Within the last few centuries, vaccines proved one of the greatest public health accomplishments. In fact, vaccines have done their jobs so well that it has become easy now to doubt their necessity. Parents have started to call into question the safety of and the need for so many vaccines in the first few years of life.
A Parent’s Duty
Most parents with young children are of an age that they may have never seen anyone with a vaccine-preventable illness. Our worries and doubts can get the best of us when we have never seen a child suffer from a disease such as polio or measles.
As a mom, I also watch the news and follow posts on social media just like many parents. Without a medical background, I can understand how frightening it is for a parent to understand and navigate what is really true about vaccines and what is not. In our day and age of false news stories and the ability to find people who will support almost any opinion, I urge you to look for reputable sources when you are exploring this important question.
A Pediatrician’s Duty
Your pediatrician should serve as your most trusted source for vaccine information. Pediatricians spend many years learning how to take care of children and base decisions on the best scientific and medical knowledge that is available. Our training includes many years of college, medical school, and pediatric residency where we not only learned the scientific basis for medicine but also how to apply what we know to real children.
We also keep up with current medical literature and can help you navigate what is important to know and what may have not received enough study yet.
Please take some time to read this post and use it as a resource.
Risks in life
Risks are everywhere and all around us. We lock the doors to our homes, put our children in car seats, and encourage them to walk instead of running with sharp objects. It is important for those caring for children to be vigilant about their health and safety. There is at least some risk in almost everything we do as humans and this translates to our children as well.
However, the risks associated with current vaccines are far smaller than the enormous benefit that they offer. Before released to the general public, vaccines go through many years of clinical research and trials to ensure their safety. There is a step-wise process that you can read more about here.
Vaccine components
There are many points of contention when it comes to vaccines. Parents are often unwilling to consent to their use for their children for many reasons. One of the top reasons is due to concern about vaccine ingredients.
As technology has advanced and our knowledge about the world around us has increased, we have discovered many things that are harmful that we once thought were safe. From food dyes and additives to building insulation techniques, plastics, pesticides, and many things in between, we have increased knowledge about what these things can do to our health.
This causes families to doubt and question that there would potentially be a similar discovery with regards to vaccine ingredients.
Vaccine Ingredients
With this concern raised, scientists have taken a closer look at the ingredients added to vaccines. In the late 1990s, scientists examined the effects of mercury on our health. Mercury exists in concentrated form in fish dwelling in the bottoms of oceans.
Mercury
When humans eat fish containing mercury, it breaks down into methylmercury. The human body does not remove this compound well. High concentrations of mercury can cause neurodevelopmental problems. The FDA asked drug manufacturers to examine their products and report on mercury out of growing concern and regulation of harmful levels.
During this time, vaccines that contained attenuated (partially inactivated) viruses and bacteria, also contained a preservative named thimerosal. The human body breaks down this mercury compound into ethylmercury and not the harmful methylmercury. At the time, the effects of ethylmercury on the human body had not been well studied.
As a result, the FDA chose to remove or greatly reduce the amount of thimerosal in all childhood vaccines until it could be studied more thoroughly. Since that time, thimerosal has been studied extensively and all research has concluded that it is safe and not associated with any health problems.
However, except for the multi-dose flu vaccine, there is no childhood vaccine that contains thimerosal. The preservative-free flu vaccine is also readily available.
Aluminum
Aluminum is another ingredient in vaccines that have made the list by concerned families. This metal serves as an adjuvant (or helper) in certain vaccines. Adjuvants are important components that assist the immune system to recognize the bacteria or viral component.
Without these chemical additions, children would need many more doses (than they already receive) of the same vaccine over time in order to achieve the results of full protection from the disease.
Is aluminum really dangerous? No, aluminum is the third most abundant element on the earth. It makes up 9% of the earth’s crust. We can find this metal in drinking cans, food containers, fruits, vegetables, and many other things that we ingest.
The average baby gets more aluminum from their formula or breast milk than they do from all of the recommended childhood vaccines combined. Aluminum is used in vaccines and is considered a safe ingredient, though highly monitored.
Formaldehyde
Formaldehyde is the next seemingly scary ingredient in many vaccines. In large quantities, it is known to cause certain types of cancers. Many vaccines are manufactured using formaldehyde. This ingredient inactivates the toxins that are released by bacteria and viruses. However, through processing, much of the quantity of the formaldehyde is removed. Extremely small, safe quantities of formaldehyde are left behind.
Our bodies also use this naturally occurring chemical as a building block for proteins and DNA.
You can read more about these and other components of vaccines on the CHOP website
See this list of specific ingredients found in each vaccine
The Science Behind Vaccines
In 1796, Edward Jenner isolated the cowpox virus. He observed that the milkmaids who worked most often with cows did not contract the deadly disease smallpox (similar to cowpox but affected humans instead of cows). As a result, he isolated the virus and scratched it under the skin of a young boy.
A small blister rose up, but the boy recovered quickly. A few months later, he injected the boy again, but this time he used the smallpox virus. The boy did not get sick from this highly contagious disease. He was immune to smallpox disease.
Smallpox had been the scourge of society. It claimed 300 million lives in the 20th century alone. Smallpox was declared eradicated from the earth in 1980 as a result of the widespread use of an improved vaccine. The only place that it exists today is in the laboratory.
A Long Way
Vaccines have come a long way since the 1800s, but the concept of how they work is the same. The idea is that scientists take a less virulent (or disease-causing) component of a virus or bacteria and introduce it to a human’s immune system through injection.
Most people get vaccines injected into a muscle. This decreases the side effects of pain and redness while delivering the vaccine components to a place where they encounter cells of the immune system more readily. You can read about intramuscular injections here.
Our immune system recognizes that the virus or bacteria does not belong in our body and through a complex series of events, destroys the invader. As a result of this process, it remembers what that virus or bacteria looks like and is better trained to more quickly remove the invader from the body the next time it sees it. It takes a certain amount of doses, or repeated exposures to the vaccine, to ensure that almost 100% of people who are immunized are protected from a particular disease.
Diseases like influenza (or the flu) require yearly vaccination due to a concept known as antigenic drift. The virus is “smart” and changes the way it presents its disease-causing components to the body. It figures out how the immune system sees it and changes to protect itself.
I wrote a blog post about influenza that you can read here.
Community Immunity and Your Family
Vaccines are not only important to the individual child’s health, but they also impact our overall public health as well. As a result of the widespread immunization of children over time, herd immunity or community immunity protects our society as a whole.
With enough people immunized against a certain disease, it is much less likely to spread or cause an outbreak. The germs can attack one person, but won’t spread to others because they are immune. If 80-95% of people receive vaccination against disease, most of the vaccine-preventable illnesses won’t spread.
This percentage is variable based on how contagious a certain disease is. Measles, highly contagious, would require 90-95% immunization in order to protect the population from an outbreak.
Herd Immunity
Herd immunity protects the most vulnerable in our society. There are many people that have weakened immune systems due to having diseases like Type 1 diabetes, HIV/AIDS, or any other condition. Their bodies cannot respond as aggressively to invading germs as a person with a healthy immune system can.
If enough people receive vaccination around them, the chances of exposure to a potentially deadly vaccine-preventable disease decrease.
Other vulnerable populations protected by high vaccine rates in the community include children treated with chemotherapy and newborn babies. Herd immunity protects the very very small number of people who are vaccinated but don’t respond to the vaccine with immunity to the disease.
When we choose to vaccinate our children, we not only protect them but our neighbors and their children as well.
As the doubt of vaccines grows, many more families are choosing to not vaccinate their children. As a result, we have seen firsthand the breakdown of herd immunity.
Outbreaks and the Law
There have been many outbreaks of measles in recent years, the largest of which was the outbreak that originated at a popular amusement park in California in 2014. Someone who had traveled overseas contracted measles returned to the U.S and went to the amusement park exposing a largely under-vaccinated population.
This caused a 147 case multi-state outbreak. This outbreak served as an impetus to find a solution to widespread vaccine refusal for the state of California. As a result, lawmakers passed SB-277 which limited vaccine exemptions for children enrolled in daycare, preschool, or public school.
We have seen many more outbreaks of measles since that time. Measles outbreaks have occurred in several communities across the country where there are high numbers of under or non-vaccinated children. There have been many cases of measles in communities in and surrounding the DFW metroplex as well.
Busting The Vaccine Myths
There are many myths surrounding vaccines. We already examined the myth that vaccines contain dangerous ingredients. Let’s look at some other myths and examine what makes them untrue.
Myth #1: Vaccines cause Autism
There are multiple studies that have shown no link between vaccines and autism. In fact, a famous article claiming a link between the two in The Lancet in 1998 resulted in retraction, removal and the discrediting of the authoring physician. While research into its cause is ongoing, the current evidence shows that Autism has a strong genetic component.
Here is a link to the most recent (March 2019) article demonstrating that there is no link between vaccines and Autism.
Myth # 2 : Infants’ immune system cannot handle so many vaccines at once
As we will discuss later, babies encounter 14 different diseases through various combinations of vaccines, a small number of antigens compared to the daily exposure to a multitude of other potentially disease-causing agents.
Babies receive exposure to countless viruses and bacteria in their natural environment. Think about the number of bacteria that is on the surfaces in your home, the viruses that your school-aged children bring home to the baby, and many other exposures. Babies have immune systems that can handle much more than we often give them credit for.
Vaccine timing is based on the earliest age at which it is safe and most effective to give a certain vaccine. It is also based on when the disease is most dangerous for a child. We need to protect kids from vaccine-preventable diseases as soon as recommended. The best way to do that is to follow the CDC vaccine schedule.
The review and update of the schedule takes place each year based on new recommendations. Endorsement by every professional medical organization that has a vested interest in the health and wellness of our society also takes place.
Myth # 3: Natural immunity is better than vaccine induced immunity
While it may be true in theory, the risks of most vaccine-preventable diseases are much greater than the risks associated with their vaccines. While sometimes you can still get a milder form of the disease after you are vaccinated, the risks of dying from the disease are negligible compared to getting the fully virulent form of the bacteria or virus.
Natural immunity only works if you are well enough to be exposed to the disease the next time. Vaccines provide immunity without the risks associated with a full-fledged attack by the virulent strain of the disease.
Childhood Vaccines
Children receive vaccination against thirteen individual viruses or bacteria in the first two years of their life. Eight of those require an additional “booster” at four years of age. The next set of immunizations occurs in adolescence. Additional recommendation includes children receiving yearly flu vaccines starting at six months of age.
The first year that they receive flu vaccine, they need two doses separated by 4 weeks and then yearly thereafter. Combining several of these vaccines allows for fewer injections for children.
In the following section, we will discuss each vaccine-preventable disease separately. We will examine the history of the vaccine itself and see why it is important to protect your children from these diseases.
Hepatitis B
Hepatitis B vaccine is the first vaccine that a new baby should receive. The CDC recommends that a newborn get the first dose of this vaccine within 24 hours of life. This vaccine has been in use since the late 1980s. Prior to that, mothers could infect their children in the womb or shortly after birth.
Hepatitis B spreads in blood and body fluids and causes acute or chronic liver disease which leads to liver failure and/or liver cancer.
Many parents wonder “Why vaccinate?” their baby for Hepatitis B. Babies don’t participate in high-risk behavior associated with transmitting the disease. While this is true, the main reason that we vaccinate newborns against Hepatitis B is the risk of getting the disease from the mother during the birth process or soon after.
While obstetricians screen mothers for Hepatitis B during pregnancy, they can possibly miss the diagnosis due to a premature checking of the lab or a false negative.
Infection with Hepatitis B through saliva is possible, although, rare. Often Hepatitis B does not have many symptoms initially, so someone could infect your baby without even knowing that they have the disease.
Hepatitis B is a virus that causes inflammation of the liver. A person infected with hepatitis B will have abdominal pain, dark urine, nausea/vomiting, yellowing of the skin, joint pains, loss of appetite, and fatigue. Some people may have no symptoms at all (usually young people). Infection with Hepatitis B can be acute or chronic. Chronic hepatitis B has no cure and leads to liver cirrhosis (scarring of the liver), liver failure, and liver cancer.
Haemophilus influenzae type b
Haemophilus influenzae type b (Hib) is a bacteria that used to claim many young lives by causing epiglottitis, meningitis, and pneumonia. This bacteria can also cause ear, sinus, and eye infections in kids. The Hib vaccine received license in the late 1980s.
Epiglottitis is a very dangerous condition for a baby or young child. The epiglottis is the flap of skin that covers the entrance to our airway when we swallow. Hib bacteria cause dangerous swelling and inflammation of the epiglottis and surrounding tissue.
Children who have this infectious disease are toxic appearing and are very vulnerable to a total collapse of their airway. Many pediatricians from my generation have never seen a case of epiglottitis due to the highly effective vaccine.
Streptococcus pneumoniae
Streptococcus pneumoniae is a bacteria with 90 different subtypes that can cause invasive (aggressive) disease in young children.
As its name implies, it causes pneumonia, but also more serious conditions such a bacteremia (blood infection) and meningitis. The PCV7 vaccine was first licensed in 2000 and protects children from the 7 most disease-causing subtypes of the bacteria. In 2010, PCV13 received license and expanded the coverage of the vaccine.
In 2009, the last year of my pediatric training, I did a performance improvement project as part of my residency requirements. We examined the occurrence of positive blood cultures (blood infections) in the post-PCV7 era on blood samples obtained from children who had presented for care to our children’s hospital in San Antonio.
Our chart review, based on children over a several-year period, showed that the incidence of blood infection greatly reduced after the introduction of the vaccine. Since that time, many more robust studies have also shown similar or better results.
Rotavirus
Rotavirus is a virus that causes severe vomiting, diarrhea, and high fever in small children. The initial vaccine for the disease was licensed in 1999. It was found to be associated with a higher incidence of intussusception which is a rare form of intestinal blockage. The incidence was 1 in 10,000 which was enough to remove the vaccine from the market. The rotavirus infection itself can also cause intussusception.
Two different Rotavirus vaccines were subsequently tested and licensed in 2006 and 2008. RotaTeq is given in 3 doses while Rotarix is given in 2 different doses. Both are oral vaccines that the baby swallows. This causes the production of protective antibodies in the child’s intestines.
Diphtheria
DTaP is a vaccine with three different components that include diphtheria, tetanus, and acellular pertussis. The pertussis vaccine, first developed in the 1920s, did not go into widespread use until combined with Diphtheria and Tetanus in the 1940s.
Diphtheria, caused by bacteria, shows the symptoms of sore throat, fever, and swollen lymph nodes. The dangerous complication of the disease is a grey or white patch that develops in the throat which causes blockage of the airway.
Tetanus
Tetanus is a disease caused by bacteria that live in the soil and thrive in environments without oxygen. It causes painful muscle contractions that are strong enough to tear muscles and break bones. Most commonly, it is known for its ability to cause “lockjaw” or tetany of the jaw muscles which is a prolonged painful muscle contraction.
Pertussis
The last component is pertussis which is more commonly known as whooping cough. Pertussis causes prolonged severe coughing and bronchopneumonia that is particularly dangerous for babies and young children. I took care of many very sick babies with whooping cough in the pediatric ICU as a resident physician.
During the 1990s, the U.S. switched from using whole-cell pertussis to acellular pertussis vaccine. Whole-cell pertussis was an effective vaccine but had difficulty dealing with side effects of increasing redness and swelling at the vaccination site with subsequent doses of vaccine.
The other troublesome association for many families was increased observation of febrile seizures. The acellular vaccine is made from components of the bacteria without having cell parts in it. The result is a better-tolerated vaccine that is not quite as effective for long-term protection as the whole-cell vaccine was.
Due to this, in 2006, it was recommended to start boosting pertussis immunity with the Tdap vaccine during adolescence. Even more recently, it has been recommended to give pregnant women the Tdap vaccine during pregnancy to protect their newborn infants from whooping cough until they are old enough to get their own dose of the vaccine.
Poliomyelitis
Inactivated polio vaccine is the currently licensed vaccine to prevent polio in the United States. It is the only polio vaccine that has been given in the U.S. since 2000. Prior to that, and in other countries around the world now, the oral polio vaccine was given.
The polio vaccine has been available in the U.S. since 1955. In 1979, the U.S. declared the eradication of polio. However, polio still exists in other countries around the world which necessitates continued vaccination against the disease. Poliomyelitis is a virus that causes a flu-like illness in young children.
It has the potential to attack the central nervous system and spine causing paralysis, muscle weakness, and muscle wasting.
It causes death by paralyzing the muscles needed for breathing. Prior to the vaccine, many people experienced disability and death from this terrible disease.
Unfortunately, right before there was widespread polio vaccine use, my own father contracted the poliovirus when he was a baby. He has spent a lifetime battling the consequences of this disease.
Measles, mumps and rubella
There are three components to the MMR vaccine. It protects against the diseases of measles, mumps, and rubella. The current MMR vaccine has been in use since 1978. When a child reaches 12 months, they receive this vaccine for the first time.
The baby received mom’s antibodies during pregnancy, meaning the child doesn’t need to have the vaccine sooner than 12 months. Giving the vaccine before these antibodies have lost their activity will result in a lack of immune response to the vaccine, and therefore a lack of long-term protection.
MMR vaccine is a live virus vaccine, so pregnant women or those with weak immune system should not receive it.
Measles
Measles, a highly contagious virus , isspread by respiratory droplets, i.e, coughing, and sneezing. It causes the three C’s – cough, coryza, and conjunctivitis (cough, fever/congestion, and red eyes) in addition to a classic appearing rash. The measles rash is flat red spots that start on the face and progress in a downward fashion over the body.
Children often have Koplik spots which are small white spots with bluish centers that appear in clusters on the buccal mucosa (opposite of the first and second molars). These spots appear two to three days before the measles rash starts. In addition to the misery of the above symptoms, measles has the potential to cause pneumonia (lung infections) and encephalitis (brain infections).
Prior to the vaccine, as many as one in 20 children who had measles would die of pneumonia. A long-term complication of measles is SSPE. Subacute sclerosing panencephalitis can occur many years after an acute measles episode. It leads to neurological deterioration which eventually leads to death.
Mumps
The Mumps virus is transmitted via respiratory droplets. It causes painful swelling of the salivary glands, fever, headaches, muscle aches, and fatigue. Some people contract mumps and have no symptoms, others go on to have the complications of orchitis (painful swelling of the testicles), encephalitis or meningitis (swelling of the brain or spinal cord), or pancreatitis.
Mumps can also cause hearing loss, heart problems (for the baby), or miscarriage if contracted early in pregnancy.
Rubella
The virus Rubella (“German measles”, or “three-day measles”), transmits via respiratory droplets. The symptoms of rubella are fever, mild rash, swollen glands, red eyes, and sore throat. It is a virus that causes much milder diseases than measles or mumps, but it can have devastating consequences to an unborn child if the mother contracts the disease during early pregnancy.
Up to 85% of infants infected with rubella in the first trimester of pregnancy will suffer birth defects and/or neurological abnormalities. Congenital rubella syndrome can cause many abnormalities which may include deafness, blindness, cataracts, heart defects, mental retardation, liver and spleen damage.
Varicella
Chickenpox, caused by the varicella-zoster virus, is an acute infectious disease. It causes an itchy rash, fever, and miserable viral feeling for 5-7 days. Most of us adults remember when we had chickenpox as a child. And if you are like me, you had it at the same time as your sibling because it is highly contagious.
For most children, varicella is a self-limited disease that they recover from easily. However, there are many other children and adults who have suffered complications from the disease. Skin infections, pneumonia, and even meningitis are possible complications of varicella.
Shingles are also a late complication of varicella infection. Once you recover from the acute infection, the virus stays dormant (or asleep) in your nerve cells and recurs as a shingles outbreak along the part of the skin innervated by that nerve.
The vaccine received license for use in the United States in 1995. Even with good vaccine coverage, there were still significant amounts of children who contracted chickenpox. This resulted in adding a second dose of the vaccine to the schedule in 2006. This caused a significant drop in varicella cases.
Children receive the vaccine at 12 months of age and then get a booster of the varicella vaccine at age 4 years old. This causes 99% of people to be immune to chickenpox and subsequently shingles. It is still possible to contract a wild-type strain of the disease, but the disease is much less severe in vaccinated people.
Hepatitis A
Hepatitis A is a highly contagious virus that infects the liver. It causes nausea, vomiting, and diarrhea, yellowing of the skin, loss of appetite, and abdominal pain. Transmitted through the fecal-oral route or through contaminated water.
Although no chronic form of Hepatitis A exists, and most infections are self-limited, Hepatitis A can cause extreme sickness. The infection can last for several months.
Hepatitis A vaccine is a routine childhood vaccination since 1995. Given at 12 months of age with a booster 6-12 months later. It has decreased the incidence of Hepatitis A by 95%.
Religious Considerations
While I don’t pretend to be an expert in all world religions, there are very few true religious exemptions to vaccinations. Most of the religious leaders of the various world religions have come forth in support of vaccines. There are a few links below to some of the more common religious considerations that I have researched over the years.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5141457/
https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-ingredients/fetal-tissues
http://www.vaccinesafety.edu/Porcine-vaccineapproval.htm
In Conclusion
There are many more things that we can discuss with regards to vaccines. This article covered the recommended vaccines up through the 4-6-year-old age range. Another set of vaccines recommended for adolescents also exists. We will discuss those in future posts.
I hope that this article can be a resource of good information for you and your family. I spent many hours researching and piecing this together and it is meant to educate and inform.
As a pediatrician, I have a heart for kids and help them to live the best and healthiest life possible. I know vaccines to be a safe and vital component for good health outcomes for all children.
Additional trusted resources
https://www.vaccinateyourfamily.org/
http://www.vaccineinformation.org/trusted-sources/
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