New Parents Survival Guide: Vaccines

Vaccines are one of the things that are harder on parents than babies. It is hard for us as parents who are supposed to protect our babies from harm to willingly allow them to feel pain. It is in the feeling of reluctance to hurt our babies that the anti-vaccine movement finds its audience. When we do not want to do something we look for something to support our opinions. Unfortunately, there have been some famous personalities who have stepped up and filled that role and have made it harder and harder for doctors to persuade people to vaccinate their children. My goal is not to necessarily persuade you to vaccinate your child (which is a very good idea), but provide you with the background details about why we vaccinate and how vaccines work.

The first thing you need to understand about vaccines is a term called immunity. Immunity in simple terms is a body’s ability to remember some- thing it has had before and keeps from getting it again. A disease attacks the body either as a bacteria, virus, or yeast. The body needs to respond to fight off the infection to keep from dying. The body has cells responsible for recognizing anything foreign or dangerous that enters it. Through a series of steps, the body starts to produce antibodies to fight off the illness to remove it from the body. Their cells store the memory of how to make these antibodies. If the body is ever attacked again by the same disease it can immediately start production of the antibodies to keep the disease from causing illness.

Some diseases are so severe they can lead to severe illness, disability or even death before the body has time to produce antibodies to fight off the illness. Before the production of vaccines, disease such as smallpox, polio, tetanus, whooping cough, strep pneumonia, hemophilus influenza, diphtheria, measles and mumps often led to disability and death. It was the severity of the illnesses that stimulated so much research and money being spent on the development of vaccines to prevent them.

The idea of a vaccine is to stimulate the body to produce antibodies to fight off an illness and to keep the memory without the person ever getting the disease. Vaccines have been designed using the actual virus that has been weakened with pieces of the virus or bacteria, by using other bacteria incapable of causing disease in humans, or a milder illness still able to produce immunity. Once a substitute is discovered scientists have to find a safe way to “infect” the person with the vaccine so the vaccine produces immunity to the real illness, but does not harm the person.

Vaccines have worked so well over the last 40 years parents have become more scared of the vaccines than they are of the disease. The main reason for this is because diseases are seen so rarely many people believe they are gone. Unfortunately the diseases still exist and if given the chance and a population of people with no immunity, they will thrive and cause disease, disability and death again.

Before we give all the credit of a disease free planet to the vaccines it should be mentioned that good sanitation, pest control, safe food and water supplies and medical care such as hospitals and medication have done an equal share of prevention and treatment for many of these illnesses. Many of the anti-vaccine people would like to give these advances all the credit for decreasing these diseases and many of the pro-vaccine group would like to downplay their importance.

Here is where I get to put my two cents into the discussion. When it comes to my children and my patients I want to prevent them from getting sick with any disease leading to their disability or death. With that in mind I want to use everything available to me. I recommend healthy living, good diet, safe homes, and vaccines that have been well tested and proven effective and safe. If those things fail then we use medical treatments to treat the illness. Would you want to go to a mechanic to fix your car who refused to use any tool except a hammer, or go to a school only teaching subtraction in math, or a doctor who treated people only by changing their diet? I know when I want something done I want them to use every tool at their disposal to get the job done right.

There have been other people who do not like the idea of giving multiple vaccines at the same time and want to alter the vaccination schedule. In that regard, I would have to defer to your doctor. There are certain vaccines, for which the schedule can be changed some, but in others there is a set timeline to give them and certain vaccines that either have to be given at the same time or separated by a given time. Many people just want to base this decision on pain they feel their child will feel from multiple vaccines. My response to these parents would be to ask them if they would prefer to have one bad day or multiple bad days? Would you rather drop a brick and smash all your toes at once and feel all the pain, or smash your big toe today, the second in a week, the third a couple days later, the fourth on another day and the fifth a couple of days later? I want to get it over all at once, because it is all just pain and I would rather have one day of pain than multiple days of pain.

Some people say vaccines cause autism. These arguments change, as they are proven wrong. The original argument was the MMR vaccine caused autism. When MMR was shown to not cause autism, then the thimerosal preservative was blamed. When thimerosal was removed from the vaccines, then it was the amount of vaccines given to shoulder the blame. The scientific community has proven each of the theories false, but the other side just changes how they blame vaccines without having to prove anything on their side of the argument.

Parents often don’t know what the actual disease does that we are seeking to prevent. Why do we want to prevent it from happening? How do babies get it from people? What would happen if we stopped vaccinating everyone?

In the section below I describe what the diseases we vaccinate against in these first two years are and why we need to vaccinate against them.

Hepatitis B: Hepatitis B is a virus transmitted by exchange of blood products, like blood transfusions and sharing needles or by unprotected sex. It can also be transmitted from an infected mother to her baby. Moms sometimes do not even have symptoms of the disease, since it can take up to six months from the infection to develop symptoms. Babies are much more likely to develop chronic liver disease which leads to liver failure and the need for liver transplants than adults are when contracting Hepatitis B. Many people argue babies do not need this vaccine because they will not be doing drugs or having sex until they are older. Unfortunately we do not get to plan when they may need a blood transfusion and we never know when they might step on an infected needle or get poked with one in a trash can as they walk by. Hepatitis is an extinguishable disease and once everyone is immunized it will go away just like smallpox has done in the recent past.

Diphtheria: Diphtheria is a disease caused by the bacteria Corynebacterium diphtheriae. Do not worry there will not be a test on how to say or spell that little booger. It is a bacteria spread through the air when people cough or sneeze, but can also be transmitted through contaminated food or by putting something in their mouth that has been contaminated with the bacteria. It mainly affects the nose and throat and causes a gray to black membrane to form. Unfortunately it does not just stop with a really sore throat, but can lead to heart damage and damage to your nervous system which may cause paralysis. If infected it has a 10 percent mortality rate and if you do not die recovery is very slow. We do not hear about this disease much in the US because of our widespread immunization but it still exists in other countries. In 1994 there were about 50,000 cases in Russia. Foreign people who may have been infected before coming to the United States are still exposing us.

Tetanus: Tetanus is the cause of the infection known as lockjaw and is caused by the bacteria, Clostridium tetani. This bacteria lives inactive as a spore in the ground and may be infectious for up to 40 years. It gets into the body through a wound contaminated by dirt. It leads to muscle spasms called tetani that resemble seizures. It can cause these spasms in your jaw, which does not allow you to open your mouth, but can also happen to any of the muscle groups in the body including your airway. If untreated, one in three people will die. Properly treated the death rate in children is less than 10 percent. Because of vaccinations in the United States we only see five cases per year and these are in unimmunized people or people who have not had their boosters. There are approximately one million cases per year worldwide.

Pertussis: A disease otherwise known as whooping cough caused by Bordetella pertussis or Bordetella parapertussis. It is a bacterial infection starting with a fever and cough that continues to get worse. After the first two weeks the cough gets deeper and the patient begins to cough up an abundance of mucous that may lead to vomiting. They may cough in such prolonged fits their breathing is affected and they may not get enough oxygen to their brain. It is especially deadly in small infants. Pertussis can lead to choking, seizures, mental retardation, apnea (when breathing stops for periods greater than 20 seconds), and death. With our immunizations in the United States we usually only see outbreaks in infants (before they can get the vaccine), unimmunized patients, or in older people who have not had a booster of pertussis vaccine.

Hemophilus type B: This vaccine is aptly named for Hemophilus influenza type B bacteria – it’s amazing that for once in medicine the names make sense. This is a nasty little bacteria and before the vaccine came out it was the leading cause of bacterial meningitis in children less than five years of age and the second leading bacterial cause of pneumonia and ear infections. The most severe infection was of course the development of meningitis that, even when treated, had a 3-5 percent incidence of death, a 20 percent incidence of hearing loss in the survivors and could cause seizures and mental retardation. Today with proper vaccines it is a very uncommon infection in children once they have been adequately vaccinated. It is still a very real threat to young infants who have not started their vaccines.

Polio: Polio has been fairly effectively wiped off the planet by a worldwide vaccination program. Polio has been rare in the United States since the early 1970s. In 2000 we converted to using a shot instead of an oral polio vaccine, because the oral polio vaccine was a live vaccine and was the only cause of polio we were continuing to see in the United States. The vaccine we use now is called IPV, or inactivated polio vaccine, and is incapable of causing disease. In 2013 the world was down to 416 cases of polio. Once polio has been eradicated then vaccination for it will no longer be needed.

Streptococcus pneumonia: Prevnar is the current vaccine for Streptococcal pneumonia and is one of the newer vaccines given to our babies. It has been routinely given for the last 15 years and has been a Godsend to babies. Streptococcus pneumonia is a bacterial infection, which, following the introduction of HIB vaccine was the leading cause of bacterial meningitis and is the leading cause of bacterial pneumonia and ear infections in children. This bacteria is nothing like its cousin the bacteria that causes strep throat and is truly a bacteria to be feared. Symptoms from strep pneumonia are going to vary depending on where the infection is located. It can cause a secondary infection such as pneumonia, ear or sinus infections and symptoms related to those conditions. It can cause meningitis with symptoms of stiff neck, vomiting, and high fever so you look like death warmed up. It can also cause a condition called bacteremia where the bacteria are in your blood. Your only symptom for this will be extremely high fever and chills. The treatments always include antibiotics, but in the cases of meningitis, bacteremia and pneumonia you can end up in hospital for treatment. Unfortunately sometimes treatment is not enough and babies die from these infections. The vaccine has done a lot to reduce these diseases in the last 10-15 years. This is not one of the vaccines you would ever want to skip.

Rotavirus: Rotavirus is a virus that does exactly what it sounds like. It acts like a rotating rooter on your intestinal tract and leaves no blockage or anything else in there (boy, I would like to use a nationally known sewer cleaning company name in that sentence). This is the largest killer of children worldwide, mainly in third world countries. Most deaths are secondary to severe dehydration. Rotavirus causes a severe, watery diarrhea, which just seems to shoot out like a very foul-smelling, green, poopy fountain. The diarrhea can be severe with 15-30 stools a day not uncommon. This is never good for a little one and unfortunately often requires I.V. fluids and hospitalization. Rotavirus has a new vaccine that started being used widely in the mid-2000s and has several new vaccines in the pipeline. This vaccine has been worth its weight in solid gold poop. I went from putting in about 75 IVs a year during rotavirus season to none last year.

Varicella: Otherwise known as the chickenpox. The virus Varicella-zoster, a member of the herpes family, causes it. It started being widely vaccinated against in the late 1990s and has decreased the incidence of chickenpox immensely. Parents often question whether we need to vaccinate against chickenpox since it is a benign viral illness. Chickenpox used to be very common, but was responsible for over 100 deaths per year in the United States and every child with chickenpox missed about 10-14 days of school. With our need these days for a two income family how many people can afford to take off two weeks to stay at home with their child? How many children can keep up in school if they miss two weeks? I do not know how you feel, but to me if any child dies from a mild illness it is unacceptable if it can be prevented.

Hepatitis A: Hepatitis A virus causes hepatitis, as you might suspect. Hepatitis is a swelling and inflammation of the liver. It is spread through contaminated stools from infected individuals and is transmitted through contaminated food or water. This is a fairly new vaccine that is now recommended to everyone, having been previously only recommended to people in high-risk areas, such as flood plains. With recent outbreaks of hepatitis from restaurants thanks to contaminated vegetables, the Center for Disease Control recommended it be a universal recommended vaccine to try to eliminate it from the population. Many find its use controversial because it is a self-limited disease, meaning is usually resolves on its own, and very rarely fatal. The great thing is it has few, if any vaccine reactions.

Measles/Mumps/Rubella: A combination shot otherwise known as the MMR. I will try to tell you what the diseases are and what they did and leave the controversy about their vaccine to your doctor to talk to you about, since this will probably change over time depending on which celebrities are currently on talk shows acting like doctors.

Measles: The classical symptoms of measles include four days of fevers, coughing, runny noses and conjunctivitis. The fever may reach up to 104 degrees F. The characteristic measles rash is classically described as a red, bumpy rash beginning several days after the first symptoms and may last eight days. Complications of the measles are relatively common, ranging from the relatively mild and less serious like diarrhea and dehydration, to conjunctivitis, which can lead to corneal ulcers as well as infections of the lung and brain. Complications are usually more severe amongst adults who catch the virus.

Mumps: The most common symptom is inflammation of the parotid (a salivary gland along the jaw line) in about 60-70 percent of infections and 95 percent of patients with symptoms. Parotitis causes swelling and local pain, particularly when chewing. It can occur on one side, but is more common on both sides. Fevers can be as high as 101-104 degrees Fahrenheit. Orchitis is a painful inflammation of the testicle. Males who are past puberty have about a 30 percent chance of developing orchitis. Following orchitis the testicles can atrophy (get smaller) and can rarely cause sterility (orchitis alone is enough for me to wholeheartedly recommend the mumps vaccine). Mumps can also cause severe headache (if you could notice it amongst the other terrible symptoms). Mumps is a contagious disease spread from person to person through contact with respiratory secretions such as saliva from an infected person. When an infected person coughs or sneezes, the droplets aerosolize and can enter the eyes, nose or mouth of another person. Sharing food and drinks can also spread mumps. The virus can also survive on surfaces and then be spread after contact in a similar manner. A person infected with mumps is contagious from approximately six days before the onset of symptoms until about nine days after symptoms start. Death is very unusual. The disease is usually self-limiting and the general outcome is good, even if other organs are involved.

Rubella: Rubella is commonly known as the German three-day measles. It is a very mild infection; usually not causing many problems unless contracted while the person is pregnant. If contracted during the first trimester of pregnancy it can lead to spontaneous abortion about 27 percent of the time. It causes symptoms similar to the flu. The first symptom is a rash on the face spreading to the body and usually fades after about three days. It can also cause low-grade fever, swollen lymph nodes, joint pains, headache and pink eye. Fever is rarely over 100.4 degrees F.

The main reason a vaccine is given is to prevent congenital rubella syndrome. This happens if a mother acquires rubella during the first trimester. If the baby survives the infection they can go on to develop car- diac, brain, eye and hearing defects. It can also lead to prematurity, low birth weight, anemia, and hepatitis. The baby can also be born with a severe rash called blueberry muffin baby syndrome. Many of these diseases you have probably never even heard about, much less even seen. Their rareness is a true testimony of how well vaccines work. In countries not giving these vaccines, some of the diseases are alive and well and kill babies every day. As a medical community we are striving to continue to develop new vaccines to further prevent disease. There are currently vaccines for strep throat, Alzheimer’s disease, HIV, genital herpes and malaria being developed. It is far better to prevent an illness from ever happening than try to treat it after you get the disease.

Think about all the things you do to protect your baby.

You put outlet covers all over your house, block all the stairways, lock up medications and always put your child in their car seat. In 2011 650 children less than 14 years of age died in car accidents. In the same year 158,000 people died from measles worldwide. There are reasons vaccines are given and exist even if you do not know or remember why.

There will always be people that take an opposing stance. There are people who refuse to take any medicines, accept blood transfusions, and eat non-organic foods. They have every right to their opinions and choices. The important things to do as a parent is understand the facts. When some- one gives you advice about how to care for your child, ask yourself if you would trust the person to take care of your child.