Vaccine answers every parent needs

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.

Final thoughts

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.

When the Needle Arrives, My Child Dives: Keeping Your Child Calm During Shots

Little boy holding up his sleeve for a shot

Children receive shots often within the first couple years of life and multiple shots if they have a chronic medical condition. These times can be anxiety-provoking for the child as well as for the parent. Here are some tips on how to prepare your child (and yourself) for shots.

  • The truth shall set you free
    • Kids appreciate honesty. Tell your child about the doctor’s visit and the likelihood of getting a shot. Begin this practice during infancy as this will help your youngster know what to expect and trust that you will be there to provide comfort and reassurance.
  • Be prepared
    • Distraction works! Consider bringing a favorite toy or blanket for youngsters. Bubbles or cartoons on a tablet or iPad may help toddlers and school-age children. Music can help older children. Some kids may try to negotiate their way out of getting a shot. When this happens, provide limits with choices. For example, “You have to get a shot. You may sit on the exam table or sit in the chair”, or “Which arm do you prefer, the right or the left?”
  • Gold star
    • Reward your child for completing the task. Stickers, choosing the Band-Aid, and a small toy from a treasure chest are all suitable examples. Focus on the positives such as sitting still, being brave or using a distraction technique such as deep breathing. Don’t focus on the behaviors that we want to decrease such as screaming or avoiding.
  • Anything else?
    • You may consider some over-the-counter topical agents that can be applied to the site prior to the shot. Ask your pharmacist or doctor for the best way to use the product.
    • Remind yourself and your child about the benefits of getting shots. They help you stay strong and healthy or to feel better quicker if sick.
    • One more thing, hugs and kisses from mommy and daddy are by far the best feel good medicine after shots (even for teenagers), so be sure to double the cuddles!

– Carnigee Truesdale-Howard, PsyD, ABPP is a Pediatric Psychologist with Beaumont Children’s Hospital Divisions of Hematology/Oncology & Gastroenterology.

No Debate: Vaccinating Children is Safe, Effective for Disease Prevention

Little boy holding up his sleeve for a shot

There’s a big debate raging among parents: to vaccinate or not to vaccinate. But if you ask pediatricians, infectious disease physicians and allergists, there’s no debate. Vaccinate.

“There isn’t a single vaccine on the market that hasn’t been cleared by the Food and Drug Administration,” says Bishara Freij, M.D., chief of Pediatric Infectious Diseases at Beaumont Hospital, Royal Oak. “The FDA even sends inspection teams to the manufacturers overseas who distribute vaccine in the United States. Having children vaccinated in the United States is a safe and effective way to prevent many communicable diseases that can be deadly.”

Those who argue against vaccinating children tend to fall back on the same misinformation:

  • There’s mercury, or thimerosal, in vaccines.
    There hasn’t been mercury or thimerosal, which is a preservative, in pediatric vaccines in more than 10 years. “The concern was always with the developing brain and the effects of mercury,” explains Dr. Freij. “Researchers measured mercury levels before and after vaccination, and found there was nothing to note.” Only multi-vial doses for adults contain some thimerosal.
  • Vaccines can cause autism.
    “This has been studied and researched endlessly in many countries because parents expressed concern,” says Dr. Freij. “There is no increased risk for autism and there’s no science to support a link. It’s just an unfortunate coincidence that children are at the height of their vaccination schedule around the same time that autism signals start showing.”
  • Why would I inject my child with poison?
    “I tell people that my son got every vaccine that was available and sometimes before it was recommended for his age,” shares Dr. Freij. “The idea of ‘poison’ is the price for success. Many of the diseases children are vaccinated against are under control now, but that leaves room for people to focus on the sideshow. The benefits of vaccination far outweigh any perceived risk of poisoning.”
  • The herd mentality
    There’s a difference between herd immunity and herd effect. “Herd immunity only happens with live vaccines,” explains Dr. Freij. “For example, I get the vaccine and it passes through my system and comes out as bodily waste. Other people inadvertently become vaccinated with direct contact and cross contamination.” The herd effect happens when unvaccinated people are the minority population. Those who are vaccinated won’t become ill, which reduces the transmission of the infection and reduces exposure for unvaccinated people. Unvaccinated people aren’t protected, they are just less exposed. “The ideal rates for vaccination are over 95 percent,” says Dr. Freij.
  • People die from being vaccinated
    Death from vaccinations is extraordinarily rare, according to Dr. Freij. “If a child dies from a vaccine, it’s usually because they were immune compromised and didn’t know it,” he says. “Or they developed anaphylactic shock which is an exceedingly rare event.”
  • My child is allergic to eggs.
    According to Devang Doshi, M.D., chief of Pediatric Allergy and Immunology at Beaumont, Royal Oak, eggs are only a concern with two vaccines in the United States: influenza and the MMR (measles, mumps and rubella). “The amount of egg protein in these vaccinations is so miniscule, the American Academy of Pediatrics and the American Academy of Allergy, Asthma and Immunology recommend giving them to children with egg allergies,” Dr. Doshi says. “The typical protocol is to give the vaccine and then have the patient stay in the doctor’s office for 30 minutes to be monitored as a precaution.” A normal reaction to the shot includes a low-grade fever, redness at the injection site and slight swelling. “Restricted airway, hives, swelling of the lips and eyelids are signs of an anaphylactic reaction, which is exceptionally rare, especially in view of an egg allergy. But the risk of not vaccinating due to an egg allergy is not worth the theoretical risk of a potential reaction and definitely not worth getting a life-threatening infection.”

If you have concerns about vaccinations, Dr. Freij recommends checking out the websites for the Centers for Disease Control and Prevention as well as the American Academy of Pediatrics. “All these concerns have been tested and debunked,” says Dr. Freij. “It’s a false sense of safety to believe medical information that’s not supported by science. You’re setting yourself up to be bamboozled.”

Vaccine Awareness

Little boy playing in leaves

As we settle into fall and winter approaches, it’s inevitable that part of your little one’s exploration will include viral/bacterial contact. While it may only lead to a simple cold, it could be something more serious with vaccine-preventable illnesses such as pertussis (whooping cough), measles and influenza (flu) on the rise. The best way to combat illness is with prevention measures such as hand-washing and through immunizations.

The World Health Organization estimates that vaccines prevent 2–3 million deaths per year from vaccine-preventable illnesses. Immunizations protect people against communicable diseases that can be spread through contact or droplets in the air. Immunizations work by vaccinating using a dead or weakened virus/bacteria, which triggers an immune response that prompts the body to create an antibody that will attack and destroy that specific pathogen if a person is exposed again. Some vaccines will require boosters before a person is fully immunized.

Vaccines do more than protect individuals; they protect communities through a concept known as herd immunity. We rely on herd immunity to help protect those who don’t respond to a vaccine or who are unable to get the vaccine due to allergy or contraindications. Herd immunity relies on 95 percent of the population being vaccinated. Unfortunately due to a reduction in vaccination rates, vaccine-preventable illnesses such as pertussis, measles and influenza are on the rise in the United States and worldwide.

  • A decline in the vaccination rate of the population led to an increase in measles outbreaks where herd immunity had been compromised. In 2011 the measles vaccination rate in France dropped to 89 percent; following the decline in the vaccination rate, 14,000 people in France developed measles.
  • A spike in pertussis cases in 2012 led to 18 deaths in the United States, mostly in infants under 3 months of age. In 2013 the number of reported pertussis cases declined and was attributed to widespread immunization of adolescents and adults to pertussis. While pertussis cases still were quite high in 2013 even with the year-over-year reduction, hopefully with increasing knowledge a further reduction will occur annually.

While children receive the majority of vaccines in the first two years of life, children may not be fully protected until they’ve had all of their boosters. Infants are the most vulnerable to disease, which is why the immunization schedule specifies the majority of vaccines to be received by two years of age. In light of the natural vulnerability of infants, it’s important to make sure that the whole family is up–to-date on immunizations to protect those who haven’t been fully immunized or are too young to receive immunizations. Certain immunizations like the flu shot need to be given annually due to the ever-changing morphology of the influenza viruses.

Myths and misinformation may confuse parents who are trying to make sound decisions regarding vaccines. Certain allergies or disease conditions may make it so a person is not a candidate for a vaccine. Make sure to get the facts and speak with your child’s health care provider if you have concerns regarding the safety of vaccines.

While exploration is wonderful to a child’s development, it’s important to ensure they are safe while doing so. As influenza season begins in October, this is the perfect time of year to evaluate the entire family’s immunization status in preparation for a healthy winter.

– Melissa Rettmann, M.S., PA-C, has a background in pediatrics and allergy. She is the mother of a toddler and volunteers with the Parenting Program.