Vaccines are so important to children’s medical care that a book about pediatric health care and medicines would not be complete without a chapter devoted to them. This chapter will review essential information about vaccines—also called immunizations—including how effective they are, why they are necessary, and what safety concerns and other worries many parents have about them. (Many good sources of information about pediatric vaccines discuss vaccines in depth and are listed later in the chapter.)
In recent years, more and more parents have become apprehensive about vaccines. Here are some of the most common questions health care professionals hear. If you have some of these concerns, you are not alone.
• Are all pediatric vaccines still necessary?
• Are vaccines safe?
• Is it harmful to give multiple vaccine shots on the same day, at the same doctor’s appointment?
If you have concerns about giving vaccines to your infant or child, your best first step is to discuss the issue with your pediatrician. Tell the pediatrician your specific fears and ask him or her to talk them through with you. Pediatric health care providers, including your pediatrician, share your wish for children—including your child—to be as healthy as possible. Giving the vaccines recommended in the current pediatric immunization schedule (figure 5.1) is an effective way of keeping infants and children healthy and free from disease.
Source: Based on the chart provided by the US Department of Health and Human Services, Centers for Disease Control and Prevention
Note: For full information regarding the recommended immunizations, including all footnotes (FN), see https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html.
As has been discussed throughout this book, the benefit of giving a drug to an infant or child should outweigh its risks, or adverse effects. Choosing to give any drug to your child is an important decision that you make as a parent. It is a decision informed by advice and recommendations from your child’s pediatrician. Vaccines are also considered drugs. All vaccines have risks, or adverse effects, and benefits. For the vast majority of infants or children, the benefits of vaccines greatly outweigh the risks. These benefits include preventing many potentially deadly infectious diseases, such as polio, measles, meningitis, and pertussis (whooping cough).
Vaccines can cause adverse effects, such as soreness at the injection site or a mild fever, but serious adverse effects are rare. The vast majority of infants and children who receive vaccines have no adverse effects from vaccines, other than perhaps a sore arm or thigh after a shot.
Some infants and children have contraindications to receiving some vaccines—in other words, some children should not receive specific vaccines because the risk of adverse effects is greater in these infants and children than for other children, and the risk may outweigh the benefits of the vaccine. For example, if a child is receiving chemotherapy for leukemia, normally scheduled pediatric vaccines will be deferred for this child until chemotherapy treatments are completed. If your child has a contraindication to a vaccine, your pediatrician will recommend adjusting the vaccine schedule.
Each January a new immunization schedule for infants, children, and adolescents younger than 18 years of age is published by the Centers for Disease Control and Prevention (CDC) and is approved by the American Academy of Pediatrics. The pediatric immunization schedule for 2017 is presented in figure 5.1. In some years the pediatric immunization schedule changes only slightly, with new or different age ranges given for specific vaccines, while in other years new vaccine products are added to the schedule, resulting in significant changes. As you can easily see, the recommended vaccines provide protection from many infectious diseases, which is good. It is far better to prevent a serious disease in your child than to have him or her contract the disease and require treatment.
In 1999, the Centers for Disease Control and Prevention, the federal government’s main public health agency, published an article describing the ten greatest public health achievements of the twentieth century. The top ten are:
• improved motor vehicle safety
• safer workplaces
• control of infectious diseases
• decline in deaths from coronary heart disease and stroke
• safer and healthier foods
• healthier mothers and babies
• family planning
• fluoridation of drinking water
• recognition of tobacco use as a health hazard
• vaccination
Considering the good that vaccines have done it is not surprising that vaccination is listed as one of these public health achievements. Pediatric vaccines have prevented literally millions of infant and child deaths from infectious diseases. Vaccines have eliminated smallpox and have controlled polio in the United States (although not in some other places in the world).
Table 5.1. Prevalence of infectious diseases targeted by vaccines (children and adults in United States)
Source: American Academy of Pediatrics Red Book (2015)
*1951–1954
Most of the infectious diseases we have vaccines to protect us from—such as measles, pertussis, and mumps—continue to develop in the United States. New outbreaks of measles and pertussis have recently occurred in the United States, in part because unimmunized children spread the viruses and bacteria that cause these illnesses to other susceptible children, including children who are still too young to be immunized against these diseases. Table 5.1 lists several infectious diseases targeted by current pediatric vaccines, showing their prevalence before and after regular vaccine use. The dramatic decline indicates how effective vaccines are. When rates of unimmunized children rise, as has been happening in recent years (for example, fewer children are being vaccinated against measles), so do the rates of, and deaths from, these infectious diseases.
Table 5.2 lists the infectious diseases the current pediatric vaccines target. Most of these infectious diseases are completely averted when a child has received the corresponding vaccine, since the vaccine prompts the immune system to prevent disease when a child is exposed to the virus or bacteria that causes the illness. Some of the other infectious diseases, such as influenza (the flu), may not always be completely prevented in a child who has received the vaccine. However, if the infection occurs in a child who has received the flu vaccine, it is much less likely to lead to a serious illness.
For example, if a child who receives a flu shot is exposed to the flu virus from other children, the child may not become ill at all, or he or she may develop a mild case of flu, perhaps becoming ill for only several days. In a child who has not received a flu shot, it is more likely that he or she will develop more serious illness when exposed to flu viruses. A flu shot may prevent the child from needing hospitalization, which might have been required if the sick child had not been vaccinated. Vaccinations against flu also prevent death in children by minimizing the flu illness. Children die each year from influenza, with as many as 171 children dying during an influenza season in recent years. Many of these children who died did not receive a flu shot, and it is quite likely that their deaths could have been prevented had they received a flu shot.
Many parents who are hesitant for their children to receive vaccines have concerns over vaccine safety and the possibility of adverse effects. Similar to other drugs, vaccines undergo many years of phased testing for safety and effectiveness in humans before they are licensed for use and made available to the public. And just like other drugs, vaccines have the potential to produce adverse effects. Fortunately, most adverse effects from vaccines are mild, such as soreness at the site of the injection.
Even after a vaccine has been approved and licensed by the FDA, it continues to be monitored for safety concerns and rare adverse effects. These safety monitoring systems and programs include the Vaccine Adverse Event Reporting System, the Vaccine Safety Datalink, the Post-Licensure Rapid Immunization Safety Monitoring System, and the Clinical Immunization Safety Assessment Project. The FDA and the CDC recognize the public’s concern about vaccine safety and have established these monitoring programs to keep a watchful eye and respond quickly to any safety issues.
Table 5.2. Diseases that vaccines protect against
In addition, various groups of pediatric medical experts, such as those at the Institute of Medicine, have reviewed all of the safety and epidemiologic data about vaccines and their potential adverse effects and have published their findings. These reports have been summarized in nontechnical language for the public and can easily be found on various Internet sites (see table 5.3 for more information). One of the best Internet sites for parents is from the CDC, available at www.cdc.gov/vaccines. One very important finding from these vaccine safety reviews is that there is no credible evidence that the MMR vaccine is a cause of autism. Much information and many studies have been evaluated by groups of various scientific experts, and all of this information points to no link between the MMR vaccine and autism.
Here are three common myths about vaccines and information that reveals the myths for what they are—myths, not truth.
MYTH: Administering more than one vaccine at one time overloads or weakens the immune system.
FACTS: Our immune systems are exposed to many viruses and bacteria from other people and the environment every day, and have evolved for this purpose. Most vaccines include several of the most important parts, termed antigenic components, of the viral or bacterial causes of the targeted infectious diseases, and can easily be “handled” by our immune systems to provide protection.
MYTH: Most vaccines are no longer needed, as these infections no longer occur.
FACTS: Of all the diseases for which vaccines have been developed, only smallpox has been eradicated and is no longer a threat to the public. Although wild polio has not been contracted in the United States in many years, the viruses that cause polio still exist naturally in other parts of the world and can be brought into the United States by others who have traveled outside of the country. All of the infectious diseases listed in table 5. 2 continue to be a threat and can be contracted and cause disease in your child.
MYTH: Vaccine doses can be separated, and spread out, and given at different times instead of on the timetable that is recommended by the pediatric immunization schedule.
FACTS: The current pediatric immunization schedule includes vaccine doses administered at specific times, often requiring more than one dose of each vaccine given at different times. The recommended separation times between each vaccine dose have been clinically tested and shown to be the most effective intervals. Vaccine dose separation times greater than recommended in the pediatric immunization schedule have not been tested and may cause vaccines to be less effective and therefore increase risk to your child.
Increasing numbers of parents are refusing one or more of the recommended vaccines for their children. A small minority of parents, about 3 percent, have reported in recent surveys that they refused all vaccines for their children. The most common reasons parents give for refusing vaccines include the belief that vaccines are no longer needed and worries about vaccine adverse effects. Other concerns expressed by parents include the belief that “natural” infection is better than vaccine-induced immunity, the conviction that vaccines are not effective, or fears about vaccine additives, such as aluminum. Other parents believe in freedom of choice and object to mandated requirements of vaccine administration for their children. If you have one or more of these concerns about vaccines for your children, you need to discuss these concerns with your pediatrician. Your pediatrician, like you, wants your children to be as healthy as possible and likely will be glad to discuss these issues with you.
Unfortunately, many Internet sites about vaccines do not provide scientifically and medically accurate information. Some of these sites may scare you about vaccines and make you afraid for your children to be immunized. Table 5.3 lists scientifically and medically accurate Internet websites that are reliable and that have been prepared by medical professionals. I encourage you to review the information on your own time. One especially compelling site is www.immunize.org/reports. This site, from the Immunization Action Coalition, includes true accounts of children and adults who have suffered or died from vaccine-preventable diseases. If you have concerns or doubts that vaccines are no longer needed, this website will provide you with plenty to think about.
Parent surveys indicate that they worry about pain from vaccine shots. This pain can be minimized by using several methods, whose effectiveness is supported by published studies. A recently published review of these approaches found scientific evidence that the following approaches can decrease pain and discomfort in infants and children associated with vaccine shots:
Table 5.3. Internet sites with reliable vaccine information
Internet site |
Organization |
Immunization Action Coalition |
|
Real-life accounts of children who suffered or died from vaccine-preventable diseases, from the Immunization Action Coalition |
|
Centers for Disease Control and Prevention |
|
www.healthychildren.org |
American Academy of Pediatrics |
Parents of Kids with Infectious Diseases |
|
Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health |
|
Vaccine Education Center, Children’s Hospital of Philadelphia |
|
Every Child by Two, Carter/Bumpers Champions for Immunization |
• Methods pediatricians and nurses can use:
Administer a sweet-tasting solution of sugar water to infants up to 12 months of age one to two minutes prior to the vaccine injection, using an oral syringe or pacifier.
Have the child sit in the parent’s lap for the injection, or use another position that is comfortable to parent and child. Avoid administering the vaccine to a child who is lying down.
If more than one vaccine is administered at a clinic visit, administer the potentially more painful vaccines, such as MMR, last.
• Methods you can use as a parent:
Learn distraction techniques that can be used while the shot is administered. Some of the techniques require a little training by your pediatrician’s office, so ask your health care provider about these methods in advance.
Consider using an anesthetic cream or ointment on your child’s skin where the vaccine shot will likely be given. It is usually best to apply the ointment 30 to 60 minutes prior to the vaccine shot (usually while you and your child are still at home). These creams include lidocaine/prilocaine (EMLA), a prescription drug, or lidocaine 4 percent (LMX 4), available as an over-the-counter drug product. It is important to place these creams on the appropriate areas where the vaccines will be given, and in a specific manner—your pediatrician’s office will explain this to you.
Breastfeed your infant to decrease vaccine shot pain. Begin nursing prior to the shot and continue for several minutes afterwards.
For children 3 years age or older, use blowing exercises, such as blowing bubbles, party blowers, or pinwheels during vaccine administration.
Because I believe vaccines are an effective means to prevent or minimize many dangerous infectious diseases, my own two nearly adult children, my wife, and I have received all of the recommended vaccines for our ages. We have flu shots each year, and both my son and my daughter have received the human papillomavirus (HPV) vaccine.
• Pediatric vaccines are one of the most effective means to prevent serious diseases in infants, children, and adolescents, and are life-saving medicines.
• Overall, pediatric vaccine products are safe, and they are continuously monitored for new safety concerns.
• Pediatric vaccines can have adverse effects, but the vast majority are mild.
• Some infants and children, a relatively small number, should not receive some pediatric vaccines, as they can cause serious adverse effects.
• The current pediatric immunizations schedule is best followed as recommended and not delayed or adapted to alternative schedules.
• Some parents have concerns about pediatric vaccines, and these concerns are best discussed with their pediatrician.
• Several reliable and medically accurate Internet websites can be viewed by parents for more information.
• Several effective methods can be used by you and your pediatrician to reduce pain from vaccine shots.
