Davis Square Family Practice Newsletter
In This Issue
Our New Website
Immunizations - Part 1
Join Our List
Join Our Mailing List
New Davis Square Family Practice Website
 Part 1
Deborah Bershel, MD 
Marie Botte, NP
Paula Mahoney, Office Mgr
Qianna Price, M.A.
O'Callaghan, M. A.
Randi Baxter, M.A.
Monica Pereira, Sec.
Jason Joyce, Sec.
Dorothy Anderson, Phlebot.
Important Info
Office Phone 
Appts.-  Same day appts. should always be available  for emergencies
Call Backs- Should be completed by your clinician by the end of day.
Refills- Allow 24 hrs. for handwritten refills
After hours- Call office for name and phone number of covering physician. If you prefer to confer with Dr. Bershel her cell is (617) 230-7988
(sometimes phone is shut off so Dr. Bershel can sleep)
 Issue #6: 
Our New Website &
Immunizations Part 1
Sneezing boy
It is the hope of this practice to provide timely and reliable information on topics of interest to our patients. As this is a relatively new addition to Davis Square Family Practice, please send us your thoughts and comments. if you have any questions about the content of this newsletter please feel free to email me at dbershel@gmail.com
Deborah Bershel, MD
Useful Website for Davis Square    Family Practice
About 10 days ago we launched our website Davis Square Family Practice and we think that you will find it particularly useful and informative. It currently enables you to make non-urgent appointments, prescrition refill requests and referrals on line. You can also download forms, such as address change, new patient questionnaire and record request on-line. Electronic bill pay will be functional by the end of March. You will also be able to obtain lab information on-line sometime later this year. In the upper right hand corner there are links to prior newsletters and 'comments'. It is extremely helpful to get both positive but especially negative comments about all aspects of our practice. The 'comments' button is linked to me personally so you can be assured that they will be taken seriously. There is also button that will connect you with our Patient Medical Library. All articles were either written or at least screened by me for accuracy and relevance. There are also immunization schedules and growth charts in the library. I plan on expanding the library over time and am interested to hear what topics that you might deem useful.
You may reach the website by using either of the following URLs:
Immunizations (Part 1)


            Part a. General Comments   
            Part b. Detailed Info On Each Vaccine   
                          for Children
       General Comments     

I believe in vaccinations against most common illnesses. They protect us from many viral and bacterial infections that have ravaged mankind throughout the centuries. We need to have enough of our population to be immune so that the small percentage of people who don't respond to the immunizations will also be protected against a particular disease (because the disease will have no place to gain a foothold). This is in part why school systems/colleges require that students be immunized against certain diseases before entrance - not only to protect the individual but in order to protect all students. The Patient Medical Library www.dsfamilypractice.com/health_library.php , I have included the current CDC guidelines for immunizations considered appropriate for the various age groups.


That being said, it is not clear to me that we need to protect ourselves from every disease known to mankind - or to every disease that the current CDC guidelines suggest. There may be risks to some vaccines that we will not know about for many years to come. Approximately a decade ago there was a vaccine against rotavirus that was mandated for all newborns. Well, it turned out to increase the risk of a rare (but often fatal) condition called intussusception and the vaccine was removed from the market. We also had a vaccine to protect against Lyme disease that we found out caused symptoms of Lyme disease in certain people with a certain hereditary factor. An epidemiological study from Canada (released in 2008) found that the old DPT (no longer in use in the USA) appeared to double the risk of asthma in children when it was administered under the age of 4 months.


If I were having my children today, I would probably have them get most of the recommended vaccinations - with some modifications. I would delay vaccinations until 4 months of age based on the findings of the Canadian study and the fact that asthma is a very widespread illness (15% of children) and is on the rise for reasons that are not clear. I would hold off on giving the hepatitis B vaccine until my child entered school (because it is only passed through blood products and sexual activity - or if the mother is a hepatitis B carrier). I would not give the hepatitis A vaccine to my child unless we would be likely traveling to a 3rd world country in the near future as it is not a deadly illness (although it is passed through food and can cause prolonged illness). Delaying all the vaccinations until 4 months of age would mean that my child would be placed at risk for some serious illnesses for an extra period of time but I believe (although I cannot prove) that the benefits outweigh the risks.  If youdesire a modified vaccination schedule, I will try to work with you and respect your decision. I only ask that you do your homework and come up with an approach that is consistent with the information that is available and your stated beliefs. Also, you need to take responsibility to keep up with the regimen you have decided upon and don't place the burden on our office to make sure that you follow your plan. Massachusetts currently allows for an exemption from mandatory vaccines for spiritual/religious beliefs in an all-or-nothing fashion. It does not allow you to pick-and-choose which vaccines you give to your child at the time of entrance into school.


Detailed Info On All  Vaccines for Children  



DTP  ( diphtheria, tetanus, pertussis)

The diseases- Diphtheria is a bacterial illness that still exists in certain parts of the world but is incredibly rare in North America. It is a very serious upper respiratory illness that can often be deadly. The disease is still present in the Caribbean and Latin America and epidemics have become more common in parts of the former Soviet Union. Tetanus (lockjaw) is a neurological illness that is caused by a bacteria that is widespread in our soil and it is a common misunderstanding that it can only be gotten with a dirty puncture wound. A simple cut in the skin and that comes in contact with soil can lead to this very serious and often deadly illness. The bacteria thrives better without oxygen, so it is true that puncture wounds are particularly worrisome. There are about 100 cases of tetanus per year in the US and about 5 deaths. Pertussis (whooping cough) is a very serious bacterial illness that is difficult to treat with antibiotics (antibiotics are used mostly to prevent spreading of the illness). It is a respiratory illness associated with a severe cough that sounds like a 'whoop'. (It is not a cause of croup which is typically a viral illness and has a bark-like cough). It is associated with a 1/1000 risk of seizures and it can be deadly (much higher risk in unimmunized children). Incidence of pertussis has increased steadily since the 1980s. The incidence in 2007 was 3.6/100,000 when 10,454 cases of pertussis were reported. A 2008 study showed that most children who get pertussis will get it from their parents (usually are unaware that they have the illness) who often have only partial immunity to it. It is estimated that up to 10% of infectious bronchitis in the fall and winter months in adolescents and adults is caused by pertussis so an unimmunized child is quite at risk even if kept at home.

The side effects of vaccination- Fever (about 1/4 children) Redness or swelling where the shot was given (about 1/4 children) Soreness or tenderness where the shot was given (about 1/4 children) For at least the last 15 years we have used the acellular DTP vaccine in Massachusetts and this is associated with a much lowered risk for high fevers and seizures than the original version. The old DTP vaccine appears to have been the origin of many people questioning the safety of vaccination as some children had seizures and some never seemed to be quite the same afterward. Statistically speaking there was no increase in neurological diseases as a result of the old DTP. Many aggrieved parents felt abandoned by the medical community and believed that there was collusion between doctors, the government and the pharmaceutical industry that makes the vaccines. My opinion is that it is likely that the vaccine caused at least some of the problems seen in these children and that the medical community was wrong to imply 100% safety. The benefits of the vaccine certainly far outweighed the risks but we told parent who has an ill child that the shot couldn't be involved and that stung like an absolute lie. If I had been one of those parents I'd have felt the same way.


Hib (hemophilus influenza B)


The disease - This was one of the most common causes of bacterial meningitis in the first 2 years of life and certainly was a major cause of death, brain damage and permanent hearing loss prior to the vaccine's inception some 25 years ago. Early administration is critical in order to prevent meningitis as that complication is most prevalent during the first year of life. Prior to the introduction of the vaccine the incidence of H. influenza meningitis was nearly 1:1000 children in the first 24 months of life.  There has been a 99% reduction since the vaccines inception. It is also a major cause of respiratory illness and ear infections although we administer the vaccine because of the meningitis risk and not these other issues. The bacteria can exist and cause infection in adults and we can easily pass it on to unimmunized children.


Side Effects of the vaccine - Redness, warmth, or swelling where the shot was given (up to 1 4 children) Fever over 101 degrees Fahrenheit (up to 1/20 children)



Prevnar (Pneumococcus)


The disease - Pneumococcus is the other major cause of bacterial meningitis that occurs in the 2 years of life (and is a common cause of it throughout life although meningitis is significantly more common in young children). It is also a major cause of ear infections and respiratory tract infections. Prior to the introduction of the vaccine there were approx. 6 children per 100000 who got pneumoccocal meningitis per year (3000 total/year). The incidence has dropped by 30% since the vaccine was introduced. Even if you keep your child at home and away from other children the bacteria exists in adults and we can easily pass it on to unimmunized children.


Side effects of the vaccine - Up to about 1/4 had redness, tenderness, or swelling where the shot was given. Up to about 1/3 had a fever of over 100.4 degrees Fahrenheit, and up to about 1/50 had a higher fever (over 102.2 degrees Fahrenheit). Some children also became fussy or drowsy, or had a loss of appetite.


IPV (Inactivated Polio Vaccine)


The disease -  Polio is a very serious viral illness that prior to the development of the vaccine caused devastating neurological complications and death. It has not been present in the United States for a few decades but prior outbreaks were seen among religious communities with large groups of unimmunized children.


Side Effects of the vaccine -  Rare with the IPV because there is no live virus. The oral polio vaccine is somewhat more effective but was associated with a few cases of polio-like illness each year. As naturally-occurring polio had not been seen for many years in the US it was deemed that the inactivated (IPV) vaccine's risk-benefit ratio was better than the oral (live) vaccine's and so it replaced the oral vaccine over 10 years ago.


Hepatitis B


The disease -  It is a viral illness that damages the liver and can lead directly to death from liver failure and to liver cancer. It is spread through contaminated blood and unprotected sexual activity and if the mom is a carrier of the virus she can pass it on to her baby. In part, due to widespread immunization, it has become significantly less common in the US over the past 25 years.

Side Effects of the vaccine -  Include:  diarrhea, headache, dizziness, vertigo, somnolence, insomnia, irritability, agitation, migraine, syncope, paresis, neuropathy, hypoesthesia, paresthesia, convulsions, encephalitis, Guillain-Barre syndrome . I've obviously stacked the deck here because I do not believe that this vaccine should be given to newborns unless the mother is a known carrier of hepatitis B. Is the vaccine likely to cause harm? - Absolutely not. But is it likely to prevent important illess prior to the teenage years (when sexual activity and drug abuse can occur)?- Absolutely not. In my mind the risk outweighs benefits. The shot should be given in middle school as it had been for years. I recommend putting off administration until your child goes to school as it is now mandated by the state. *


MMR - (measles, mumps, rubella)


The diseases- Measles is a systemic viral illness that is associated with high fever, respiratory illness and a widespread rash. It can be deadly and even recently in parts of the undeveloped world, where the vaccine was not available, there were epidemics of the disease where over 100,000 children would die from a single outbreak. Prior to the advent of the vaccine in the 1960s there could be 1/2 million cases per year during an epidemic. Currently is rare in the US (less than 1 case per million each year) but small outbreaks have occurred  during the past decade. Mumps is a viral illness associated with swelling of the salivary glands , fever and fatigue. It is usually self-limited but it can cause infertility if you get it after puberty. Incidence is about 6,000/year (2/100,000). Rubella is a mild viral illness that can cause a fever and a rash. In the past decade rubella has been essentially wiped out (less than 25 cases per year). The main problem with this illness is that it can cause birth deffects if you get it during pregnancy.  In 2001 there were 4 cases of congenital rubella syndrome whereas during the last major epidemic in the 1960s there were  more than 10,000 fetal deaths and about 20,000 children born with congenital defects. All women should get a blood test prior to getting pregnant to ensure immunity. You cannot get immunized during pregnancy as the vaccine is a live virus.


Side Effects of the vaccine - As this is a live vaccine, it takes 7-10 days for the attenuated (weakened) viruses to take hold. At that time a fever, mild respiratory illness and rash can occur. I'm convinced that the MMR does not cause autism. Multiple large studies confirm this conclusion and autism is actually present well prior to the administration of the MMR - it just often isn't obvious to parent or doctor.


Varicella-  (chicken pox)


The disease - It is a viral illness largely spread through the air. It causes respiratory symptoms, fever and a characteristic rash with scattered fluid filled pustules (often) over the entire body. It can cause hospitalization and even death. Prior to the advent of the vaccine there were about 4 million cases of chicken pox per year, 5-10,000 hospitalizations and 100 deaths. It has never been clear in my mind as to whether the decision to approve universal vaccination was made on a purely public health basis or on a financial cost-to-society basis (1 billion/year in 1995 dollars).


Side effects of the vaccine - As the vaccine is comprised of a live attenuated (weakened) virus a low grade infection can occur. Mild chicken pox-like illness may arise 7-10 days after administration of the vaccine. Shingles has been reported after administration of the vaccine.


Rotavirus -


The disease - It is a viral gastrointestinal illness spread from hand to mouth. It is highly contagious from hand to mouth and from contaminated surfaces and parents can give it to children and visa versa. Dehydration is one of the major causes of severe illness and death world wide in infants. In the United States rotavirus causes about 20% of all cases of diarrhea in infants and about 40% of deaths (20-60 per year).  It is estimated to cause over 50,000 hospitalizations per year. The vaccine is 75% effective but (8% effective in preventing severe infection. This vaccine has not been made mandatory in order to attend school although the original one (which was pulled off the market due to possible side effects) was required. This illness is a major nuisance and cost to society. I consider this vaccine optional - in part because I think that good parenting and early contact with a doctor should prevent the most severe outcomes (although not necessarily prevent hospitalization). *


Side Effects of the vaccine - Babies may be slightly more likely to be irritable, or to have mild, temporary diarrhea or vomiting after getting a dose of rotavirus vaccine than babies who did not get the vaccine.


Hepatitis A -

The disease -This is a viral gastrointestinal illness that can be spread from feces and contaminated food (such as at a restaurant). A high percentage of cases, especially in children, show no symptoms at all. You can (especially as an adult) become jaundiced (turn yellow), have a fever and feel extremely fatigued - sometimes weakened for months but the disease is usually self-limited. It is not associated with death. I consider the vaccine optional except if traveling outside North America and Western Europe. *


Side effects of the vaccine - headache (in 1/6 adults & 1/25 children) loss of appetite (about 1/12 children), tiredness (about 1/14 adults)


Influenza -


The disease - It is a viral respiratory illness that is associated with a fever, dry cough, sore throat, headache and muscle aches. It is typically spread through the air or hand-to-hand.  The illness is usually limited to 3-5 days. Because the viral strains change each year a new vaccination is required to achieve maximal protection. Between the age of 6 months to 9 years a second booster dose is required if unimmunized from prior years. Approx. 40000 people die every year in the United States from this illness (usually the very old or those with chronic illness). It is particularly prudent to get vaccinated if you or your child or anyone in the home has a chronic illness such as asthma, emphysema, diabetes, coronary artery disease, chronic kidney disease, etc. Healthcare workers and those who work with children have a special obligation to be vaccinated.


Side effects of the vaccine - soreness, redness, or swelling where the  shot was given hoarseness, sore or red eyes, cough, itchiness, fever, aches. Most of these symptomswill be mild and you cannot get the flu from the flu shot.


* These are my opinions and are not necessarily the opinions of most of the medical community.

  (Part 2 will be about the adult vaccines)


3/6/2010 D. Bershel

I hope you found the information in this newsletter useful . The next issue will include "My Top Preventive Medicine Ideas". I will attempt to complete the second part of the vaccine article in the coming months. It will cover the adolescent and adult vaccines. Again, please let us know your thoughts on the newsletter.
Deborah Bershel, MD