Parents are enrolling their children in school, students are entering college, and health care workers are preparing for the upcoming flu season. It's the perfect time to remind family, friends, co-workers, and those in the community to catch up on their vaccinations. Jody Murph, MD, MS, pediatrician at University of Iowa Children's Hospital, says immunizations are one of the most valuable and one of the most cost-effective public health interventions we have.

"In the 1920s, measles, diphtheria, and whooping cough killed 2,000 individuals every year in the United States. And today, most of our young parents and many of our young pediatricians have never even seen these diseases. Each year, if you look worldwide, 2.5 million children under the age of five die from vaccine-preventable diseases. And adults also die from vaccine-preventable diseases - 600,000 people around the world die from hepatitis B every year and nearly 250,000 die from human papilloma virus.

"So it's an incredibly important benefit that we're able to give our children,"Murph says. "It's one that's constantly changing as far as the vaccines that are available and the recommendations for their use. Families need to continue to talk to their health care providers about 'What vaccines should my child get today?'

"The Advisory Committee on Immunization Practices (ACIP) makes recommendations about who should receive which vaccine and when those vaccines should be given. That recommendation changes virtually every year for some vaccines as new vaccines are added or new recommendations are made. This is published in January of each year, so health care providers have access to these recommendations and parents should always ask about vaccines when they take their child for a well-child visit."

Murph says the first childhood vaccine is given at birth with the first dose of the hepatitis B vaccine. The primary series is complete by two years of age. "There are some boosters that are given subsequent to that and then there are some targeted vaccines given to adolescents at age 11 to 12.  

Several newly approved vaccinations this year include:

• The HPV vaccine is a new vaccine that was just approved this year. It's given in three doses: first dose, then two months later a second dose, and then a third dose at six months. It's licensed by the FDA to be given to girls between the ages of 9 and 26 years. The Advisory Committee on Immunization Practices recommends that all girls 11 to 12 years of age should be given this vaccine.

HPV is one of the most common sexually transmitted diseases and in the United States, says Murph, with 20 million people are infected with this virus, and it's estimated that 75 percent of sexually active young women at sometime will acquire the human pappiloma virus. "If they become infected, the body usually clears the infection on its own, but for five to 10 percent of these young women, they may develop persistent infection and if this persistent infection is one of the high risk types of virus, they are at risk for cervical cancer.

"HPV is the highest risk factor for cervical cancer, so the importance of this vaccine is that it includes the two types that account for 70 percent of all cervical cancers. And if you look worldwide, cervical cancer is the second most common cancer among women, with nearly 300,000 deaths each year. And in the United States each year, we have 10,500 new cases and nearly 4,000 deaths every year."

• Varicella is chicken pox and this vaccine has been around since 1995 when we began using it routinely. Recently it's become apparent, says Murph, that with only one dose, we saw breakthrough infections, where vaccinated children who had not developed immunity are becoming infected. "So recently, the recommendation from the ACIP was that a second dose should be given at 4 to 6 years of age. So first dose is given at 12 to 15 months, second dose is given at 4 to 6 years, and we now have a combination vaccine, which includes the measles, mumps, rubella vaccine and varicella, so we can in fact give these two vaccines together. So instead of getting two shots, they can get one.

"The vaccine update was related not only to what we saw in Iowa, but again nationwide, we saw that with only one vaccine, just as with measles vaccine, only one vaccine is insufficient because not every child develops an adequate immunity after one, so they need two." 

• Rotavirus is the most common cause of severe gastroenteritis or vomiting and diarrhea in the world and among children, there are 440,000 deaths every year around the world, and 80 percent of these occur in developing countries. Murph says the vaccine is 74 percent effective at preventing any disease caused by this virus, but it's 98 percent effective in preventing severe disease.

"And I think that's the most important part, each year there are many children who are hospitalized or severely ill with vomiting and diarrhea caused by this particular virus, so this looks as though it will be a very effective vaccine to prevent that. It's given routinely at two, four, and six months of age and it's important for parents to know that the first dose must be given between six and 12 weeks of age.

• Hepatitis A vaccine is not a new vaccine, but a new recommendation for a vaccine that we've been using for many years, says Murph. "Hepatitis A is a common liver infection and it's often transmitted among children. Children may not have symptoms, they may not turn yellow or become jaundiced, so they frequently pass that to their playmates and their families and their child care providers.

"The recommendation was made recently that all children should be immunized against hepatitis A beginning at one year of age, with the second dose being given six to 12 months later. This is a highly effective vaccine, it's nearly 100 percent effective after the second dose, so this is important.

"With the globalization of the food supply, we not uncommonly have fruits or vegetables that come to us from developing countries, where the risk of hepatitis A is more common. We've had outbreaks in restaurants of hepatitis A related to the food supply. So I think this is something that, again, we want parents to talk to their health care providers about."

Murph says it's important that parents seek accurate information about vaccines and vaccine preventable diseases. "Their health care provider is the best source of information about that. There's a Web source, www. immunize.org , which also has a very balanced presentation of benefits and risks.

"I think parents try to make good decisions for health care for their children, but sometimes what they read in the literature or what they hear in the media are reports more about possible adverse risks than about the benefits. I want parents to feel comfortable knowing that the risks of a vaccine are far less than the risks a child would have if they acquired the wild disease, he says.

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