DIPTHERIA, PERTUSSIS, TETANUS
Diphtheria: This disease is caused by a bacteria and may cause failure to breathe, paralysis and heart failure. One out of every 10 people who get diphtheria die from the disease.
Pertussis: Also called “whooping cough”, this bacterial disease causes coughing and choking spells that may last several weeks. Infants are most severely affected. Complications are frequent: 16 out of every 100 babies develop pneumonia, 2 out of 100 have seizures, 1 out of 200 develops lifelong brain problems and 1 out of 200 die from the disease. Outbreaks of pertussis among unvaccinated children still occur in the United States (at least 1000 cases each year).
Tetanus: Also called “lockjaw”, this bacterial disease causes muscle spasms. Tetanus kills 3 out of every 100 people who get the disease.
Benefits: The vaccine protects at least 90 out of 100 children from getting pertussis and makes the illness very mild in other cases. Between 85 and 95 of every 100 children are protected from diphtheria and tetanus for at least 10 years following the primary series of vaccinations.
Risks: This vaccine comes in two forms: The older form (DPT) was used for many years with excellent results but some common reactions include soreness, swelling and redness at the injection site. Some children also experienced crankiness, drowsiness and decreased appetite for up to two days with this vaccine. Less common reactions (between 1/100 and 1/1000 cases) included nonstop, inconsolable crying for 3 or more hours, fever of 105 degrees or an unusual high pitched cry. Rare reactions (1/1750 cases) included seizures and episodes of becoming pale, limp, and unresponsive. Although brain damage has been reported following DPT immunizations, experts agree on the basis of studies involving more than 100,000 infants that the vaccine is not the cause.
The newer form of the vaccine is called DaPT. It is more highly purified and is associated with fewer serious side effects. Limb swelling and tenderness lasting for a few days occasionally occurs after the 4th or 5th booster. We use only DaPT in our office for infants and preschool age children.
Tdap, used routinely for adolescents, contains less pertussis vaccine. DT (pediatric diphtheria-tetanus vaccine), Td (Adult tetanus-diphtheria vaccine), and T (tetanus vaccine) are sometimes used in special circumstances. They all may cause mild fever and sometimes soreness, swelling and redness at the site of the injection.
Reasons to delay giving DaPT or Tdap: The vaccine should not be given if the person has a febrile illness more serious than a common cold, an unstable seizure disorder, or deteriorating development.
POLIO and IPV VACCINE
Polio, caused by a virus, causes paralysis of the arms and legs as well as the muscles that allow us to breathe. Death or lifelong limb weakness are the main complications of this disease. This used to be a common childhood disease until this vaccine became available. Outbreaks still occur in unprotected groups of people.
IPV VACCINE (Inactivated Polio Vaccine)
Benefits: IPV is a “killed vaccine”, not a live or attenuated (weakened) vaccine. It affords complete protection against a life-threatening and paralytic disease.
Risks: The only risks are occasional redness or tenderness at the vaccination site.
Reasons to delay or not to give IPV: The vaccine should not be given to people with a febrile illness more severe than the common cold or a history of an allergic reaction to diphtheria vaccine (not to DPT).
HAEMOPHILUS INFLUENZA TYPE B
HAEMOPHILUS INFLUENZA TYPE B
Haemophilus Influenza Type B is a bacteria which causes meningitis (swelling of the covering of the brain and spinal cord), usually in children between ages 3 months and 3 years. Before the development of the vaccine, 12,000 cases were reported each year in the United States. Five out of every 100 children who came down with this disease died. Over 30 out of every 100 cases resulted in hearing loss, learning problems, and other neurological problems. Other life threatening illnesses of the bone, heart, and airway are also caused by this germ.
Benefits: Three to four doses of this vaccine protect infants and children against serious disease caused by Haemophilus Influenza Type B, including meningitis.
Risks: Patients may occasionally experience fever lasting less than 24 hours (fewer than 2/100 doses). Occasional redness, swelling, or soreness at injection site lasting one or two days (3/100 doses) is also seen. Rarely, reported events for which no cause and effect has been found include rash, hives, and Guillain-Barre Syndrome (temporary paralysis following infection).
Reasons to delay or not give vaccine: This vaccine should not be given to people with a febrile illness more severe than the common cold or a history of an allergic reaction to diphtheria vaccine (not to DPT).
Hepatitis B is an inflammatory liver disease caused by the Hepatitis B virus. Symptoms include jaundice, poor appetite, nausea, and fatigue. Sometimes rapid liver failure leading to death occurs. Occasionally, a person may develop chronic illness leading to cirrhosis or cancer of the liver. Transmission of the virus occurs through sexual intercourse or contact with the blood of a carrier, although many people (up to 30-40 %) contract the disease without obvious risk factors. Babies born to mothers who carry the virus will often be infected at birth. In general, however, hepatitis B is not a disease common to the pediatric population in the United States.
HEPATITIS B VACCINE
Although most infants and children are not at risk for Hepatitis B, The American Academy of Pediatrics now recommends immunization for all infants against this virus. Universal immunization of infants will prevent this disease from occurring later on or in adulthood. It also helps prevent cancer of the liver. Immunization in infancy, a time when frequent routine visits to the doctor are scheduled, provides the best time to assure that a maximum number of Americans will become immunized. Routine vaccination of adolescents not previously vaccinated against Hepatitis B is also recommended.
Benefits: The Hepatitis B vaccine now used is a “recombinant” vaccine. Ordinary yeast are genetically altered to produce the Hepatitis virus coating. This is not a live vaccine. Injection of this material in 3 doses spread over at least a 6 month period provides complete protection in 95% of children vaccinated. Protection lasts at least 10 years and probably for life.
Risks: Soreness at the injection site.
Reasons to delay or not give vaccine: The vaccine should not be given to someone with a febrile illness more severe than the common cold or to anyone with a yeast allergy.
Pneumococcus is a bacteria that causes pneumonia, meningitis, and ear infections. This bacteria is of special concern because it has become resistant to many antibiotics. Vaccination is a good way to prevent pneumococcal disease and may become the only way to combat this antibiotic-resistant disease in the future.
PNEUMOCOCCAL VACCINE (PREVNAR)
Benefits: Pneumococcal vaccine prevents illness from the thirteen varieties of pneumococcus that are most common in the United States and include the ones most resistant to antibiotics. It is made from the coating of bacteria and is not a live vaccine. An older pneumococcal vaccine protects against more varieties and is equally as safe but is not effective when given to young children. Since young children are at highest risk, routine immunization with Prevnar in infancy is indicated.
Risks: Mild side effects may occur shortly after the vaccination. These include soreness, redness and swelling at the site of the injection. Occasionally a low-grade fever lasting less than a day is noted. A small number of children will get a bump under the skin which goes away by itself within a few weeks.
Reasons to delay or not give vaccine: The vaccine should not be given to someone with a febrile illness more severe than the common cold.
MEASLES, MUMPS, AND RUBELLA
MEASLES, MUMPS, AND RUBELLA
Measles: This viral disease causes high fever, cough and a rash which last for two weeks. Complications include convulsions, hearing loss and mental retardation. One out of every 500 to 10,000 cases end in death.
Mumps: This viral illness causes fever, headache and swollen salivary glands. Complications include painful swelling of the testicles (1 out of 4 males), meningitis (1/10 cases), encephalopathy (1/200 cases) and hearing loss.
Rubella: Also called German measles, this viral illness causes a rash and fever. This is a mild illness in children. However, if a pregnant woman contracts the disease, her unborn baby may be born blind, deaf or be mentally retarded. Rubella also causes miscarriages.
Benefits: MMR vaccine is a live, attenuated vaccine that protects children from these diseases when given according to schedule.
Risks: Occasionally a child may experience soreness or redness at injection site that lasts 1 to 2 days. One to 3 weeks following vaccination there may be a self-limited rash (5/100 doses), fever (5/100 doses), mild swelling of jaw or neck glands (1/7 doses), mild joint pain lasting 3 days (1/100 doses), or self-limited numbness in the hands and feet (rare). Very rarely (1 in a million doses) encephalopathy has been reported. However, there is no evidence MMR vaccine causes encephalopathy.
Recently (late ‘90’s), there has been some public interest in a theory that suggests that MMR vaccine may be linked to autism, a developmental disorder of language and social skills often associated with mental retardation. The theory was based on the observation of developmental regression in 12 children following vaccination. Subsequently, large studies in England involving nearly 500 patients, as well as larger studies in Sweden and other countries have failed to find any relationship between vaccines and autism. Children who receive MMR vaccine are no more likely to become autistic than children who do not get the vaccine. Both the United States Center for Disease Control and The American Academy of Pediatrics remain confident in the safety of this important vaccine.
Reasons to delay or not give vaccine: The vaccine should not be given to anyone with a febrile illness more severe than the common cold, neomycin allergy, an abnormal immune system (certain cancers, certain treatment for cancers, high dose prednisone), to anyone who has received gamma-globulin injection within the past 3 months, or to pregnant women. It is safe to give MMR to a child whose mother is pregnant.
VARICELLA (CHICKEN POX)
VARICELLA (CHICKEN POX)
Chicken pox is a viral illness which causes an itchy rash, mild fever, headache and sore throat. Complications include infection of the lesions by bacteria, low platelets, arthritis, inflammation of the liver, encephalitis or meningitis, and kidney problems. Reyes syndrome, a disorder of liver failure and encephalopathy, may be seen following a case of the chicken pox, especially if the individual has taken aspirin during the illness. Chicken pox is often more severe in adults. Pneumonia, although rare in children, is the most common complication in adults. Infection in a pregnant woman may result in birth defects. When a maternal infection occurs between 5 days before and 2 days after delivery, severe disease may occur in the baby with a 5% chance of death.
This live, attenuated vaccine is prepared from a weakened chicken pox virus. It provides full protection against getting chicken pox in 70% to 90% of people who are immunized. Those who do get the disease following the vaccine will get a much milder case. Individuals over thirteen years old require an initial series of 2 vaccines at least one month apart. Immunity is expected to be life-long following primary vaccination plus a booster.
Benefits: Although complications of chicken pox are relatively uncommon, chicken pox is often uncomfortable and frequently leaves several small scars. It causes parents to miss work and children to miss school for the approximately one week which it lasts.
Risks: Mild side effects may occur shortly after the vaccination. These include soreness, redness and swelling at the site of the injection. Between 2% and 4% of children may experience rash, fever, nausea and malaise anywhere from one to four weeks following the vaccine.
Reasons to delay or not give vaccine: The chicken pox vaccine should not be given to someone with a febrile illness more severe than the common cold. It also should not be given to anyone with a condition which severely compromises the immune system such as treatment with certain cancer drugs, prednisone or AIDS. It should not be given if the individual is pregnant or in close contact with a pregnant woman who has never had or has never been immunized against the chicken pox.
Influenza virus causes the wintertime illness commonly known as “the flu”. Symptoms include high fever, cough, and generalized body aches which last about one week. Occasionally complications including pneumonia occur. Although the disease is usually self-limited, influenza can lead to hospitalization and occasionally even death, especially in otherwise healthy young infants, the elderly, and people with certain chronic illnesses. Between 5 and 20% of the population will get the flu every year. More than 200,000 people are hospitalized with flu-related complications, of whom about 36,000 people will die.
INACTIVATED INFLUENZA VACCINE
Yearly influenza vaccine is now recommended for all children between ages six months and 18 years old.
Benefits: Inactivated influenza vaccine will prevent illness from specific strains of influenza A and influenza B. The vaccine is designed each year to protect against those strains thought to be likely to occur in that winter season.
Risks: As with most vaccines, redness and soreness may occur at the injection site, along with fever and muscle aches.
Reasons to delay or not give vaccine: Anyone who has ever had a severe (life-threatening) allergic reaction to a previous dose of influenza vaccine should not get another dose. Anyone who is moderately or severely ill at the time the shot is scheduled should probably wait until they recover. Anyone who has ever had Guillain-Barré Syndrome should talk with their provider before getting Influenza vaccine.
MENINGOCOCCAL DISEASE (MENINGITIS) and MENACTRA
MENINGOCOCCAL DISEASE (MENINGITIS)
Meningococcal meningitis is an infection of the spinal cord and fluid surrounding the brain. Meningococcal disease also causes blood infections. Children and young adults, particularly college freshmen who live in dormitories, are most often affected by meningococcal disease, but persons of any age can become infected.
MENACTRA (MENINGOCOCCAL VACCINE)
Benefits: Meningococcal vaccine is a killed vaccine that prevents 4 types of meningococcal disease. These include 2 of the 3 types most common in the United States. A booster shot is recommended after 5 years.
Risks: Mild local side effects such as redness or pain at the injection site occasionally occur. A small percentage of people who receive the vaccine may develop a low grade fever, headache, or fatigue that last for one to two days. In post marketing studies several cases of Guillian-Barre Syndrome, a rare but serious disease that causes paralysis, occurred within six weeks of vaccine administration. Recent studies however implied that the vaccine did not cause the disease.
Reasons to delay or not give vaccine: The vaccine should not be given to people with a febrile illness more severe than the common cold. It should not be given to people who have had a serious allergic reaction to a previous dose of the vaccine. It should not be given to persons with any bleeding disorder, such as hemophilia or thrombocytopenia, or to persons on anticoagulant therapy.
HUMAN PAPILLOMA VIRUS (GARDISIL)
HUMAN PAPILLOMA VIRUS
Human papilloma virus (HPV) is a common, sexually transmitted virus acquired by over eighty percent of sexually active people. Usually the virus causes no symptoms, no harm and is eliminated from the body by the immune system. Occasionally, HPV will cause genital warts. Most significantly, in those women who do not clear the virus on their own, HPV can lead to cervical cancer. HPV is also the major cause of mouth and throat cancer, penile and rectal cancers. There is no way to predict which people will be unable to clear the virus on their own.
HPV VACCINE (GARDISIL)
Benefits: HPV vaccine is a non-infectious vaccine made up of virus-like particles of four varieties of human papilloma virus. Three doses of the vaccine confer lifelong immunity against these varieties of human papilloma virus and complete protection against cervical cancer caused by these types of HPV. A woman who has received HPV vaccine reduces her chance of acquiring cervical cancer by about 85%. The vaccine does not protect against varieties of HPV not contained in the vaccine. The vaccine is indicated for all people between ages 9-26 years.
Risks: There are no known serious side effects. As with any vaccine, pain and redness at the infection site may occur. Fever, nausea, dizziness and fainting have been occasionally reported.
Reasons to delay or not give vaccine: Do not vaccinate patients with known allergy to any of the vaccine components or allergic reaction following administration of a previous dose of vaccine.
Rotavirus is the most common cause of gastroenteritis in the winter in infants. Violent vomiting and diarrhea sometimes lead to dehydration and the need for hospitalization.
ROTAVIRUS VACCINE (ROTATEQ)
Benefits: Rotateq and Rotarix are oral live virus vaccines effective against five varieties of Rotavirus. Following a series of three immunizations, these vaccines prevent severe illness in 98% of children and all illness in at least 70% of children for one year following immunization. Protection for a second year following vaccination is almost as good. Protection beyond two years has not been studied.
Risks: There have been no serious side effects associated with this vaccine. Mild vomiting, diarrhea, and irritability occurred occasionally.
Reasons to delay or not give vaccine: Infants with known allergy to any component of vaccine should not receive Rotateq or Rotarix. Immunocompromised infants (those whose immune systems are not normal because of certain diseases and medications) and infants with immunocompromised household members probably should not be immunized with these vaccines. (No studies are available).
Hepatitis A virus is one of several viruses that cause acute liver disease. Consequences of Hepatitis A disease range from self-limited asymptomatic illness to complete liver failure and death. The disease is transmitted by infected fecal material through person-to-person transmission, contaminated water, and shellfish living in contaminated water. Other foods washed in contaminated water may also transmit the disease.
HEPATITIS A VACCINE
Benefits: Hepatitis A vaccine is an inactivated whole virus vaccine. It is not a live vaccine. Two doses of vaccine six months apart is thought to confer nearly one hundred percent life-long immunity.
Risks:There are no known serious side effects. As with any vaccine, pain and redness at the infection site may occur.
Reasons to delay or not give vaccine: It is safe to administer the vaccine to immunosuppressed patients but the immune response may be less than optimal. Do not vaccinate patients with known allergy to any of the vaccine components or allergic reaction following administration of previous dose of vaccine.