Tuesday, November 18, 2014

Do Your Vaccines Contain Mercury?

We are often asked if our vaccines contain mercury. Some parents even want to see the package insert to check. Note: even if they do contain mercury, it usually doesn't say "mercury", so I suspect some of these parents wouldn't notice. Why wouldn't they notice? Because they learn one tag word that they should avoid, but they really don't understand what it is and why they need to avoid it. It's hard to talk to some parents who are adamant that they don't want vaccines for their children, but they don't know why... they just "heard they aren't safe." Really? You're not going to give your child something that has been shown time and time again to not only be safe, but that also saves lives? Just because you heard something you don't even remember details to you'll skip something that could save your child's life?

Short answer to the above question: No standard vaccine for children has had thimerosol since 2001. Some flu vaccine for older children and adults continues to have thimerosol, but most that we order for our office does not. If we offer a type with thimerosol, we will notify you before you choose to vaccinate. Not that we think it matters, but we know parents worry and want to know.

Most years I get the FluMist, but I think the year pictured it was in short supply.

Parents worry about thimerosol despite not really understanding when or why it's used. It's really sad when they ask if we have the "new" MMR without thimerosol. The MMR has never had thimerosol in it. Not ever. Yet many people share the mis-information online that it was/is the cause of autism. And people believe it. That's how much their online research has taught them.

If you hear that vaccines aren't safe from someone but don't ask for and understand the details, including looking at research papers and written articles that address the issue (along with evaluating the reliability of each research report and article) then you really shouldn't take the advice blindly. They might know as little as you on the subject and are just passing along bad information. Or the article you read might just be filling you with incorrect information. It's easy to do when a writer has a motivating factor, such as when the CDC Whistleblower "reanalyzed" data.

Mercury comes in many forms. Thimerosol (one form) is felt by scientists to be safe for use in vaccines at the very low levels required for its effect in vaccines. It has been removed from most vaccines given to children though due to a very vocal group of anti-vaxers getting some congressmen on their side. Not scientists or doctors, but law makers. This has increased the cost but not the safety, in my opinion. We use single dose vaccines except for staff flu shots, for whom we use the cheaper multi-dose vial. The multi dose must have preservatives, such as thimerosol, to keep it from getting contaminated with multiple uses. We usually have a few doses left out of that to give to patients so it's not wasted. When this type is given to patients, their parents are always told it is a multi dose type. There were only limited doses left over this season and they were gone long ago. Many parents were just happy to be able to get a flu shot for their child when they were in short supply early in the vaccine season and they trusted that it was safe.

So... would I give a vaccine with thimerosol to my kids? Yes. (And my oldest is a teen who did get the standard back when he was a baby, which was vaccines with thimerosol.)

Do we give them now? Not usually.

I think that many smart people still get blindsighted by well written but technically not correct information. They simply can't read all the studies, know how to understand the statistical significance of each study, and all the science behind everything. I have a degree in medicine and still rely on experts to do reviews and summarize the vast amount of information. I read some of the studies, but don't have enough information to make truly educated decisions based on what I have access to. Too many studies are behind pay walls and I don't want to pay to read them, nor do I have the time to read every study. 

But I trust expert panels that do.

Here are some links to pages that list the studies if you want to read them for yourself:


Sunday, November 9, 2014

What if the flu vaccine doesn't cover the right strains?

Recent news reported that the FluMist nasal spray might not cover the Influenza A H1N1 strain as well as the injectable might. I know this may cause concern for parents whose children have already gotten the FluMist vaccine this season.

Don't panic! (Gee, I've said that a lot this year with the delayed shipments of flu vaccine...)

Why not panic? 

First, this is a theoretical concern. It is based on the findings that the FluMist didn't cover the H1N1 well last season and it is the same vaccine this year.

Second, the main strains of influenza that are starting to circulate this year are NOT that H1N1 strain anyway.

I thought FluMist was preferred this year...

The CDC continues to state that the preferred vaccine for 2-8 year olds is the FluMist because it seems to be more effective than the injectable form against the other strains contained in the vaccines. (This is of course only if the child doesn't have contraindications to the FluMist and the FluMist is available. No one should delay vaccination if one form is available to wait for another form.)

Should we wait to get the shot? I know there are shipping delays...

Both the CDC and the AAP state to give whatever vaccine is available as appropriate and to not delay giving the vaccine to wait for another type. This makes sense. If you can be vaccinated with only one type due to the shipping delays, why risk being completely unprotected when you can get a vaccine that will most likely protect. No vaccine is 100% effective. With influenza we have the additional difficulty that the flu virus changes each year, but there is some protection across types when the flu vaccine is given.

Why doesn't the strain match?

Flu strains change every year and scientists predict what strains will be circulating. The vaccine companies all make vaccine against the predicted strains. This year the main strains that have been identified in people sick with the flu are Influenza A H3N2 and Influenza B. It is still early in the season, so findings might change, but so far both the FluMist and injectable vaccines seem to be effective against those strains. The FluMist appears to offer better protection than the injectable if the strains are not quite matched.

In short: 

Any age-appropriate influenza vaccine should be used as soon as possible to protect as many people as possible against the flu.

Do kids who got the FluMist need to be given a shot this year?

No. It is not recommended to do a second vaccination unless it is the first flu vaccine and a child needs a booster dose this season. It is appropriate to use either form of the vaccine for eligible children over 2 years, and mixing and matching is okay, but there is no recommendation specifically to do that.

The good news: 

We are starting to see shipments of flu vaccine! Hopefully we'll soon be able to vaccinate your children!

Sunday, November 2, 2014

Menthol for Sore Throat, Colds and Coughs... Should we use it?

I am often asked about the use of Vick's Vapo Rub (or other menthol products and refer to all brands in this post).

We see menthol for vaporizer dispensers, in cough drops, and the good ole jar of rub that mom used on our chests when we were sick.

But should we use it?

Cough drops 

Menthol is a mild anesthetic that provides a cooling sensation when used as a cough drop. The menthol is basically a local anesthetic which can temporarily numbs the nerves in the throat that are irritated by the cold symptoms and provide some relief. (Interestingly, menthol is added to cigarettes in part to numb the throat so new smokers can tolerate the smoke irritation better. Hmmm...)

Menthol cough drops must be used as a lozenge and not chewed or swallowed because the menthol must slowly be exposed to the throat for the numbing effect. They are not recommended for young children due to risk of choking. Since science lacks strong evidence, but the risk to most school aged children is low and it is safer than most other cough medicines, I use the "if it seems to help, use it" rule for children not at risk of choking. Do not let any child go to sleep with one in his mouth. First, he might choke if he falls asleep with it in his mouth. Second, we all need to brush teeth before sleeping to avoid cavities!

Vaporized into the air

When it is put into a vaporized solution, menthol can decrease the feeling of need to cough. It should never be used for children under 2 years of age. They have smaller airways, and the menthol can cause increased mucus production, which plugs their narrow airways and may lead to respiratory distress. Infants can safely use vaporizers (and humidifiers) that put water into the air without any added medications.

The rubs for the skin

We've all seen the social media posts supporting putting the menthol rubs on the feet during sleep to help prevent cough. That has never made sense to me, and the link provided discusses that it is not a proven way to use the rubs.

Menthol studies show variable effectiveness. It has been shown to decrease cough from baseline (but the placebo worked just as well) and did not show improved lung function with spirometry tests (but people stated they could breathe better) in this interesting study. (So people felt better, but there really was no objective improvement.) Putting menthol rubs directly under the nose, as opposed to rubbing it on the chest, may actually increase mucus production according to a study published in Chest. In children under age 2, this could result in an increase in more plugging of their more narrow airways. There is a more recent study that does show children ages 2-11 years with cough sleep better with a menthol rub on the chest.

Note: There is a Vick's BabyRub that does not contain menthol. Its ingredients have not been proven to be effective and some of the ingredients have their own concerns, but that does not fall into this discussion.


Menthol products should never be used in children under 2 years of age. It can actually cause more inflammation in their airways and lead to respiratory distress.

If a child ingests camphor (another ingredient along with menthol in the rubs) it can be deadly. It has been known to cause seizures in children under 36 months when absorbed or ingested in high concentrations. Menthol rubs sold in the US contain camphor in a concentration that is felt to be safe if applied to intact skin in those over 2 years of age. Mucus membranes absorb medicines more readily than intact skin, so do not apply to nostrils, lips, or broken skin. Do not allow children to handle these rubs. Apply only below their necks to intact skin. 

Many people using the menthol rubs experience skin irritation. Discontinue use if this happens.