Over the river and through the woods

We just got back from spending the long weekend at my grandma's house, providing Emmett the opportunity to meet his great-grandmother and his great-uncle Matt (it was also E's first visit to Oregon giving him three states, or 6% of the 50, lifetime. At this rate he will have visited all fifty states by the time he is three-and-a-half).

This was our longest trip to date by any mode of travel, and Emmett used the trip to remind us that he likes riding in the car even less than his father does. To provide views into the multi-faceted child that is Emmett, I thought I would post a short video of Emmett expressing his feelings on car travel while traveling home from Oregon. This video is intended to be juxtaposed against this morning's video of Emmett's vocalizations. The astute video viewer might notice when comparing the two videos that there are slight differences in tone and frequency of vocalizations between the two. In order to prevent calls to Child Protective Services I preface this video by saying that I had been trying to calm him for some time previous (I was in the backseat with him while Andrea drove) and succeeded shortly after this. I figured that recording 30 seconds of Emmett's outburst is important both for posterity and for those who might be led to believe, via this blog, that Emmett is all smiles all of the time.



Speaking of happy, tomorrow is vaccination #2. Emmett is scheduled to receive the polio and pneumococcus (Pc) vaccines. Andrea and I decided that we would do the polio (Dr. Sears recommends it at 9 months, but the vaccine has very few side effects and as we are skipping a number of the early ones he recommends we figured we could slip it in here---I should say that we are not excited about the fact that it is made of monkey parts, but if Emmett is going to have any chance at the presidency we should give him this as the days of the press keeping the secret of a polio-stricken president are surely in the past). I am leaning toward Emmett not getting the Pc tomorrow for reasons I will elaborate below. Those who don't find their interests piqued by vaccine talk should walk away now.

Pc can be pretty bad stuff, causing things like pneumonia, meningitis, etc., so somebody thought it to be a good candidate for a vaccine. The vaccine developed and in use gives immunity to 7 strains of Pc and has been very effective in reducing these strains since vaccination started around 2000. However, the first catch with this vaccine is that there are 90 known strains of Pc (7 of 90 is 7.8%, so the vaccine is 1.8% closer to total immunity than Emmett is to total visitation of all of the states in the USA...hmmm). The second, more important, catch is what has happened since that time. The photograph below is of a plot from a paper that I picked up tonight at UCSF which Dr. Sears references in his book (Pediatric Infectious Disease Journal 26, pp. 461-467, for those interested). The gray bars show the number of cases of Pc at a Dallas hospital which were infections of one of the seven strains in the vaccine, and the number has clearly decreased since the vaccination started in 2000 (good). The black bars, though, are the number of cases for Pc strands not in this group of 7 strains, and it is clearly going up with time. Take home message: we are improving with the 7 covered types, but are paying for them with the non-covered types. Worse yet, since the introduction of the vaccine there have been reports (cited in this article) of increasing anti-bacterial resistance of at least one of the non-covered types which is also rising in frequency. All this gives me pause as to whether the bunch-of-seven is the best vaccine approach to this problem and if we are not, perhaps, losing ground as a result.


It would be so great if we could make some sort of a numbers argument to decide if we should have Emmett get this vaccine. Estimates for the number of "severe" cases have a wide range of 400 to 60,000 per year in the US (pre-vaccine with the latter, and "severe" loosely defined), so with ~4,000,000 newborns each year in the US this gives probabilities in the range of 1 in 10,000 to 3 in 200---- however, seizures as a side effect occur with a frequency of about ~1 in 20,000....plus there is the presence (again) of aluminum with its semi-unknown side effects, so the numbers don't tell a whole lot.

Things we have working for us not getting the vaccine are the facts that it is much more prevalent in child-care facilities and with non-breastfed children, so our chances of occurrence should be a bit lower (how much??? who knows??). Right now I am leaning toward not getting the shot and I am hoping that we get a chance to talk with the doctor pre-poke (though I am pretty sure I know her opinion already). I will give the paper and Dr. Sears another read pre-appointment and will report back with our final decision. Also, I have a copy the paper if anyone wants some light reading.