By Christina Elston
Immunization guidelines change yearly. Here’s how, and why it’s so important to keep up with immunizations for kids:
From high-resolution ultrasounds in utero, to UV-coated sunglasses and calcium-fortified orange juice, a host of new high-tech measures factor in to how we protect our children’s health these days. They make one of the most common tools – childhood immunizations – seem almost old-fashioned.
And they are. The first vaccine, against smallpox, was introduced in 1798. Still, new recommendations are added to the schedule each year, and the list of preventable illnesses continues to grow.
Lots of Shots
By the time kids are 18 years old, federal guidelines call for them to be vaccinated against 16 different illnesses. While needle-shy kids might not welcome the recommendations, health experts are enthusiastic.
“I look at it as great news,” says Gary Marshall, M.D., author of The Vaccine Handbook: A Practical Guide for Clinicians. “Every time they add another vaccination to the schedule, that’s another disease that will not harm children.”
Aware that all those jabs can take their toll, researchers are working on new combination vaccines to pack the same amount of protection into fewer shots. FDA is considering licensing Pentacel, a new vaccine that includes DTaP (diphtheria, tetanus and pertussis), Hib (haemophilius influenzae type b), and IPV (inactivated polio) vaccines, taking the place of three separate shots. A Hib and meningococcal conjugate combination vaccine is currently also being studied.
Why We Need Them
Even with experts doing all they can to minimize the pincushion effect, it can be tough for parents to understand why vaccines are worth it.
“When kids get their vaccines, nothing happens,” Marshall says. “Kids don’t get sick. This is the essence of preventive medicine.”
Another issue that sometimes makes parents lax about fully vaccinating their children is that they don’t understand the severity of some of these diseases. For instance, Marshall says, the flu kills about 36,000 people a year, as many as 3,600 of whom are children.
But Are They Safe?
But what about the vaccines themselves? Concerns about vaccine safety, some of which have proven to be legitimate, have been raised for decades. The first oral, live-virus polio vaccine, licensed in 1961, caused polio infection in about one in every one million children who received it, according to Neal Halsey, M.D., director of the Institute for Vaccine Safety at Johns Hopkins University. “We no longer use the oral polio vaccine because of that problem,” he says. Children now receive a vaccine containing inactivated polio virus.
More recently, the first vaccine against rotavirus, called RotaShield, was pulled from the market in 1999, after less than a year, because it caused a rare digestive obstruction in one in 10,000 babies who received it. RotaTeq, a replacement vaccine that has not been associated with this problem, has been added to the schedule this year.
Additional alarms have been raised about potential links between thimerosal – a mercury-containing vaccine preservative – and autism and other serious problems. The government began removing the preservative from the vaccine supply in 1999. Although the Institute of Medicine, an independent nonprofit organization that advises the federal government on health matters, concluded in 2004 that there was no such link, the removal effort continues.
Even so, some parents seeing their tiny baby injected with so many substances worry about safety. But Marshall points out that a baby is exposed to fewer antigens – substances that cause the body to produce a protective immune response – in a combination vaccine than they encounter in everyday life.
One combo vaccine that protects against five different diseases, for example, exposes the body to just 10 antigens. Meanwhile, “every time the baby takes a drink, or breathes the air, or gets licked in the face by the family dog, there is this bombardment,” Marshall says. “Babies’ immune systems are robust, and they are designed to respond to antigen stimuli in the environment.”
And that fever babies tend to get after vaccination? Marshall says it’s a sign that the body’s immune system is responding just the way it should.
And unlike Marshall, who works in the Division of Pediatric Infectious Diseases at the University of Louisville School of Medicine, many parents don’t have first-hand experience with the diseases vaccines are designed to prevent.
“I have stood by the bedside of babies who have died of meningitis, and had their parents cry on my shoulder. I have seen children die of chickenpox,” he says.
The 2006 outbreaks of measles in Boston and mumps across the Midwest, and the increasing number of pertussis cases across the country since the 1980s, also serve as reminders that these diseases aren’t completely gone. The measles outbreak began with a man from India who had immigrated to Boston, the mumps outbreak possibly with a visitor from England, where MMR vaccination rates are low. [See updated information about pertussis - "whooping cough" outbreaks in several states.]
“Even though we’ve got the diseases under control in our country, people are flying in and out of here all the time,” warns Amy Pisani, M.S., executive director of the immunization advocacy group Every Child By Two.
Keeping Track and Stopping Gaps
Keeping your child’s immunizations up to date begins with that very first visit to the pediatrician. Pisani stresses that starting on time is essential, because infants are the most vulnerable to infectious disease. She adds that kids who start late are more likely to stay behind, and not be fully protected. In fact, each year 2.1 million U.S. children aren’t immunized on time.
“Parents know better,” says Pisani. “They just can’t keep up with the schedule.”
One tool every parent should have is a vaccination record, kept at home and updated at every doctor’s check-up. Parents also need to call their pediatricians about annual check-ups, says Deborah Wexler, M.D., executive director of the Immunization Action Coalition, which offers information about vaccines and vaccine-preventable diseases.
When you call, ask about which vaccines are recommended for your child, and whether the office will have those vaccines on hand on the day of your appointment. This will help you to avoid a return trip for a shot that wasn’t available. Also ask about insurance coverage, so that you can plan accordingly.
Pisani recommends asking your pediatrician about participating in the local immunization registry. This can help both you and your pediatrician maintain a record of all immunizations your child has received, and keep track of when immunizations are due.
It’s just one more way of protecting our kids. Marshall says that all parents have a choice for their child: protection or vulnerability. “It’s beyond me,” he says, “why any parent would choose vulnerability.”
Older Kids and Vaccinations
It’s a challenge to get adolescents and teens to do just about anything, including getting them vaccinated.
“It’s not locked into those early visits to the doctor’s office like we see for infants,” says Wexler. But locked in or not, there are so many vaccines now recommended for adolescents that they have their own immunization schedule.
Some things on the schedule are catch-up vaccinations kids might have missed earlier, while others are doses they need to get during their tweens and teens. It’s important to ask about any and all vaccines you think your child might need. Some, such as Hepatitis A, are only offered routinely to those in certain high-risk groups but might still be a good idea for your child.
By the way, if you're an adult, you’re not out of reach of the needle yet. Especially if you’re pregnant or around young children, there are some boosters and catch-up vaccines you should consider.
The National Immunization Program’s Childhood Immunization Schedule lists the ages at which each vaccine or series of shots should be given. If you have any other questions about what vaccinations your child needs and when, check with your child’s physician or other health-care professional.
Every Child By Two–– Offers information about diseases and vaccines, immunization schedules and a guide to paying for vaccinations if you don’t have insurance.
Immunization Action Coalition– Offers information about vaccines and vaccine-preventable diseases, including photos of the consequences of these diseases.
The Vaccine Handbook: A Practical Guide for Clinicians, by Gary S. Marshall, M.D.; Lippincott, Williams & Wilkins, 2003.
Christina Elston is a longtime health writer and editor at Dominion Parenting Media.