In writing the following articles on vaccines , I realize that this task is very delicate. There are many vaccines, and the consensus is less strong. The fiasco of H1N1 vaccine left traces. So, before continuing to describe all these vaccines, many of which seem useful, I would like to address the question: Why vaccinated? Against what? How to Choose?
I do a lot of vaccines, children of course, I also remind parents that have to be updated.
In fact, several questions can be added:
What latitude for parents?
What is the role of the pediatrician in this decision?
The pediatrician there a legitimacy to deal with this decision?
How is it informed?
How do I know if a vaccine is safe?
How do I know if a vaccine is useful?
What is the role of the state and ministry of health?
The need to protect people going on it before individual interest?
In conclusion
Obviously, I do not have all the answers. And even though I would have, it is not at all sure they are suitable parents. My personal experience (15 years of responsibility in the Hospitals of Paris, then 25 years of Pediatrics in the city) will be furiously tapped.
What latitude for parents?
"In Honor to whom honor", let the parents
How do they decide to parents to vaccinate their children?
Most delegates the decision to the pediatrician "We trust you Doctor, it relies on you."
is very amiable, and it might seem comfortable. That is less than it seems.
Provided that confidence is great when the child is sick, and parents have so little choice, as it is less reason to take preventive measures such as vaccination.
A splinter group refuses almost all vaccines. If parents
entangle themselves-it is rarely the discussion and they quickly caught more fun to attend a colleague coolest, usually listed medicines called "soft" .
To not go into too theoretical considerations, I will take two examples :
Meningococcal meningitis C in 2002:
In Clermont region, a slight increase in fatal cases of this terrible meningitis has led a campaign of vaccination of children. Television and radio arrived. We no longer talked of nothing else in France. The Minister said: "We need to vaccinate." There was a new vaccine which we knew little. But the psychosis was such that the firms were raided. Faced with such enthusiasm, there was little choice, he was vaccinated. This was done. Even the most critical of parents arrived at the office with their vaccine and I understand.
But we know that the meningococcus germ is a very fragile not stand a few seconds to cool and ventilate just a few minutes to kill all microbes suspended in the air. Efficiency is partial because there are still bugs in the nose, but their transmission is slowed down. That's a start. But it's probably a method so cheesy that it has not even been recalled.
Hepatitis B vaccine carrier controversy :
is a vaccine that I propose for infants. To the reticent, the question sometimes arises when K appears in the "ugly" displays " there is a case of hepatitis B in school Immediately consultation and question, probably innocent " is this-that my child is vaccinated and if not why not? "Fortunately the answer is easy:" your child is not immunized because you were there unfavorable "
And to calm the parents suddenly become very demanding I add:" reassure you do not catch hepatitis B so fast, we will vaccinate "
In no time the vaccine considered suspect became indispensable.
can multiply these examples endlessly emotional response to personal risk scans all cultural reticence sometimes so deeply rooted.
The choice of the parents must always be taken into account but we see that it is subject to variations understandable.
What is the pediatrician's role in this decision?
The pediatrician there a legitimacy to deal with this decision?
How is it informed?
How do I know if a vaccine is safe?
How do I know if a vaccine is useful?
The pediatrician's role is to inform parents of what he knows about vaccines.
I the it is legitimate decision support because it makes sense be better informed and as he himself made many vaccines, he knows the most common side effects.
pediatrician How is it informed?
This is where it gets complicated: I do not know how "pediatricians" are informed. I only know how, I am:
There are studies the Fac and hospital experience. This is not negligible.
publications and recommendations of our experts .
There are reps who preach to their chapel.
personal culture. I would mention that " Plague" by Camus that I read very early in the influenza A, a gem!
ago French and foreign journals . When a French magazine is dedicated to vaccines, but only 30 pages, there are 5 pages of advertising for major brands of vaccines, there may be doubts about the independence of the review, but those who write in are not necessarily all rotten.
There are great magazines like the New England Journal of Medicine (NEJM) that I love, which has virtually
no advertising except for drugs for the third age (maximum one page). It is an adult medicine journal that I use daily, but I doubt that many doctors are subscribers of town because it's expensive, in English and there is one issue per week. It's quiet!
This is not the only great magazine but keep the time to care for small children and see her live!
For fans who can read : "To Science "
or" Research "or" The World "are filled with medical information.
But it takes time. To read more, I am forced to reduce my consultation hours. We can not have a doctor who works 12 hours a day and is more aware.
course there Internet which is a great tool (site available to subscribers of the NEJM is very rich). There are two major reservations on medicine on the Internet:
1. is everything and anything in particular on the forums where the worst rubs rarely the best.
2. Internet Alzheimer . There is nothing more than 5 years and even sometimes more than 1 year so that the whole experience of the former is completely ignored. This experience exists only in books. But books are expensive especially in medicine. It is a lack for those who give up investing in the paper when the web is free.
How do I know if a vaccine is safe?
How do I know if a vaccine is useful?
For some vaccines diphtheria, tetanus, polio, pertussis, Haemophilus is very easy because we have a long experience and it is observed that in countries where vaccination is not done well the situation is delicate .
Others remain reluctant: low to the measles, lower for pneumococcal e but the vaccine is a little painful and somewhat recent (ten years), more strong for hepatitis B while the disease is the leading cause of liver cancer in Asia poor (here is alcohol, but there is no vaccine and anyway it would have little success). Two vaccines
ask me more seriously.
The vaccine against meningococcal C because it is new about 10 years and rarely used in the U.S. where Americans usually flock to new vaccines.
The vaccine against HPV (cancer of the uterus) is even more recent, and that we will know that in 30 years if it is helpful or harmful. Opinions are sharply divided.
If I were in the single thought, I'd do the "Pari de Pascal "
Should we believe in God?
YES of course because if we win there.
If no one loses nothing.
But I can not bring myself to this kind of approach as unscientific practice that some pharmaceutical companies a powerful business lobby, if not more.
This impairs the clarity of the debate.
As Lao Tzu would have said: "Post tenebras lux" "Post in the darkness is luxury" (free translation, very free Dr. kid who is 6 years of Latin, but if he will!)
I do not believe that these vaccines are harmful but the gray areas in particular that concerning the vaccine Rotarix *, recently taken off the market in the U.S. does not enlighten us, so to say!
Anyway everyone is doing the best.
What is the role of government and ministry of health?
The state is as it may , wedged between the heat wave of 2003, contaminated blood, mad cow disease, deficiency of growth hormone and the WHO, not to mention the precautionary principle, nor the election. On the occasion of Influenza A, the State showed its limits. Some experts have shamelessly spread their incompetence and other, very rare, reluctant to mainstream, were treated to all the names of birds .
D years an article in Le Monde . Com, Professor Marc Gentilini, infectious disease specialist, a member of the Academy Medicine and former president of the Red Cross considers "indecent" the funds mobilized by the state to cope with the possible outbreak of influenza A in September, compared with low amounts allocated to other diseases far more deadly .
Needless to say he was not listened while it is a world-renowned figure.
Needless to say he was not listened while it is a world-renowned figure.
The need to protect people going on it before self-interest?
is a big question which I imagine, sometimes nagging makers.
She probably asked for smallpox vaccination because the vaccine was not completely harmless but widespread vaccination has eliminated the disease.
This question will perhaps again about the poor TB vaccine efficacy, to balance with the emergence of tubercle bacilli resistant to many antibiotics. The protection of individuals would no longer be effective in vaccinating everyone.
But it is not enough to want to get there. The fiasco of flu has clearly shown.
In Conclusion
Role of the pediatrician, parenting.
The pediatrician informed of the existence of vaccines, the Act and recommendations French and foreign, if he has knowledge. In his way of giving information, it is surely sometimes some excitement or some reservation that probably affect the parents' decision. I'm not "alternative" but I'm definitely the "sweet Pediatrics.
Parents ultimately decide. Their history, their culture, the propensity to alternative medicine or other sweet influence their decision. Must be taken into account. But when I'm convinced of one thing, experience shows me that the parents follow me the most.
"It's hard to be parents, to decide what is good for her child,
It is much easier to be a pediatrician. Do not take advantage. "
good winter. Happy reading
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