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Infants and RSV

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orion:
'Long and short - Orion, you did nothing wrong and couldn't have prevented this.  I know that doesn't sound great, but I hope it makes you feel  a bit better if maybe someone with a cold was around and you didn't stop them from being in the vicinity of your child."

Thanks Necro, I felt awful about it. I am still confused as to rather or not an adult can have it. I have heard different things. I have heard that yes adults can get it, that it just seems like a really bad cold to them and no most adults can't get it because they are immune to it, so I'm confused. My doctor seems to think that I gave him a cold and that he picked it up someplace else and that he was more susceptible because he was sick. In which case he probably would have picked it up in the doctors office when I brought him in for the cold. One thing I do know is there are different stains of it, so a child can get it more than once. Interestingly I have been doing a lot research on RSV now (I had never even heard of it before this). Turns out my neighbors kid had had it once when he was very small and also quit breathing so this is not uncommon. Also they do apparently have a vaccine for it now that they give to preemies under two pounds, it's $1200.00 a shot and they give it twice a year. (My mother has a friend with a preemie grandchild) I heard that it doesn't have mercury in it. I personally have mixed feelings on vaccinations, I had seen a few years ago on the discovery channel that toddlers instinctively eat dirt in order to build there immune systems. Interesting program, though I don't think I will be encouraging him to eat mud pies  :) Congrats on having your first soon!  :) Please be advised that your wife will only get more irritable and moody as she gets further along ... Damn am I glad thats over with!

orion:
"I'm also a strong proponent of breast feeding for at least the entire first year. Babies gain immunities from breastmilk without being exposed to sicknesses. Basically anything you are immune to, they will start to develop immunites to also."


That's the main reason to breastfeed. The formulas are good these days, but they lack in antibodies. You would think that would have worked better, my wife used to work in a daycare and was sick all the time. I would have thought the baby would have had a bullet proof immune system.

Eloiwyn:
As a pediatrician, I deal with both RSV and flu a LOT, and Saint asked me to comment on this thread...

1.) RSV severity varies widely.  Young children, particularly premature infants, can have life-threatening respiratory distress.  Other children will be spared the bad breathing difficulty, but have miserable cough and cold symptoms for several weeks.  Other children will have nothing more than regular cold symptoms.  Adults and older children can easily have RSV and never know it-- adults with "colds" can end up infecting their infants, who then have much more serious disease.  However, even if it was your cold that resulted in your child's RSV infection, there is little point in beating yourself up about it.  RSV, and cold viruses, are REALLY good at what they do.  They spread VERY easily.  If they didn't, they wouldn't still be around! 

2.) There is no point in purposefully exposing someone to RSV to "build up their immunity".  First of all, it is the youngest infants who are most endangered by the virus-- deliberately exposing them to the virus is a very inadvisable game of Russian Roulette.  Second of all, having RSV disease does not make you immune to further infection.  Babies can and do have multiple RSV infections, sometimes even more than once in the same season.

3.) There is not actually a vaccine for RSV.  A vaccine works by introducing your body to a part of a germ, or something similar to the germ, to teach your immune system how to produce antibodies to fight that germ if it is encountered again.  Once your immune system learns how to make those antibodies, it can (in most cases) produce them whenever needed later on.  What we have for RSV is different-- we basically provide the body with ready-made antibodies that circulate for a while and provide protection while they last, but eventually the antibodies wear out and go away, leaving you vulnerable again.  Getting a vaccine is the equivalent of learning how to fish.  Once you learn how, you can feed yourself.  Synagis, the "RSV shot", is the equivalent of being handed the fish already caught.  When it's gone, you're hungry again.  To protect a baby from RSV, you have to give the Synagis shots once a month throughout the RSV season-- usually five months total.  This is hideously expensive.  While no one wants their child to suffer from RSV, the expense is really only justifiable in very high-risk children-- premature infants, and some others with heart or lung disease.

4.) Fear of mercury should not stop you from getting vaccines.  Mercury comes in a lot of different forms, and when it comes to elements form makes a BIG difference.  Chlorine, for example, by itself in its gas form, is a deadly poison.  Chlorine paired up with sodium, on the other hand, is common table salt.  Big difference.  Most of our experience with mercury has been in the form of methylmercury-- that's the form of mercury that causes scares when it accumulates in seafood.  Methylmercury is unquestionably a neurotoxin, and we have a good bit of data on it, and have established thresholds for how much is too much.  By contrast, the thimerosol used in vaccines is an ethylmercury.  The data that we have suggests that ethylmercury is much less toxic than methylmercury-- however, there has not been enough data to establish separate thresholds, so everyone has erred on the safe side and has used the same guidelines established for the more dangerous methylmercury.  The amounts of mercury in vaccines never exceeded these very conservative guidelines, and there has never been any evidence that the mercury in the vaccines caused any problems. 

There was no question however of the problems caused by contaminated multi-dose vaccine vials.  There were cases of people getting very sick indeed from Staph and other bacteria sneaking into the vaccine vials in between patients.  That's why they started using thimerosol-- to keep the vaccine clean and safe.  Nowadays the manufacturing process is better, there are more single-use vials, and there are alternative preservatives.  This, combined with the increased number of vaccines bringing the total mercury exposure closer to the safety thresholds, prompted the removal of thimersol from almost all of the currently used vaccines.  It is still used in some adult tetanus and most adult flu vaccine.

5.) Flu shots DO work.  If we didn't have good science showing a decrease in illness, the insurance companies would not be paying for it!  Unfortunately, there IS a great deal of educated guesswork in deciding which flu strains to vaccinate for each year, and some years the vaccine is not a good match for the strains that sweep through the country.  It also takes several weeks for the vaccine to take effect, so you are still vulnerable for a while after you get the shot.  It also ONLY protects you from the influenza virus, and does nothing against RSV or the hundreds of cold viruses out there. 

However, flu is a SCARY virus.  Every couple decades a really virulent strain comes through and slaughters people.  The flu epidemic in 1918-1920 killed over 50 MILLION.  Even though one particular year's vaccine may not always be a great match, there is reason to believe that getting yearly flu shots gives you a much better repertoire of anti-flu antibodies, giving you much better odds of having some defense against rogue strains in the future.  Flu is also truly miserable even when it's not a life-threatening case.  People generally have a solid week of high fevers, wracking coughs, and all-over aches.  For kids, that's a solid week of missed school, and a solid week of missed work for the parent caring for them, nevermind the additional days when the siblings then catch it.  I recommend flu vaccine for all of my patients, and have my family vaccinated as well.

--Eloiwyn

saint:
That's a funky reaction. Do you have any allergies to eggs?

Though I'm getting older and it's becoming more of a concern, I really don't worry about me getting flu too much. I get vaccinated though so that I don't run the risk of getting it myself, and then exposing my kids or other people around me to my flu.

orion:
Thanks Eloiwyn that was very informative (cool info about the RSV shot) and I appreciate it very much... I think I'm going to print that up and tack in on the quark board in the office. I have gotten my flu shot this year (the first one I have had in decades). We don't want to get the flu and then bring it home to baby. Seeing as to what RSV did to him I can say that infants that young are really delicate and have a hard time with illness. I do have one question for you if you don't mind me asking. My six year old boy is afraid of needles, but he has agreed to the nasal spray which we will take him in for on Thursday. I understand that unlike the shot, the spray is a weekend live strain of the flu. My question is, is there any chance he might be contagious from getting the spray vaccine instead of the shot. I'm sure that the risk is minimal if not non existant (it wouldn't make any sense to have a flu vaccine that was) but after what we went though with the RSV I'm finding myself super paranoid about these things.

Thanks so much,
Sean

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