Tylenol and Vaccines

It seems like a lot of moms I know routinely give their kids tylenol either before or after their childhood vaccine shots, to make the experience a little less painful and keep fevers down. I've even heard of some pediatricians that in the past have told moms to give it. (Though my pediatrician never recommended it, I never heard any reasons not to use it). We'd been giving it to our daughter around shot time.

Well, recently a couple studies came out that reveal that tylenol decreases the response of vaccines by decreasing the antibody response, and the antibodies are why you want the vaccines--they are the how you end up being protected from viruses. After seeing what these studies show, I won't be using tylenol for my daughter's shots again! Here are the details, printed in the Lancet, arriving in my email from my journal watch service:

Prophylactic Acetaminophen Reduces Immunogenicity of Childhood Vaccines

        Children given acetaminophen with vaccinations have lower rates of fever in response, but the vaccinations produce a lower immunogenicity, reports a Lancet study.
Researchers, including some from the sponsoring vaccine manufacturer, followed over 400 infants receiving primary and booster immunizations. Half received acetaminophen via suppository in three doses over the first 24 hours after vaccination, and half received no prophylaxis.
        The percentage of children with a temperature of 38 degrees C or higher was significantly lower in the acetaminophen group by some 40% to 50% both at primary and booster immunizations. However, vaccine immunogenicity was lower in the acetaminophen group — significantly so for some antigens, e.g., all 10 pneumococcal serotypes after the primary immunization. The authors hypothesize that the effect could result from acetaminophen's preventing inflammation.
         Over 95% of all children had seroprotective antibody levels, but researchers argue that antipyretics "should ... no longer be routinely recommended" with vaccination. Editorialists agree, calling the case "compelling."

Acetaminophen After Vaccination Reduces Antibody Response

      Prophylactic doses of acetaminophen given after vaccination reduce fever but blunt antibody response to multiple antigens.
      Fever is common after vaccination, leading some to recommend prophylactic antipyretics. But do such agents affect vaccine immune response? In an industry-supported study, investigators randomized healthy infants in the Czech Republic to receive vaccines alone or followed by three doses of acetaminophen (suppositories) over 24 hours. They assessed febrile response and antibody response to vaccine antigens after primary and booster doses.
      The infants received 10-valent pneumococcal nontypeable Haemophilus influenzae conjugate vaccine coadministered with diphtheria–tetanus–acellular pertussis, hepatitis B, H. influenzae type B, oral rotavirus, and inactivated poliovirus types 1, 2, and 3 vaccines. Primary vaccine doses were administered at ages 3–5 months; booster doses at ages 12–15 months. Infants remained in the same group for primary and booster doses; however, based on initial results, the study was amended before completion, and not all acetaminophen-group infants received acetaminophen after booster immunization.
Fever >39.5°C was uncommon after primary vaccination in both groups (3/233 [1%] with no acetaminophen; 1/226 [<1%] with prophylactic acetaminophen). However, fever 38°C was significantly more common in the no-acetaminophen group than in the acetaminophen group (66% vs. 42%). Acetaminophen recipients showed significantly reduced antibody response to 10 pneumococcal conjugate vaccine serotypes and multiple other antigens. Children with and without fever in the acetaminophen group showed similar diminution of antibody response.
      Comment: The authors conclude that acetaminophen should not be given prophylactically as a routine practice with vaccination. Whether the same effect would occur with other commonly used agents, such as ibuprofen, is unknown but should be studied. The authors postulate that acetaminophen may interfere with interactions among dendritic, B, and T cells by reducing the local inflammatory response. Editorialists note the need to also assess whether antipyretics increase the proportion of vaccine nonresponders and reduce population protection.

No more prophylactic tylenol for our baby! At a later date I'll post about why we are not concerned about vaccinations and autism, and why kids should get vaccinated.

Brain stimulation among other things...

Yesterday I was reminded of this crazy job I had once when I was in medical school. I worked at a place called the Brain Stimulation Laboratory, which was located (of course) a Psychiatry Hospital. I did this for almost a year, some while taking med school classes. It was a strange place. There was the mad scientist/inventor/manic doctor who ran the place. He was rumored to only sleep a few hours each night and had a CV that weighed about 10 pounds because he had so many publications and inventions. I had a desk in a room with two other scientists–one was a Israeli-Russian guy, Jewish, who happened to hate working with the other one–a Japanese women. They were in cubicles on opposite sides of the room, as far as they could be from each other, and the fighting exchanges between them were outrageously entertaining. My desk was of course located in the cubicle between the two, where I spent most of my time trying not to laugh when they lapsed into their forgein tongues to mutter curses at each other. Fortunately I was out of the room and down the hall in the lab most of the time.

We were working on something that the defense department was funding–an investigation into whether we could create a “thinking cap” to keep fighter pilots from falling asleep when sleep-deprived. I was just doing my part in the war on terror, ya’ll. What it involved: getting volunteers to sign up to be sleep-deprived for several nights a week (they were monitored in a wing of the hospital where I can only image the poor nurse poking them to keep them awake all night), and then instructed to fly a flight simulator program for most of the next day. While they were “flying” I directed either real or placebo magnetic stimulation (TMS) to a specific part of their brain. (We had previously used a fMRI to locate the area we’d target in each indivual). Lest you think that a magnet can’t stimulate the human brain, think again! For part of the set up of the procedure, I moved the magnet over the motor cortex until the subject’s thumb twitched involuntarily with each pulse of the magnet. Needless to say, we were not successful in creating a “thinking cap.” But the data we gathered revealed a whole lot of other stuff in sleep deprivation research, and people are still anazyling what we gathered and writing about it in professional journals!

Why this is sorta cool: scientists have to add me as an author any time they use the data I collected in their studies! So that means there are all sorts of studies that I get my name on without having to do any more research than I did that year in med school. Cool deal, right? I guess it works out well if you are building up your CV for all the hoops you have to jump through in academic medicine. So to all my med student friends: try to get in on the data collection or benchwork level whenever you can, since it’s higher yield in terms of the number of times you get your name put on stuff. Just part of the game, ya’ll.

So anyway, yesterday I got an email with another manuscript to review and sign off on that’s going to print. And I hardly lifted a finger!

This blog

I'm starting this blog to share my thoughts and experience as a homemaker with whoever would like to follow along. And yes, I have an MD. That's another story, a long one, which I'll tell you later. But suffice it to say that gives me a unique perspective on being a full-time homemaker. I call myself a homemaker rather than just a "stay-at-home-mom" because I feel that it better describes the entirety of what I do everyday. I am making a home, a refuge, an escape, a learning center, a safe haven, and it not just for my daughter--it's for my husband too! Calling myself a "stay-at-home-mom", though there is certainly nothing wrong with the description, just doesn't include the fact that caring for my husband is my calling, too!

I love what I do everyday, more than I loved even when I was practicing medicine, and I enjoyed that, too. Perhaps one day I will return to medicine. Probably I will in some way. But for now I'm in a season of life where I believe this is exactly what I am called to do.

So if you'd like to hear my opinions (they are like armpits, everyone has them!), advice (but consult your own doctor and don't take what I say in place of that), experiences, and thoughts, then follow along.