Safety and prevention

Immunize your children for life!

The first vaccines
Most parents of young children today are too young to remember how the fear of life-threatening disease was a part of childhood just a few years ago. In the 1950s, parents forbade their children from swimming in pools or lakes in the summer because of a threat of polio. When the Salk and Sabin vaccines became available, people stood in line to have their children protected against the horrors of polio.

There are now immunizations that protect children against 10 diseases. By age two, children should have received vaccinations against diphtheria, tetanus (lockjaw), pertussis (whooping cough), polio, measles, mumps, rubella (German measles), hepatitis B, chicken pox and Hib meningitis.

Existing vaccines continue to get better. For years, parents were warned of possible side effects from the pertussis vaccine. In the early 1990s, the first a-cellular pertussis vaccines were introduced and by 1997 the American Academy of Pediatrics recommended all children receive the a-cellular vaccine.

Children still must be immunized
Because of the success of these vaccines, people forget that these diseases can and do occur in the United States, as well as in countries that do not have strong immunization programs. Some of these illnesses have no cure and children still die from them.

You should discuss your child's immunization schedule with your pediatrician or health care provider. Most states require children receive all or many of these vaccinations before entering kindergarten.

How vaccines work
Our bodies have a wonderful system of defense that protect us against all kinds of diseases. When foreign substances like bacteria or a virus enter your body, your body begins an assault against the invaders by producing substances called antibodies. These antibodies fight the disease and help you to get over the illness. Even after you are well, the antibodies often stay in your system. Their presence keeps you from getting that same illness again. This is called immunity. When babies are born, they have antibodies from their mothers and are temporarily immune to many diseases. But in a few months this immunity is lost, and babies must receive vaccines to protect them against these diseases.

Vaccines are made from the actual bacteria or viruses that cause illnesses. When you receive a vaccine, however, you receive a processed form of the germs so you don't get sick. But it's still enough to fool your immune system into thinking it is under attack. Antibodies are produced and immunity builds up, protecting you from disease.

Keep track
Because vaccines must be given at certain ages and in certain amounts, it's important to keep a record of when your child received a shot. Your doctor or health care provider will also keep track. If you don't have a record form, ask your doctor for one. All states require children receive certain vaccinations before they are allowed to begin school.

Affordability
If because of financial reasons your children have not been immunized, contact the Yale-New Haven Primary Care Center at (203) 688-2470 or the health care agency in your town. Lifetime protection for your child is too important.

Types of immunizations

Chicken pox (Varicella)

Until recently, getting chicken pox was a childhood right of passage. Now health professionals regularly administer the vaccine to children at age 12 to 18 months. Symptoms of chicken pox, which is caused by a virus in the herpes family, are a rash, itching and fever. This disease can be very serious and lead to pneumonia, brain damage or death. Even with vaccination, about 10 percent of children can get chicken pox, but the disease is much milder. Doctors recommend all children who have not been immunized or had the disease receive the vaccine by age 13. Chicken pox is a much more serious disease in adults.

Diphtheria, tetanus and pertussis (DTP)

The DTP combination shot provides protection against diphtheria, tetanus and pertussis and is usually one of the first vaccines children receive. The combination is given together to eliminate the need to give a baby three separate shots.

Diphtheria is caused by bacteria that infects the nose, throat and vocal cords. It can progress, attack the heart and interfere with breathing and movement leading to death. Fortunately, immunizations have all but eliminated diphtheria. Though only a few cases occur each year, the disease could still be fatal in unvaccinated children and is spread easily by coughing and sneezing.

Tetanus was once called lockjaw because a first sign of tetanus infection is spasms of the jaw muscles. Tetanus is not spread from person to person like most diseases. Instead, the bacteria enter the body usually through a wound or scratch and manufactur a poison that causes muscle spasms. Because of the high level of immunization, tetanus is rare in the U.S.

When was the last time you had a tetanus booster?
Health care providers recommend all adults receive a tetanus booster every 10 years. If you can't remember when your last tetanus shot was, you are probably due for a booster. Check with your doctor or health care provider.

Pertussis, also called whooping cough, as its name implies, causes severe coughing spells that interfere with eating, sleeping, even breathing. Brain damage can also occur. Several thousands cases of pertussis are still seen in the U.S. each year in young children who are not immunized or who do not receive all their shots. A new acellular vaccine is now available and has fewer side effects than the whole-cell vaccine.

Haemophilus Type b Influenza

Haemophilus influenza type b vaccine is a relatively new vaccine that offers protection against this bacteria. Children who get infected with Hib are at increased risk of getting meningitis, a serious inflammation of the lining of the brain, as well as pneumonia. Hib usually affects children age 4 and younger, with the most serious cases seen in children age six months to one year. Because of different manufacturers, when and how often your child receives this vaccine series will vary. Children older than five rarely get Hib and probably do not need the shot. The vaccine has been so successful that the illness in the U.S. has decreased by 95% since the vaccine was introduced in 1988.

Hepatitis B

Though hepatitis B vaccine is not always required for entry into public school, many health care providers now recognize its value in protecting children from this serious liver disease. Newborns often begin the three-shot series of this vaccine before they leave the hospital. Older children who missed the vaccine can get it anytime. Children are immunized to prevent them from becoming infected as adults. Adults can also receive the vaccine.

Hepatitis B can lead to cirrhosis and liver cancer. Symptoms include loss of appetite and tiredness, yellow skin or eyes, muscle and joint pain, diarrhea and vomiting. While some people have symptoms, others may not and will carry the virus in their blood all of their lives. These people are called carriers because they can spread the disease without ever knowing they have it. A pregnant woman can pass the disease on to her newborn. If the baby is not immunized, the baby can become a carrier. As many as 25 percent of these babies ultimately die from the disease. The disease is spread through sexual contact or sharing intravenous needles, razors or toothbrushes.

Measles, mumps and rubella (MMR)

The MMR combination provides protection against measles, mumps and rubella and is usually given at 12 to 15 months. Most children receive a booster at about kindergarten to protect the small number of children who did not receive enough protection from the first shot. Some doctors prefer to postpone the booster to about age 12.

Measles
At one time, nearly all children came down with measles, which is highly contagious. The disease, which is characterized by a rash, high fever, cough, runny nose and watery eyes, can last for two weeks and lead to ear infections, pneumonia, even encephalitis (a brain inflammation that can cause mental retardation and death). It can also cause a pregnant woman to have a miscarriage if she is not immune to measles. A lax attitude toward measles immunization caused an outbreak of measles in the U.S. in 1990, proof that these diseases can still strike those who are not immunized.

Mumps
Children who are immunized can avoid having mumps, a one-time common childhood illness that causes swelling around the jaw and can even lead to deafness and encephalitis. Mumps can also strike adults, and causes painful swelling of the testicles in teenage and adult men.

Rubella
Also called German measles, rubella is usually a mild disease in children. Symptoms include low-grade fever, rash on the face and neck and occasionally pain or swelling in the joints. The greatest risk is to an unborn baby. If a pregnant woman is infected with rubella early in her pregnancy, she has a 75 percent chance of having a deformed baby. If you are thinking of becoming pregnant, your doctor or health care provider can see if you are immune to rubella.

Polio

There is no treatment for polio, a serious disease that can cause paralysis and even death. Before a vaccine was developed in the 1950s, as many as 20,000 people in the U.S. were affected each year. Some had to rely on a machine for breathing for the rest of their lives.

Live vaccine (OPV)
In the past, children received several doses of the live oral polio vaccine, which were given as drops, usually beginning at two months of age. The virus in this vaccine had been greatly weakened, but it provides excellent protection against polio. There is literally a one-in-a-million chance that a child can get polio from the live vaccine.

Inactivated vaccine (IPV)
As of January 2000, the U.S. Centers for Disease Control and Prevention recommends all infants receive this form of the vaccine. In the past, the killed polio vaccine was used only if a child had low resistance to disease, or a family member had weakened resistance due to diseases such as cancer, AIDS or steroid treatments. Though polio has all been eliminated from the U.S., it still strikes in other countries. Sometimes, travelers going to these places may receive a polio booster.

As of January 2000, an immunization schedule endorsed by an advisory committee of the U.S. Centers for Disease Control and Prevention, the American Academy of Pediatrics and the American Academy of Family Physicians recommends children receive all four doses of inactivated polio vaccine. OPV will be acceptable only for special circumstances such as to control outbreaks, for imminent travel to polio-endemic countries, and if parents refuse the number of injections needed at the time of the third and fourth doses.

• YNHH Health Library: Immunizations

Reviewed: Eugene Shapiro, MD
Last revised: June 4, 2007 (dh)

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.