Be Wise - Immunize!
By Robert Steele, M.D.

Vax Schedule Birth ¢ Hepatitis B #1 2 months ¢  DTaP #1 ¢ Polio #1 ¢  Hib #1 ¢  Hepatitis B #2, ¢  Pneumococcus #1 ¢  Rotavirus #1 4 months ¢  DTaP #2, Polio #2, Hib #2 ¢  Pneumococcus #2 ¢  Rotavirus #2 6 months ¢  DTaP #3, Hib #3 (depending on the type of Hib vaccine used, this dose may be omitted) ¢ Pneumococcus #3, ¢ Rotavirus #3 ¢  Hepatitis B #3 ¢  Influenza (if appropriate) 12 months ¢  MMR#1, Varicella#1, Hepatitis A     #1 ¢  Pneumococcus #4, ¢  Hib #4 ¢  Influenza (if appropriate) 15-18 months ¢  Polio #3,  DTaP #4, ¢  Influenza (if appropriate) 18-24 Months ¢  Hepatitis A #2, ¢  Influenza (if appropriate) 4-6 years ¢  MMR #2, Polio #4, ¢  DTaP #5, Varicella#2, ¢  Influenza (if appropriate) 11-12 years ¢  Tdap Meningococcus ¢  Human papillomavirus (girls) -     3 doses ¢  Influenza (if appropriate)

The vaccine schedule has become much more complicated than it once was. Children are receiving far more shots than they ever did. Now, children could receive as many as 24 shots by 2 years of age and five shots in a single visit. Some parents question the importance and safety of vaccines and whether their child should receive so many at one time.

Parents should adhere to the vaccination schedule, for two reasons. The first is to protect your child. Even if we think the chances of getting any of these diseases are small, the diseases still exist and can still infect anyone who is not protected.

Travelers are especially vulnerable. A few years ago a 63-year-old U.S. traveler to Haiti caught diphtheria and died. He had never been vaccinated. In 2005 and 2006, outbreaks of measles and mumps occurred in several states within the U.S. The measles outbreak began in a group of travelers (who had not been vaccinated) upon their return from a trip to  Romania where they had been exposed to measles.

The second reason to get vaccinated is to protect those around us. A small number of persons cannot be vaccinated for medical reasons such as a severe allergy to vaccine components. Another small percentage of people simply do not respond to vaccines. These persons are susceptible to disease, and their only hope of protection is that people around them have been successfully vaccinated and cannot pass disease along to them.

A successful vaccination program, like a successful society, depends on the cooperation of every individual to ensure the good for all. We shouldn’t rely on people around us to stop the spread of disease if we ourselves can be vaccinated.

Vaccine Myths

Myth No. 1: Diseases had already begun to disappear before vaccines were introduced be cause of better hygiene and sanitation.

Better nutrition, not to mention the development of antibiotics and other treatments, have increased survival rates among the sick; less crowded living conditions have reduced disease transmission; and lower birth rates have decreased the number of susceptible household contacts. But looking at the actual incidence of disease over the years  leaves little doubt of the direct impact vaccines have had, even in modern times.

The real, permanent drop in case of measles in the U.S. coincided with the licensure and wide use of measles vaccine beginning in 1963. Are we expected to believe that better sanitation caused incidence of each disease to drop, just at the time a vaccine for that disease was introduced?

It’s clear that not only would diseases not be disappearing without vaccines, but if we were to stop vaccinating, they would come back.

Myth No. 2: The majority of people who get disease have been vaccinated.

It is true that in an outbreak those who have been vaccinated often outnumber those who have not – even with vaccines such as measles, which we know to be about 98 percent effective when used as recommended.

This is explained by two factors. No vaccine is 100 percent effective. Most routine childhood vaccines are effective for 85 percent to 95 percent of recipients. For reasons related to the individual, some will not develop immunity. The second fact is that in a country such as the United States the people who have been vaccinated vastly outnumber those who have not.

Myth No. 3: There are “hot lots” of vaccine that have been associated with more adverse events and deaths than others. Parents should find the numbers of these lots and not allow their children to receive vaccines from them.

 The concept of a “hot lot” of vaccine as it is used in this context is wrong. It is based on the presumption that the more reports to the Centers for Disease Control and Prevention Vaccine Adverse Event Reporting System (VAERS), a vaccine lot is associated with, the more dangerous the vaccine in that lot; and that by consulting a list of the number of reports per lot, a parent can identify vaccine lots to avoid.

This is misleading for two reasons. 1) A report made to VAERS does not mean that the vaccine, or other vaccines from the same group or lot caused the event. Only some of the reported health conditions are side effects related to vaccines. A certain number of VAERS reports of serious illnesses or death do occur by chance alone among persons who have been recently vaccinated. VAERS reports have many limitations since they often lack    important information, such as laboratory results, used to establish a true association with the vaccine.

2) Vaccine lots are not the same. The sizes of vaccine lots might vary from several hundred thousand doses to several million, and some are in distribution much longer than others. Naturally a larger lot or one that is in distribution longer will be associated with more adverse events, simply by chance. Also, more coincidental deaths are associated with vaccines given in infancy than later in childhood, since the background death rates for children are highest during the first year of life.

Reviewing published lists of “hot lots” will not help parents identify the best or worst vaccines for their children. If the number and type of VAERS reports for a particular vaccine lot suggested that it was associated with more serious adverse events or deaths than are expected by chance, the Food and Drug Administration (FDA) has the legal authority to immediately recall that lot. To date, no vaccine lot in the modern era has been found to be unsafe on the basis of VAERS reports.

Myth No. 4: Vaccines cause many harmful side effects, illnesses, and even death – not to mention possible long-term effects we don’t even know about.

Vaccines are very safe. Most vaccine adverse events are minor and temporary, such as a sore arm or mild fever. These can often be controlled by taking  acetaminophen before or after vaccination. More serious adverse events occur rarely (on the order of one per thousands to one per millions of doses), and some are so rare that risk cannot be accurately assessed. As for vaccines causing death, again so few deaths can be attributed to vaccines that it is hard to assess the risk statistically. The Institute of Medicine in its 1994 report states that the risk of death from vaccines is “extraordinarily low.”

Myth No. 5: Giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune system.

A number of studies have been conducted to examine the effects of giving several vaccines at the same time.  These studies have shown that the recommended vaccines are as effective in combination as they are individually, and that such combinations carry no greater risk for adverse side effects.
There are two practical factors in favor of giving a child several vaccinations during the same visit. First, we want to immunize children as early as possible to give them protection during the vulnerable early months of their lives. Second, giving several vaccinations at the same time will mean fewer office visits for vaccinations, which saves parents both time and money and may be less traumatic for the child.

Myth No. 6: The DTaP Vaccine causes SIDS.

One myth that won’t go away is that DTaP vaccine causes sudden infant death syndrome (SIDS). This belief came about because a moderate proportion of children who die of SIDS have recently been vaccinated with DTaP; and on the surface, this seems to point toward a causal connection. But this logic is faulty; you might as well say that eating bread causes car crashes, since most drivers who crash their cars had probably eaten bread within the past 24 hours.

Myth No. 7: Thimerosal causes autism.

Some parents are concerned that thimerosal, a mercury-containing preservative still contained in the influenza vaccine, causes autism. However, during the past few years a series of biological and epidemiological studies have shown this concern to be unfounded.

Myth No. 8: Vaccine-preventable diseases have been virtually eliminated from the United States, so there is no need for my child to be vaccinated.

It’s true that vaccination has enabled us to reduce most vaccine-preventable diseases to very low levels in the United States. However, some of them are still quite prevalent - even epidemic - in other parts of the world.

Travelers can unknowingly bring these diseases into the United States, and if we were not protected by vaccinations these diseases could quickly spread throughout the population, causing epidemics here. At the same time, the relatively few cases we currently have in the U.S. could very quickly become tens or hundreds of thousands of cases without the protection we get from vaccines


Lessening the Pain of Vaccines

For most children, getting vaccines simply means the pain of getting a shot. Although pain is to some extent unavoidable, there are a few things worth trying in older children.

Blowing away the pain: One technique is called “blowing away the pain.” Just before the shot, take out a feather, tell the child to take a deep breath, closing his eyes if he wants, and then blow out...blow, and blow on the feather until you or the nurse tells them to stop. The distraction of blowing on the feather has been shown in one study to lessen the amount of pain perceived by the child.

Cold versus pain: Swab a small amount of alcohol on the forearm of the same arm that will receive the vaccine. The child then blows on the alcohol before and during the shot. Our bodies don’t feel cold and pain in the same place at the same time.

Tylenol before, feeding afterward: For babies, a dose of acetaminophen 30 minutes before and a bottle or nursing immediately afterward can help minimize the pain of shots.