Beyond the Needle - A Physician's Guide to Increasing COVID-19 Vaccination Rates

10. Understanding the COVID-19 Vaccines for Children Under 5 Years to 6 Months Old & Addressing Vaccination Concerns for Parents

• I-VAC & IAFP

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Daniel Johnson, MD and Christina Wells, MD, MPH, FAAFP host this expanded episode to discuss, in detail, the COVID-19 vaccines for children under 5 years to 6 months old . They acknowledge that many physicians may be hesitant to recommend parents vaccinate their infants. They will help listeners understand more about these vaccines so they are better equipped when recommending the COVID-19 vaccination and answering questions that parents may have.   

The COVID-19 vaccine has been studied more than any other vaccine in history.  Drs. Johnson &  Wells will discuss the experiences they encountered in their practices and share information to help other clinicians include these vaccines as part of a regular patient visit.  

Our subject matter experts encourage clinicians to always take the opportunity to vaccinate.  The best time to vaccinate is when the patient is in your office and agrees to it.  Don’t wait for the child to move up to the next age group if they are in an age group that is eligible for a vaccine now.

In this episode, they will share:    

  • Strategies they have used to address parental concerns
  • Resources that may be helpful to give to the parents to help them make their decision
  • Challenges, other than vaccine hesitancy, they have encountered, as well as positive experiences
  • Best practices to mitigate concerns about the various COVID-19 vaccines & reduce the risk of improper dosing
  • Staffing issues & strategies that have been useful to help staff feel comfortable administering the vaccines
  • Ways you can use every visit as an opportunity to offer and discuss the COVID-19 vaccines, not only for the infant or toddler, for the parents and anyone else in the household
  • Resources that are available to clinicians
  • Details about the Moderna & Pfizer vaccines- differences, similarities, dosing, side effects, etc.
  • How this vaccine is similar to vaccines we have for other viruses & how vaccinations vary for respiratory & non-respiratory viruses.

Objectives:

  •  Understand various concerns parents have when deciding whether to have their infants or toddlers receive the COVID-19 vaccines
  • Identify the differences between the Pfizer & Moderna vaccines for this age group
  • Utilize various strategies to help to increase the uptake of COVID vaccines within your office
  • Explain how vaccines for respiratory viruses differ from non-respiratory viruses and why boosters are needed
  • Discuss best practices for storage and administration of vaccines 
  • Gain confidence to address concerns that the COVID-19 vaccines were developed too fast & the details to support why they are the most researched of any vaccine up to this point

Learn more at:
www.illinoisvaccinates.com/podcasts/









Visit us at illinoisvaccinates.com/podcasts.

Dr. Carl Lambert (00:04):

Welcome to Beyond the Needle, a physician's guide to increasing COVID-19 vaccination rates brought to you from the Illinois Academy of Family Physicians through the Illinois Vaccinates or IVAC Grant. I am Carl Lambert, Family Physician and a member of IAFP and I'm an Assistant Professor of Family Medicine at Rush University Medical College. IVAC is a joint effort administered by the Illinois Chapter of American Academy of Pediatrics, the extension for Community Health Outcomes ECHO-Chicago and the IAFP.

(00:32):

Funding for this podcast series is provided by the Office of Disease Control through the Illinois Department of Public Health. Through this podcast series, we will empower the primary care physician to feel confident in implementing COVID-19 vaccination so that their patients can receive the vaccine at a routine visit. Support for providers is available through boot camps, learning collaboratives, do-it-yourself toolkits and this podcast series. CME Credit is available for each podcast. For more information, visit Illinoisvaccinates.com under podcasts. Thank you for joining us as we come together to vaccinate against COVID-19.

Dr. Christina Wells (01:09):

Hello, and welcome to another episode of Beyond The Needle. Today, we're going to be discussing vaccines in the age group of six months to five years. And today we're going to really be talking about how providers can help to promote vaccines in their offices and also to address concerns and issues related to vaccines. Today we have with us Dr. Daniel Johnson and he's going to be introducing himself a little bit later. I am Dr. Christina Wells and I'm a Family Medicine Physician at the University of Illinois and I've been working there for almost 13 years. I see kids in my office, as well as adults and we also have Dr. Daniel Johnson. Dr. Johnson, welcome. Tell us a little bit about yourself.

Dr. Daniel Johnson (02:08):

Well, thank you, Christina. So my name is Dr. Daniel Johnson. I'm a Pediatric Infectious Disease Specialist who works at the University of Chicago and Comer Children's Hospital, as well as a few other area hospitals, seeing patients with pediatric infectious diseases. And, of course, included in that list is patients who have SARS-CoV-2 and develop COVID-19, the complication of SARS-CoV-2. I also happen to be a native Chicagoan, having grown up on the south side of Chicago. I see patients not only at Comer Children's but also at Mount Sinai, Edward Hospital and our services when we go out to NorthShore System.

Dr. Christina Wells (02:57):

Well, thank you so much for joining us today, Daniel. We know that this is such great information that needs to be provided today. And so we're happy to be able to draw from your expertise in this area. And so the first thing that I wanted to ask, we've been hearing about how, during the summer months, the number of COVID vaccines that are given has plateaued. And so what are some of the strategies that you think that providers can utilize to help to increase the uptake of COVID vaccines within their offices, especially as we're going to be going into the school physical season?

Dr. Daniel Johnson (03:49):

Well, the school physical season really offers the most important opportunity to be able to recommend COVID vaccination. It's been interesting, because like you said, there's been a plateauing. And when you talk to people about their attitudes around vaccination for COVID vaccine, as well as others, well almost always comes down to something very similar, which is that people say the most important determinant for deciding whether or not to get a vaccine is a recommendation from their primary care group.

(04:25):

And so the physical season creates an easy opportunity to be able to interact with a large number of patients where the focus is well childcare and well childcare, as we all know, is heavily influenced by vaccination. And so it's a critical time to raise with those families, the importance of COVID vaccination as another vaccine to receive. We know the miracle of vaccination, it's saved countless lives and that's ever so true with COVID as it is with other disease processes. The thing that is then critical for us as pediatric providers is to bring it up.

(05:12):

If a family doesn't ask about it, then ask them. Ask them what they think, what have they heard? Engage them in a conversation. Most people are willing to talk about the vaccine. And even if they initially say, "Oh, I know everything." Or, "I don't need to hear anything," wait and come back to it. Most people in my experience, then want to talk about it. They may initially say, "Oh no, we don't need to." You come back to it near the end of the visit and just say, "Oh, I'd love to talk to you about this. I've done a lot of reading about it or I've given this a lot of thought and I'd love to share with you my thoughts about that and what my recommendation is. And I'd really like to answer your questions so that way we can have a conversation."

(06:01):

And often with that second request is when many people who turn down that first offer then say, "Well, yeah, I actually do have a question." Or, "I'd like to hear your thoughts." And then, of course, if they don't want to talk about it, at least saying to them, "You know, I've looked into this and I recommend it. I've looked into this, I got the shot. I'm recommending it to all of my patients." Or some other kind of starter where you're not presuming anything about what they want to do. You're starting with something open-ended and then you're moving towards a recommendation. That recommendation is critical to decision making by families.

Dr. Christina Wells (06:51):

Yeah, I think that's really, really important. And I've also heard when you mention about the importance of providers being able to recommend the vaccine to their patients and how parents will be willing to at least listen and be influenced by those recommendations. And so as a follow-up to that, anytime in medicine there is something new, it takes a little while for that to take hold. And so what strategies, what recommendations would you give providers to say, "Well, how do we ourselves become better equipped at recommending the vaccine?" Being able to answer questions that parents may have and maybe be getting beyond our own hesitancies in recommending something that's relatively new to us?

Dr. Daniel Johnson (07:50):

Well, that's a great question. And this is something which I think comes up for everybody. All of us care a great deal about our patients and our decision making around what we recommend is not only built on the data but also built on our desires to ensure that children stay healthy and safe. So when you come from that position, it's a good starting point for the conversation with a parent. You're, in essence, aligning yourself with them.

(08:27):

So I often start out by acknowledging that I know that they want the best for their child and that's what I want for their child, as well. And people can have different points of view about what's best and that's why we should talk about it. I usually begin the conversation by acknowledging that I've had other families that have been hesitant and that we've had many conversations with people in the office around what to do with the vaccine.

(09:04):

The first thing I remind them is that this vaccine has been studied more than any other vaccine in history. There is more data around this vaccine than any vaccine that's ever come out. And the reason for that is because of our ability to be able to gather data has changed immensely in the last 10 years. We now have electronic medical records, we have the ability to be able to contact patients anywhere, anytime. We have the ability to manage huge quantities of data in a way where previously we had to use paper and pencil, we didn't have the ability to sift through things the way we do now.

(09:51):

We can gather data passively, we can gather data actively. Passively by just hoping that people will share it but they have the opportunity to be able to do that. Actively by actually reaching out to them and asking them to share it by actively looking at electronic medical records and in an anonymous way information so that we are not in way undermining a person's privacy but we are able to gather immense amounts of information.

(10:27):

These vaccines have been used on millions of people and to have the tools be able to gather that data has resulted in this being a vaccine where we have more information than any other vaccine ever created up to this point in time. So when you have that amount of information, it gives you the chance to be able to identify all the things that go right and some of the things that may not.

(10:58):

And then be able to prepare for them, for those things that haven't gone ideally. That's why we know that we have to give boosters. That's how we know how to reduce the risk of complications from the vaccine. All of this feeds our ability to be able to make the best recommendation to families. And in that way, offer them the highest level of protection for their child.

Dr. Christina Wells (11:27):

Thank you. Thank you for that response. Very, very helpful information and helping us as providers to be better equipped, to provide valuable information and approach it in a way as a partnership with our patients to let them know that, I am looking out for the best interests of your child, just as you would and so let's partner together in that process to do that. So that's a very, very good approach.

(12:00):

Another question is, in thinking about parents coming into the clinic, we know that now for children, age six months to five years for Pfizer, there's a vaccine. And for Moderna, there's a vaccine for six months to six years. How do you deal with parents who come in and want a particular type of a vaccine? How do you counsel those parents as to the differences between the vaccines or just some key points that may be helpful for parents?

Dr. Daniel Johnson (12:34):

It's true that we have some parents who come in and say they want the Pfizer vaccine. In the case of our clinic here at University of Chicago, that's the one that we carry. And so it's an easy one then, great, it's a perfect matchup. Some families come in wanting Moderna. So I let them know where they can go to get Moderna because if that's what they want, I want them to be able to get the vaccine that makes them most comfortable. Now some people come in and go, "Well, which one do you recommend, Doc?"

(13:09):

And that's when we then will certainly have a conversation around the pros and cons of the vaccines. What we first say that both vaccines are effective, both vaccines generate an immune response and there is not a strong reason to choose one over the other but there are some differences between them. One is that the Pfizer is three doses, Moderna's two doses. If you've got a child who's really needle phobic, well then, sounds like two doses should be preferred over three. Now the payoff of getting those three doses is that the amount of antigen.

(13:55):

So what's causing the irritation or reaction by the immune system that's in the vaccine is lower, the amount is lower in the Pfizer vaccine compared to the Moderna vaccine. And that translates actually into a lower occurrence of side effects. Now, some people come in who are particularly worried about the side effect profiles. I mean, the side effects for both vaccines are similar and they're pretty minor. And that, of course, people get a sore arm, they get some redness where the shot occurs. Some people develop some fatigue or fever or body ache. All of these things go away within the first 48 to 72 hours, a very large percentage.

(14:42):

In fact, most don't develop any of those systemic symptoms. People do get a sore arm but the incidents with Pfizer is about half the incidents of the sore arm with Moderna. The redness is almost non-existent with the Pfizer, whereas it's a little more common with Moderna. Moderna is more likely to cause fatigue, body ache and fever. Whereas Pfizer, actually the incidence of those things was about the same as the placebo and the placebo was just saline.

(15:19):

So some people just complain about things. So the occurrence of that side effect is really rare with Pfizer. So for people who were worried about side effects, maybe the Pfizer is a better choice even though it's more doses. We have more efficacy data with the Pfizer than we do with the Moderna. Some people are very focused on that. We do know that both of them lead to the generation of an immune response, it's very strong. We just can do that kind of comparison in contrasting of the vaccines.

(15:55):

But the truth is maybe the biggest decision maker is what's in the office that day because both are going to work, both are going to provide protection, both have pretty mild side effect profiles. And I'm happy to report that like the kids who were in the five to 11- year-old age group the incidence of myocarditis is almost non-existent. For kids who are 12 to 18, myocarditis occurs with the vaccines about one in 10,000 doses if you're a boy, about one and a hundred thousand doses, if you're a girl. For the five to 11-year-old age range, the occurrence of myocarditis, pericarditis is about one in 750,000 doses. And for kids under the age of five, we don't know the exact number yet but it appears to be even lower than that.

(16:55):

Fortunately, we have yet to see any significant side effects from the vaccine in kids under the age of five. In other words, we haven't seen irritation of the heart, myocarditis or pericarditis. We haven't seen hospitalizations or any kind of significant long term reaction from those vaccines. So we don't worry about significant side effects with these vaccines, as much as those really minor ones.

(17:27):

And for the older age groups, the efficacy data is there. It shows protection and showed protection through population studies. So we know the vaccine works for people above the age of five. We have every reason to believe it works just as well for kids six months to five or in the case of Moderna, six months to six. But we don't have the efficacy data from Moderna that we do from Pfizer.

Dr. Christina Wells (17:54):

Right. And one of the things that I wanted to put out here was, how do you address people who are just adamantly against vaccines?

Dr. Daniel Johnson (18:05):

This comes up repeatedly. It seems that even amongst providers, there's a certain amount of angst about this vaccine. And some of that is because it's a new vaccine and so people quite naturally wonder about new vaccines. Part of it, I think, is the fact that the vaccine doesn't offer the level of protection that other vaccines that we're used to giving young children offers. So when you think about all the other vaccines that we use, with the exception of influenza, we anticipate protection levels that are 80, 90% and they protect against infection, whereas vaccines that are focused on respiratory viruses.

(18:59):

So influenza and COVID, they're unable to provide long term protection. They're only able to provide short term protection. But they do continue to protect against serious complications, which makes them incredibly valuable. When we think about the risk of death from things like Chickenpox, Hepatitis C, when we think about death from other common illnesses that we vaccinate against, there's little difference between the COVID vaccine and those vaccines.

(19:40):

So the real distinction has to do with preventing complete infection, which is something the vaccine just simply can't sustain. But it greatly reduces hospitalization, it greatly reduces morbidity. It greatly reduces mortality and it prevents future complications such as MIS-C. So those are all very strong reasons.

(20:07):

And when we compare it to influenza, which is doing the same thing, most of us are very comfortable recommending influenza. When we look at the rate of complications associated from Hepatitis B or from Chickenpox, this vaccine works just as well and we're very comfortable recommending Hepatitis B and the Chickenpox vaccine. So why not do the same with COVID?

Dr. Christina Wells (20:40):

Good. Yeah, I agree. I think that, you know what? I think, in general, change is always something for people and you could think of something new as also being change. And this may not be a perfect correlation but when you think about guidelines like aspirin, they came out with guidelines now that you don't use aspirin for primary prevention, although I wasn't using it anyway. But then when you have that, it still takes a while before people start to adapt something that's new and so you have to continue to encourage people, continue to help them to understand the data that's out there.

(21:23):

The safety of doing this thing that maybe a little different or new to what you were doing before. And so, I think that there's always that understanding, sometimes we're hesitant to address the real things or the real concerns that people may have. But I think addressing them sometimes really helps to filter out the misinformation that may be out there. To filter out the hesitancy that may be out there and really may have the impact of actually encouraging people to make that change or add the new thing that you're trying to get them to do.

Dr. Daniel Johnson (21:59):

No, I agree with that. I also come back though, to the fact that, even though the vaccine doesn't provide long term protection against infection for roughly the first three months following its use, patients are protected somewhere around 70% and then it starts to decline. So here you get protection for those months, it then declines downward but with boosting, it goes right back up again. And again, the long term protection. I mean one out of every, roughly 3,300 children who get COVID get MIS-C, right? Multi-System Inflammatory Syndrome of children.

(22:41):

Roughly 50% to two-thirds of those children end up in an intensive care unit. To be able to have a vaccine that's 90% efficacious at preventing that complication right there, that's a pretty good tool to be able to offer people, to be able to reduce that risk. And even though during the pandemic we've seen the death of about 600 children, that's over two and a half years to have a tool that's more than 90% effective at preventing death in children. I mean, it's a low number compared to adults, that's 600 roughly but it's 600 too many.

(23:26):

And to have the opportunity to prevent death in that group. And there's no way to predict which child was going to die. If you look at the kids who have died, about half of them have underlying conditions. But just to clarify, Measles, Mumps, Rubella are also viruses, all three of them. So it's not the fact that it's a virus. It's really a few different things. The first is that it's a virus that is able to change its surface proteins. And because it can change its surface proteins, it means the immune system is constantly having to adjust to a new target. So that's one reason why it is more challenging.

(24:09):

The second is that it is a virus that mainly infects the respiratory tree. And trying to generate antibodies that persist in the nose is very difficult. The antibodies that persist and respond are ones that are in the serum in the blood but you need to be able to provide protection in the nose because that's where the infection is setting itself up. Whereas with some of the other viruses that you mentioned, their site of infection is through the bloodstream and at distant locations but influenza coronavirus is right in the nose.

(24:55):

And so that creates also a challenge. The rate at which they replicate is fast and so they're able to rev up before the immune system gets a chance to respond. See our bodies are producing antibodies all the time but they're producing many different antibodies to meet the challenge of whatever pathogen is trying to enter our body. If we kept all the antibodies circulating simultaneously, our blood would be like sludge, it wouldn't be able to flow. So antibody producing cells come and go.

(25:35):

Our bodies are able to remember them and selectively create them again. And so they come back and then those cells produce the antibodies but that takes a little bit of time. And so if you have something that's in the nose, it doesn't have to travel from the nose before it's reproducing at a high level. That allows the virus to reach a high level before our bodies have a chance to turn on the immune system at a necessary level to actually clear it out. So that's why it's hard.

Dr. Christina Wells (26:15):

All right. So I wanted to shift a little bit to talking about some things that we providers may experience in the office in dealing with vaccine administration. And I want to give you a little scenario and maybe you can also speak to how your office has done this and some strategies for offices that may be like mine and how we could better do things. So one of the things that we've done is that, instead of having the vaccine available every day, we've done children on some days, we do adults on other days, we even had it where some days we were doing Pfizer, some days we were doing Moderna.

(26:58):

Now for a young children, we're talking about six months to five-years-old, we're doing certain age groups. We're just doing them twice a week. And so now we're trying to transition into being able to just make it a part of the routine practice. Whereas anytime a child comes in for a visit, they could potentially get the vaccine, no matter what day it is of the week. And I know some clinics also have these special COVID vaccine clinics. What strategies do you recommend for putting it into just regular clinical practice?

(27:38):

And then also, I think, to tie into that part of the reason we we're doing that is concerns about the different dosing and dosing errors. And so that was a big concern. So are there strategies that you guys have used that made it easier to put it into clinical practice that made those dosing errors less likely to occur because you implemented certain practices that are helpful? What could you speak to that?

Dr. Daniel Johnson (28:08):

Yeah. A lot of offices have done what you're describing and many of them are transitioning just like you said. And they did this because they wanted to give time to their staff to get used to the vaccines. I mean, get used to as in, how to recognize the bottle, how to draw it up properly, to learn one vaccine series before needing to learn another one. I think that makes good sense. And so, as you said, many are beginning to entertain the idea of making this transition. So how can we make this transition work to everybody's benefit?

(28:53):

Well, the first is to make sure that there's very clear labeling, so that in that way everybody knows which part of the refrigerator, where these vaccines are being held, is for which vaccines. And there's quite a few vaccines in those refrigerators, not just COVID vaccines but also all the other ones. And so it's a good idea to label those boxes that they're in to make it very clear, what's what. The second is to make sure that you have up on a wall, a pictogram. A picture of the vial with clear explanation as to which vial is which and then the dose associated with that vial.

(29:41):

And there are a lot of tools like this available. In fact, the IVAC project, Illinois Vaccinates Against COVID, which, of course, the beyond the needle is part of that project has a lot of tools that you can find on the website that can be put onto the wall in the vaccine room. So that way, when someone pulls out a vial, they can match it up to the picture on the wall. Now, of course, you can read the label but sometimes people don't bring their glasses in or sometimes people aren't a little bit of hurry.

(30:21):

And so it's a little bit easier to match it up to the picture on the wall. And then if you match it up to the picture on the wall and you have the information about what's the vaccine dose underneath it, well then, that just means people don't have to depend on their memory, they can just depend on reading and that makes it a lot easier. Another thing that we have done is, we've made corresponding labels that are color coded. So that way, people when they draw the syringe, they have it labeled. Because a lot of times people come in, they're taking care of multiple children in the same room, they need to give vaccines to multiple kids in that room.

(31:12):

Or in our clinic, many times we're giving vaccines to adults at the same time as giving it to kids and so you want to make sure that you know which syringe has which vaccine in it. And yeah, you could write on it but it's a lot easier to put a label on it. And so we have color coded labels to make sure that you not only have the name written on it but you also have a color coding. And we found that really cut down on the risk of the wrong syringe being used. I mean, this and that, we hadn't very many such mistakes but when we had our first mistake, we said, "Okay, what else are we going to add in?" And that color coding made a huge difference.

(32:04):

So label the refrigerator, try and separate. If you have more than one refrigerator for vaccines, put the Pfizer in one, put the Moderna in another one. If you have multiple shelves, put the Pfizer on one shelf, put the Moderna on another one. So that way you just keep them far apart, label the area, very clear. Put up the pictograms so that way everybody knows which vial goes with which vaccine and make sure that you have information underneath that describes the dose. So that way, you know which dose you need to draw up.

(32:45):

The other thing that we've found that's important is, don't just ask the patient their birthday and their name, ask them how old they're. Because sometimes when we try to do the math on birthdays in our head, we don't get it right. And so sometimes we think a six-year-old is a seven-year-old or more likely a seven-year-old's a six-year-old or a six-year-old's a five-year and then we're at that threshold for change.

(33:14):

So it's always a good idea to ask, "How old are you?" So that way you can make sure that the math you did in your head corresponds to what the child's age actually is. And that also lessens the chance of giving the wrong dose to a person. So those are at least a few tricks that we've learned that have helped us stay safe for our patients.

Dr. Christina Wells (33:41):

Those are some really good strategies. I appreciate you sharing that. And as I wanted to follow up on something you kind of mentioned, you said that getting the right age of the patient of a child is important. What would you suggest if a parent brings a child in ... Because we know the dosing is a little bit different. If a parent brings a child in and that child is four-years-old but it's going to be five in another, maybe three or four weeks. How would you suggest that dosing? Would you tell the parent, "Hey, go ahead and just get it now because you're here." Or would you say, "Maybe you should just wait and get the five-year-old dose?"

Dr. Daniel Johnson (34:26):

Never wait. We firmly believe, I know you do, too, that you never want to waste an opportunity. You just never know what's going to come up. And sometimes family members says, "Oh, we'll be back in two weeks." But something comes up that prevents it and two weeks turns into two months or longer. So take advantage by delivering that dose. You just make an adjustment for the next dose. So if the child starts at the lower dose and goes through a transition age, well then you just transition with them in terms of the dosing parameters.

(35:06):

And because the area where this comes up the most, actually that I get the most questions, is Moderna's two doses, Pfizer is three. When you transition up, how do you deal with that if you have, let's say, the Pfizer for the young kids but only Moderna for the older kids? And we just want you to go ahead and transition with it. So if you got one dose of Pfizer and now the only thing you have in the office is Moderna, well then, they're going to get two doses of the Moderna. That's okay because they would've been looking at three doses anyways.

(35:50):

And so now you just give them the two doses of Moderna. We don't recommend for the primary series that you mix and match. So if you start with one but you transition to the other, well then, you're going to transition fully to the other. Now let's say you gave two doses of the Pfizer and you only have the Moderna. Well, the recommendation would be to just give one dose of Moderna because you've already given two doses of the Pfizer. So that's the exception. But other than that, I think it's all about just paying attention to the child's age. But never miss a chance, never miss a chance to vaccinate.

Dr. Christina Wells (36:35):

Right, great. Can you share a positive experience that you've had in vaccinating a child under five?

Dr. Daniel Johnson (36:45):

Well, sure. I mean the positive experiences I've had have been all about protecting kids by helping the parents know that they've done whatever they could to prevent infection. I think we've all had the experience during this pandemic of receiving a call from family that says, "Oh, I'm so glad I vaccinated my child against COVID because I got COVID yesterday. And knowing that my child is vaccinated helps me sleep at night because I know I've given them the best chance of not getting sick from me, from the parent who's got COVID."

(37:32):

So that's really very satisfying to get those kind of calls or to hear that sense of relief in the parents' voice to know that they just have to worry about themselves or they only have to worry about one child. I just had that occur with one of my own nieces, where they got sick from COVID and they had vaccinated one of their kids and they just felt much less anxious because they knew that they had provided the maximum protection they could to their child.

(38:10):

The other positive story ... I'm not going to just end with one, you gave me an opening. The other positive stories for me have to do with the family where I walk in the room and I say, "Oh, I'd love for you to get the COVID vaccine today." And they go, "No, I'm going to wait." And then I go out of the room, I come back in and the family says, "Well, I do have a question for you." And then they ask that question and we talk a little bit and then they say to me, "Well, okay, let's do this. Let's get this done."

(38:51):

I'm an Infectious Disease Specialist, I'm not a generalist. I take care of some pretty high risk patients and it feels really good when they say that to me. And I'd say about 90% of my families that I take care of and said they want the vaccine, with about half of them starting the visit, not wanting it and about half of them by the end of the visit saying, "Okay, let's do this." That's really satisfying, feels really good.

Dr. Christina Wells (39:25):

Great, great. It's awesome to hear success stories and how you've been able to motivate patient or parents to accept the vaccine and get it for their children. And it's about, again, going back to what you mentioned earlier, that partnership, that trusting relationship, trusting that, "I'm doing what's going to be best for your child and I'm going to partner with you to do that." Okay. Thank you again for that response, Daniel. Do you want to mention that even though vaccines start at the age of six months, that there is still a way that mothers can protect their infant children who are under the age of six months and how would that way be?

Dr. Daniel Johnson (40:14):

That is so important. So yes, I mean, this is a wonderful thing. There is now data showing that if women get immunized during pregnancy, they reduce the risk of hospitalization for their newborns from COVID. There's actual data proving that. I mean, we presumed it because all babies are born, if they're born after 32 weeks gestation, with their mother's antibodies. Because they have their mother's antibodies, we've assumed that those antibodies we're going to offer protection to the newborn for a few months.

(40:55):

Well, now there's comparative data showing that babies whose mothers have been vaccinated have a lower risk of being hospitalized. Now, part of that may be that their mothers have a lower likelihood of getting COVID. But actually it looks like from the data, that what is also providing value is the antibodies that they passed on to their newborn. And by the way, the protection is strongest when the moms receive their dose during the second or third trimester. And that's why we think it's definitely linked to antibody.

(41:35):

Now, the other thing is that moms who breastfeed, they also pass antibody in breast milk. And someone got this clever idea to try to measure antibody in the back of the throat of babies who are breastfeeding and, sure enough, it showed they had the presence of antibody at the back of their throat. Now we don't know that that antibody is providing protection. We don't know. And that's because it's a hard study to look to see whether those breastfed babies with antibody have protection against COVID. So that, I haven't seen any trial do it but the presence of antibody is at least encouraged.

(42:23):

So you can protect your baby by getting immunized during pregnancy. Maybe you can protect your baby with a booster dose or if you didn't get immunized during pregnancy, at least getting immunized while your breastfeeding. Now, of course, this naturally brings up the question, is it safe to give the immunization to pregnant women? And the answer is, yes. Hundreds of thousands of pregnant women have been immunized and it shows the vaccine is safe. It actually shows even more women who are vaccinated have a lower likelihood of miscarrying during pregnancy.

(43:04):

Women who are vaccinated have a lower likelihood of delivering pre-term babies, so going into labor early. So not only are you passing along antibody to your newborn but you're also reducing the risk of complications that can arise during pregnancy and as a result, provide protection so that your baby stays inside longer and is more mature and there's less likelihood of the baby having a severe complication from COVID. Because we know that pregnant women who get COVID have a higher likelihood of being hospitalized, have a higher likelihood of miscarrying, have a higher likelihood of having stillborn and of ending up in an intensive care unit. All those are to the betterment of the newborn.

Dr. Christina Wells (43:56):

Well, that's really awesome to hear. Now we know that we can protect people from birth. So there's protection for everyone from COVID. So that's very, very interesting and very vital information that you shared. Daniel, as we wrap up here, is there anything else that you would like to share with us about the importance of vaccinating our under five-year-olds?

Dr. Daniel Johnson (44:25):

Well, I just want to emphasize once more that the Kaiser Family Foundation looked at the factors that determine whether people are going to get vaccinated. And they said families reported that the strongest influence was a recommendation from their provider. They also reported that a small percentage of families said that their provider had brought up COVID vaccination with them over the course of the last year. And so it's an opportunity, not only as providers to bring this up with families about the child in front of me but I make it a routine now to ask the parents, are they vaccinated? Because I want them to get vaccinated, too.

(45:14):

Because the way to protect everybody in the household is to maximize the number of people who are vaccinated. So you can protect your child, you can protect yourself, you can protect grandma and grandpa, your siblings, all the way along, if you get vaccinated. So using that time in the office to ask about the child in front of you, the family in front of you, is a valuable tool to limiting the spread of COVID. Because, yes, for a few months there's protection against infection but also protecting people against the morbidity and mortality that's associated with COVID by being vaccinated. So thanks for giving me the chance to get on my soapbox and talk about that.

Dr. Christina Wells (46:01):

Well, thank you so much, Daniel. You have provided such great information. Dr. Johnson, we're so happy that you were able to join us today and we were able to have this conversation that I know will be helpful to providers who are vaccinating children under five-years-old. And how they can work as partners, again, with their parents to do what is best for our children.

Dr. Daniel Johnson (46:27):

Thank you.

Dr. Christina Wells (46:29):

Thank you again for joining us today. And this has been another episode of, Beyond The Needle. We look forward to you joining us for our next episode.

Dr. Carl Lambert (46:44):

Thank you to our expert faculty and to you, our listener for tuning into this episode. If you have any comments, questions or ideas for future topics, please contact us directly at podcast@ilvaccinates.com. For more episodes of, Beyond The Needle, please visit www.Illinoisvaccinates.com/podcasts.  You'll find links to resources, transcripts, speaker disclosures, a survey to gather your feedback and instructions to claim CME credit. Subscribe to this podcast series on Healthcare Now Radio, Spotify, Apple, Google Play or any of the major podcast platforms. Please follow the Illinois Vaccinates Projects on Facebook, Twitter, Instagram and LinkedIn. Thank you again. We hope you tune into our next episode.

 Resources:

Speaker Information:

Daniel Johnson, MD, is a respected physician, researcher, and teacher. He is an expert in pediatric infectious diseases and in the care of HIV-infected children.  Additionally, he is the founder and Director of ECHO-Chicago. He completed his training in 1986 and is boarded in Pediatrics and Pediatric Infectious Disease; his clinical care focuses on inpatient and outpatient infectious diseases.  

At the University of Chicago Medicine, Dr. Johnson is Professor of Pediatrics, Vice Chair for Clinical Services, Section Chief of Academic Pediatrics, Section Chief for Pediatric Infectious Diseases. He practices at Comer Children’s Hospital, Edward Hospital, and Mount Sinai Hospital. 

Throughout his career he has enjoyed teaching medical students and residents, working as a faculty member in the section of pediatric infectious diseases from 1987-1999 before serving as Chair of Pediatrics for Chicago’s Mount Sinai Health System. He then returned to the University of Chicago and has been there ever since.  He is published in the areas of HIV, infectious diseases, health outcomes and community medicine.

Dr. Johnson is committed to improving access to quality healthcare for underserved populations using an asset-based approach that leverages existing resources to strengthen community services. He developed ECHO-Chicago in an effort to further those goals and has continued to lead the program as it expands and develops.  He works closely with area clinics and providers to expand the availability of pediatric primary care and specialty services on the South Side of Chicago. 

Additionally, he was instrumental in the creation of two nonprofits that were critical to the development and expansion of services for HIV infected and exposed children and their families. He also founded the pediatric and adolescent HIV program at the University of Chicago Medicine. 

A native Chicagoan, he can be found gardening in his backyard trying to ensure there is always something in bloom throughout the growing season, playing racquetball, or spending time with his family.

 

Christina Wells, MD, MPH, FAAFPis an Assistant Professor of Clinical Family Medicine in the Department of Family Medicine at the University of Illinois-Chicago. Dr. Wells has a strong interest in the health and education of vulnerable populations. She has worked at a Federally Qualified Health Center for the past 12 years where she provides care to underserved communities. She also volunteers her time to provide health seminars and coordinate health fairs for communities in need. She has a passion for medical student education and serves in various academic roles including as the current college-wide director of the Medical Colloquia course at the University of Illinois College of Medicine and as the Assistant Director for the Patient Centered Medicine Scholars Program in the Family Medicine Department. She specializes in both preventive health services and management of chronic diseases, with an emphasis on lifestyle medicine. She has additional training in HIV, addiction, and mental health care. She graduated from the University of Illinois College of Medicine in 2006. She also has a Masters of Public Health degree with an emphasis in Nutrition and Wellness. She currently provides patient care at the University of Illinois Mile Square Health Center. She also serves as an IAFP board member.

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