HPV Vaccination for Boys too

The American Academy of Pediatrics have joined the CDC to recommend that boys should also receive the HPV vaccine.

I am curious to see how parents will react to these recommendations. With girls, many parents were apprehensive when I would mention HPV vaccination. It can be hard for a parent to imagine their 11-year old girl as being eventually sexually active, let alone needing protection from STIs. What many parents fail to see is that even if their child, boy or girl, makes all the right choices regarding sexual activity, their future partner may not have. And this is what I tell parents. Giving the HPV vaccination is not a predictor or indication of future behaviors. It is just protection from disease.

http://thechart.blogs.cnn.com/2012/02/27/boys-should-get-hpv-vaccination-too/

From CNN:

Boys should get HPV vaccination too

Parents have been hearing a lot about the human papillomavirus, or HPV, vaccine. But what was once designed solely for girls and young women up to the age of 26 to protect them from different strains of the virus, is now also being strongly recommended for younger boys.

Following in the footsteps of the Centers for Disease Control and Prevention, the American Academy of Pediatrics is recommending females and males at 11 to 12 years of age have routine HPV vaccinations.

Doctors say the vaccine is most effective if administered before a child becomes sexually active, and responds better in the bodies of younger children, usually between the ages of 9 to 15.

HPV is known to be the root cause of cervical cancer in women, and HPV can lead to other health problems in both females and males, including genital warts and mouth and throat cancers.

Young men diagnosed with HPV have also developed penile cancer and even anal cancer. These viruses, found primarily in sexually active adolescents and young adults, are the most common sexually transmitted viruses in the United States.

It was also stressed in the AAP recommendations that young men having sex with other young men should be particularly careful and consider being vaccinated.

The policy paper recommended that men 20 to 26 years old who have not been vaccinated for HPV, or who have not completed their series of HPV shots (the vaccine is administered in three doses), should do so as soon as possible. That’s because the CDC estimates about 7,000 HPV associated cancers in the U.S. could be prevented in young men by the HPV vaccine each year.

The AAP made their decision based on data provided by the Advisory Committee on Immunization Practices on vaccine efficacy, safety and cost effectiveness.

Although some parents have been reluctant to have their children inoculated with another vaccine because of possible side effects, such as weakness, fever, tingling, itching and hives, researchers say the benefits outweigh the risks.

Dr. Englund on Rotavirus Vaccine

http://www.king5.com/health/childrens-healthlink/Parents-can-worry-less-after-vaccine-safety-study-139125364.html

by Jean Enersen

Bio | Email | Follow: @jeanenersen

Posted on February 14, 2012 at 6:00 AM

Updated Tuesday, Feb 14 at 11:46 AM

As part of their routine well child visits baby Jose and baby Stanislav will be getting immunizations.

Those include a rotavirus vaccine, available since 2006. It protects against a virulent form of diarrhea.

"Bad diarrhea means two to twelve stools within 24 hours. It often lasts for several days. These kids may need to go in the hospital. They certainly need oral rehydration and often intravenous rehydration," explained Dr. Janet Englund.

Seattle Children's Pediatrician Dr. Englund is a Professor of Pediatrics at the University of Washington. She's part of a team tracking the disease across the country.

"We are finding an incredibly decreased amount of rotavirus this year compared to four years ago. We are finding the vaccine is very effective. But we are still finding rotavirus in kids who haven't been vaccinated," she said.

Some parents may opt out because rotavirus vaccines had a rocky start. An early version was pulled off the market in 1999, after it was linked to a rare but dangerous intestinal blockage called intussusception. Untreated, it can be life threatening.

Researchers led by Irene Shui, ScD from the Department of Epidemiology, Harvard School of Public Health, poured through nearly 800,000 records of Rotateq, the new vaccine given to babies from May 2006 to February 2010.

"Because the rotavirus vaccine is given to almost every child in the United States, it's crucial to monitor the vaccine's safety," said Dr. Shui.

Their findings were just released in the Journal of the American Medical Association.

"Our study did not find an increased risk of intussusception following the rotavirus vaccine," said Dr. Shui.

It's good news for babies, and for pediatricians.

"We want this data to present to our patients and say this is a good vaccine. We already thought it was. But now we have a lot more proof," explained Dr. Englund.

Still, she said, no vaccine can protect against all cases of diarrhea.

"I think it's really important if your baby can't take in more than he or she is pooping out, then that's when you need to call the doctor," she said.Seattle Children's has more information on their website to help parents decide when to call the doctor.

Dr. Englund also reminded parents the vaccine isn't recommended for children older than infants, saying older kids and adults don't get as sick as babies do from rotavirus.

PNP Job: Philadelphia, Pennsylvania

Pediatric Nurse Practitioner

Job ID: Position Title: Pediatric Nurse Practitioner Company Name: Children's Surgical Associate, Ltd. Industry: Healthcare Job Function: Nurse Practitioner, Pediatric Entry Level: No Location(s): Philadelphia, Pennsylvania, 19104, United States

Posted: February 20, 2012 Job Type: Full-Time Job Duration: Indefinite Min Education: MSN Min Experience: 1-2 Years Required Travel: None

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Contact Person:	Denise Cundo	Fax:	215-386-4036
Email Address:	csahr@email.chop.edu

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Job Description

The Division of Orthopaedic Surgery at The Children’s Hospital of Philadelphia, one of the top pediatric orthopaedic groups in the country, is seeking a Nurse Practitioner with a passion for patient care and a career in a cutting edge, outpatient academic environment. This position will require a bright, responsible, career-oriented professional who will work with one or more very busy pediatric orthopaedic surgeons. The successful applicant will be given responsibilities in patient care coordination, patient teaching, and problem solving. The Nurse Practitioner will work closely with team members including Nurse Practitioners, Physician Assistants, and Registered Nurses in the Division, with the opportunity to participate in clinical research.

Position is full time 5 days per week, with potential late start extended evening hours

Job Requirements

• Graduation from an accredited Nurse Practitioner program with a Masters degree
• Licensure as a Certified Registered Nurse Practitioner (CRNP) in the Commonwealth of PA
• Licensure as a Certified Registered Nurse Practitioner (CRNP) in the state of NJ preferred
• National certification as a Nurse Practitioner
• Pediatric and/ or orthopaedic experience preferred
• Critical analysis and problem-solving skills
• Ability to work independently
• Ability to interpret laboratory and radiographic data
• Ability to perform diagnostic and therapeutic procedures
• Ability to work collaboratively through consultation with other health care team providers
• Ability to communicate verbally and in writing in English

PNP Job: Minneapolis, MN

Pediatric Nurse Practitioner- Wound Ostomy Care

Job ID: 9318868 Position Title: Pediatric Nurse Practitioner- Wound Ostomy Care Company Name: Children's Hospitals & Clinics of Minnesota Industry: Healthcare Location(s): Minneapolis, Minnesota, 55401, United States

Posted: February 21, 2012 Job Function: Nurse Practitioner, Pediatric Entry Level: No Job Type: Full-Time

Company: Children's Hospitals & Clinics of Minnesota view full company profile

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Contact Person:	Judy Brown	Phone:	612-813-8133
Email Address:	judy.brown@childrensmn.org
Apply URL:	http://www.childrensmn.org

PNP Job: Orange County, CA

Job Description

Join us! CHOC is constantly growing and offering new programs and services as we continue to meet the needs of over 250,000 children annually in Orange County, CA making the opportunities for your career enrichment endless.

The Cardiovascular Nurse Practitioner functions in an Advanced Practice role as a clinical expert in the management of pediatric cardiac patients within a family centered care environment. Practicing within developed Standardized Procedures and Process Protocols the Cardiovascular Nurse Practitioner plans, implements and evaluates the plan of care for medical and surgical pediatric cardiovascular patient population. Management includes but not limited to, performing history and physical examination, ordering and interpreting appropriate diagnostic and laboratory tests, and furnishing of pharmacological and non-pharmacological therapies in a cost efficient manner.

The Cardiovascular Nurse Practitioner functions both as an independent practitioner and in collaboration with the multidisciplinary cardiac team. In this role, you will provide consultation and education to patients, families, and members of the multidisciplinary teams.

Job Requirements

• Graduate of an accredited Nurse Practitioner program, MSN required.
• License/Certifications: Current CA RN license, Nurse Practitioner certification, current PALS and BLS, and Furnishing and DEA number.
• Previous Job Related Experience: Minimum three years experience as a pediatric critical care RN, with minimum of 1 year pediatric CVICU.
• One year experience as a Nurse Practitioner in pediatric critical care, prefer pediatric cardiovascular experience.

Additional requirements:

• While this is a day position, it also requires night call.
• Ability to set goals and judge results in accordance with the highest standards: care with sensitivity and respect; advance care through development of new ideas and technology, promote teamwork to achieve CHOC's mission, and understand an exceed customer expectations.
• Critical analysis and problem solving skills
• Ability to interpret laboratory and radiographic data
• Ability to perform diagnostic and therapeutic procedures
• Ability to work collaboratively through consultation with a multidisciplinary team.
• Excellent communication skills and the ability to engage in effective conflict resolution

  Join CHOC's multidisciplinary team and make your mark!

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Contact Person:	Susan Lee Brevoort	Phone:	714-532-8794
Email Address:	sbrevoort@choc.org
Apply URL:	http://www.choc.org

Unring the Rotavirus Vaccine & Intussusception bell

JAMA published a study on February 8, 2012 that summarized findings that challenge the link between rotavirus vaccine and intussesception. I have pasted the abstract below.

The study reviewed Vaccine Data Safetylink (VSD) data from n=309,844 first doses for intussception, n=786,725 total. They checked for intussception 1-7 and 1-30 days post vaccination and found that those who had received vaccine were at no increased risk for intussception.

This is important information to pass onto families and the community. As the saying goes, you cannot unring the bell, and this is particularly true with vaccines. When it was hypothesized that vaccines may cause autism, vaccines rates began to fall dramatically. Diseases that were once unheard of began to reemerge. Parents hold that same caution with rotavirus vaccine and intussception. Even when it was believed that there may be a causal relationship, it was based on observations of intussception in 1 in 8000 cases of rotavirus vaccination. Clinical trials rarely include an "n" of 8000, so the chance of intussception was deemed incredibly low.

So now we know better, but do we believe it? The CDC website is full of information that is backed by studies to prove what vaccines do and do not cause. I often refer parents here. Despite what I may tell them during a 20 minute visit, many parents need time on their own reading the information for themselves.

One thing that is good about this awareness of vaccines it parental involvement. I do not think it is good for parents to blindly trust their provider. They have a right and duty to question the care that is being given to their child.

• JAMA. 2012;307(6):598-604. doi: 10.1001/jama.2012.97

  Risk of Intussusception Following Administration of a Pentavalent Rotavirus Vaccine in US Infants

  1. Irene M. Shui, ScD;
  2. James Baggs, PhD;
  3. Manish Patel, MD, MPH;
  4. Umesh D. Parashar, MBBS, MPH;
  5. Melisa Rett, MPH;
  6. Edward A. Belongia, MD;
  7. Simon J. Hambidge, MD, PhD;
  8. Jason M. Glanz, PhD;
  9. Nicola P. Klein, MD, PhD;
  10. Eric Weintraub, MPH

  [+] Author Affiliations

  1. Author Affiliations: Department of Epidemiology, Harvard School of Public Health (Dr Shui), and Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Shui and Ms Rett); Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Baggs, Patel, and Parashar and Mr Weintraub); Marshfield Clinic Research Foundation, Marshfield, Wisconsin (Dr Belongia); Institute for Health Research, Kaiser Permanente Colorado (Drs Hambidge and Glanz), Community Health Services, Denver Health (Dr Hambidge), and Department of Epidemiology, University of Colorado School of Public Health, Denver (Drs Hambidge and Glanz); Vaccine Study Center, Northern California Kaiser Permanente, Oakland (Dr Klein).

  ABSTRACT

  Context Current rotavirus vaccines were not associated with intussusception in large prelicensure trials. However, recent postlicensure data from international settings suggest the possibility of a low-level elevated risk, primarily in the first week after the first vaccine dose.

  Objective To examine the risk of intussusception following pentavalent rotavirus vaccine (RV5) in US infants.

  Design, Setting, and Patients This cohort study included infants 4 to 34 weeks of age, enrolled in the Vaccine Safety Datalink (VSD) who received RV5 from May 2006-February 2010. We calculated standardized incidence ratios (SIRs), relative risks (RRs), and 95% confidence intervals for the association between intussusception and RV5 by comparing the rates of intussusception in infants who had received RV5 with the rates of intussusception in infants who received other recommended vaccines without concomitant RV5 during the concurrent period and with the expected number of intussusception visits based on background rates assessed prior to US licensure of the RV5 (2001-2005).

  Main Outcome Measure Intussusception occurring in the 1- to 7-day and 1- to 30-day risk windows following RV5 vaccination.

  Results During the study period, 786 725 total RV5 doses, which included 309 844 first doses, were administered. We did not observe a statistically significant increased risk of intussusception with RV5 for either comparison group following any dose in either the 1- to 7-day or 1- to 30-day risk window. For the 1- to 30-day window following all RV5 doses, we observed 21 cases of intussusception compared with 20.9 expected cases (SIR, 1.01; 95% CI, 0.62-1.54); following dose 1, we observed 7 cases compared with 5.7 expected cases (SIR, 1.23; 95% CI, 0.5-2.54). For the 1- to 7-day window following all RV5 doses, we observed 4 cases compared with 4.3 expected cases (SIR, 0.92; 95% CI, 0.25-2.36); for dose 1, we observed 1 case compared with 0.8 expected case (SIR, 1.21; 95% CI, 0.03-6.75). The upper 95% CI limit of the SIR (6.75) from the historical comparison translates to an upper limit for the attributable risk of 1 intussusception case per 65 287 RV5 dose-1 recipients.

  Conclusion Among US infants aged 4 to 34 weeks who received RV5, the risk of intussusception was not increased compared with infants who did not receive the rotavirus vaccine.