[5 min read]
In this article:
- There has been an uptick in misinformation around childhood vaccines, and more recently the safety of the pain reliever and fever reducer acetaminophen for pregnant women.
- Childhood vaccines are safe and save lives. Acetaminophen is the only pain reliever that can be safely recommended for pregnant people.
- A Providence Swedish pediatric infectious disease expert offers clarity on the use of these drugs and why these treatments are critical for keeping women and children healthy.
There has been a lot of discussion about vaccine and medication safety in recent news. The social media outlets where many of us get our information are bubbling with thousands of opinions about the right thing to do. The truth is that there are important facts to know about vaccines and medications, and decisions about your family’s health care are best made you and your care team — after a careful discussion about your concerns and goals.
For more guidance on best practices for family health decision-making and some perspective on what we are hearing in the news lately, we spoke with Frank Bell, M.D., a pediatric infectious disease expert at Providence Swedish. Dr. Bell is also a clinical associate professor at Washington State University’s Elson S. Floyd College of Medicine and Vice President of the Washington Chapter of the American Academy of Pediatrics.
What are some of your major concerns as a pediatric doctor specializing in infectious diseases?
Well, what we have been hearing must be very scary for parents and parents of young children in particular. As physicians, we want to empower them and help direct them toward the best decisions for their family, not frighten them or give them information that we know to be factually incorrect and, in fact, puts their kids’ (or their own) health at risk.
There has been a central focus on immunizations for sure, but now we have been hearing about other trustworthy and tested treatments used by physicians and practitioners who look after patients of all ages. At this point, the normal health measures which we've relied upon for more than six decades have been turned on their head.
Doctors want parents to know that we are cautious and careful. We do not make a recommendation without an assessment that the benefits are likely to outweigh the risks, and we would always say take the smallest amount for the shortest period, consistent with what we hope to achieve from taking that medicine.
Avoid being driven by fear. Consider thoughtful discussion and reviewed, tested evidence. Talk to the people you trust, whether that's your own pediatrician or primary care physicians. Talk to practitioners in family medicine, especially practitioners with whom you have established a relationship. Your health care providers want to know what's on your mind and want to know what you're concerned about. Parents should never worry about the fact that their questions may not be welcomed.
What would you like parents to know about the treatments or medications that have been in the news lately?
Let’s start with acetaminophen during pregnancy. Autism is a neurodevelopmental condition and the relationship we heard about between acetaminophen and autism is based on a recent review of some 40 + studies performed over the last 10 years, which turned up nothing new to support the idea that taking acetaminophen during pregnancy is a cause for autism. Most experts agree that genetics are largely behind who gets autism, with environmental factors likely playing a smaller role. This is where it’s very important to distinguish between association and causation. We have known for a long time that one risk factor for autism or other neurodevelopmental conditions is a fever or an infectious illness during the mother’s pregnancy. So, for me, the most obvious causative relationship is that during pregnancy the parent was taking acetaminophen for an illness or fever — it’s not the acetaminophen that's responsible for the diagnosis, it's more likely the fever or the illness.
Then we have the hepatitis B vaccine. Hepatitis B is not a trivial condition. Somewhere between 80% and 90% of infected mothers will pass it on to their babies and something like 25% of those children will die eventually from that infection, whether from liver cancer or inflammation and cirrhosis of the liver. There was an initial recommendation when the vaccine first came out to administer it only to higher-risk groups. It worked to some degree but did not in any way eliminate the infection. When we moved to a ‘universal birth dose’ we went from 20,000 cases per year of infection in the United States, to 20 cases a year: that’s a reduction of more than 99%. There is no question that science suggests that the appropriate time to offer routine immunization is at the time of delivery. If we wait until four months, a year, or 12 years, we're going to leave those children unprotected, at risk at the time in their life, if they are exposed, where they're most likely to fail to clear the infection and to develop serious long-term, and possibly, fatal disease.
And with early childhood vaccinations like the mumps, measles, rubella (MMR) and diphtheria, tetanus and pertussis (DTaP), it’s important to remember that these vaccine combinations have been around for a very long time and have been used with great success. And parents invariably say they don't want to have to come back next week, next month, or in three months when things may get busy and they are going to forget. They would rather get the vaccines together now in one shot.
The discussions last week were mostly focused on the measles, mumps, rubella, and varicella/chicken pox (MMRV) combination. This is typically given as a preschool booster at around four years old. It has a slightly increased risk of febrile (fever-related) seizures compared with giving MMR and the varicella vaccines by separate shots which are usually given at the 12-to-15-month visit. Febrile seizures are scary but are not serious in the long run and do not damage the brain. They're usually brief, lasting only a few minutes, and a child who has a febrile seizure will almost invariably make a full recovery. But, again, most all pediatricians give the MMR and varicella vaccines separately at the 12-to-15-month visit, which brings that small risk of seizure even smaller.
What are you advising your patients and other patients who may be concerned about these developments?
Avoid being driven by fear. Consider thoughtful discussion and reviewed, tested evidence. Talk to the people you trust, whether that's your own pediatrician or primary care physicians. Talk to practitioners in family medicine, especially practitioners with whom you have established a relationship. Your health care providers want to know what's on your mind and want to know what you're concerned about. Parents should never worry about the fact that their questions may not be welcomed.
Learn more and find a physician or advanced practice clinician (APC)
When you have questions or concerns about your child’s wellness, Swedish Pediatrics is here to help. Call today to schedule a visit.
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Information for patients and visitors
Related resources
What to know about hand, foot, and mouth disease and how it spreads
For vaccine and health care guidance, trust the experts
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As vaccination rates drop, whooping cough is surging. Here’s what you should know.
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.
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