Wrong vaccine... what now?
June 1, 2014 11:39 PM Subscribe
I believe my son received the wrong vaccine. I don't trust his doc. I have questions.
My five (two months shy of six) year old is way behind on his vaccines. My wife refused to trust that vaccines are safe for years, but has been coming around over time (or possibly is just humoring me) and now at least we're finally moving on this shit.
Anyway, he had had 4 shots of DTaP and was due for his 5th, but hadn't had any polio. The doc (a naturopath that I am increasingly displeased with but nonetheless will withhold scare quotes) suggested as a way to catch up that he could receive a combo vax: DTap + IPV so he'd only need 2 more IPV's in the future. I am 90% sure it was Kinrix, but don't have the name in writing. We go for it. I'm thinking "hallelujah." This was on Wednesday.
A bit of research later and I find out two things.
1) His prior DTaP shots were Sanofi -- not GSK. Apparently mixing/matching vaccine manufacturers is a no-no, or at least frowned upon.
2) Kinrix isn't approved for the primary series of IPV.
So my questions:
1) Aside from a prominent, still-present and itching, but diminishing rash at the injection point and a slight fever a couple of days ago, is my son in any danger? What are the implications here?
2) I told my wife that I was pissed off that the doc could make such a basic mistake, and that as a pediatrician she should know vaccines cold -- even for a catch-up scenario. My wife suspects that docs make these kinds of mistakes all the time. Which is it? Am I overreacting?
My five (two months shy of six) year old is way behind on his vaccines. My wife refused to trust that vaccines are safe for years, but has been coming around over time (or possibly is just humoring me) and now at least we're finally moving on this shit.
Anyway, he had had 4 shots of DTaP and was due for his 5th, but hadn't had any polio. The doc (a naturopath that I am increasingly displeased with but nonetheless will withhold scare quotes) suggested as a way to catch up that he could receive a combo vax: DTap + IPV so he'd only need 2 more IPV's in the future. I am 90% sure it was Kinrix, but don't have the name in writing. We go for it. I'm thinking "hallelujah." This was on Wednesday.
A bit of research later and I find out two things.
1) His prior DTaP shots were Sanofi -- not GSK. Apparently mixing/matching vaccine manufacturers is a no-no, or at least frowned upon.
2) Kinrix isn't approved for the primary series of IPV.
So my questions:
1) Aside from a prominent, still-present and itching, but diminishing rash at the injection point and a slight fever a couple of days ago, is my son in any danger? What are the implications here?
2) I told my wife that I was pissed off that the doc could make such a basic mistake, and that as a pediatrician she should know vaccines cold -- even for a catch-up scenario. My wife suspects that docs make these kinds of mistakes all the time. Which is it? Am I overreacting?
Get a new doctor (a pediatric MD, NOT a naturopath) whom you have confidence in, transfer your son's medical records (which should indicate which vaccines were administered), and proceed from there.
posted by Jacqueline at 12:35 AM on June 2, 2014 [27 favorites]
posted by Jacqueline at 12:35 AM on June 2, 2014 [27 favorites]
IANA physican. IAA epidemiologist but not a vaccine specialist, IANYE.
I haven't heard any concerns about mixing manufacturers. We worry about ensuring kids get what they need despite different manufacturers making different formulations, and about keeping good track of what a kid gets so that in the unlikely event of an ineffective lot, you can revax only the kids who need it. I think vaccine manufacturers generally refer only to their own products in their information leaflets (including what the expected vaccination series is) because of liability issues. They can't take the risk that another manufacturer might change their formulations or have licensing issues, so they talk only about the products they make in-house.
But FDA licenses those products stringently, and manufacturers have to meet content standards set for the whole industry. So IPV (inactivated polio vaccine) is IPV , and DTaP is DTaP (i.e. diphtheria-tetanus-acellular pertussis), no matter who makes it. But DTaP is different from Tdap which is different from DT and Td (it's a very stupid nomenclature, but the letter size represents the dose of active ingredient for that disease. aP is a lot of acellular pertussis vaccine; ap is a little. Which you get depends on what works best for your age group and how many doses you need. And if there's no ap, there's no pertussis protection.) And when you string things further together, DTaP is still DTaP.
Have a look here. At his previous visits, if he had a sanofi product, it would have been Daptacel, which is a DTaP formula , the same stuff as Kinrix less the polio component, or Pentacel, the same stuff as Kinrix plus the Haemophilus influenzae type b component. He wouldn't have gotten a Tdap formula because those are restricted to kids 10 and up, or just DT, because that's pretty much reserved for boosters.
So he's not in danger from mixing vaccine manufacturers, and if I understand what he's had, he's covered against diphtheria, tetanus and pertussis (he might not even have needed a fifth dose if he got his fourth dose at or after age 4). If you get the timing right, i.e. you manage to get the third dose six months after the second, I think he will only need two more IPV doses.
But don't take my word for it. Here's the CDC's catchup scheduler. If you enter all the information about what he's had (note that they don't care about manufacturers), with his date of birth, you should be able to see what he still needs and how he should get it.
(Here's the logic-puzzle-footnoted catch-up schedule.)
And seriously, you guys need to find a pediatrician you both trust.
posted by gingerest at 1:05 AM on June 2, 2014 [72 favorites]
I haven't heard any concerns about mixing manufacturers. We worry about ensuring kids get what they need despite different manufacturers making different formulations, and about keeping good track of what a kid gets so that in the unlikely event of an ineffective lot, you can revax only the kids who need it. I think vaccine manufacturers generally refer only to their own products in their information leaflets (including what the expected vaccination series is) because of liability issues. They can't take the risk that another manufacturer might change their formulations or have licensing issues, so they talk only about the products they make in-house.
But FDA licenses those products stringently, and manufacturers have to meet content standards set for the whole industry. So IPV (inactivated polio vaccine) is IPV , and DTaP is DTaP (i.e. diphtheria-tetanus-acellular pertussis), no matter who makes it. But DTaP is different from Tdap which is different from DT and Td (it's a very stupid nomenclature, but the letter size represents the dose of active ingredient for that disease. aP is a lot of acellular pertussis vaccine; ap is a little. Which you get depends on what works best for your age group and how many doses you need. And if there's no ap, there's no pertussis protection.) And when you string things further together, DTaP is still DTaP.
Have a look here. At his previous visits, if he had a sanofi product, it would have been Daptacel, which is a DTaP formula , the same stuff as Kinrix less the polio component, or Pentacel, the same stuff as Kinrix plus the Haemophilus influenzae type b component. He wouldn't have gotten a Tdap formula because those are restricted to kids 10 and up, or just DT, because that's pretty much reserved for boosters.
So he's not in danger from mixing vaccine manufacturers, and if I understand what he's had, he's covered against diphtheria, tetanus and pertussis (he might not even have needed a fifth dose if he got his fourth dose at or after age 4). If you get the timing right, i.e. you manage to get the third dose six months after the second, I think he will only need two more IPV doses.
But don't take my word for it. Here's the CDC's catchup scheduler. If you enter all the information about what he's had (note that they don't care about manufacturers), with his date of birth, you should be able to see what he still needs and how he should get it.
(Here's the logic-puzzle-footnoted catch-up schedule.)
And seriously, you guys need to find a pediatrician you both trust.
posted by gingerest at 1:05 AM on June 2, 2014 [72 favorites]
Mod note: One comment deleted. As a general note here, let's try to give specific helpful information in response to this described situation and the questions the OP is asking (the OP is not asking "are vaccinations good/bad," for example, or "should we vaccinate our child").
posted by taz (staff) at 2:32 AM on June 2, 2014
posted by taz (staff) at 2:32 AM on June 2, 2014
1. He's not in any danger. The worst thing that can happen is that he'll need to have a extra shot. Kids are re vaccinated frequently if there is a mess in the records
2. Your response is a little stronger than most but you don't sound over the top about it. You're trying to do the best for your kid
Congratulations on getting this done.
posted by SLC Mom at 2:48 AM on June 2, 2014 [1 favorite]
2. Your response is a little stronger than most but you don't sound over the top about it. You're trying to do the best for your kid
Congratulations on getting this done.
posted by SLC Mom at 2:48 AM on June 2, 2014 [1 favorite]
A small rash at the injection site and a fever within a day or two of a vaccine is perfectly normal. My kids' pediatrician always gives us a handout with side effects from each vaccine so you know if something is to be expected or not. Here is a list from the CDC's website.
Good for you guys for getting it done. I would also find an actual pediatrician if you can, and work with him or her to get your son caught up with his vaccines.
posted by sutel at 3:34 AM on June 2, 2014
Good for you guys for getting it done. I would also find an actual pediatrician if you can, and work with him or her to get your son caught up with his vaccines.
posted by sutel at 3:34 AM on June 2, 2014
I'm seconding the MD route to fully address your concerns. However, I think an MD who specializes in family medicine (instead of pediatrics) is going to have the more holistic approach your wife likes ("holistic" referring to the "whole" person, not to things like homeopathy, etc.). Since they treat the entire family, they will also look at family dynamics in a way that pediatrics doesn't. This may be useful for your family moving forward with these kinds of decisions, and especially if you and your wife are having disagreements on care.
posted by zizzle at 4:09 AM on June 2, 2014 [7 favorites]
posted by zizzle at 4:09 AM on June 2, 2014 [7 favorites]
Bring your child to a real doctor and your questions will quickly be answered. You don't say where you live, but in North America naturopaths are not doctors. Regulations vary by state in the US. But you've already indicated here you don't think the naturopath did the correct vaccination and are asking for medical advice on the correct vaccinations. This kind of routine vaccination is not medically complicated and real doctors don't "make these kinds of mistakes" all the time.
posted by Nelson at 9:07 AM on June 2, 2014 [2 favorites]
posted by Nelson at 9:07 AM on June 2, 2014 [2 favorites]
"2) I told my wife that I was pissed off that the doc could make such a basic mistake, and that as a pediatrician she should know vaccines cold -- even for a catch-up scenario. My wife suspects that docs make these kinds of mistakes all the time. Which is it? Am I overreacting?"
Anecdote: my pedi suggested a vaccine shortly before a birthday that made that # of the dose unnecessary. (That sounds confusing, without going into endless detail: after certain ages often many fewer doses of a vaccine is indicated. If we had waited a few months on this vaccine it would have reduced total doses.) I thought this was a "basic mistake" and also decided that "docs make these kinds of mistakes all the time." Most children who vaccinate do so on schedule so I don't think the doctors automatically know the catch-up schedules when each catch-up schedule is going to be different.
posted by RoadScholar at 1:48 PM on June 2, 2014
Anecdote: my pedi suggested a vaccine shortly before a birthday that made that # of the dose unnecessary. (That sounds confusing, without going into endless detail: after certain ages often many fewer doses of a vaccine is indicated. If we had waited a few months on this vaccine it would have reduced total doses.) I thought this was a "basic mistake" and also decided that "docs make these kinds of mistakes all the time." Most children who vaccinate do so on schedule so I don't think the doctors automatically know the catch-up schedules when each catch-up schedule is going to be different.
posted by RoadScholar at 1:48 PM on June 2, 2014
I do not endorse the use of naturopaths for primary care, but have to agree with the proposition that health care providers of all types make do mistakes in vaccine choice/timing/route/etc.
That notwithstanding, I see nothing to worry about in your child having received Kinrix. There is a general preference for continuing a series with the same brand if possible but CDC's stance is to give the vaccine you have rather than foregoing vaccination.
FDA approval of a vaccine for a certain dose of a series rests on the dosing scheme under which the manufacturer put it through clinical trials; if Kinrix isn't approved as a primary series dose it's probably just because GSK was trying to configure its product line a certain way and certainly not because a polio vaccine that is beneficial as a booster has the potential to be harmful when given as part of the primary series.
I agree with the recommendation to consult an MD/DO/NP but you could also call 1-800-CDC-INFO.
posted by lakeroon at 7:23 PM on June 2, 2014
That notwithstanding, I see nothing to worry about in your child having received Kinrix. There is a general preference for continuing a series with the same brand if possible but CDC's stance is to give the vaccine you have rather than foregoing vaccination.
FDA approval of a vaccine for a certain dose of a series rests on the dosing scheme under which the manufacturer put it through clinical trials; if Kinrix isn't approved as a primary series dose it's probably just because GSK was trying to configure its product line a certain way and certainly not because a polio vaccine that is beneficial as a booster has the potential to be harmful when given as part of the primary series.
I agree with the recommendation to consult an MD/DO/NP but you could also call 1-800-CDC-INFO.
posted by lakeroon at 7:23 PM on June 2, 2014
I am a doctor. Doctors do make mistakes, especially when they're doing things in a way which isn't the usual way they do things. I'm not sure this was a mistake, but I definitely would support you seeing an MD who specializes in holistic care (if that is something you value), rather than a naturopath.
They will still be human and as such they may make a mistake, but what I see as the most important thing is how your provider responds when you ask questions about the care they've provided, and whether they can or will explain the situation to you in a way that you are satisfied with. Sometimes that includes apologizing for a mistake and explaining why it happened and how it will be addressed, or sometimes that means clarifying why something was done in a non-standard way (that the internet or anecdotes from friends may disagree with).
posted by treehorn+bunny at 8:13 AM on June 3, 2014 [1 favorite]
They will still be human and as such they may make a mistake, but what I see as the most important thing is how your provider responds when you ask questions about the care they've provided, and whether they can or will explain the situation to you in a way that you are satisfied with. Sometimes that includes apologizing for a mistake and explaining why it happened and how it will be addressed, or sometimes that means clarifying why something was done in a non-standard way (that the internet or anecdotes from friends may disagree with).
posted by treehorn+bunny at 8:13 AM on June 3, 2014 [1 favorite]
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posted by epo at 12:00 AM on June 2, 2014 [21 favorites]