All posts by Dr. Pichichero

Some Vaccine Updates with Dr. Pichichero

 Teenagers and Whooping Cough

When adolescents contract whooping cough, a.k.a. pertussis, they usually don’t whoop but they cough, sometimes for up to 3 months.  So the illness can be quite impactful for patients as well as others because without treatment, patients can be contagious to classmates and family members.  Fighting against pertussis has had its issues thru the years: there has been waning immunity problems after experiencing pertussis infection, the old DTwP vaccine had to be discontinued in the US years ago due to safety issues, and then the newer Tdap has been in the news recently because of the rapidity of waning immunity in teenagers.  In assessing the results of the news a few comments are needed. First the study population was from California and that is a State where pertussis has been circulating much more than in most other States.  Exact reasons for a higher prevalence of pertussis in California are not fully understood, but a high rate of vaccine refusals may be a significant factor.  Secondly, the study used a mathematical model that would provide an estimate of waning immunity.  Nevertheless, the observations alert health care providers and the community that pertussis can occur even in vaccinated teenagers, especially as time passes after vaccination. The solutions are few at this time.  Public health care officials are unlikely to recommend boosters more frequently than already advocated (although that is an option).  Alternative formulations of Tdap to include other or additional ingredients could be a path forward, but the vaccine industry is tackling so many new diseases with vaccine development programs that a push for a better DTaP or Tdap is unlikely in the near term.

Flu vaccine: intranasal or shot?

More and more parents are requesting the intranasal flu vaccine at Legacy Pediatrics and each year we purchase more to accommodate those requests. The kids don’t want the shot and the parents don’t want to deal with the crying or pouting of their kids. The intranasal flu vaccine is live while the shot is a killed virus. The intranasal flu cannot be given to children below age 2 years or to children with asthma. In the news recently, a report described how the intranasal flu vaccine was not as effective as the shot last year (not this year since we don’t know yet). It turns out that the manufacturing process for the intranasal flu vaccine had a problem such that one of the strains in the vaccine was ineffective. Legacy Pediatrics has conducted studies of the different flu vaccines in years past and in those studies, the 2 vaccines performed equally well. So we will stay tuned for further research on this subject and advise the parents of our patients accordingly. Legacy Pediatrics does not currently have any more intranasal flu vaccine for this year and we do not intend to have any more for this season. The manufacturer has been unable to ship anymore to any offices this season. We still have flu shots available and we highly recommend you have you and your child vaccinated – it’s not too late!! We have seen a BIG increase in flu cases in just these past 2-3 weeks. In fact, take a look at the updated NYS Department of Health Weekly Influenza Surveillance Report.

Week Ending March 12th, 2016





Spring Allergies and Asthma

Photo by Wade Morgen

Photo by Wade Morgen

Every year as the trees and grass start to grow, we receive lots of calls about what to do. Here is some useful advice:

At the end of the day take a bath or shower to get rid of the pollen in your hair and on your body. Remove the clothing worn that day and don’t throw it in a heap on the bedroom floor. The clothing has pollen stuck to it too.

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Why get flu vaccine?

Influenza virus and pneumococci bacteria “dance” together.

Most parents know that the Flu vaccine has been proven to reduce the frequency of not only the flu but also ear infections, sinus infections and pneumonia caused by a bacteria called “pneumococcus”.  How that happens is becoming clear.  Our group has been studying the details of the interaction between Flu virus and pneumococci to unravel the steps in the dance between the flu virus and the pneumococcus in the nose that results in significant respiratory diseases.  Pneumococci live in the posterior part of the nose and upper throat as usually peaceful bacteria in all of us, harmlessly present in relatively low numbers.  The bacteria are so common that our studies to detect pneumococci in the nose and throat discover their presence in up to 80% of infants and young children and about 20% of adults at any one time.  However, the bacteria are harmless in patients that have a competent immune system unless an intercurrent viral upper respiratory infection like a cold or the flu occurs.

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Summer Time Illness and Physicals

The summer time is vacation time for our school aged patients and that reduces the frequency of illness because the kids are not cooped up indoors and most of the infections that they catch are respiratory (colds, flu, bronchiolitis, pneumonia, ear infections, sinus infections, etc.). But illness still occurs often enough and it is almost always caused by Enteroviruses.

Dr. Casey and I wrote one of our first articles together on the topic of Enterovirus infections, published in Contemporary Pediatrics June 2001. The key points of our article I share here with you:

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