Childhood Immunizations: An Objective Examination
July, 2008 -- Over the years, a wide range of immunizations for children and teens have been developed. These vaccines protect against diseases as diverse as polio, chicken pox, whooping cough, measles, meningitis and human papillomavirus. Immunizations typically begin in infancy and now continue through life. In fact, adults need booster shots for tetanus and diphtheria and most physicians also recommend a yearly flu shot. Additional vaccinations are needed as we age, for example, the shingles vaccine is recommended at age 60.
As the new school year nears, many parents are making pediatrician appointments to ensure their children’s immunizations are up-to-date. Some wonder if immunizations are really necessary since the diseases they protect against are all but vanquished. Others hesitate to vaccinate because of concerns about vaccine side effects. Their concerns are fueled by media stories about parents who believe their children’s autism or other health problem was related to a vaccine they received and by the recent decision by the National Vaccine Injury Compensation program that vaccines given to a young girl with a previously undiagnosed underlying cellular disorder known as mitochondrial disorder may be linked to the brain damage she suffered and the autism-like symptoms she developed.
But in counterpoint to those concerns, researchers from Boston recently discovered a genetic mutation found in some children with autism. They looked at the entire genetic code of nearly 1,500 children with autism and found that 24 children with autism had missing or duplicate DNA on chromosome 16. They compared this finding with over 18,000 control subjects. Although not every autistic child had this DNA abnormality, it appears to be an important key to unlocking the biological roots of autism. Scientists believe this mutation increases the risk of autism 100 times. This finding also supports many researchers’ view that autism has a genetic cause and is not caused by vaccines.
“The best protection parents can provide for their children is to make sure they receive the vaccines recommended by the Centers for Disease Control and Prevention (CDC) within the recommended timeframe,” says Dr. Miles J. Varn, PinnacleCare’s Chief Medical Officer.
Vaccine concerns answered
One reason some parents question the need for vaccination is that they have never seen the devastating consequences of the diseases these immunizations prevent.
“It’s a question of the length of your perspective,” explains PinnacleCare Medical Advisory Board Member Dr. Michael Johnston, a pediatric neurologist. “I have been in this field for 20 years and I have seen the terrible complications and damage to the nervous system that infectious diseases like measles and meningitis can cause—brain damage, blindness, deafness, death. Over the years, I have seen complications from these diseases drop dramatically as immunization rates have risen. It’s a dangerous world with pathogens, viruses and bacteria that can do a great deal of damage. Vaccines have led to a major reduction in death and disability for our children. If we stop immunizing, the risks these diseases present will return. The risk benefit assessment is very clear. Children in general are better off with vaccinations than without them.”
Data from a large historical study released by the CDC in 2007 demonstrates the power of immunizations. That study found that death rates for 13 preventable diseases had hit all time lows in the U.S. For nine of the diseases studied, death rates had dropped 90 percent since the introduction of vaccines, while for smallpox, diphtheria and polio, deaths had dropped by 100 percent.
Counter to the belief that many of these diseases are no longer a threat is the fact that diseases such as diphtheria and measles are still fairly common in other countries. That means unvaccinated children are at risk if they’re exposed to these diseases which can return to the U.S. with travelers and visitors. In fact, there have been minor outbreaks of measles in California in recent years among unvaccinated children. In addition, in 2003 13 unvaccinated children died from whooping cough or pertussis.
Dr. Johnston also notes that diseases that people think of as more of a nuisance than a health threat, like chicken pox, do actually present a real danger. Chicken pox or varicella is especially dangerous to children under one, adults and pregnant women. Some of the risks linked to the disease include secondary bacterial infections, pneumonia, encephalitis, kidney disease, and necrotizing fasciitis, a serious skin infection that often requires skin grafts to repair damaged tissue. Of the approximately 4 million varicella cases in the U.S. each year, 10,000 people are hospitalized and 100 die.
Another parental worry is that vaccines could overload a child’s immune system. But the science does not support that concern. “Children have an enormous capacity to respond safely to challenges to the immune system from vaccines,” says Dr. Paul Offit, Chief of Infectious Diseases and Director of the Vaccine Education Center at the Children's Hospital of Philadelphia. “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.”
What immunizations does your child need?
For some children, for example those with suppressed immunity, developmental delays or seizures, physicians may recommend a modification of the vaccination regimen. It’s important that parents report any concerns about their child’s development to their pediatrician so the child can be carefully assessed and an appropriate plan can be made for vaccinations and other health issues.
For the majority of children, the U.S. Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics and the American Academy of Family Physicians recommend the following immunization schedule:
- Diphtheria, tetanus, pertussis (DTaP): five shots, four of which are given before 18 months with an additional shot between ages four and six Polio: four doses given at two months, four months, between six and 18 months and between ages four and six
- Measles, mumps, rubella (MMR): two doses, one between twelve and fifteen months, the second between ages four and six
- Varicella (chickenpox): two doses, the first between twelve and fifteen months, the second between ages four and six
- Hepatitis B: first dose at birth for healthy babies, plus two additional doses by six months
- Hepatitis A: Two doses, the first at age one, the second six months later
- Haemophilis influenza type B (Hib): protects against meningitis, pneumonia and other diseases. Three or four shots starting at two months and completed by fifteen months
- Pneumococcal infections: protects against pneumonia, meningitis and sepsis. Four shots at two, four, six and twelve to fifteen months
- Yearly influenza vaccine: recommended for children six months and older
- Rotavirus vaccine: protects against a serious gastrointestinal illness. Doses given at two, four and six months of age
- MCV4: given to 11 and 12 year olds to protect against meningitis
- Diphtheria, tetanus, pertussis booster: for 11 to 12 year olds
- Human papilloma virus (HPV) vaccine: protects against the virus that is the leading cause of cervical cancer and is also linked to many head and neck cancers. Recommended for girls and women 11 to 26 years old
Your pediatrician is the best source of guidance on what immunizations your child needs and when they should be received, so talk with your child’s doctor if you have any questions or concerns.
PinnacleCare Members can get the information they need with one call In addition to talking with your child’s pediatrician, PinnacleCare Members can turn to their Advocate team for objective, evidence-based information on vaccination.
“The benefits that vaccines offer far outweigh any risk,” notes Dr. Varn. “We can prevent a host of life-threatening diseases with these immunizations, protecting our children and the wider community from the devastating outcomes these diseases can cause.”
Resources
“Public health risk seen as parents reject vaccines.” The New York Times explores the risks that children are exposed to when their parents decide to forgo childhood immunizations. http://www.nytimes.com/2008/03/21/us/21vaccine.html
