Marin Pediatric Associates - News from The Practice Marin Pediatric Associates

COVID Vaccine Clinics for Kids Ages 6 mo-4 yr
(updated 6/10/22)

We are excited to partner with Marin County Public Health in the rollout of COVID vaccines for our patients ages 6 months to age 4 years. The county is gearing up to provide this vaccination at their established sites but we will also be running a number of COVID vaccine clinics for our patients as well. The county offers vaccine resources on their website: https://coronavirus.marinhhs.org/vaccinefinder

We are anticipating FDA and CDC approval of the COVID vaccine for this age group any day and plan on launching our first COVID vaccine clinic for our youngest patients on Saturday, 6/25/22. Additional dates to follow.

Both Pfizer and Moderna are up for consideration by the FDA. For now, Pfizer’s 3 dose schedule has shown superiority to the 2 dose schedule proposed by Moderna. Our initial clinics will be offering only the Pfizer formulation for our youngest patients. As information emerges, and efficacy data becomes available, we may offer the Moderna vaccine as well... Stay tuned.

COVID Vaccine Clinics for Kids Ages 5 and up

We continue to offer COVID vaccine clinics for other age groups as well. As of the present day we are only offering Pfizer vaccine. Pfizer vaccine is currently (as of 6/10/22) the only approved vaccine for kids 5-17.

We strongly recommend an interval of at least 4 weeks between dose #1 and #2 of the initial series for better efficacy. We encourage boosters for everyone, and extra boosters for higher risk patients. We suggest waiting 2-3 months after a COVID illness for best efficacy of a booster shot.

We are 100% behind getting our kids vaccinated against COVID! We know the very real risks of COVID infection. And we are just beginning to learn of some of the long-term consequences of COVID involving cardiovascular health, mental health, and diabetes.

Though younger patients generally have milder illness, they too are seeing Long-COVID, even in those with minimal or no initial symptoms. And the potentially more serious complications like MIS-C. To date nearly 900 kids in this age group have died in the US from COVID and many more hospitalized. The bigger tolls from COVID on our kids’ mental health, education, economic stability, and family life are harder to quantify but painfully clear.

The virus is not going away and is likely to become an endemic infection once the pandemic is officially over. That means that just like influenza, it will circulate, possibly seasonally, but will not be causing mass outbreaks disrupting, school, sports, business, etc. This means that your child WILL eventually get COVID. It seems so much better to face that illness vaccinated rather than unvaccinated. Furthermore, the virus will continue to mutate, and we are unable to predict whether the severity of the next variant will be the same, milder, or perhaps worse. Vaccine induced immunity, PLUS the inevitable natural immunity (aka hybrid immunity) seems to be our best defense against both short term severe illness, and long-term consequences of the infection.

We are impressed by the science behind these vaccines and the tremendous amount of world-wide scientific oversight and data available. There truly has never been a vaccine being offered to kids with so much groundwork of study and post-release surveillance data behind it. Nealy 6 BILLION people world-wide have been vaccinated and nearly 12 billion doses have been given! Sadly, there is an enormous amount of misinformation and outright fabrication about COVID and the vaccine out there on the internet. We are happy to discuss your questions and concerns and provide you with the evidence- based information available to help you feel comfortable moving forward with vaccinating your children.

COVID-19 Info (4/15/21)

Keeping up with daily changes in the pandemic response has not allowed time to keep our website routinely updated but we wanted to take this opportunity to share with you some important information.

Our office is part of a coordinated response to the pandemic, working with our Public Health Department, UCSF, Marin Health Medical Center (formerly MGH), as well as our fellow pediatric colleagues.

With rumors and false information circulating daily, we encourage you to look at science-based sources for the most reliable and up to date info on COVID-19. We list our suggestions below and we are here to answer any personalized questions you may have.
- Marin County Public Health
- American Academy of Pediatrics (HealthyChildren.org)
- The CDC

This pandemic requires the best in all of us to get through it. We thank you all for your support and send ours out to our patient family!

Office and Video visits:
Our office remains open and we are continuing to see patients. We are adapting on a daily basis to meet our patients needs with the best possible, evidence-based practices.

At Marin Pediatrics, we are maintaining a “clean office” for the safety of our patients, staff and doctors. That means most of our visits are video visits for concerns about illness, injury, etc. If during a video visit it is determined that additional care is needed, we will triage you to the lab for non-COVID-19 testing, our office for additional evaluation or for COVID-19 testing, outpatient x-ray, or the appropriate ER for emergency care. Marin Health Center, working in partnership with UCSF, is asking us to divert all pediatric COVID-19 patients to UCSF Benioff Mission Bay ER.

Specific changes in our office practice due to the COVID-19 pandemic:

• - All in-person office visits are by appt only, no drop-ins.
• - Main entrance and waiting room for well patients only. You will be
             screened for exposures, symptoms and fever prior to being brought
             to an exam room.
• - Fewer in-office visits to allow for social distancing and careful
              disinfection of rooms and equipment between patients.
• - In-person visits are limited to 1 parent + 1 patient.
• - Everyone over 2 is expected to wear a mask at all times when they
             are in the office. PLEASE BE ADVISED THAT VALVED MASKS ARE
             NOT ACCEPTABLE AND MAY SPREAD COVID-19 IF THE WEARER IS
             SHEDDING VIRUS. The one-way action of these valves filters the air
             as the wearer breaths in, but expels it unfiltered onto the rest of us
             as the wearer exhales.
• - We are offering telehealth (video visits via ZOOM) for all our patients
             for continuing care. If in consultation with your doctor, an in-person
             visit is deemed necessary, a separate access directly from South
             Eliseo Dr is available (see our MPA flag and MPA patient parking
             signs at the street access entrance).

SCHOOLS AND COVID

Schools in Marin have offered varying degrees of in-person learning since the start of the school year. Through the heroic efforts of school staff, nurses and the public health department, and the students and families this has been documented success. Until the post-Thanksgiving surge, there had not been a single case of student-to-student transmission. And even since then just a very few.

This means the often painful protocols for illness screening as well as social distancing, masking and hand hygiene are working!!! You are more than 35 times more likely to be exposed to and contract COVID in a non-school setting. Nearly all of the spread has been in small social gatherings. That means it is safer for the kids to be in school! Not to mention the undisputed benefit to their mental health and quality of education.

Public Health, schools, and physicians are working hard to continue to make schools the safest possible environment for our students. This includes expanded routine screening in the schools, and VACCINATION! Our teachers were in the top tier of people prioritized to get the vaccine, and now teens age 16+ are eligible. We hope that kids age 12+ will be eligible by the summer (see COVID vaccine section for more info).

PEDIATRIC AFTER HOURS CLINIC

For now, the Pediatric After Hours Clinic at Larkspur Landing is open all evenings, weekends and holidays though these hours are subject to change. The clinic offers video and in-person visits as well as COVID testing.

The After Hours Advice Nurse will continue to be available during all non-business hours.

COVID Testing

• - A Zoom visit with one of our MD’s is required to determine when to
             schedule for testing, and the most appropriate test to run.
• - The type of COVID testing we have in our office has varied based on
             the available kits supplied to our office. Your MD will determine which
             test is most appropriate as well as the optimum timing of the test.

TYPES OF COVID TESTING available at our office:

• - There are two types of RNA molecular amplification tests performed
             in our office. The Marin Public Health Department and the CDC have
             confirmed that both test are equally reliable for screening purposes
             or for after a suspected COVID exposure. If your child's school has
             not updated their administrative policies to accept either test, please
             refer them to https://coronavirus.marinhhs.org/schools.


• - ABBOTT ID NOW – results typically available in 10-15 min.
• - PCR testing – results typically available in 48 hrs.

TIMING OF COVID TESTING:
If there is a suspected COVID exposure, the optimal time for testing is 5-7 days post-exposure. Both tests are highly sensitive and accurate, though timing is everything. There is a very small chance of missing a positive case if the Abbott test is done before 5 full days after exposure.

Pediatric After Hours Clinic (PAHC) is now in a new location effective 10/30/18. Phone numbers and after hours nurse triage advice remain the same.

The new address:
PRIMA Medical Offices
1100 Larkspur Landing Circle
Larkspur Landing

These offices are located near the Larkspur ferry terminal, and adjacent to the Marin Country Mart shopping complex, and the Courtyard by Marriott. Hopefully the easy access off of Highway 101, plentiful parking, and newly renovated offices will make the experience easy for all.

PAHC will also have signage to redirect patients should they arrive at the wrong site (formerly at 1260 South Eliseo Dr).

Two of our MPA physicians, Doctors Stenback and Palfy, continue to work some of the shifts at PAHC. PACH is staffed by Pediatricians to provide urgent, pediatric care, after regular office hours.

Marin Pediatric Associates is excited to announce that effective 9/18/2018 we will be a UCSF-Benioff Children's Hospital Partnership Practice.

While MPA remains an independent practice, this partnership will allow us to streamline access to UCSF specialists, though not restrict us from referring to the best specialist for your child, regardless of their institutional affiliation. The partnership will also allow us to participate in ongoing educational opportunities for our physicians and staff that promote best medical practices. Our electronic medical records system will continue to be EPIC, but will be integrated into the UCSF system. EPIC has emerged as the leading EMR system, allowing us access to our patient records wherever they might be seen in the nation-wide EPIC Community Connect system. Unfortunately, this means re-registering all our patients and new registration paperwork for everyone. We apologize in advance for this inconvenience.

This change will also impact our insurance provider status, and billing: Effective 9/18/18 we will be providers under the umbrella of UCSF Benioff Children's Physicians (UBCP). Our status as preferred providers for all the various insurance providers* should remain unchanged but the contracted relationship will be under UBCP and their Tax ID number. Any services provided prior to that date will be billed directly through MPA and our Tax ID. For a period of time, you may receive billing statements from both.

*HMO Patients: You will need to continue to designate a Marin Pediatric Associates Physician as your PCP (Primary Care Provider) to receive care in this office. Our HMO contract remains exclusively with Meritage Medical Network. (we are NOT providers under Brown & Toland or Hill Physicians)

*MediCal / Partnership Patients: You will need to continue to designate Marin Pediatric Associates as your provider to receive care in this office.

Early Morning Drop-in Clinic

Effective January 2016 we have created an urgent care early morning clinic. This is available in our office 8:30am-9:20am Monday-Thursday for our current patients (no appointment necessary).

One of our physicians will be available to see your child before regularly scheduled office hours. This service is intended to supplement the after-hours clinic, which is available at a separate location for nights and weekends urgent care.

School Immunization Requirements

In July 2015, Governor Jerry Brown signed into law SB 177, which eliminates the "Personal Belief Exemption" or "PBE" for vaccines for all children attending both public and private schools. This new law will take effect in the middle of 2016. Medical exemptions will still continue. Parents not wanting to vaccinate their children will have the option to home school their kids.

Here is an excerpt from the New York Times regarding this historic legislation:

At MPA, we believe that vaccination is one of the most important things parents can do for the health of their children. We also believe that it is part of our social contract as good citizens to ensure that the most vulnerable in our society are protected. Whether it's a newborn baby too young to have been vaccinated, or a cancer patient, or even someone taking arthritis medications, there are members of your community who are more susceptible to disease. These people are counting on you to not endanger their health by passing on a disease that could have been completely avoided with a vaccine.

School Immunization Requirement for Pertussis (Whooping Cough)

Every student entering the 7th grade will need to provide the school with documentation of their Tdap vaccine. This requirement began with the 2011-12 school year and continues annually.

 

In September 2010, then Governor Schwarzenegger signed into law AB354, which required all 7th through 12th graders to get the Tdap vaccine before entering school in the fall of 2011. Each student needed to submit proof of their Tdap booster before entering school for the 2011-12 school year. Now and in all subsequent school years, only entering 7th graders will need to provide this "proof".

 

This vaccine protects against Tetanus, Diptheria (bacterial croup) and Pertussis (Whooping Cough). In 2010, Whooping Cough was epidemic in California at rates not seen for over 50 years, and resulted in 10 infant deaths. Marin County had the second highest rate of infection in the state! In 2012 the state of Washington is experiencing a Pertussis epidemic!

 

This vaccine is typically given between the ages of 11 -12. In response to the 2010 epidemic, 10 year olds were encouraged to get the booster that year. The vast majority of our patients have had their Tdap vaccine and we can provide you with the proof needed by the school. For those who have not yet received their Tdap, (~15% of our 11 year old patients) please contact us to see if your child needs a check-up and this vaccine can be given at that time. But fee free to call us any time to verify your child's Tdap status.

 

We can provided you with a copy of your child's immunization records which will constitute "proof" of having received their Tdap booster.

 

(Our practice does not participate in the Vaccine Registry (PC based) due to the fact that our computer system is Mac based. Unfortunately this means your School Nurse will not be able to get your immunization records off the registry).

Updated guideline for Tdap Vaccine

Tdap vaccine

This vaccine protects against Tetanus, Diptheria (bacterial croup) and Pertussis (Whooping Cough). Changes in the indications for this vaccine include:

• expanded age range: age 7 to 100+
• recommending the vaccine for pregnant women
• eliminating any restrictions based on
  a Td (tetanus and diptheria only) vaccine given in the past

These recommendations were added to the existing indications of:
• Age 11-12, and older teens if this booster was missed
• All adult caregivers of infants

In 2010, Whooping Cough was epidemic in California at rates not seen for over 50 years, and resulted in 10 infant deaths. Marin County had the second highest rate of infection in the state! We believe this was largely due to the high rate of "personal belief exemptions" causing especially low vaccination rates. NO vaccine provides a 100% guarantee of protection and the effectiveness can wear off in time. To counter this, we rely on "herd" immunity: the more people out there who are vaccinated the less chance of an infection finding traction in a community of susceptible individuals and starting an epidemic.

 

In September 2010, then Governor Schwarzenegger signed into law AB354, which required all 7th through 12th graders to get the Tdap vaccine before entering school in the fall of 2011. Each student needed to submit proof of their Tdap booster before entering school for the 2011-12 school year.

 

Now in 2012 and in all subsequent school years, only entering 7th graders will need to provide this "proof." We can provide you with an official copy of your child's vaccinations that will fulfill this requirement.

 

Tdap has been available since the end of 2005 to everyone age 10-64. This vaccine is typically given between the ages of 11 - 12 as a booster to the DTaP last given around kindergarten entry, and to any adult caregivers of young infants.

 

In response to the epidemics, kids as young as 7 are now eligible for the vaccine under certain circumstances. In addition, pregnant moms are advised to get the vaccine to protect themselves and to provide "passive immunity" or antibodies to the fetus that will continue to protect the child into early infancy.

 

What we don't yet know about the Tdap vaccine is just how long the immunity it provides lasts. We know from recent experience that the 5 dose DTaP series given from ages 2 months to 5 years wears off 5-8 years from the last dose, which is why we recommend the Tdap booster at age 11. We also know that immunity from the actual illness wears off in a similar time frame. Will we come to recommend a Tdap booster every 5 years? Every 10 years? Since the Tdap vaccine is only 7 years old, we will only now be able to study how long its effectiveness will last. So stay tuned!

Updated guidelines for vaccination against Meningitis

Meningococcal disease is a serious illness caused by a type of bacteria called Neisseria meningitidis. It can lead to meningitis (infection of the lining of the brain and spinal cord) and infections of the blood. Meningococcal disease often occurs without warning – even among people who are otherwise healthy.

Meningococcal disease can spread from person to person through close contact (coughing or kissing) or lengthy contact, especially among people living in the same household, or dormitory.

There are at least 12 types of N. meningitidis, called "serogroups." But 5 of these serogroups A, B, C, W, and Y cause most meningococcal disease.

Meningococcal disease, though rare (1,000-2,600 cases/yr in the US) is a very scary disease. Even with antibiotic treatment, the disease is fatal in up to 15% of patients. Amongst survivors, up to 20% will suffer permanent disabilities such as hearing loss, brain damage, kidney damage, amputations, nervous system problems, or severe scars from skin grafts.

Anyone can get this disease but it is seen most commonly in infants, teens, especially college freshmen, and people with certain medical conditions affecting their immune function, such as lacking a spleen, or taking a drug called eculizumab (also called Soliris®).

There are now 2 types of meningitis vaccines available:

1) Meningococcal Vaccine (MCV4)

MCV4 (Menactra®, or Menevo®) protects against meningococcal disease caused by 4 of the 5 main serotypes (A,C,W and Y). This vaccine has been in use since 2005, and the current 2 dose schedule in place since 2011. We provide menacta in our office.

The current vaccine schedule for MCV4:

• - 1st dose at Age 11-12, and older teens if this dose was missed
• - A booster at ages 16 -18 or 5 years after the initial vaccine

2) Meningitis B Vaccine

Men B (Bexsero® and Trumenba®), available since 2015, protects against meningitis caused by serogroup B. Due to higher side effect profile, and shorter duration of protection (2-4 yrs), these vaccines were initially used in outbreak situations.

Since 2017, we have been recommending adding this vaccine as a routine for our college bound patients, or any teens living in dorms, entering the military or having other risk factors as listed above.

These vaccines may also be given to anyone 16 through 23 years old to provide short term protection against serogroup B meningococcal disease; 16 through 18 years are the preferred ages for vaccination – we suggest starting this vaccine as a high school senior.

For high risk patients, these vaccines are recommended routinely for people 10 years or older.

For best protection, more than 1 dose of a serogroup B meningococcal vaccine is needed. The same vaccine must be used for all doses. We provide Trumenba® in our office.

The current vaccine schedule for Men B (Trumenba®):

• - 2 dose schedule: at 0 and 6 months (i.e. 6 mo apart)
• - 3 dose schedule: at 0, 1-2 mo, and 6 mo. This older, 3 dose schedule,
•       is preferred if started in an outbreak setting or in patients with
•       medical conditions placing them at higher risk for invasive
•       infections.

More than half of the people who get serogroup B meningococcal vaccine have mild problems following vaccination. These reactions can last up to 3 to 7 days, and include:

• - Soreness, redness, or swelling where the shot was given
• - Tiredness or fatigue
• - Headache
• - Muscle or joint pain
• - Fever or chills
• - Nausea or diarrhea

New for 2015- the new HPV9 vaccine providing expanded protection against cancer!

This vaccine protects against cancers caused by the human papilloma virus, the most common sexually transmitted virus in the US. Changes in this expanded vaccine include protection against 5 additional strains of the cancer producing variety. This new and improved vaccine continue to protect vaccinated people from strains 6 and 11 which are responsible for over 90% of venereal warts. With the addition of the added strains, the vaccine protects against 7 of the cancer producing variety.

Cancers know to be caused by the HPV:

• most cases of cervical cancer
• many vaginal and vulvar cancers
• many penile cancers
• many anal cancers
• many head and neck cancers

... and the list is growing as we learn more about this nasty virus.

In the United States, an estimated 75 to 80 percent of males and females will be infected with HPV in their lifetime. For most, HPV will clear on its own. However, for those who don't clear certain types, HPV can cause cancer: cervical, vaginal and vulvar cancers in women and anal and some head and neck cancers in both men and women. HPV can also cause genital warts in both men and women. There is no way to predict who will or won't clear the virus.

In our office we offer the HPV9 vaccine called GARDASIL9™ which helps protect against the 9 types of HPV, specifically types 6, 11, 16, 18, 31, 33, 45, 52, and 58, that cause the most disease. It is estimated that HPV accounts for more than 80 percent of anal cancers, nearly 100% percent of cervical cancers, over 70 percent of vaginal cancers and the majority of vulvar cancers. HPV types 6 and 11 cause approximately 90 percent of all genital warts cases.

Each year, more than 20,000 HPV-associated cancers occur in women; cervical cancer is the most common. In the U.S., about 12,000 women get cervical cancer every year, and about 4,000 women die from it. Gardasil-9 can prevent most of these cancers. More than 11,000 HPV-associated cancers occur each year in men; oropharyngeal cancers are the most common.

Anal cancer affects both men and women, with approximately 60 percent of cases occurring in women. According to the American Cancer Society, it is estimated that approximately 2,000 men and more than 3,000 women will have been diagnosed with anal cancer in 2010. There is no standardized screening recommended for the general population for anal cancer and many people are diagnosed when the disease is more advanced.

HPV is the culprit for serious disease, especially for women, even if is caught early. Cervical surgery is required to treat and remove precancerous changes in the cervix. This can affect the ability of a cervix to stay closed throughout a pregnancy until the expected full term.
So protect you kids from cancer!!!
Get vaccinated!

3 doses are recommended, with the 2nd dose given 2 months after dose 1, and the final dose given 4 months after that. But if your child has fallen behind in this schedule, there is no need to repeat doses; we just pick up where you left off. For patients who have already completed the HPV vaccine series with the older HPV4 vaccine, we are awaiting official recommendations on using the HPV9 vaccine as an additional booster.

The HPV vaccine is licensed for ages 9-26.
It only works in prevention mode. If you've already been exposed the vaccine cannot do it's job.

Recommended age to start the vaccine: ages 11-13. Older teens and young adults should catch-up if they are behind.

Outbreaks of Vaccine Preventable Diseases

No vaccine itself is100% effective at protecting your child against the disease it is designed to prevent so "herd" immunity is a very important part of reducing the potential for community outbreaks. Marin has one of the state's highest rates of personal belief exemptions (PBE), parental waivers that allow children to enroll in kindergarten without receiving vaccinations against diseases such as measles, polio or whooping cough. In some schools such as Marin Waldorf and San Geronimo Valley, more than 50% of the children have PBE's and so are under-vaccinated.

 

We believe the large number of whooping cough cases in Marin during the 2010 epidemic may be linked to the growing number of parents who refuse vaccinations for their children. More recently outbreaks of measles and mumps have been linked to unvaccinated children who returned from foreign travels.

 

Measles/Mumps/Rubella: (prevented by the MMR vaccine)

 

Measles elimination has been maintained in the United States for more than a decade through high population immunity secondary to high MMR vaccination coverage. Coverage with 1 dose has been >90% among children aged 19–35 months since 1996. The increase in measles importations and outbreaks during 2011 serves as a reminder that measles remains endemic in many parts of the world and unvaccinated U.S. residents continue to place themselves and others in their communities at risk for measles and its complications.

 

This hit especially close to home with the 2014-15 measels outbreak at Disneyland. These diseases may not usually be common in the United States, but this is absolutely not the case for the rest of the world. In this instance, a tourist from the Philipines unwittingly carried measels from their home country, where the disease is much more common, and infected over 130 people. A similar incident caused the 2011 outbreak on Cal's campus, which personally affected many of our patients. Even if you and your family do not plan on traveling to these at-risk areas, these diseases can still find their way to your community, and it is important to make sure your children are protected! Another outbreak could just be a single plane flight away!

 

The increase in importations reflects recent increases in the incidence of measles in countries visited by U.S. travelers. The source of almost half of the measles importations in 2011 was Europe, which reported >30,000 cases of measles, including 27 cases of measles encephalitis, a complication that often results in permanent neurologic damage, and eight measles-related deaths in 2011. Five countries (France, Italy, Romania, Spain, and Germany) accounted for more than 90% of cases reported to the European Centers for Disease Prevention and Control. 2011 also saw smaller outbreaks of measles in Ecuador and New Zealand and large outbreaks in Africa (South Sudan and the Congo).

 

Importations of measles virus into the United States will likely continue and cause outbreaks in communities that have clusters of unvaccinated persons. Maintenance of high MMR vaccination coverage is essential to prevent measles outbreaks and sustain measles elimination in the United States. Despite the relatively small number of reported cases in the United States, the public and the health-care providers must remain vigilant. A drop in MMR vaccination coverage in a community can increase the risk for large, sustained measles outbreaks, as experienced recently in San Diego, Canada and France, or reestablishment of endemic transmission, as experienced in the United Kingdom.

 

Mumps: In 2006, the United States experienced a multi-state outbreak involving 6584 reported cases of mumps. This resurgence predominantly affected midwestern college students with the highest attack rates occurring among those living in dormitories. The next 2 years had few reported cases.

 

However, beginning in July 2009, the largest U.S. mumps outbreak since 2006 has occurred. The index case was an 11-year-old boy who had returned on June 17 from the United Kingdom where an ongoing mumps outbreak involves more than 4000 cases.

 

Mumps came home to Marin in December 2011 when an unvaccinated child returned from travel to Japan. Fortunately the winter school break limited the transmission but the next time we might not be so lucky.

 

Why should you worry about mumps? Rare complications of mumps include sterility and permanent neurologic damage such deafness.

 

Pertussis (Whooping Cough) Outbreak:

As kids get older, protection from some childhood vaccines can begin to wear off. Teens also develop risks for different diseases as they get older. Help your child transition into adolescence in a healthy way by staying up-to-date on pre-teen vaccines.

 

Currently, Washington State is in the midst of a Whooping Cough epidemic with over 1000 cases reported as of mid April 2012.

 

In 2010 there was a Pertussis, or Whooping Cough outbreak in California, the highest number of cases in over 60 years with very high rates of infection in Marin. You may have gotten information about a case of Pertussis in your child's preschool, school or camp.

 

Pertussis is caused by a bacteria (Bordatella Pertussis) that is spread by coughing or sneezing. Infants under the age of 1 and the elderly will suffer the most from Pertussis, and often need to be hospitalized due to the disease and its complications. In very small infants, Pertussis can be deadly (10 infant deaths were reported in the 2010 California outbreak).

 

A typical case of whooping cough may appear similar to a common cold, and starts with a cough and runny nose for one to two weeks, followed by weeks or months of rapid coughing fits that sometimes end with a whooping sound, or by vomiting from the severe cough. Fever is rare.

 

Children are immunized against Pertussis (the DTaP vaccine) at 2, 4, 6, and 15 - 18 months, and are given a booster dose before starting kindergarten. Another booster (the Tdap vaccine) is given to middle school students (age 11 - 13 years). The reason so many booster doses are needed is that Pertussis immunity (from both the vaccine and illness itself wears) off after 3 - 5 years. This is why so many adults, teens and 8, 9 and 10 year olds are susceptible to Pertussis. Moms delivering at Marin General are vaccinated for Pertussis after their delivery if they have not already been vaccinated. Pertussis vaccination for dads, and all household contacts is urged as a way of cocooning newborns against exposure to this disease.

 

Because infants, especially newborns, are at such high risk, the State of California is now recommending a Pertussis vaccine in the third trimester to boost mom's immunity in time for delivery. State law now requires documentation of a current Tdap vaccine for all students entering the 7th grade.

 

The Pertussis vaccine itself is not 100% effective at protecting your child against Pertussis so "herd" immunity is a very important part of reducing the potential for community outbreaks. Marin has one of the state's highest rates of personal belief exemptions, parental waivers that allow children to enroll in kindergarten without receiving vaccinations against diseases such as measles, polio or whooping cough. We believe the large number of cases in Marin may be linked to the growing number of parents who refuse vaccinations for their children.

For more information visit these web sites:

Marin County Health Dept

CDC

Seasonal Flu Vaccine

2021-2022 Seasonal Flu Vaccine shots are here!

Since 2010, the CDC and AAP recommend flu vaccines for ALL people 6 months and older! The best time to get the flu shot for kids is as soon as it is available! (Unlike older adults who do not have as robust an immune and therefore may be advised to get the flu shot later in September or early October).

This season, more than ever, a flu vaccine can help protect against the flu. Though we acknowledge that this protection is imperfect, in the setting of the COVID pandemic, any steps we can take to reduce the burden of disease in our patients and the population at large is essential. Last season saw very little flu due to the COVID infection control strategies of masking, sheltering in place and mostly Zoom school. This year is expected to be closer to “business as usual” for the influenza virus.

To maximize the efficiency and safety of giving flu vaccines, we will be conducting Saturday flu shot clinics beginning Sept 11 as well as some weekday clinics. Please call the office to schedule. The location of the flu shot clinic will be outside, on South Eliseo Drive, along the path leading to our rear entrance. Look for the MPA flag, MPA patient parking placards, and tent—you can't miss it. We request that all our patients wear short sleeved shirts, shorts or skirts/dresses for easy access for your favorite flu shot givers at this drive- through clinic.

For the present, we will be unable to offer flu vaccines to parents and caretakers as we have done in the past. We encourage adults to get their flu shots at their doctor's offices or pharmacies as soon as possible.

We recommend flu vaccine for ALL our patients 6 months and older, and parents and caretakers of infants or kids at higher risk from complications of influenza. (Be sure to request the quadrivalent flu vaccine if you are getting your flu shot at your local pharmacy)

2021-22 season: Quadrivalent flu vaccine protects against 4 different flu strains, two A and two B strains. Quadrivalent influenza vaccines will contain: an A/Victoria/2570/2019 (H1N1) pdm09-like virus, an A/Cambodia/e0826360/2020 (H3N2)-like virus, a B/Washington/02/2019- like virus (B/Victoria lineage) and a B/Phuket/3073/2013-like virus (B/Yamagata lineage).

Why we recommend influenza vaccination:
Influenza results in close to 40,000-90,000 deaths per year and over 300,000 hospitalizations. Some seasons hit the pediatric population harder than others. H1N1 (remember that pandemic prequel?!) seemed to have particular affinity for the pediatric age group and pregnant moms with slightly higher than usual complication rates in these groups. Though most of our patients will experience the "flu" as no worse than a particularly bad cold, the children under age 2 and those kids with underlying medical conditions are especially vulnerable to complications. Even healthy individuals with no risk factors can have surprisingly severe illness or complications from influenza. To protect all our patients, and especially the most vulnerable, both individual immunity and "herd" immunity works best. Annual flu vaccination boosts your immunity from previous vaccines or exposures to influenza as well as providing specific immunity to those strains we believe are circulating the globe this season. For more information please visit the links section, flu information web sites.