Hib Vaccine Recall, Childhood Cancer Survivors – PediaCast 094

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  • Hib Vaccine Recall
  • Survivors of Childhood Cancer
  • Developmental Milestones



Announcer 1: This is PediaCast.

Announcer 2: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every child. For every reason.


Announcer 1: Welcome to PediaCast, a pediatric podcast for parents, the Research edition. And now direct from Birdhouse Studios, here is your host, Dr. Mike.

Dr. Mike Patrick: Hi everyone, and welcome to PediaCast, its episode 94, for Friday, December 14, 2007. Vaccine Recall, Cancer Survivors, and Milestones. It's all coming up in a Research edition. Although the vaccine recall is not really a research topic, but we have breaking news, we like to bring it to you. So I will talk a little bit about the recent vaccine recall.


Actually, it's hot in the news because it just happened yesterday. Actually, today's Friday, isn't it? Wednesday, I think it was Wednesday in the afternoon when it was initially announced. But you see it's Thursday, I got to be used to recording this the evening before, I got all mixed up with my days. So I apologized. OK, but let's moved on.

You know, I usually put the Pediascribe plug at the end of the podcast. My wife Karen takes care of the Pediascribe blog. Actually just a mom blog. It's pretty cool, and of course I'm married to her so you know, and I think it's pretty cool [laughing]. It is though, really. She does a nice job with the blog. OK. Got to get use of the date again. Yesterday, on the blog, her post was called "I laughed myself silly” And I laughed myself silly too.


So I wanted to share this one to you. And if you're the type of person who doesn't usually make it all the way through to the end of a podcast, I wanted to make sure that you knew about this. My daughter who is 13 years old, she's very dramatic, to say the least. And she has a Mac book; you know and has a little iCam, camera there on it.

And that she was supposed to be, we thought she was doing school work in our son’s room, she had the door closed, and you could hear her talking. And Karen just taught she's working on history, and reading a chapter of her history book out loud. What turns out she was recording herself, and the video that she recorded, and she gave us permission to do this. It was pretty funny [laughing]. I mean, very dramatic. It's about dorky hairstyles, and how they can change your life. And really, you just have to see it to believe it. We actually posted it at th YouTube with her permission. I know she's 13, but you're home school.


So, I mean she's really involved in theater and so her theater friend, she might not want them to know about it. But we don't have to worry about; you know school making fun of her, unless her brother makes fun of her or her mom and dad, which I guess, I'm kind of them, like telling you about it. So in any case if you go to Pediascribe.com, there is also a link in the show notes over Pediacast.org, and we have a link there. I laugh myself silly you're going to see it to believe it. It's Katie's YouTube debut. So, be sure you check that out.

All right. Let's see what we're talking about. We got the Hib vaccine recall; we're going to talk about that, and then a couple of research studies that are going to be interesting. OK, more than kind of. They're really, really interesting. You want to stick around for it, trust me. Don't forget if there's a topic that you would like us to discuss here on PediaCast, all you have to do is go to Pediacast.org and click on the contact link.


You can also email pediacast@gmail.com if you go that route; make sure you let us know where you are from. And then of course, the voice line is also open 347-404-5437. We have not had a call to the voice line quite a long time. So that's another way that you can get a hold of us. All right, don't forget the information presented in PediaCast is for general educational purposes only.

We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you do have a concern about your child's health, call your doctor and arrange a face to face interview and hands on physical examination. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at Pediacast.org. And with all that in mind, we will be back with our research round up right after this short break.



You know, I should also remind you that you can listen to PediaCast live as it's recorded if you go to Pediacast.org and click on the live link, there are directions there. We were up at the SHOUTcast servers, so we do a streaming feed and you can listen to it live.

If you like any directions on how you can do that at the website. Also on that live page, we have an on-air, off-air sign so that way you know whether we are streaming or not. So that's something else to check out. I also should mention sometime after the first of the year, I think we're going to coordinate a date and a time when we're going to do a live show that will not be a podcast, and we will take questions as they come.


Maybe spend a couple hours together, I think that would be fun. And that's kind of in the works. We're working on it and we'll give you the details. Best time to catch us is usually between the 7 and 8:00 hour, Eastern Time. All right, let's talk about this recall of vaccine.

Merck has announced a voluntary recall in the United States for 1.2 million doses of Hib vaccine, and they're urging doctors to immediately discontinue the use of affected lots. Although the recalled vaccines passed standard sterility test before release, Merck is initiating this voluntary recall as a precaution. Merck has identified the potential for a contamination with bacillus bacteria during evaluation of the Hib vaccine manufacturing process.


No problems have been reported in Hib vaccine recipients, but physician should be aware of the possibility of infection appearing within one week of vaccination. There are no concerns about the effectiveness of the vaccines being recalled. Therefore, children who have received vaccines from these lots do not need to be re-vaccinated.

Additional information is being evaluated to determine the impact this recall will have on the overall availability of Hib vaccine. In the meantime, the Merck Academy of Pediatric recommends continuing to use the Hib vaccine as recommended. Providers with a limited supply of Hib should contact Sanofi Pasteur, another company that makes Hib shots to determine the availability of vaccine to meet their needs.

But the AAP goes on to say that healthcare providers facing a temporary shortage of Hib vaccine may defer the booster dose of Hib normally given a 12 to 15 months for those children not had increased risk for invasive Hib disease.


Children increase risk for this disease include Alaska native and American-Indian children. Children with sickle-cell disease, Hib, anatomic or functional asplenia, malignancies, or other immuno compromising conditions. OK. That's a little technical for most of the audience. But we do have quite a few doctors and nurses in the crowd as well, so we'll keep some of the more technical stuff in there for you.

Further recommendations will be developed based on evaluation of additional information on current supply. The expected duration of Mercks production suspension and Sanofi Pasteurs capacity for increased production. In the show notes, we have a link to an article in WebMD about this recall, also a link to a question and answer sheet from the CDC, and of course information directly from Merck as well. So, you can find the links to all of those things in the show notes. Now, what is Hib? Well, Hib it's a type of bacteria, and Hib stands for Haemophilus influenza Type B.


Now remember, influenza, that's a virus not a bacteria. We were talking about the flu. Now this is not bad, it's just a bacteria that has influenza as part of its name. So, Haemophilus influenza Type B and what is the cause? It causes what can cause meningitis, asepsis, epiglottitis, which is a life threatening inflammation of the flap.

You know, that covers the trachea when you swallow. So this is, you know, an important vaccine Hib disease can be very, very serious. Now, if you do have to wonder if this contamination would be an issue if our vaccines still contain Thimerosal, which is that mercury containing preservative that we took out.

So my question is, what about the kids? You know, because if there's a shortage of this and they don't get their Hib vaccines like they're supposed to because of this shortage. And let's say that they are not protected against Haemophilus influenza Type B. And let's say they get meningitis from it and have a…you know, very serious outcome may be hit to their brain, you know, and they have neurological complications the rest of their life.


Or they die from it? Because before the Hib vaccine came out, there was plenty of bad meningitis and people whose lives were changed forever because of an infection with this bacteria or who died from it. So now my question is this: if a kid gets Hib and develops severe meningitis and has a neurological complication or dies from it because they couldn't get their vaccine because of this problem, could the parents sue the scare monikers who claimed mercury in the shots caused brain damage, despite a lack of scientific proof for making the claim?

I mean, the vaccine manufacturers took Thimerosal out of the vaccines because of fear of litigation, not because a connection had really been shown between the mercury and anything. I mean all of the shots that I received as a baby I had mercury in them.


All the shots that you as parents out there had when you were babies had mercury in them. And you know, maybe that's why I'm making this argument because the Mercury affected my brain to the point that I can't think clearly. You know, we did not have a shortage of vaccines because of a reduced shelf life or contamination recalls before the Thimerosal is taken out of all the vaccines. And now we face vaccine shortages everyday not just Hib, and we face unprotected kids getting life threatening diseases and there are diseases that routinely killed kids less than half a century ago.

And why are we putting our kids in harm's way? Because we have to cave in to the scare monikers and their lawyers. So at what point do the rest of us stand up to these groups and say enough? All right, I am going to get myself into a lot of trouble over that one, but I feel strongly about it. OK let's talk about a couple of research studies. This first one chronic health conditions in adult survivors of childhood cancer.


Incidentally, I meant to make this connection, I don't think I quite made it clear. The Thimerosal or the mercury containing preservative, it was there so that the vaccine would last longer on the shelf then would keep bacteria from growing in it. So it made the vaccine safer by keeping contamination, particularly with bacteria out of the vaccines.

OK. So in case you did not make that connection, now you have no excuse [laughing]. OK. So, chronic health conditions in adult survivors of childhood cancer, this was in the New England Journal of Medicine, and basically, the researchers looked at this question: 80% of children diagnosed with cancer will become long term survivors. And really, that's a major medical achievement because prior to the 1970s childhood cancer was almost always a fatal situation. However, with the use of chemotherapy and radiation, and better and better protocols, kids are surviving childhood cancer. In fact, 80% of them will become long term survivors.


However, late effects can arise from the use of chemotherapy and radiation including cardiovascular disease, renal or kidney dysfunction, thyroid problems, and secondary malignancies, just to name a few. So the authors of this study utilized the childhood cancer survivor study, which was a cohort study that follows patients diagnosed with childhood cancer between 1970 and 1986 at 26 different centers in North America.

There's over 10,000 patients in the study group. So, the researchers looked at adult onset health problems in this group, and then they compared it to the health problems encountered in the siblings of these patients, siblings who did not have cancer. So they're hoping that the genetic and the environmental differences therefore are minimized, because you've got the same moms and dads, you've got the same environment that the kids are growing up in.


So they're trying to differentiate, you know, the thing that's different between the survivors and their siblings is the cancer, and then let's see what the chronic health condition of these people years and years later is. So what did they find? Well, they found that the cumulative incidence of a chronic health illness at 30 years post treatment of a childhood cancer was about 73%. So, about 73% of people who had a childhood cancer ended up with a chronic health condition of some sort by 30 years post-treatment.

And that was three times more likely than when you compare it the rate to the siblings. So, they were three times more likely than their siblings to have a chronic health condition, and 73% of them have that. Now, the cumulative incidence of a severe or life threatening chronic condition or death was 42%, and these patients were eight times more likely to have that happened as compared to their siblings.


So, almost half of them had a life-threatening or chronic condition by the time they were 30 years old. Seventy-three percent of them had a non-life threatening condition but chronic health condition, and the ones that had the life-threatening one or death were eight times more likely to have that compared to their siblings.

Now the most common conditions that we're talking about were cardiovascular disease, secondary malignancy, kidney problems, and then endocrine problems like thyroid dysfunction that sort of thing. The incidence of these constantly increased with time, and did not plateau. That means that as get further and further away from the childhood cancer episode, they were more and more like to have a chronic health condition, and it seemed that as you went on that number just got higher and higher, and did not plateau.


And the ones at the greatest relative risk for having a chronic health condition after their childhood cancer or the ones who had bone tumors, CNS or central nervous system tumors, and Hodgkin's disease. So, the authors conclude that survivors of childhood cancer have a high risk of developing chronic health conditions and therefore, they require close monitoring as part of their routine health supervision. Now, my point with this is not to scare you, if you have a child who has survived cancer.

My point is, that this folks need to be followed closely because it gives you better chance of that chronic health condition being one that's managed versus the one that becomes life threatening or causes death. So, you know, it's really important that some pressed upon, [16:49] the folks who did have childhood cancers, that they really do need to see their doctors frequently, and that you know, being really plugged into the medical system very well.


I want to show, we have with this study is, remember we're looking at folks who were treated for childhood cancers between 1970 and 1986. Today, many treatments are different that we certainly know more about what kind of problems you can run in to. And so, therapies are adjusted somewhat to account for that.

So if you're looking at this numbers, and trying to apply them to your own child who's a cancer survivor, you can't really do that because today's treatments probably will cause less problems down the road. Question is a study to tell you that. Maybe there'll be more problems, you know only time will tell. But regardless, the point here is that it's important for survivors of childhood cancer to be tightly plugged into the health system throughout the rest of their lives.
OK, let's move on. One more study for you. This is an interesting one; this is infant developmental milestones and subsequent cognitive function. So basically, this is, let's look at kids, are they meeting their developmental milestones? And let's see how smart they are later in life and see if there's a correlation.


This was done at the Behavioral and Clinical Neuroscience Institute at the University of Cambridge and University College in London, and it was published recently in the Annals of Neurology. So what is the relationship between infant developmental milestones and later intellectual function? What I looked at 5,362 infants who were born in the United Kingdom in 1946. Yes you've heard me right, in 1946 [laughing].

OK. And then what they did is at age 2, the parents were asked to recall when their child could stand unassisted, when they could walk, and when they could say words. And then at age 8, the researchers evaluated their nonverbal reasoning, their reading comprehension, their word, pronunciation, and vocabulary. At age 26, they look at their reading comprehension, and also took a look at the highest educational or training level that the person obtained.


And then at age 57, so you see this is a really nice longitudinal study here folks, started in 1946. At age 57, they look at verbal fluency and general intellectual function. So again, over 5,000 people they looked at and followed on through the years and then compared how well they met their developmental milestones.

When they stood, when they walk, when they started talking, and then compared it to these things later in life, such as their intelligence, their nonverbal reasoning, reading comprehension, vocabulary, those kind of things. And how much education ended up getting. So what they find out? What they found out that earlier motor and speech development is significantly associated with a greater IQ at age 8, a higher reading comprehension at age 26, and better verbal fluency at age 57.


On average, every month earlier, that a child learns to stand, there's a half IQ point gain at age 8. In terms of speech development, that was significantly related to their reading comprehension at age 26. And with regard to speech development, that was significantly link to progression beyond basic education. So the earlier the kids talk, the more likely they were to go to college, basically. The others conclude that the age which infant developmental milestones are attained is associated with subsequent general intellectual function.

Hhhmmm. Well, I can say about it. Traditional thought dictates that the mild to moderate delay is not an issue, particularly, and I always say this but it's just so true, particularly when that's the family pattern. I mean if you have a family pattern of kids not walking until they're 14 months old, or you know, not really talking much until they're 2-1/2 or not standing until they're 8 or 9 months old.


And in that same family you have, you know, college educated folks, then you know, it's probably you know, that's obviously was not an issue and traditionally, that's what were taught. Obviously, you know, months of delay is an issue, there's no question about that. But we're talking more the mild delays here. So, the study would suggest otherwise. I mean, you can't force milestones on a kid, but you can make sure they're getting plenty of stimulation and opportunity to meet their milestones.

And then, can I ask, well, if you're in the family environment that does that, then you're probably in the family environment that's going to encourage you to read and do your score, you know, those are the things too. If your child is delayed despite your best efforts, and it's mild delay, well, may give these parents an earlier idea that school intervention might end up being needed, might, of course, being the keyword there.


So I'm not, you know, it's an interesting study, let's put it that way. I mean, for them to do a longitudinal study or they started looking at folks in 1946, that's pretty cool actually. Don't take much to excite me these days. All right. That wraps up for today's program. A couple of research studies there for you, and of course the Hib recall, so you're got a little more information about that. So we'll go ahead and take a quick break, and we'll wrap up the show and wrap up the week. Right after this.


OK. As always, thanks goes out to the Nationwide Children's Hospital for providing the Bandwidth for our program. Also Vlad over VladStudio.com for providing the artwork for the website and the feed. And of course, thanks to all of you for taking time out of your busy day to join us here at PediaCast.

Don't forget the Pediascribe blog if you want to see my daughter in all her glory, make sure you check out the link in the show notes to "I laughed to myself silly” And it's her little diatribe on dorky hairdos and how it affects your life. It's interesting. OK, don't forget iTunes reviews.

They're coming in every time I make it a point of mentioning them, I get 4 or 5. So I really appreciate that. We had some very, very nice things said. Nice reviews. I just really appreciate it. My personal goal is for 200 reviews by the New Year, and I think we've to like 166. So I don't know. It's going to be a tough one to crack by that. Please if you haven't left an iTunes review for us, if you could take a time out to do that, it will only takes couple minutes to do.


OK. So everybody have a great weekend. I'll get those last minute Christmas chores done, but try to relax too. Maybe if you can find some time to play with your kids, get them on the floor with them dads, particularly. Moms you know do that all the time, but dads going to push a little bit more sometimes to get down on the floor and play with your kids, but it's an important thing to do. And then, so please take time at your date this weekend sometime to do that. So until next week. This is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.


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