Of course, with all the new developments, staying up-to-date on the latest immunization news can be a bit overwhelming. To help, we went straight to the experts for answers to your top vaccination questions.
Why do babies get so many more shots than we did when we were kids? The answer is simple: Since there are more safe and effective vaccines today than there were a generation ago, more are recommended. Twenty years ago, children got five vaccinations by age 2, immunizing them against seven diseases. Today, most kids get about 20 vaccines by their second birthday, protecting them against 11 diseases. And that's a bonanza for children's health. "Many diseases that once routinely killed or harmed children have been almost completely eliminated," says Paul Offit, M.D., chief of infectious diseases at Children's Hospital of Philadelphia and coauthor of Vaccines: What Every Parent Should Know (IDG, 1999).
Take haemophilus influenzae type b (Hib), for instance. Before the Hib vaccine was introduced in 1990, Hib meningitis killed 600 children every year and left many others with hearing loss or mental retardation. Now there are fewer than 70 cases a year. And before the vaccine for measles became widely available in 1988, children occasionally died or became brain-damaged because of a measles infection. Now the disease is hardly ever seen.
Fortunately, the number of needles that kids must endure may go down within the next few years. Under development is a "supershot" vaccine that, in a single injection, would protect against five diseases: diphtheria, tetanus, pertussis, hepatitis B, and polio. Also in the works is a shot that adds chicken-pox immunity to the measles-mumps-rubella (MMR) vaccine.
Could so many shots weaken my child's immune system?
There's no reason to worry that your child's immune system will be overwhelmed. In fact, a child could get 10,000 vaccines in one day and still not "use up" her immunity, according to a recent study published in Pediatrics. "Fears that multiple vaccines could weaken immunity are unfounded," says Neal Halsey, M.D., director of the Institute for Vaccine Safety at the Johns Hopkins University/Bloomberg School of Public Health, in Baltimore, and a member of the Parents advisory board. "The immune systems of babies are capable of responding to many different shots -- even when given simultaneously."
What's more, advances in chemistry have allowed scientists to simplify some vaccine formulations. So although kids today get more vaccinations than children did 20 years ago, they're exposed to fewer antigens -- the proteins and substances that stimulate an immune response.I've heard that certain vaccines increase the risk of autism. Any truth to that?
Researchers have found no evidence that any vaccine increases the risk of autism, a baffling disorder that leaves children developmentally delayed and emotionally isolated. Some parents of autistic children whose symptoms appeared shortly after their MMR shot have suggested a link between the vaccine and the disorder, but most doctors attribute that to coincidence: MMR shots are given to children between 12 and 15 months, the age at which behavior and speech patterns usually become pronounced enough for parents to notice something wrong. Furthermore, a panel of experts assembled last year by the federal government to study vaccine safety found no explanation for how the MMR vaccine could cause autism.
Researchers have also investigated links between vaccines and such conditions as juvenile diabetes, SIDS, and multiple sclerosis, and the results have been reassuring. A recent Centers for Disease Control (CDC) study of 1,020 children found that vaccinations do not increase the risk of juvenile diabetes. A 2001 report from the Institute of Medicine concluded that the hepatitis B vaccine does not cause multiple sclerosis or related neurological disorders.
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Vaccination Update
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Inside this article:
Introduction Common Questions Answered Chart: Shots Every Child Needs
What about asthma?
One gray area is whether vaccinations might increase a child's chances of getting asthma. After reviewing recent research, the government panel could not rule out an association between vaccines and allergic diseases like asthma. The reason: Vaccinations prevent many childhood infections that were once common -- and a handful of studies suggest that kids who get fewer infections when they're young are more prone to asthma. "It's called the 'too clean' theory," says Michael Welch, M.D., a pediatric allergist-immunologist in San Diego and chair of the American Academy of Pediatrics (AAP) section on allergy and immunology. He explains that some experts believe that fighting off viral infections at an early age may help the immune system mature in such a way that there is a decreased chance that the child will develop allergies to his environment. But the theory has not been proven, and other doctors dismiss it as unfounded. "Besides, the very real benefits of immunizations far outweigh any possible increased risk of asthma," Dr. Welch adds. My sister's baby got sick after getting her shots. Should I be concerned about side effects? While no vaccine is totally risk-free, serious reactions are extremely rare. "The chance of a severe complication is very slim," Dr. Halsey says. Like all medications, however, vaccines can cause a range of less serious reactions. Most common are fussiness, restless sleep, a low-grade fever, and soreness at the injection site -- all of which you can treat by giving your child acetaminophen or ibuprofen at the time of the injection. "Recent studies show that this strategy can prevent some of these mild side effects," says Gary Overturf, M.D., director of pediatric infectious disease at the University of New Mexico, in Albuquerque. Certain shots can also cause slight skin reactions. About one in 20 kids gets a measles-like rash a week or so after an MMR shot. And some children get small bumps after a varicella, or chicken-pox, vaccine. These are usually nothing to worry about and go away in a few days. Beyond that, the most common complications are fever-related seizures and allergic reactions. Two vaccines -- the MMR and the DTaP (diptheria-tetanus-pertussis) -- occa-sionally cause fever, which can trigger seizures in some children. These seizures occur in six to nine of every 100,000 children vaccinated against MMR and in one of 14,000 chil-dren vaccinated with the whole-cell DTaP vaccine, according to a recent study published in the New England Journal of Medicine. However, the whole-cell version of the DTaP has recently been replaced with a new formulation that makes seizures even less likely. Vaccines can also prompt allergic reactions in children who are hypersensitive to one or more of the shots' components. Children with allergies to eggs, gelatin, or neomycin (an antibiotic) may want to steer clear of the MMR, varicella (chicken pox), polio, and flu shots. The hepatitis B vaccine contains yeast, so any child allergic to baker's yeast could have a reaction. Serious reactions are rare, but to be safe, let your pediatrician know if your child has any allergies.You can learn more about potential reactions by reading the CDC's Vaccine Information Statements at www.immunize.org/vis. My doctor tells me there is a shortage of some vaccines. What's the deal? Manufacturing delays over the past year have caused many physicians' offices to experience shortages of vaccines for eight of the 11 preventable childhood diseases: the vaccine against diphtheria, tetanus, and pertussis (DTaP); the one for measles, mumps, and rubella (MMR); the varicella vaccine; and the new vaccine Prevnar, which protects against pneumococcal bacteria. While most of these shortages are expected to end within a few months, experts say that the Prevnar vaccine may continue to be scarce until next summer. For vaccines still in short supply, public-health officials are recommending that babies who haven't received their first shot be given priority. Older children may need to put off their scheduled boosters. Although kids who don't get their boosters on time will still have partial immunity, it's important to be vigilant about scheduling catch-up shots for your child. Why does a newborn need a hepatitis B vaccine? Isn't that a sexually transmitted disease? Sexual transmission is only one means of contracting hepatitis B. "It's very infectious by blood, more so than HIV," Dr. Baltimore says. "But you can also get it from contaminated saliva, and a mother with the disease can transfer it to her infant at birth." So in fact, something as innocent as sharing a toothbrush or a washcloth with an infected person could spread the disease, which can lead to chronic hepatitis or liver failure. Until recently, most babies got their first dose of this vaccine at 2 months of age. But the newest immunization schedule recommends that all newborns be given a hepatitis B shot within 12 hours of birth because this lifelong infection passes so readily from mother to infant during the birth process. Does my child really need the varicella shot? What's so bad about chicken pox? Chicken pox is usually a mild illness, producing just an itchy rash and a mild fever, but not always. "It can cause pneumonia, encephalitis, and severe skin infections," says Robert Baltimore, M.D., a professor of pediatrics and epidemiology at Yale University. What's more, because most kids today are vaccinated against chicken pox, it's less likely than before that an unvaccinated child will get this contagious disease naturally. And not getting chicken pox as a child puts a person at risk of contracting it as an adult, when the illness is generally much more serious. Should my baby get a flu shot? Though kids aren't required to get a flu shot before entering day care or school, it's probably a good idea, even for babies. "Because children between 6 months and 23 months are at risk for flu complications such as pneumonia, it's best to have them vaccinated," Dr. Offit says. Currently, the CDC immunization schedule recommends the flu shot only for kids over 6 months who suffer from certain disorders, including asthma, diabetes, congenital heart disease, and sickle-cell anemia. But that's likely to change soon. Earlier this year, a CDC advisory panel decided to encourage flu shots for all children ages 6 months to 23 months. With all the progress being made in medicine, isn't there a painless way to immunize kids? Not yet, but researchers are hot on the trail of ways to deliver vaccines without discomfort. A flu vaccine in the form of a nasal spray is close to approval by the FDA and is expected to be available by the end of this year. If it catches on, other vaccines will likely be formulated as nasal sprays down the road. Vaccine guns that use compressed air to painlessly deliver antigens at supersonic speed may also be coming soon. And a vaccine patch, a bandage that kids would wear for a few hours, is about five years away. One day, kids might even get immunized by munching on foods. Scientists are working on engineering bananas, tomatoes, and other vegetables to produce vaccines.While injections will probably be standard practice for at least the next several years, pain-free protection against a number of diseases is on the horizon.
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