it closed the pipe makes it sicker. And essentially, that's what happens when you get a cold or flu. Imagine your pipes as the airways. And so when you have an infection, any kind of respiratory infection, your airways will get sicker. So that's that coating. And on top of that, if you have an underlying asthma, what asthma is is very sensitive airways. It is a lot of inflammation, so very thick airways, you start off with sick the airways. And on top of that, you get more thicker airways because of the inflammation and at some point the air. It's very difficult for the air to get in and out of your lungs. And so that's that's what happens when a kid with asthma gets a cold or flu. On top of that.

Deborah Howell
Wow, that sounds tough. All right now, how can a cold or flu trigger an asthma attack?

Jen Jen Chen, M.D.
Well, it really has to do with your immune system, and I don't want to get in the nuts and bolts of it . But basically what happens is when you get a virus, usually a virus, respiratory infection, that virus will trigger a certain type of immune system, and it will release certain chemicals, so to speak, that will actually trigger an asthma attack. And so for an asthma attack, that's when your airways will, as I mentioned, become more inflamed. But on top of that, it can cause what we call bronchospasm, which are when your airways will shrink because they're so reactive. And so that leaves a child to have coughing, wheezing or complain they can't get air in very much.

Deborah Howell
Mm-Hmm. And what are some of the serious complications the flu can cause for kids with asthma and other respiratory conditions?

Jen Jen Chen, M.D.
Oh, here they actually just got off of being in the hospital and on it. It can hit very quickly and very hard. And I think the rapidness of how quickly this can escalate is probably the most worrisome part because when you're talking about a child and how small their airways are, they don't have a large caliber to work with. And on top of that, do you have the asthma that a child has? And when the diameter of your airways, it's small enough that the air can start getting out. It's pretty much like if you were taking a straw and putting it in your mouth and breathing in and out with a straw. And you can imagine that the complications can make anywhere from having an overlying pneumonia because of just a simple cold or flu to, you know, being in the ICU. And the reason for having more infection, like on top of the virus that have some kind of bacterial infection like a pneumonia is because when you have asthma, you have a cold, you have a lot of mucus in there like everybody knows, but that means its saved. And it's trapped by those smaller airways and it doesn't go anywhere. Usually, when we have a cold, we can cough it up pretty easily because you have a larger lungs than your average child. So what happens is when you have asthma, everything is trapped up in there. The musus is a perfect situation for bacteria to overpopulate and then and then you start getting pneumonia. And then with that, all the complications ad up to the point where you can end up in the ICU.

Deborah Howell
So terrible, so terrible. So let's talk about some of the ways that families can help prevent the flu.

Jen Jen Chen, M.D.
And a lot of it really is sort of the common sense that I know a lot of parents really know about their washing hands, things like that. But the most important thing I don't know about the flu is that it is transmitted by droplets in the air. So I suggest parents want to go out and take a look at that video where you look at someone who's coughing and see how far the droplets can spread. It's a little scary. It's quite a few feet, actually, so that the sneezing, the coughing that can all spread the flu so preventively, if you do have cold symptoms, it's great to wear masks and then vice versa. Hand-washing, just staying away from people who are coughing. And teaching kids about that would be the best.

Deborah Howell
OK, and who actually should get a flu vaccination.

Jen Jen Chen, M.D.
The flu vaccination should really be received by everyone unless your doctor specifically otherwise says so based on your medical history. And there are certain types of flu vaccinations that are appropriate for those who have asthma and those who don't. For instance, we have a flu vaccination that injected, which is kind of the dead virus just to boost your immune system. And that's what kids with asthma should be getting. And then as opposed to the nasal administration of the flu virus, and that's just as same flu vaccine. But that's not going to cater for kids with asthma.

Deborah Howell
Got it. And what should parents do if their child with asthma catches the flu?

Jen Jen Chen, M.D.
I would ask if you had a fair shot at asthma and you and he or she got the flu. I would just give a quick call the doctor, just to let them know about the symptoms. Only because it can spiral so quickly and within a day or two, it could potentially get much worse. It's often difficult to find a doctor at night, and it's just too good to give your doctor a heads up that you know this is happening. And then on top of that, a lot of kids with asthma have something called albuterol, which is also known as a rescue inhaler. And if they do have albuterol on hand, I would start giving it earlier rather than later. It's really hard to play catch up when you're dealing with the flu and asthma. So if you give it earlier, it can kind of nip it in the bud, at least to prevent those bronchial spasms that, as I was talking about earlier,

Deborah Howell
I think that's just such a great idea to just call your doctor, give them a heads up because you're your kid is so sick and you don't know whether to transport them to the doctor and if that will make them worse. And you know, you just constantly second guessing,

Jen Jen Chen, M.D.
Right, its scarry. It's really scary when they when they have a flu and asthma and when it goes so quickly, at least your doctor can help you out. You know, you just don't want to deal with it at like 3:00 a.m. Yeah. Like, it always happens with kids.

Deborah Howell
That's always the thing. And I'm wondering, how can parents determine when it's time to call their child's doctor?

Jen Jen Chen, M.D.
Any time you're worried, I think parents have the best radar. Honestly, they know their kids the best. They have their gut instinct and any time that starts worrying otherwise, specifically, when your child has problems breathing in terms, it can be anything. Kids are different, so some kids will say, I can't, its like an elephant sitting on my chest, or some kids will say that I will be coughing throughout the night and they'll be struggling to breathe. I mean, at that point, it's it's definitely you should call your doctor, but again, call your doctor early. There's no problem with that. That's what we're here for.

Deborah Howell
Great. And is the cough. Does it sound different when the flu is involved?

Jen Jen Chen, M.D.
That is a really good question. So when the when first of all, there's not actually so much of a cough, you find more of cough, stuffy nose in a cold and flu, it's just they get hit hard in terms of you get tired. Very tired. Very fatigued. A lot of body aches. Very high fevers. The coughing can be an issue, especially they have asthma, but it's not that congested coughing that you see with cold.

Deborah Howell
OK, got it. And Dr. Chen working families go to find out more information about asthma management at treatment at Miller Children's.

Jen Jen Chen, M.D.
I think the best place to start would be our website because it really has a lot of information and contacts and resources. And that's at www.millerchildrenshospitallb.org, and then slash pulmonary.

Deborah Howell
Sounds good. And any final thoughts before we wrap up today?

Jen Jen Chen, M.D.
No, just take care of your kids, take care of yourselves and have a very healthy 2017

Deborah Howell
and get your vaccination right?

Jen Jen Chen, M.D.
Get your vaccination, Yes.

Deborah Howell
Well, thank you so much, Dr. Chen, for your time today. We really do appreciate you being on the show.

Jen Jen Chen, M.D.
Thanks for having me.

Deborah Howell
For information or to listen to a podcast of this show, please go to MemorialCare.org. That's MemorialCare.org. And that is all for this time. I am Deborah Howell. Thank you so much for listening and have yourself a terrific day and sleep well tonight.

Announcer
We're talking wellness at MemorialCare Health System. It's time for our weekly dose of wellness. Here's Deborah Howell.

Deborah Howell
And welcome to our show, this is your weekly dose of wellness, I'm Deborah Howell, and today our guest is Dr. Marnie Baker, a pediatrician with MemorialCare Medical Group in Irvine, whose practice emphasizes prevention by focusing on the benefits of nutrition and injury avoidance. Dr. Baker and I will discuss the concept of herd immunity and why our most vulnerable children rely on us the most and really, how childhood vaccinations help protect everyone. Welcome, Dr. Baker.

Marnie Baker, MD, MPH
Thank you for having me.

Deborah Howell
Oh, it's our pleasure. Believe me. Can you please tell us a little bit about the state of childhood vaccinations in California?

Marnie Baker, MD, MPH
Well, it's a little bit concerning because despite the fact that we have widespread availability to free vaccinations all over our state, we have been seeing an increasing trend of parents that are declining vaccination for their kids. And you can see this, in fact, from looking at the number of personal belief exemptions. And that is a form that parents fill out in order to have their child enter kindergarten in public schools.

Deborah Howell
Mm-Hmm.

Marnie Baker, MD, MPH
And with the decline vaccination based on their personal beliefs, this form needs to be filled out. And we have found that the number of children entering public schools on these personal belief exemption have doubled since about 2007.

Deborah Howell
Wow. So one out of how many children are exempt or choose to fill out the form?

Marnie Baker, MD, MPH
Interestingly, if you look on the, for example, the California Department of Public Health website, you can actually look up your own school because there's a huge variation. Some of the schools are still maintaining 99% vaccination rates.

Deborah Howell
Mm-Hmm.

Marnie Baker, MD, MPH
Unfortunately, some of the schools have as high as a 15 or 20% personal belief exemption rate, meaning that 15 to 20% of those kids are entering either unvaccinated or under-vaccinated.

Deborah Howell
So two or three out of ten kids not vaccinated. Why do you think parents are not vaccinating their children?

Marnie Baker, MD, MPH
Well, that's a complicated answer, and I think my answer would depend on if I'm answering as a physician or a parent myself, as a parent, I certainly understand that there's been a lot of fear placed on the vaccines from a lot of media coverage and media attention that has gone to the questioning the safety of the vaccines.

Deborah Howell
Mm-Hmm.

Marnie Baker, MD, MPH
As a physician, I, of course, feel that there's been overwhelming scientific evidence proving the safety of vaccines. So as a physician, it's sort of difficult for me to understand why a parent would decline vaccinations. But again, as a parent, understanding that we all want to do the best thing for our kids and when we haven't even seen these diseases that are threatening our children because so many of these diseases have been eliminated. And then there's this fear has been placed into us questioning the safety of the vaccines. And I think that that's why some parents have made the decision to decline the vaccine.

Deborah Howell
I see, I understand that's got to be tough for you to try to play a dual role there as a physician and as a parent when people come to you. What do you tell them?

Marnie Baker, MD, MPH
I try to review the the facts, of course. Again, as a physician, knowing that there's an overwhelming amount of scientific evidence proving the safety of the vaccines and multiple studies that have shown that, you know, vaccines are not associated with autism or some of the other concerns that have been raised giving parents resources to to look up information for themselves and then helping them understand, as we have seen that as the vaccination rates decline, their child will be at risk for these vaccine preventable diseases.

Deborah Howell
That was my next question what has happened as a result of parents not vaccinating their children in schools in particular?

Marnie Baker, MD, MPH
Well, unfortunately, in the state of California, in the last year, we have seen a measles outbreak. In fact, two measles outbreaks. The initial outbreak was in the spring of 2014, and we are currently undergoing a measles outbreak right now, and we've also had an alarming increase in the number of pertussis cases or whooping cough. So we're currently in a pertussis epidemic in the state of California also, and again, these outbreaks have been clearly linked to the declining vaccination rates.

Deborah Howell
Can you explain a bit more about herd immunity?

Marnie Baker, MD, MPH
Yes, absolutely. So herd immunity is a concept where the majority of a population that is vaccinated will protect those very small number of children that are not able to be vaccinated. So for example, in the case of measles is about 95% of the population is vaccinated against measles. Then if there are a few children, less than 5% that are not vaccinated. That immunity of the herd or the majority will actually prevent the spread of the disease. But if, for example, the threshold of the immunity drops and less than a certain percentage of the kids are vaccinated, it allows the disease to spread more rapidly and then those children that cannot be vaccinated will be susceptible and exposed to the disease.

Deborah Howell
It's almost the opposite of survival of the fittest. The herd mentality. The herd.

Marnie Baker, MD, MPH
Yes, absolutely. I think that that's a great, great analogy.

Deborah Howell
What kind of child would not be able to have a vaccination for measles, for example?

Marnie Baker, MD, MPH
So measles is one of those vaccines that is a live virus vaccine. Again it is live and it's called attenuated. So it's been modified so that even getting this live virus vaccine, it gives you immune protection but does not make you sick. But there are cases where children and certain people in the population cannot receive this vaccine because it is a live virus. So, for example, pregnant women may not cannot receive a live virus vaccine.

Deborah Howell
Mm-Hmm.

Marnie Baker, MD, MPH
Children that have cancer that are undergoing chemotherapy and their immune systems are suppressed. They can't receive the measles vaccine. Also, children that have had an organ transplant, such as a heart, liver or lung transplant, and they're taking medications to suppress their immune system. They cannot receive the measles vaccine. So again, the concept of herd immunity shows us that those small percentage of children that can't be vaccinated really do rely on the rest of the population vaccinating their children in order to protect the other.

Deborah Howell
So you're not only protecting your child, you're potentially protecting every child in your child's class.

Marnie Baker, MD, MPH
Absolutely. And that's why it it's such an important public health issue, because again, it really is about about doing the right thing for not only your own child, but doing the right thing for the community, for all of our children.

Deborah Howell
I think this is a new concept for for many people.

Marnie Baker, MD, MPH
Yes, and I think again, because during this time where we've seen an increase in anti-vaccination, I think that parents understood that they were just making an individual decision for their child. And it wasn't until we've seen the increase in pertussis and measles in California that it really does bring to light that this is this is a community issue. This is not an individual parent choice. This is really an important thing to protect the safety of all of our children.

Deborah Howell
Right. It's sort of a wonderful tribal thing when you get right down to it, absolutely all taking care of each other, it takes a village. That's right. Dr. Baker, in your opinion, can we stop the current measles outbreak?

Marnie Baker, MD, MPH
Absolutely. We can actually stop this outbreak now as soon as we get those vaccination rates. There's still plenty of time to vaccinate your child, even if there was an exposure. If the measles vaccine is given within a few days of the exposure, it likely can offer some protection. If we get all of those parents that have, you know, put off or declined measles vaccine for whatever, whatever their personal belief, then if they go and get their children vaccinated and we can push that percentage past the threshold needed, we absolutely can stop the outbreak and prevent further spread of this disease.

Deborah Howell
And the same goes for pertussis.

Marnie Baker, MD, MPH
Yes, pertussis is a little bit more complicated because immunity against the pertussis vaccine does does sort of decline with age and the pertussis vaccine. Although it is protective, it doesn't have quite the level of protection of measles vaccine. So again, I think the pertussis outbreak will be a little bit trickier to handle. But again, the bottom line being that getting all the kids vaccinated is definitely the first step towards eliminating these diseases. All right. And I think pretty much all the doctors I know would agree with you.

Deborah Howell
And of course, if you have questions, go to your physician, ask the question and you know, what is what is the percentage of doctors that would probably say yes, absolutely get the vaccination?

Marnie Baker, MD, MPH
Oh, I would say that that, you know, a physician trained in in vaccines and medical science more than, you know, 99.5% of physicians are going to advocate for vaccinating their patients and their own children.

Deborah Howell
Thank you so much. Dr. Marnie Baker, wonderful pediatrician. I know you've got our kids on your mind and in your hearts, and we thank you so much for your good work.

Marnie Baker, MD, MPH
Thank you very much.

Deborah Howell
It's been a pleasure having you on the show today to talk to us about the importance of vaccinations. To learn more or to listen to a podcast of the show, please visit MemorialCare.org I'm Deborah Howell. Join us again next time as we explore another weekly dose of wellness and have yourself a fantastic day. Take care of your kids.

Announcer
MemorialCare health system, excellence and health care presents weekly dose of wellness. Here's your host, Deborah Howell.

Deborah Howell
Welcome to the show, I am, Deborah, how and today we'll be talking about the flu and what we as parents need to know about it. Our guest today is Dr. Eric Morley, a pediatrician with Memorial Care Medical Group. Welcome, Dr. Morley.

Eric Morley, MD, MPH
Hi, thanks for having me.

Deborah Howell
Absolutely. Now we have something in common in that both our dads were doctors. However, you actually followed in your dad's footsteps, and I clearly did not.

Eric Morley, MD, MPH
I did, yes.

Deborah Howell
Well, you know, the flu is certainly one of the major reasons patients went to see both of our fathers, and it persists to this day. Dr. Morley, why is this particular flu season more aggressive than others?

Eric Morley, MD, MPH
Yeah, there's a few reasons. First of all, the current strain of flu, which is known as H3N2, is genetically much more aggressive than some of the previous strains. So that's that's number one. But you know, something else is going on is there's a lack of people becoming immunized and when not enough people get the flu vaccine, you start losing something called herd immunity. And herd immunity is where enough of the population is vaccinated to prevent the transmission of the disease between people. So those two things more aggressive illness and less people getting immunized are largely responsible for a more severe season.

Deborah Howell
Got it. Now is the flu shot effective?

Eric Morley, MD, MPH
The flu shot is effective now. A lot of people have said, well, the flu shot is not that effective, and that's why I'm not getting it. The official number is it's about 30% effective. However, you have to kind of look at how that's defined and when they're defining effectiveness. They're defining, they're saying for something to be effective. That means you don't get the disease at all. But the interesting thing is with the flu shot is that even if you end up getting the flu, if you had the flu shot, you will have a less severe illness and for a shorter duration. So it is definitely effective.

Deborah Howell
OK, and now the myth of all myths, can you get the flu from the flu shot?

Eric Morley, MD, MPH
No, it's it's impossible to get the flu. From the flu shot to the flu shot is a dead vaccine. So a lot of people may think that you can get the flu from the flu shot for a few things. First of all, there are occasionally small side effects like soreness, headache, fever that you get as a result of the body ramping up against the flu shot and that may be mistaken for the flu. And the other thing is that most people end up getting the flu shot during the the cold and flu season. So if they got the flu shot and then they happen to get a cold, you know, a day or two later, they may think, Oh, well, that that was the flu and I got that from the flu shot.

Deborah Howell
Got it, okay. So here's another thing that confuses people what's the difference between a cold and the flu in children?

Eric Morley, MD, MPH
Well, a cold is really kind of just a generic term for a typically a viral upper respiratory infection. And when we say viral upper respiratory infection there, there are a lot of viruses going around right now. And for much of the year, they can they can cause them. Flu is only one of those viruses, and flu tends to be much more severe in and lasts for a longer period of time. So essentially a cold and the flu are kind of the same thing, but the flu is a more severe version than most courts.

Deborah Howell
Maybe you can walk us through the symptoms.

Eric Morley, MD, MPH
Sure. A lot of times both of them will have a cough, runny nose fever. Flu tends to have more body aches. Some people have vomiting or or diarrhea. But those those those big upper respiratory symptoms so cough and runny nose and fever are the ones that often times can you can have in any sort of viral infection. And so those are the ones that get kind of mistaken for a cold versus the flu.

Deborah Howell
OK. And I've also heard, you know, over the years that, you know, flu brings the fever and the cold. Yeah, not so much.

Eric Morley, MD, MPH
The fever is going to tend to be more intense and lasts longer in the flu, but you can have a fever with either one.

Deborah Howell
OK. And when should you take your child to an urgent care or emergency room?

Eric Morley, MD, MPH
You know, that really depends on the individual child and the age of the child. Less than three months of age, if they have any sort of fever or signs of respiratory distress, they definitely should be seen right away. Older children, it really depends more on if they have any sort of chronic diseases or, you know, if they're at baseline, pretty, pretty healthy in that case, you know, if it's a normal child and they're at baseline, pretty healthy, then I would, you know, be more if they have a high fever or they're showing signs of dehydration. And the one thing what are is in mind that

Deborah Howell
I was just going to interrupt you briefly to tell everybody that's listening the signs of dehydration?

Eric Morley, MD, MPH
Yeah. So one thing is just knowing how much they've they've been drinking. So if they are drinking significantly less than normal, that that can be an indication. They may be dehydrated for a little bit younger kids. We look at, you know, how many wet diapers they've had a day and those have dramatically decreased or for an older child. You can look at, you know, how much they're urinating every day. Signs of, you know, more significant dehydration, their mucous membranes meaning like their lips or nose, that those general areas will be dry, maybe even become chapped. Some children may cry without tears. These are all be signs and things to look for that your child may become becoming dehydrated.

Deborah Howell
Thank you so much.

Eric Morley, MD, MPH
Yeah, but the one thing I want to mention is if all that being said, if you do think that your child has flu or you know that he or she has been exposed to someone with flu, one thing to keep in mind when deciding to bring them into an urgent care or an emergency room is that the difference, one difference between flu and common cold is that flu actually had a medication you can get for it called Tamiflu. But that needs to be started typically within 48 hours of the onset of symptoms

Deborah Howell
Okay within 48 hours. So you might be running around to a few stores this year trying to find a little bit of Tamiflu. So be good to have some.

Eric Morley, MD, MPH
A lot of places are out.

Deborah Howell
Yeah. And how long do flu symptoms last, doctor?

Eric Morley, MD, MPH
Typically about seven to ten days, you know, most viral upper respiratory infections are more than three to five day range. But flu tends to, as I said, tends to be a little bit more severe and lasts a little bit longer.

Deborah Howell
OK. And are there some specific ways to help boost your child's immune system that you recommend to your patients?

Eric Morley, MD, MPH
There certainly are a lot of ways that the people talk about, like vitamin C or airborne or different, different supplements, really, when it comes down to it that none of those have been shown to do much good unless you happen to be deficient in some vitamin or nutrient at baseline. What I always recommend is just good nutrition, good hydration and plenty of rest.

Deborah Howell
And exercise too, right.

Eric Morley, MD, MPH
And exercise, of course.

Deborah Howell
Is there anything else you want parents listening right now to know about this particular flu season or the flu in general?

Eric Morley, MD, MPH
Yeah. You know, we've talked about the kind of specific criteria when you should come in to be seen and what you should be looking out for. But you know, in real life, none of these things fit into a perfect box or cookie-cutter pattern. So if parents are at all concerned, you know, that's that's why you establish a good relationship with your primary care doctor so that you can call in with concerns and express those and talk about it and figure out when would I need to, you know, come in what would be the best time for my particular child? And then the only other thing that I would emphasize is that, you know this this year, people have been waiting to hear how bad this season is to see if they need to get immunized or not. And you know, you may have heard that actually this year, it's been so bad that some some children have have died , and the most of the people who have died have been the ones who have not been immunized. So there's there's really no reason to wait. You should if you haven't gotten your flu shot, you should get it right away.

Deborah Howell
I was going to say it's not too late for this season, correct?

Eric Morley, MD, MPH
Absolutely not. And prevention is always better than treatment.

Deborah Howell
I remember I was about eight and I had the flu and I was, you know, on the couch with an afghan (blanket). My teeth were chattering. And, you know, my mom brought me some ginger ale and and I said, Mom, when am I going to die? And she said, “What do you mean?” She goes, and I said, “Well, George Washington died of the flu, so I assume I'm going to die, too.” And she said, “no, not everyone dies from the flu.” But it might be good to have a little talk with your kids about this because, you know, they read things in the history books and you know, and the flu used to be quite often fatal. And that's just not the case anymore with our vaccinations.

Eric Morley, MD, MPH
Absolutely. It's, you know, it can be a scary illness. So the more knowledge you have about it, the better.

Deborah Howell
Talk to your kids, establish a great relationship with your pediatrician. And if you want to find a MemorialCare Medical Group pediatrician, you can visit www.MemorialCare.org/medicalgroup. Thank you so much, Dr. Morley, for being on the show today. We really enjoyed your perspective.

Eric Morley, MD, MPH
Oh, thanks for having me.

Deborah Howell
Be well and for more info or to listen to a podcast of this show, just go to MemorialCare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.