image credit: CDC, James Gathany
August is Vaccine Awareness Month and unless you’ve been living on a deserted island you are very aware of vaccines! Between the nationwide measles outbreak this year and the constant arguments for and against vaccination on social media, vaccines are big news these days.
Convincing you to vaccinate your children isn’t the focus of this piece. Discussions around vaccination are better suited to the office setting where you can have an honest dialogue with your trusted resource: your pediatrician. Instead, here are some less frequently considered questions and answers around vaccination that every parent should be aware of.
Why are vaccines given to infants even if they aren’t going to daycare?
Vaccines (small, inactive doses of dangerous bacteria and viruses) were created against specific illnesses because those diseases result in severe illness, and rarely death, especially in infants and young children. A baby’s ability to fight infection is limited because the immune system is still encountering the world and building defenses as it goes along. By providing vaccines, the body gets a head start building a suit of armor against disease. Getting the infections themselves would induce immunity of course, but with the potential “high cost” of severe illness or possibly death, vaccines are a great opportunity for “low cost” immunity in comparison.
An infant’s immune system is on the prowl for new things and primed to generate immunity to protect the growing child. Children benefit from repeated exposure to new things for acceptance and tolerance and vaccines are no different. Repeatedly giving small-dose vaccines allows for robust response that gets reinforced and generates sustained immunity.
Delaying vaccines until school-age or older decreases the likelihood of achieving robust response from vaccines. Older children, teenagers and adults often need higher doses to achieve immunity compared to infants. Adults, for example, have much poorer response to everything from the flu vaccine to the shingles vaccine (which is just a super-high dose of the chicken pox vaccine) compared to infants.
Giving vaccines in infancy also improves the chances of lifelong immunity.
Why is the Hepatitis B vaccine given to infants? I thought Hep B was sexually transmitted.
You’re right (in part) about how Hep B is transmitted. Hep B is a virus that can also be transmitted through blood transfusion, breast milk, and human bite. Virtually all mothers are now tested during pregnancy to see if they are silently infected with the Hep B virus, so we know which babies are at greatest risk from that standpoint. However, risk still exists since fathers aren’t tested. Here’s how: Dad has undiagnosed, chronic, asymptomatic Hep B virus in his body. He and mom are still having sex. Mom is breastfeeding. Mom becomes infected and is asymptomatic too. Mom then gives baby Hep B.
Other Hep B risk scenarios exist, too. Scenario #2: Child goes to childcare/school and gets bitten by another child who is not vaccinated and whose Hep B status is unknown. Scenario #3: Due to some sort of an accident or medical condition, your child needs a blood transfusion. Your child then is at risk for Hep B from the blood needed to save his life.
Since Hep B exposure is so haphazard and unpredictable, and because immunity is best achieved in infancy, vaccination is recommended in the first few months of life.
Is the flu vaccine worth it? Won’t my child still get the flu?
Each spring, the world’s smartest infectious disease experts collaborate to determine which strains of the flu should be included in that fall’s influenza vaccine. Most of the time, those experts are very good at predicting which strains will affect the world later that year. Occasionally though, Mother Nature throws a curve ball and an influenza strain morphs (the H1N1 strain was one of those). Even in the worst possible case, as evidenced in the year H1N1 wreaked havoc, getting the flu vaccine diminishes the severity of illness no matter which strain you get.
Infants and children respond better to the vaccine than adults. About 70 to 80% of the time the vaccine works in children, which means that 70 to 80% of children who get the vaccine don’t get influenza. The 20 to 30% who still catch the flu have milder illness, fewer hospitalizations, and almost never die from influenza (compared to those children who didn’t get the vaccine). Bottom line: Still worth it.
And no, you can’t get the flu from the flu shot: it’s a dead vaccine.
What about HPV vaccine for my teenager? Does it cause (fill in the blank)?
The HPV vaccine has been reputed to cause infertility, multiple sclerosis, migraines, ovarian failure, hypersexuality, chronic fatigue syndrome, etc.
Here’s the lowdown: Europe and the United States had huge population studies that were not funded by pharmaceutical companies. Those studies showed that teenagers who got the HPV vaccine were no different in their disease profiles after receiving vaccine than teenagers who didn’t. HPV vaccine doesn’t cause any of that bad stuff but it does prevent all sorts of cervical, anal and oral cancers.
Here’s the rub: The vaccine is most effective if given before age 15 and before any sexual initiation (oral sex or intercourse). For these reasons, giving the first dose at 11 and getting the second dose at 12 makes sense. The data is clear that this does not result in earlier initiation of sex. In fact, it seems that the tweens who got HPV vaccine at 11 and 12 were slightly later at first sexual contact that children who received the vaccine later or never received it. Of course, it isn’t the vaccine delaying things but may instead reflect the fact that parents who are comfortable with the HPV vaccine are also comfortable talking about sex with their children.
Can I let my kids play with/be around unvaccinated children?
Giving your children vaccines provides them with a suit of armor of sorts. No protection is perfect, but vaccinations done on time and in the usual way confers excellent protection. Once a baby has received the primary series (by six months for all vaccines but MMR and chicken pox), he is in very good shape. Even after a single vaccine, the immune system is stimulated and immunity to the disease begins, so being around others shouldn’t be feared.
Of course, common sense needs to prevail. For very young infants or for those who can’t be immunized, if the children you are going to be around have signs of illness or were exposed to serious contagious illness and are not vaccinated themselves, being cautious makes sense.
I’m sure some of you have other questions, like whether there is mercury in vaccines (there’s not) or whether aluminum is a concern (nope) or if preservatives are a concern (vaccines have been preservative-free for years now).
Another question parents ask is if the number of vaccines is too much for a baby’s immune system. This is a long answer, but the short answer is no. The antigen load was much higher when I was a kid than infants receive now because vaccine doses were so much higher back then.
I wish I had the space and time to answer every vaccine question, but I don’t. However, Beaumont provides this information and I can also direct you to this additional resource for answers.
I also encourage parents who have concerns about vaccine safety to talk to their pediatricians about them. We won’t vaccinate a child who is too fragile or for whom vaccines are risky. Avoid Googling information since it can be difficult to discern what is “good” science from “bad” science. Instead, trust that we pediatricians, like you, have your child’s best interest at heart. We are your best partners for the health of your child.
– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.