Howard Nass MD FAAP Pediatrics childhood vaccines
Childhood Vaccines, an Inoculation Primer
There are few routines in the life of a parent more distressing than taking their young son or daughter to the doctor for shots. A little background might help them over the trauma, and appreciate what a good thing they are doing for their children.
It was discovered in the Orient hundreds of years ago that smallpox could be controlled if a small amount of the live virus was taken from the lesions of sick people and injected into healthy subjects. An unfortunate side effect was that many of these healthy subjects went on to develop smallpox.
Obviously we have come a long way from these days, and from the early days of the last century when disease was attributed to "atmospheric conditions" or to "polluted air" and not contagion. Even Edward Jenner, who developed the first safe vaccine against smallpox in 1796, had no idea why it worked.
We now know that vaccination works by tricking our immune system to develop an antibody response, thus protecting us-and our children-from once common and fatal diseases.
Vaccines work in several ways. Some like the diphtheria, whooping cough, tetanus, and Salk polio vaccines are dead, modified forms of the disease causing organism. Sometimes the organism is injected or swallowed in a weakened form (weakened strain), as in the Measles, Mumps, Rubella, Sabin Polio, and intranasal influenza vaccines.
Newer vaccines, like the one for Hepatitis B are genetically engineered. Others like the HIB Conjugate Vaccine, are combinations of a polysaccharide vaccine with another protein.
Here's an overview of some of the vaccines normally given to children, including some newer ones representing the significant progress made in just the last few years. A full schedule of childhood and adult vaccination, courtesy of the Center for Disease Control can be separately found in our web site.
Diphtheria, Pertussis, Tetanus (DPT) vaccines are given at 2 months, 4 months, 6 months, 12-18 months, and 4-6 years of age. These vaccines are proven, safe, and have afforded excellent protection since the 1930's. A newer form of this vaccine is DTaP (acellular pertussis). The pertussis portion of this vaccine was modified to reduce side effects such as fever, swelling, and fussiness while offering excellent protection against the disease and has fully replaced the DTP vaccine for use in the United States.
Tetanus and Diphtheria (Td) boosters have traditional been given to adolescents and adults in order to maintain immunity to these diseases. Although Pertussis is usually not life threatening at these ages, infection with Pertussis can act as a reservoir for infection of younger patients. Vaccination with the new TdaP vaccine is currently recommended for most adolescents and adults, and is now required for entry into the 6th grade in the New York City public school system.
Hoemophilus Influenza B (HIB) can cause a very severe form of bacterial meningitis, as well as epiglotittis, an often fatal infection in the upper airway of young children. It also causes infections throughout the body. The HIB vaccine is one of the miracles of modern medicine. Its use over the past 20 years has completely wiped out this disease in the United States.
Hepatitis B is one of the lesser known but more deadly illnesses in the world. Hepatitis B can be transferred by sexual contact, needle sticks, human bites, the sharing of razors or toothbrushes, or by any blood borne contact. It is often transmitted mother to child during childbirth. Many people with Hepatitis B infection are asymptomatic carriers, which means that they show no signs of disease but can infect other people. Hepatitis A is spread by fecal oral transmission. Hepatitis B Vaccine, and now Hepatitis A Vaccine are parts of the routine childhood vaccination schedule in order to help prevent liver disease and liver failure. Catch up vaccination with Hepatitis A Vaccine is recommended for those who did not receive this vaccine as a child.
Varicella (Chicken Pox) when acquired as a child is usually a self-limited illness, yet may, in some cases, cause severe complications, and even death. Vaccination at 12-18 months has been recommended for some time. Reexposure to Varicella disease is felt to be key in providing long term immunity and is why in most cases people "get chicken pox one time only." Due to the success of the vaccine, there simply aren't that many cases of chicken pox out there. A second dose of VZV has therefore been recommended for most children entering kindergarten. Catch up vaccination is recommended for most children who were not vaccinated at these times.
Influenza Vaccine and Pneumococcal Polysaccharide Vaccine are recommended for certain high risk groups. Influenza Vaccine is also currently recommended for most children ages 6-59 months and their family contacts.
Most pregnant women should receive the "Flu Shot" to protect themselves and their developing fetus.
Rotavirus can cause severe diarrhea, dehydration, and even death. A new Rotavirus vaccine is recommended for most children at ages 2 months, 4 months and 6 months.
The new HPV vaccine has already shown great promise in decreasing the incidence of HPV infection; the causative organism for certain cancers in both men and women.
New and improved vaccines are always being developed, however, many of our currently available vaccines never make it to many of our children. Speak with our office so that we can review your child's records and assure that your child receives all of his or her vaccines, and on time.
You can reach Dr Nass's office at (718) 520-1070 to schedule an appointment.