Immunization

Childhood Immunizations

Immunization has been called the most important public health intervention in history, after safe drinking water. It has saved millions of lives over the years and prevented hundreds of millions of cases of disease.

None of us wants to see our children get sick. And getting them immunized can protect them from a number of very serious diseases.

But did you know that getting your children immunized...

· Can also protect their friends, schoolmates, and others from those same diseases? Some children can’t get certain vaccines for medical reasons, or some children are not able to respond to certain vaccines. For these children, the immunity of people around them is their only protection.

· Can help protect your grandchildren, their grandchildren, and future generations from diseases? If enough parents fail to get their children immunized, diseases that had been under control can come back to cause epidemics. This has happened in several countries.

· Could, ultimately, even help rid the world of diseases that have been crippling and killing children for centuries? Immunization allowed us eradicate smallpox. Today polio is nearly gone, and in the future measles and other diseases will follow.

Vaccines have a remarkable track record. For example...

· Diphtheria used to be one of the most dreaded of childhood diseases, killing over 10,000 people a year in the United States. After we started vaccinating children in the 1930s and 1940s the disease began to disappear. Today most doctors will never see a single case of diphtheria, much less have a child die from it.

· In 1962, the year before measles vaccine was introduced, almost 500,000 cases of measles were reported in the United States, and many more cases went unreported. Ten years later there were about 32,000 cases and 10 years after that fewer than 2,000. 2002 and 2003 combined saw only 100 cases.

· Parents in the 1950s were terrified as polio paralyzed children by the thousands. Then we learned how to prevent polio using the Salk and Sabin vaccines. There has not been a case of wild virus polio in the United States since 1979.

· Smallpox was one of the most devastating diseases the world has ever known. It killed millions of people every year. In 1967 the World Health Organization undertook an intensive, worldwide vaccination campaign. Twelve years later the disease had ceased to exist. There hasn’t been a single case since. Smallpox is the first, and so far the only, disease we have ever eradicated from the Earth; and it was thanks to vaccination.

Childhood Immunization Schedule

There are 9 vaccines for 13 diseases in the US. Vaccines work best when they are given at certain ages. For example, measles vaccine is not usually given to children until they are at least a year old. If it is given earlier it might not work as well. For vaccines requiring multiple doses, the doses should not be given too close together.

The childhood immunization schedule as of November 2005 is available online at www.cdc.gov/nip/recs/child-schedule.htm. The chart shows the routine childhood immunization schedule for the United States. It tells you what vaccines are recommended and the ages at which they should be given. A bar spanning several ages means the dose may be given at any time during that age range. For example, the 3rd dose of polio vaccine may be given any time between 6 and 18 months.

While these are the recommended ages for vaccine doses, the schedule is flexible. If a child doesn’t get a dose of vaccine at the recommended age, he can catch up later. Sometimes a child needs to get a dose earlier than the recommended age. Within limits, this can be done too. Your provider can give you more information.

Diseases Summary

Diphtheria

Caused by: Bacterium — Corynebacterium diphtheriae

Spread by: Air, direct contact

Signs and Symptoms: Sore throat, mild fever, membrane in throat, swollen neck

Complications: Heart failure, paralysis, pneumonia, death

Hepatitis A

Caused by: Virus — Hepatitis A

Spread by: Personal contact; contaminated food or water

Signs and Symptoms: Fever, stomach pain, loss of appetite, fatigue, vomiting, jaundice, dark urine

Complications: Liver failure, death

Hepatitis B

Caused by: Virus — Hepatitis B

Spread by: Contact with blood or body fluids

Signs and Symptoms: Fever, headache, malaise, vomiting, arthritis

Complications: Chronic infection, cirrhosis, liver failure, liver cancer, death

Hib disease

Caused by: Bacterium — Haemophilus influenzae type b

Spread by: Air, direct contact

Signs and Symptoms: May be no symptoms unless bacteria enter blood

Complications: Meningitis, epiglotittis, pneumonia, arthritis, death

Influenza

Caused by: Virus — Influenza

Spread by: Air, direct contact

Signs and Symptoms: Fever, muscle pain, sore throat, cough

Complications: Pneumonia, Reye syndrome, myocarditis, death

MeaslesCaused by: Virus — MeaslesSpread by: Air, direct contact

Signs and Symptoms: Rash, fever, cough, runny nose, pinkeye

Complications: Pneumonia, ear infections, encephalitis, seizures, death

Mumps

Caused by: Virus — MumpsSpread by: Air, direct contact

Signs and Symptoms: Swollen salivary glands, fever, headache, malaise, muscle pain

Complications: Meningitis, encephalitis, inflammation of testicles or ovaries, deafness

Pertussis

Caused by: Bacterium — Bordetella pertussis

Spread by: Air, direct contact

Signs and Symptoms: Severe cough, runny nose, fever

Complications: Pneumonia, seizures, brain disorders, ear infection, death

Pneumococcal

Caused by: Bacterium — Streptococcus pneumoniae

Spread by: Air, direct contact

Signs and Symptoms: Pneumonia (fever, chills, cough, chest pain)

Complications: Bacteremia (blood infection), meningitis, death

Polio

Caused by: Virus — Poliomyelitis

Spread by: Person to person

Signs and Symptoms: May be no symptoms, sore throat, fever, nausea

Complications: Paralysis, death

Rubella

Caused by: Virus — Rubella

Spread by: Air, direct contact

Signs and Symptoms: Rash, fever, lymphadeno-pathy, malaise

Complications: Encephalitis, arthritis/arthralgia, hemorrhage, orchitis

Tetanus

Caused by: Bacterium — Clostridium tetani

Spread by: Exposure through breaks in skin

Signs and Symptoms: Stiffness in neck, difficulty swallowing, rigid abdominal muscles, muscle spasms, fever, sweating, elevated blood pressure

Complications: Broken bones, breathing difficulty, death

Varicella

Caused by: Virus — Varicella Zoster

Spread by: Air, direct contact

Signs and Symptoms: Rash, fever

Complications: Bacterial infections, meningitis, encephalitis, pneumonia, death

Questions and Answers

Why do children need so many shots?

Some of us may have gotten only 3 vaccines as children: DTP, polio, and smallpox. There were no vaccines for measles, chickenpox, mumps, and other diseases — which meant that many of us also got those diseases! The simple answer to why children get so many shots is because they can. Scientists have developed vaccines against more diseases, and we give them to our children to protect them from those diseases. Children don’t get smallpox vaccine any more because we have eradicated the disease. Within our lifetimes, we may also eradicate polio, and that vaccine too will no longer be needed. More combination vaccines may also reduce the number of shots children will need. At the same time, vaccines may be developed to protect us against even more diseases.

Why are vaccines given at such an early age?

Vaccines are given at an early age because the diseases they prevent can strike at an early age. Some diseases are far more serious or common among infants or young children. For example, up to 60% of severe disease caused by Haemophilus influenzae type b occurs in children under 12 months of age. Of children under 6 months of age who get pertussis, 72% must be hospitalized, and 84% of all deaths from pertussis are among children less than 6 months of age. The ages at which vaccines are recommended are not arbitrary. They are chosen to give children the earliest and best protection against disease.

What if my child misses a dose of vaccine?

They can continue the series where they left off. Vaccinations are not rendered invalid and do not have to be repeated when there is a longer-than-recommended interval between doses in a series.

How safe are vaccines?

They are very safe. But like any medicine, they are not perfect. They can cause reactions. Usually these are mild, like a sore arm or slight fever. Serious reactions are very uncommon. Your health-care provider will discuss the risks with you before your child gets each vaccine, and will give you a form called a Vaccine Information Statement, which describes the vaccine’s benefits and risks. The important thing to remember is that vaccines are much safer than the diseases they prevent.

Do vaccines always work?

Vaccines work most of the time, but not always. Most childhood vaccinations work between 90% and 100% of the time. Sometimes, though, a child may not respond to certain vaccines, for reasons that aren’t entirely understood. This is one reason why it is important for all children to be immunized. A child who does not respond to a vaccine has to depend on the immunity of others around her for protection. If my child is immune to measles, he can’t pass the disease along to your child who failed to respond to measles vaccine. But if my child never got the vaccine, he can not only get measles himself, he can pass it along to others who are not immune.

What will happen if my child doesn’t get his vaccinations?

One of two things could happen:

1. If your child goes through life without ever being exposed to any of these diseases, nothing will happen.

2. If your child is exposed to one of these diseases, there is a good chance he will get it. What happens then depends on the child and the disease. Most likely he would get ill and have to stay in bed for a few days up to 1–2 weeks. But he could also get very sick and have to go to the hospital. At the very worst, he could die. In addition, he could also spread the disease to other children or adults who are not immune.

What are my child’s chances of being exposed to one of these diseases?

Overall, quite low. Some of these diseases have become very rare in the United States (thanks to immunizations), so the chances of exposure are small. Others, such as varicella and pertussis, are still relatively common. Some are rare in the U.S. but common elsewhere in the world, so there is risk not only to travelers, but also to anyone exposed to travelers from other countries visiting here.

If my child’s risk of exposure to disease is so low, why should I bother getting him immunized?

This is a good question. One answer, of course, is that even if the risk of getting these diseases is low, it is not zero. Even if only one child in the whole country gets diphtheria this year, that child has a 1 in 10 chance of dying. Vaccination would have protected him.

But there is also another answer. With diseases growing more uncommon, parents should think not only of their own children but also of other children and of future generations of children.