Friday, October 21, 2016

New HPV 2 Dose Schedule for 9-14 Year Olds

     We all like when an immunization shot schedule gets easier! The HPV (human papilloma virus) vaccine has been used since 2006 in this country. The current vaccine is "Gardisil 9" and offers excellent protection against HPV strains that can lead to cancer and other issues. Recent studies have looked at whether giving two doses of the HPV vaccine at the preteen age would provide very good protection versus given three doses. The study showed that the two dose schedule gave very good protection. The second dose was given 6-12 months after the first dose. In fact, the protection was so good for 9-14 year old receiving two doses, their protection was better than the 15-26 year olds receiving three doses!
     So you will likely find that we will recommending a different schedule for the 9-14 year olds receiving the vaccine. Discuss it with your doctor. When we routinely offer the vaccine in the pre-teen years, getting the first dose at one visit and another in 6-12 months should give your child excellent protection against HPV. This will allow us to give the vaccine in two consecutive check-ups, simplifying the schedule and reducing trips back to the office in between well visits.
     If you have felt hesitant about this vaccine, please know we feel it is very safe and very effective. My own three children have received the vaccine. Other than some arm soreness, they have had no side effects. And my wife and I can rest easier knowing that they and their spouse/partner are better protected from cancer and other issues.
     We hope this new schedule for those that start the vaccine before they turn 15 years of age will encourage everyone to start the vaccine at a younger age (11-13 year olds) when the protection they will receive from the vaccine will be at it's best. Please discuss with your doctor if you have questions or concerns.
     Here is a link to an article from the Centers for Disease Control and Prevention with more information.

Wednesday, October 12, 2016

Our office's patient portal.

     With our change about a year ago to our current medical software, we now have the capability to have a patient portal. Patient portals are secure, safe, online websites that give convenient access to personal health information. Many patient portals allow you to request well visits, request non-urgent appointments, access your health information, access your immunizations, ask non-urgent questions, request prescription refills, update contact information, and more.
     We know many of the families that have been in the office in the last number of months have provided information so that you can access our patient portal. The portal is located at
     Our patient portal is currently set up so that you can request a well visit appointment, request non-urgent appointments, request prescription refills, ask non-urgent questions, access your child's immunization records, check your child's growth curves, check you child's upcoming appointment(s), and see a summary of previous visits.
     We plan to set up a link from our website at to reach our patient portal. We hope to make it convenient to access.
     An important note: our patient portal should not be used to reach us with urgent or emergency issues. The portal will be checked periodically during routine office hours (9:00 a.m.-noon Monday through Saturday; 1:00-5:00 p.m. Monday through Friday), but not when the office is closed after hours, on weekends (besides Saturday morning), or on Holidays when we are closed. Leaving an urgent issue on the portal for us to read later will delay when we will be getting back with you. As you know, for an emergency, call 911 or go to the emergency department at Nationwide Children's Hospital. For an urgency, call our office (after hours, call and leave a message) or go to Nationwide Children's Hospitals Urgent Care or emergency department.
     We look forward to your feedback.

Tuesday, October 11, 2016

Why do some medical offices not consistently have the flu vaccine this 2016-2017 year?

     In the Spring of 2016, the national organizations made the recommendation to not do the Flu Mist nasal influenza vaccine because of it's lack of effectiveness in the last 3 influenza seasons. This information was available for us soon enough to cancel our Flu Mist order for the 2016-2017 season and increase our order of the flu shot. However, this has happened all over the country and has increased the demand for the flu shot routinely used with children (there are some flu shots that are not used for all ages). This increased demand has meant that the makers of the flu shot have had some delays producing enough flu shots to keep all office's supplied at all times. Although we do not know when it will be received, we will keep you updated when we know more about our supply.
     We actually order the flu vaccine in the previous Winter for the next season. That means by February 2016, our order was placed for the 2016-2017 season. We added to our order of flu shots once it was known that the Flu Mist would not be used this year.
     A review of our recommendations may be helpful. We recommend the annual flu vaccine to all of our patients 6 months and above [there are some of our patients who cannot safely receive the vaccine -- the most common reason is a history of anaphylaxis (severe allergic reaction) to egg and egg protein]. The first year the vaccine is given, if the child is less than 9 years of age, they get the best protection if they receive two doses a month apart. Unless there are special circumstances some year (there were a few years ago when the H1N1 strain emerged), that is the only time a second dose is needed the same season.
     Years ago, it was thought the vaccine's protection against influenza only lasted a few months,  The current recommendation says to give the vaccine from when it is first available in July-September and it is fine to receive it, if not received previously that season, for as long as the flu vaccine supply is available (we have given it as late as January when it has still been available). It takes about 2 weeks for the vaccine to work well, and the typical season for influenza in the community is from October or November through February or March, so ideally the vaccine is received by October each year. In our experience, the vaccine continues to give protection throughout the season.
     Each year, experts pick the 3 or 4 strains of influenza in the vaccine for that year. As you may be aware, some years the match of what is in the vaccine as protection and what strain goes through the community can vary. Some years, the protection is terrific because there was a good match. Other years, many who received the vaccine may still become ill with influenza because the match was not a good one. We do not yet know this year about how well matched the vaccine strains will be with the virus strains in the community.
      To summarize: 1. we recommend the flu vaccine, 2. only the flu shot is available this year, 3. we are out of the vaccine right now but expect more doses soon, and 4. we will keep you up to date about our supply.