August is National Immunization Awareness Month. According to the Center for Disease Control and Prevention, vaccine-preventable disease levels are at or near record lows. But that does not mean we can take high immunization coverage levels for granted. It is still very important to continue to receive immunizations throughout your life. Christine Ziebold, MD, PhD, MPH, pediatric infectious disease specialist at University of Iowa Children's Hospital, talks about pediatric vaccinations and why they are so important:
With childhood diseases becoming more and more uncommon, why is it still important to vaccinate and immunize?
Because the childhood diseases we vaccinate for are really serious illnesses and are not eradicated. That means they are not gone forever in this country, let alone other countries, and most never will be eradicated. So it is very important to keep up the defenses.
If enough people are vaccinated against a disease, it cannot spread. This is something we call herd immunity and hence, we have universal vaccination programs. That means everybody needs to get vaccinated and the success depends on participation.
At what age should immunizations and vaccinations begin?
At birth when a baby's mother is unsure if she has had hepatitis B immunity or not. You really don't know this because you may not have any symptoms, so you need to be tested. The hepatitis B vaccine has been an absolute blessing to this country because it has stopped children from getting liver disease, cirrhosis, and liver cancer later in life.
Is it okay for a baby to receive multiple vaccinations on the same day?
This is a great question. People think that the immune system can get overwhelmed. The immune system is an absolutely amazing living thing. We know that infants a few hours after birth are capable of mounting immune responses—protective immune responses, that is. We know that infants have the capacity to respond to enormous amounts of antigens, so the seven different illnesses we vaccinate them against at the age of two months is a tiny amount.
It's been calculated that infants have the potential to react to 10,000 vaccines at one time, and there are clear data that vaccinated children are not more likely to develop infectious diseases than unvaccinated children. Actually, infants get fewer antigens in vaccines today than they did 40 or 100 years ago.
Why so many shots within the first year of life?
Because it's the time of the highest vulnerability for infectious diseases for a child, they don't wash hands and they're just much more vulnerable. The other reason is that we have more vaccines available that we didn't have just 10 years ago.
What are the risks parents take by choosing not to immunize their child?
The risks are clearly first to their child remaining unprotected when the fire strikes so to speak. Now sometimes this may work out fine and a child may overcome an infection with or without complications. However, sometimes the child may get extremely ill and it may be hard to treat with antibiotics getting more and more resistant, for example. Sometimes vaccinations or illnesses postponed are much harder to deal with when older, for example chicken pox in adults.
Are there circumstances when you would recommend children not be immunized?
Yes, but they are really rare. They apply first and foremost to kids who have documented hypersensitivity with anti-phylaxis—a life-threatening allergic reaction to a vaccine component, and that could be eggs, gelatin, neomycin. There are also kids who have immune deficiencies, even HIV infected children we vaccinate with regular vaccines, including MMR. So it's really rare exceptions.
Why do adolescents need immunizations if they received them as infants?
It's interesting because we've learned more about vaccines as time went on. The immune response to certain bacteria is subject to aging, which is true for whooping cough, very clearly.
Some children may have fallen through the cracks and never received them, too. In the case of rubella, girls need to be immune prior to child bearing. Birth defects due to rubella were rampant before we had immunization and repeat at teenage years.
Vaccines are, let's face it, essentially imperfect imitations of the real thing, an infection. We learned from recent outbreaks with measles and mumps that some people who were vaccinated got it. Vaccines can differ in strength and the potency can depend on storage conditions. Giving it improperly—too shallow into the skin or the muscle or the reverse (too deep)—can affect the immune response. All these things that can happen need to be rectified.
Do vaccines and immunizations have side effects?
It is clear that vaccines have more or less painful side effects, but usually they're benign. They're mild. The local reactions are the most common ones—redness, pain, swelling, and then mild or moderate fever. Real serious adverse events are rare.
There is a lot of information on the Web about side effects and the need for immunizations. What do you tell parents who question the need for, or are worried about, the side effects of vaccinating or immunizing their child?
This is a tough one. I tend to stay relatively firm and brief. I listen respectfully and carefully to see what the concerns exactly are. I try to correct any misperceptions and produce data and refer them to well-researched sites because very often I find that the information the parents have found are not really bona-fide. This is a difficult situation, but many of us are rather categorical because we are worried that unvaccinated children put other kids at risk. |
