Immunizations

The physicians of The Pediatric Group fully support vaccines and believe in their safety.  It is our obligation to be knowledgeable about the risks and benefits of the immunizations we recommend for our patients.  None of us accept vaccine safety data blindly, but have made educated, informed decisions about our recommendations to our patients.  We believe strongly in the sound body of scientific evidence that exists to support vaccine safety.

We recommend that if you have questions beyond a discussion with your pediatrician that you refer to these websites mentioned below, as we consider them to be expert resources on the subject.

Consult the Center for Disease Control and Prevention website for the recommended immunization schedule.

The Children’s Hospital of Philadelphia’s Vaccine Education Center is a comprehensive resource for vaccine information.

The Allied Vaccine Group is another good site to check out.  Here’s a quote from their site:
“You will not find blind advocacy here, or anger, or fear. Instead you will find the facts you need to know, whether you are a patient, a parent, a health care provider, a researcher, a journalist or a policymaker.”

Another excellent site for information is provided by the Johns Hopkins School of Public Health.  Their Institute for Vaccine Safety has medical research summaries and citations for you to utilize in your quest for information.

Immunization Myths

Sitting through your baby’s immunization-induced meltdown can be as painful for you as it is for her. That is, if the nagging worry that these routine shots could do more harm than good doesn’t get to you first. No wonder a recent study from the University of Michigan found that 93 percent of pediatricians had at least one parent who refused a vaccination for their child during the past year.

Why are vaccines under fire? Some experts say it’s due to their success. “It’s the natural evolution of a  vaccine program,” says Paul Offit, M.D., chief of infectious diseases and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “As you eliminate the diseases, people are not as compelled to get vaccines.” Adds Kathryn Edwards, M.D., spokesperson for the National Network for Immunization Information, “Many diseases are out of sight and then out of mind. So people don’t see the value of vaccines.”

Yet high immunization rates are necessary to keep diseases like measles and even polio from making a dangerous comeback. Here are ten myths about vaccines -and the truth behind them.

Myth 1: Getting so many vaccines will overwhelm my child’s immune system.

No doubt about it, the immunization schedule recommended by the Centers for Disease Control and Prevention and the American Academy of Pediatrics (AAP) can seem daunting. Your child can receive up to 23 shots by the time she’s 2 years old and as many as six shots at a single doctor visit. So it’s not surprising that many parents have concerns about how vaccines might affect a child’s developing immunity and often cite these as a reason to refuse a vaccine.

But it should be the least of your worries. “Children have an enormous capacity to respond safely to challenges to the immune system from vaccines,” says Dr. Offit. “A baby’s body is bombarded with immunologic challenges – from bacteria in food to the dust they breathe. Compared to what they typically encounter and manage during the day, vaccines are literally a drop in the ocean.” In fact, Dr. Offit’s studies show that in theory, healthy infants could safely get up to 100,000 vaccines at once.

The bottom line: It’s safe to give your child simultaneous vaccines or vaccine combinations, such as the five-in-one vaccine called Pediarix, which protects against hepatitis B, polio, tetanus, diphtheria, and pertussis (also known as whooping cough. Equally important, vaccines are as effective given in combination as they are given individually.

Myth 2: As long as other children are getting vaccinated, mine don’t need to be.

Skipping vaccinations puts your baby at greater risk for potentially life-threatening diseases. “The ability of immunizations to prevent the spread of infection depends on having a certain number of children immunized,” says Thomas Saari, M.D., professor of pediatrics at the University of Wisconsin Medical School in Madison. “Scientists refer to this as ‘herd immunity.’ Unfortunately, the level of immunization required to prevent diseases such as measles from spreading from child to child is high – 95 percent.” In 2003, the national vaccination rate in children ages 19 to 35 months was only about 80 percent – though that number increases to the mid-90s when children reach school age. These rates may not be high enough to provide herd immunity, especially as exemptions from school vaccines are on the rise.In studies from Colorado, where residents claim high numbers of vaccine exemptions for medical, personal, and religious reasons, kids who are not immunized are at greater risk for disease. Case in point: They’re 22 times more likely to come down with measles.

Myth 3: Now that major illnesses have largely disappeared, we really don’t need vaccines anymore.

Don’t bet on it. Despite our relatively high vaccination rates in the U.S., many American communities still have outbreaks of diseases like measles and pertussis, a respiratory illness characterized by spasms of coughing that can last for weeks or even months. In 2003, 13 children died of the infection.

Unvaccinated children can also spread infection to vulnerable family members. “Those children are more likely to give a disease to those who can’t fight it off, such as a six-month-old or a grandparent living at home,” says Dr. Saari. The incidence of whooping cough has been increasing since 1980, and the Centers for Disease Control and Prevention recently recommended a pertussis booster shot for 11-year-olds because the risk of passing the disease to a vulnerable relative is so high.

What’s more, diseases are spread by people from foreign countries who travel here. “Air travel has extended the range of diseases from countries where people aren’t immunized,” says Dr. Saari. “We’re no more than one airplane ride from being exposed to many diseases.”

Myth 4: Vaccines cause autism and other disorders.

Concerns about a link between a combination vaccine for measles, mumps, and rubella – called the MMR vaccine – and the developmental disorder autism got kicked up by a case report from England seven years ago. But it has been roundly discredited. The notion has persisted because autism tends to emerge around the time that the vaccine is given – when a child is a year old. Experts stress, however, that this does not mean the vaccine caused the problem. “Not only is there no evidence that it causes autism, there’s evidence that it doesn’t cause autism,” Dr. Offit says.” In fact, there have been 14 studies that show your risk of getting autism isn’t any different if you got the MMR vaccine or if you didn’t.”

The Institute of Medicine backed up that conclusion in a report issued last summer. Worries linger, Dr. Offit adds, because “it’s hard to unring the bell. People reasonably assume that if there is nothing to it, why was there so much smoke?” Parents have expressed similar fears about vaccines and the incidence of sudden infant death syndrome (SIDS). “Numerous vaccines are given to little babies over that first year, just when a lot of developmental changes are occurring,” says Dr. Edwards. “If something happens around the time a vaccine is given, it’s easy to think the vaccine caused it.”

Myth 5: My baby might get the disease it’s supposed to prevent.

“Most vaccines we give today, such as meningitis and DTaP, contain killed vaccines – not live agents that could replicate,” says Dr. Edwards.

That’s true of the scariest diseases doctors vaccinate against, such as polio, which was once made with live weakened polio virus. Until this type of vaccine was phased out, around 1994, a tiny fraction of people – one in 2.4 million – contracted polio from the vaccine itself. But since then, children in the U.S. have received polio vaccine made from killed virus, so there’s no risk of contracting the disease from the shot. A few vaccines that are on the schedule do, however, contain live weakened virus to provoke an immune response. These include the MMR and chicken pox immunizations. “These vaccines have the potential to cause some mild illness – a little fever and rash,” explains Dr. Edwards. “But the illness is much less severe than if a child naturally contracted measles or chicken pox.”

Myth 6: Vaccines can contain preservatives that are dangerous.

Until recently, many vaccine concerns centered on the safety of thimerosal, a compound that prevents the vaccine from being contaminated by bacteria and contains a form of mercury called ethylmercury. Mercury in large quantities is known to be harmful to a child’s developing brain. Worries about thimerosal’s effect on children prompted its removal from nearly all childhood vaccines in 1999. (Thimerosal is still present in some flu vaccine – though you can ask your doctor for a thimerosal-free shot.)

Yet it’s become clearer since then that ethylmercury does not pose the same health hazard as its cousin, methylmercury, a metal found in the environment that’s known to accumulate in the body and cause harm to developing children. “The body is able to eliminate ethylmercury much more quickly than it can eliminate methylmercury,” says Dr. Offit. University of Rochester researchers confirmed that when they compared mercury concentrations in the urine, blood, and stools of children who got vaccines containing thimerosal with those of kids who received only thimerosal-free vaccines. All the children had mercury levels well below the EPA’s most stringent public safety limits.

Even if your baby received a vaccine that contained thimerosal, the overwhelming majority of data support a lack of association between the substance and neurological problems, says Margaret Rennels, M.D., the chair of the committee on infectious diseases of the AAP, who points out that children are exposed to mercury from many environmental sources. “The reality that a lot of people seem to miss is that the largest source of organic mercury is the environment: the air we breathe, the water we drink, and the fish we eat. That’s due to the burning of coal,” she says. You can lessen your child’s mercury exposure by limiting the amount of fish she eats. The Food and Drug Administration says that it’s safe for young children to eat albacore tuna once a week and fish that are lower in mercury (such as “chunk light” tuna, pollack, salmon, and catfish) twice a week. (Shark, swordfish, king mackerel, and tilefish, which have high mercury levels, are off the menu.)

Myth 7: You shouldn’t give a vaccine to a child who has a cold.

It’s reasonable to think that a sick child would be more likely to have a bad reaction to a vaccine or that it might present an added burden to her immune system if she’s fighting off a cold. Yet studies show that having a mild illness doesn’t affect a child’s ability to react appropriately to the vaccine.

“Certainly if a child comes in with a fever of 102 and a rip-snorting ear infection, it’s not the best time for a vaccine,” says Dr. Rennels. “But a low-grade fever, mild respiratory infection, or a little diarrhea shouldn’t be reasons to delay one, especially if the illness is on the way out.”

Of course, vaccines can themselves trigger side effects, including fever and rash, as well as soreness at the site of the injection, but these are rarely cause for alarm. The five-in-one Pediarix is more likely to cause a low fever than the individual shots are, but many moms say the fewer injections for their child, the better. Call your doctor right away if your child has hives (which can indicate an allergic reaction), a fever of 105 degrees or higher, or convulsions.

Myth 8: I had chicken pox when I was a kid and it isn’t a big deal.

Like several common childhood diseases, chicken pox isn’t a big deal for most kids. “But on rare occasions children can die from it,” Dr. Rennels observes.

Before the vaccine was introduced, many children were hospitalized each year with serious complications, including pneumonia and dangerous skin infections. “Chicken pox lesions can become infected with staph, including necrotizing fasciitis – the ‘flesh-eating’ bacteria,” says Dr. Rennels. Getting the vaccine is especially important now that less of the chicken pox virus is in circulation. “Children who don’t get chicken pox or the vaccine are at risk of getting it as an adult, which is a much more serious illness.”

Myth 9: Vaccines can provide 100 percent disease protection.

Not quite. The best vaccines are those made with live weakened virus, such as MMR and chicken pox, which are about 95 percent effective. The effectiveness of vaccines made with killed, or inactivated, virus is between 75 and 80 percent. That means there’s a chance you could be vaccinated against a disease and still get it. But, says Dr. Edwards, if all children are vaccinated against an organism, it’s less likely to hang around. That’s why vaccinating an entire population is so important. “Not getting vaccinated is like failing to stop at a four-way stop,” Dr. Edwards says. “If three people get vaccinated but one doesn’t, the risk is not bad. But if two people don’t get vaccinated, the burden of risk is greater on everyone.”

Myth 10: It’s best to wait until children are older before starting to give them vaccines.

Immunization schedules are designed to protect the most vulnerable patients from disease. If you wait to give the vaccine, you may miss the window when a child is most vulnerable. “When you get off the schedule, you really put your child at risk,” Dr. Saari says.

Case in point: Last year in Wisconsin 300 children under age 1 came down with whooping cough, 177 of them less than 6 months old. Of these, half were hospitalized and three died. Yet, says Dr. Saari, “for a child to die from whooping cough in this day and age is criminal.”

The text of this article was copied with permission from an article in Babytalk magazine.  The author is Beth Howard, a freelance writer.

More Info

The Shot Parents Need to Get

What is the world is Tdap?

New Federal guidelines call for adults to vaccinated against pertussis (a.k.a “whooping cough”). Pertussis, commonly known as whooping cough, is a highly contagious infection of the respiratory tract.  Most children are immunized against pertussis with their routine childhood immunizations.  However, because the last pertussis immunization is given at age 4-6, that immunity wanes as the child gets older; and often teenagers, young adults, and adults are left unprotected.  Outbreaks of this highly contagious disease are on the rise. There has been an epidemic of pertussis over the past 1-2 years.  In 2004, 27% of the reported cases were in the 19-64 age range.  Pertussis in adults will manifest as a cough, often mild, or it may be severe with prolonged coughing spells followed by the characteristic “whoop” that may even result in vomiting due to the severity of the spasms.  Complications may include rib fractures and/or pneumonia requiring hospitalization.

Most importantly adults with pertussis can transmit the infection to others who are at risk, primarily young children and infants, who are exposed to their parents’ coughing and respiratory secretions.

Infants are at highest risk of pertussis-related complications because they have no immunity at all and their airways are much smaller.

The Advisory Committee on Immunization Practices (ACIP) has now recommended the routine use of a new tetanus booster.  Normally, tetanus boosters (Td) only gave protection against tetanus and diphtheria.  The new vaccine (Tdap) includes another dose of pertussis vaccine.  This is recommended for all adults 19-64 in place of the old tetanus booster.

If it has been greater than 10 years since an adult has had a Td booster, they should now receive a singe dose of Tdap, the tetanus, diphtheria, and acellular pertussis vaccine.

Tdap may be given to adults if the interval has been under 10 years since their last tetanus booster if they are in contact with younger children who may be susceptible to pertussis.

Adults who have frequent close contact with children less than a year of age, such as parents, childcare workers, and health-care providers should receive a single dose of Tdap.

We can only immunize children in our practice.  However, all parents are urged to discuss this new vaccine with their personal physician.  If it has been more than two years since you have received a Td tetanus booster, you should see about getting a Tdap booster to help prevent the further spread of pertussis.

Vaccines for Children

Why was the VFC program created?

Many parents can’t afford to pay for vaccines on their own. When large groups of children go without vaccines, it leaves them unprotected and disease outbreaks can happen. This program allows everyone to stay healthy by getting his or her vaccines on time.

Do I have to bring anything to prove my child is eligible for free vaccines?

No. You do not have to show any proof that your child is eligible for free vaccine. However, we are required to ask you and document the following:

  • Does your child have any health insurance coverage?
  • Does your insurance plan cover required childhood immunizations?
  • Is your child of American Indian or Alaskan Native heritage?
  • PLEASE NOTE:  It is the parent’s responsibility to inform us that your child’s insurance does not cover immunizations BEFORE any shots are given.  Unless you tell us otherwise, we assume your child is covered.  No changes can be made once shots are given and insurance is billed.

We may have some of this information on your child in their chart or as part of our normal business records, but if your child’s insurance changes, you must inform our office of those changes.

The vaccines are free, but what if I can’t pay for the doctor visit?

Although the vaccines your child may receive are provided free of charge, the doctor still has the right to charge a fee for an office visit. Also, the doctor participating in the VFC program also has the right to charge an administrative fee for giving your child a shot, and this will be in addition to an office visit fee. This administrative fee is similar to a patient’s insurance co-pay, except in this instance the fee helps the doctor to offset their cost of doing business related to administering vaccines. This administrative fee is different in every State, and is capped at a limit  that cannot be exceeded.  In 1994 these fees were published in the Federal Register and remain unchanged.

Please note: If a doctor’s office participates in the Vaccines for Children Program, the doctor is required by law to administer the vaccine to a child even if a child cannot afford to pay the administrative fee. This requirement only applies to the administrative fee for vaccines, not for office visit fees, or any other fees established by a doctor’s practice. Parents must make appropriate payment arrangements with providers relative to office visit charges.

My child is behind on their shots. Can they still get VFC vaccine?

Yes, absolutely. It doesn’t matter how far behind your child is in receiving their shots. The VFC Program will provide us with all the recommended childhood shots to get your child caught up. Call our office to discuss how your child can be brought back up to schedule. Consult the recommended catch up schedule for details.

My child is healthy.  I’ll just wait until school age to get them vaccinated.

No. This is highly discouraged. Many of the immunizations children need today are intended for very young children in their first months of life, because that is when they are most at risk for contracting vaccine-preventable diseases. Thus, waiting for when a child starts school can be very dangerous to your child’s health in their first five years of life. Additionally, the standard of care today for all young children is that they be examined and evaluated by a doctor for other important purposes besides immunization. Immunization is just one component of your child’s overall well-being. So please bring your child for regular and periodic visits as scheduled.

For more information, see the Vaccines for Children section of the CDC web site.