Old Shots, New Shots, Cheap Shots and Pot-Shots!

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

With the advent of a new school year, doctors’ offices see a flurry of worried students clutching a computer generated notice from the Health Department. Basically, it informs them of impending suspension unless a deficit in their immunization status is corrected immediately. Many students are accompanied by guilt-stricken parents who feel that they have somehow made a great omission and let their offsprings down.

This scenario demonstrates yet another problem with medical record keeping in our province. As it turns out, most youngsters who show up in our offices are properly immunized, but there is no reliable communication link between the health department, which issue the notices, and family doctors who do the immunizing. The notice in effect becomes the missing link. It informs me of what immunizations are contained in the health department archives. Most of the time, I simply fill in the date of the missing immunization and hand it back to the patient who takes it back to the health department. Confusing? Yes. Inefficient? Yes. But that is where it stands at the moment.

As many new parents have noticed, modern technology has resulted in an explosion of potential immunizations. New vaccines are appearing at an accelerated rate. Ten years ago, a newborn baby would receive five shots during the first two years offering protection against eight disease strains. Parents of a child born today will be advised to have up to 18 different shots to protect against as many as 13 disease entities. It seems that we are reaching for a syringe at every infant visit. The latest shots to be available on the provincial tab offer protection against pneumococcal disease, chicken pox and a single strain of meningococcal disease. The meningitis shot covers the group C variety only. Provincial guidelines suggest it be given as a single shot at one year of age while manufacturers’ guidelines suggest three shots sooner. Beyond that it can only be given on the provincial tab at age 12 and then at age 15 to 19. The guidelines produce confusion for some parents. A four-year-old cannot get one, while their one-year-old sibling can. In addition, some groups of students are receiving the shots at school clinics.

Tracking all this activity and guidelines is a challenge for doctors and understanding it all is a challenge for parents. But data from Britain is suggesting that the provincially funded menjugate shots, while continuing to be safe, may not provide the life-long immunity as hoped. It seems that immunity may only last a few years. One solution is already on the market and available for purchase. It is a new “better” menjugate shot providing immunity to multiple strains of the disease. As the province has stock-piles and orders of the older shots in place, a dilemma of sorts may be approaching.

A few quick points on the other shots. They all carry similar side effect and low risk potential and they all have exceptions for high-risk individuals.

Most grade 7 students are offered the Hepatitis B vaccine. This is a strain transmitted by intimate or blood to blood contact. Students have the option of receiving the shot from their physician, but must go through the process of obtaining the vaccine. One option that I often recommend to students of vacation prone families is to purchase the combined Hepatitis A and B vaccine. Hepatitis A is a milder form of hepatitis, but is more widespread and acquired from food and poor sanitary conditions. By combining A and B vaccines, you get double immunity with fewer shots. It is an approach that has been adopted by some jurisdictions in the United States.

Flu shots are also available on the public tab, and everyone is encouraged to receive one annually unless you are allergic to eggs. There may be some availability of the nasal spray form for the many people who are needle phobic, but it will probably cost extra. There are no avian influenza shots mainly because it is not yet a problem.

The newest shot on the market is the HPV vaccine. It is aimed at strains of Human Papilloma Virus that are implicated in causing cervical cancer. The vaccine is not cheap, but may eliminate the need for regular PAP tests some day.

Finally, I would like to welcome the humorous anecdotes of Len Chapman that will accompany my column. Born in Oakville, Ontario, in 1955 and a long time resident of Mississauga, Len began cartooning in the 1990s. Often working freelance, Len is a regular contributor to Reader's Digest Canada and RD International. Lenny and his wife Marguerite have a daughter and grandson, and two felines: Ginger & Meka. In “A Doc Day Afternoon”, Len lends his wit to spice up my dry humor. Any similarity to my medical practice or me is purely coincidental according to Len. Stay Healthy!

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