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Sunday, October 18, 2009

Giving Acetaminophen with Vaccinations May Reduce Their Effectiveness:

A new study published in the medical journal Lancet this week reported that routine administration of acetaminophen (Tylenol) to children after vaccinations decreased their antibody response.

The children in the study were given acetaminophen suppositories every 6-8 hours continuously for a 24-hour period. How this applies to most parents is not entirely clear. In reality, many parents give only one dose of acetaminophen either immediately prior to or after vaccinations, few give it around the clock for a day. According to the study, if a child develops a fever after vaccination, giving one does of acetaminophen does not decrease antibody levels. However, the authors state that acetaminophen should not be given prophylactically to prevent a fever.

Why would acetaminophen decrease antibody levels? One proposed hypothesis is that acetaminophen interferes with the body's inflammatory response and thus decreases the antibody levels.

This study leaves a lot of unanswered questions.
1.What is the significance of the lower antibody rates? Were the lower antibody rates still within the range of being considered a significant response to the vaccine, meaning would that level of antibodies still confer immunity to the child?

2. If the child does not have a fever, does one dose of acetaminophen prior to or immediately after vaccination significantly affect antibody levels?

3. Does ibuprophen (Motrin) have the same effect on antibody levels?

Regardless of the unanswered questions given the results of this study, it would seem prudent to not prophylactically treat children with acetaminophen, or any other anti-inflammatory agent, prior to or after immunizations in order to prevent a fever. However if the child does develop a fever, there should be no qualms about treating it with acetaminophen. The exceptions to this advice would be any child with a history of febrile seizures. Parents of children with febrile seizures should discuss the use of prophylactic acetaminophen use with their child's doctor.

It would also be prudent to avoid using acetaminophen as a pain reliever for immunizations. For parents looking to reduce the pain of vaccinations, there are analgesic creams available. One such cream is called Emla and is a mixture of lidocaine and prilocaine. It is applied to the area 30 minutes to an hour prior to the injection. Parents can ask their child pediatrician for a prescription for an analgesic cream and apply it at home prior to leaving for the doctor's visit.

For a non-pharmacological way to ease pain, studies have shown that sucking on a pacifier dipped in a sucrose solution such as Sweet-Ease significantly reduces an infant's perception of pain. Although common in the hospital setting, most pediatrician's offices do not have Sweet-Ease. However, you can discuss with your doctor making an at home sugar solution and bringing it with you.