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Woman And Infants

Web-Exclusive Q&A: Childhood Immunizations

Immunizations are one of the best ways to protect our children against life-threatening diseases. Dr. Peter Kriz, a pediatrician affiliated with Women & Infants Hospital who maintains a private practice, Coastal Waterman Pediatrics, in East Providence, answers some basic questions about childhood immunizations.

Why do we immunize our children against diseases that aren't as prevalent any more?
While the prevalence of life-threatening diseases such as measles and paralytic polio has drastically been reduced thanks to decades of immunization here in the United States, outbreaks of these diseases still occur in both developed and developing countries around the world. Measles still infects more than 20 million people globally, causing death in approximately 2% of infected individuals. In an era of global travel, international adoption, and vaccine skepticism, parents should be aware of the potential risks of declining immunizations for their children.

How do immunizations work?
Immunizations are made from germs or parts of germs that cause disease. The germs in vaccines are either killed or weakened so they won't make your child sick. Most vaccines are introduced to your child's body by injection. The exceptions: rotavirus vaccine is an oral vaccine; and FlumistĀ® is an intranasal, live-attenuated influenza vaccine. Your child's body makes antibodies against these vaccine germs the same way it would if it were invaded by the disease itself; the antibodies destroy the vaccine germs, and then stay in the body, giving your child immunity. If your child were ever exposed to the natural disease, these antibodies would protect against infection.

What vaccinations must children get to enter kindergarten? Are there others they should get?
As of June 2005, all Rhode Island children are required to have received the following vaccine series prior to school (kindergarten) entry:

  • Five doses of DTaP(diphtheria, tetanus, pertussis) vaccine
  • Four doses of polio vaccine
  • Three doses of hepatitis B vaccine
  • Two doses of MMR (measles, mumps, rubella) vaccine
  • One dose of varicella (chickenpox) vaccine or documentation by a health care provider of a history of chickenpox disease

For specific questions or exemptions, please visit the Rhode Island Department of Health.

Are there more vaccinations given now than 20 years ago?
In the mid-1980s, seven vaccines were routinely administered: diphtheria, tetanus, pertussis, measles, mumps, rubella, and polio. Hib (Haemophilus influenzae type b) was added in the late-1980s, hepatitis B and varicella in the 1990s, and pneumococcal vaccine in 2000. Since 2004, influenza, hepatitis A, meningococcal, rotavirus, and human papillomavirus (HPV) vaccines have been added to the recommended childhood immunization schedule. Currently, several vaccines are routinely administered in combination - diphtheria, tetanus, pertussis, polio, and Hep B are combined into one shot; and measles, mumps, rubella, and varicella are also combined into one shot - to minimize the number of injections necessary to complete the recommended vaccine schedule.

Is there a schedule for vaccinations? What if we miss one at the scheduled time?
The Advisory Committee on Immunization Practices (ACIP) periodically reviews the recommended immunization schedule for children 0-18 years of age. To view the current vaccine schedule, visit the Centers of Disease Control and Prevention (CDC) website. Figures 1 and 2 provide information regarding age-specific vaccine recommendations, while the Table provides information regarding catch-up vaccine schedules.

Are there side effects to the vaccinations?
According to the American Academy of Pediatrics' Red Book: 2006 Report of the Committee on Infectious Diseases, "All licensed vaccines in the United States are safe and effective, but no vaccine is completely safe and effective in every person. Some vaccine recipients will have an adverse reaction, and some will not always be protected fully. The goal of vaccine development is to achieve the highest degree of protection with the lowest rate of adverse events. Adverse events after immunization include both true vaccine reactions and coincidental events blamed on the vaccine." For a more comprehensive discussion of true vaccine reactions, coincidental events, indications for withholding vaccines, or reporting vaccine reactions, visit the CDC website.

What does the future hold for immunizations?
Currently, there are approximately 30 ongoing clinical trials worldwide with preventive HIV vaccine candidates; advanced testing is now taking place or planned for several candidates. In 2006, more than 39 million people worldwide were living with HIV. With nearly 14,000 people becoming HIV-infected every day, the development of an HIV vaccine must become a priority regarding global health. If you have additional questions regarding childhood vaccines, you may download a FREE copy of the CDC's Parents' Guide to Childhood Immunizations.

In order to provide answers to your most pressing health care questions, the clinicans at Women & Infants participate in an ongoing series of web-exclusive interviews.

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