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PARENTS Report: Vaccine Update 2007

Remember when mumps-infected Millicent kissed heroic Bobby Brady and it looked like the entire Brady Bunch would be quarantined? That's the closest a lot of us have come to the mumps. But to more than 4,000 people in the Midwest this past spring, TV Land reruns took on shades of reality television when this painful illness spread through Iowa and seven other states. And last year in Indiana, 33 church members came down with the measles, an unexpected gift from a teenage missionary returning from Romania.

Because diseases like these are still rare, it's easy to underestimate the importance of immunizations. But recent outbreaks prove that vaccines can be all that stand between your child and serious illnesses. "There are many unfounded rumors about vaccines," says Parents advisor Neal Halsey, MD, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health. "Minor side effects are real. However, immunizations are essential for keeping all children healthy." Here's the latest info you must know.

 
Hepatitis B

This is your baby's first vaccine, usually given in the hospital hours after birth. He'll get two more doses before 18 months. This infectious liver disease can become chronic and last a lifetime.

Did you know? Since Hepatitis B is sexually transmitted and not typically associated with babies, the vaccine perplexes some parents; but the first dose is important because an (unknowingly) infected mother can easily pass the virus on to her child during delivery, says Margaret Fisher, MD, editor-in-chief of the American Academy of Pediatrics' Immunizations and Infectious Diseases. And the stakes are higher for babies: Ninety percent of infant cases become chronic -- compared with only 6 percent of cases in adults -- and one in four babies die.

Diphtheria, Tetanus, Pertussis

The DTaP, as it's now known, is a five-dose vaccine that guards against diphtheria (a respiratory disease), tetanus (a potentially fatal bacterial infection), and pertussis (whooping cough). The "a" in DTaP stands for "acellular" pertussis; this newer version of the shot has fewer side effects, such as soreness and fever, than the previous DTP vaccine, which contained "whole-cell" pertussis. Your baby receives four doses from 2 to 18 months and the last one between ages 4 and 6. Between ages 11 and 12, your child needs a slightly different booster called Tdap.

In the news: "Whooping cough is the only vaccine-preventable disease that's actually on the rise," says Dr. Fisher. The infection causes long coughing spells -- sometimes powerful enough to crack a rib -- and the signature "whooping" sound when a child gasps for air between coughs. There are a variety of reasons for the surge in cases. Adults may not have been fully immunized, and some vaccines given in the 1980s were less effective. Immunity for whooping cough wanes five to 10 years after vaccination; that's why preteens -- and all adults -- should get a booster. Although older kids and adults generally recover from whooping cough, the biggest risk is that they'll pass along the highly contagious disease to young children. "It's most dangerous for babies to get pertussis in their first six months, before they've had three doses of the vaccine," says Dr. Halsey. The stats are grim: Ninety percent of the pertussis-related deaths reported to the Centers for Disease Control and Prevention (CDC) between 2000 and 2004 were infants under 4 months old.

Haemophilus Influenzae Type b (Hib)

Meningitis is a potentially lethal inflammation of the lining of the brain and spinal cord. The viral type tends to resolve on its own without treatment, but bacterial meningitis can be fatal in a matter of days. Before this vaccine debuted in the late 1980s, Hib was the leading cause of bacterial meningitis in children under age 5, and two-thirds of cases were in children younger than 18 months, says Dr. Fisher. Today, the vaccine comes in either a two- or three-dose series starting at 2 months and ending at 12 to 15 months. It's been amazingly effective: Hib incidence has plunged 99 percent.

Inactivated Poliovirus

In 1953, Jonas Salk's discovery of a safe and effective polio vaccine was huge news; the paralyzing viral disease that tended to strike children had terrified parents. Babies used to get an oral vaccine containing weakened live virus, but it carried a very small risk of actually causing polio. Since 2000, American doctors have only used the inactivated poliovirus shot, which can't cause the disease. Your child gets it at 2 months, 4 months, and 6 to 18 months, as well as a booster between ages 4 and 6.

Did you know? Polio is still a threat -- there were more than 1,300 cases worldwide this year. "Because of international travel and adoption, even Americans are at risk," says Henry Bernstein, DO, chief of general pediatrics at Dartmouth-Hitchcock Medical Center, in Lebanon, New Hampshire. Because 95 percent of people who contract the virus don't develop symptoms (paralysis occurs in fewer than 1 percent of cases), it can be easy to overlook -- making immunization even more critical.

Measles, Mumps, Rubella

Although these once-common diseases are usually not very serious, measles and mumps can lead to meningitis, and mumps can cause deafness. Your child gets two doses of the MMR vaccine: one at 12 to 15 months, and another between ages 4 and 6. Although some past research suggested that the MMR shot might increase the risk of autism, large studies have now debunked this myth.

In the news: This year's unexpected mumps outbreak shocked health officials: The disease hadn't been on their radar in decades. Cases started at an Iowa college and marched across the Midwest. Because the second MMR dose wasn't recommended until 1989, many of the young adults who got mumps probably never had a second shot, says Dr. Halsey. The CDC estimates that one MMR dose is 80 percent effective against mumps; the second dose ups effectiveness to 90 percent. Double-check that you've had two doses yourself.

Varicella

The chickenpox vaccine celebrated its 10th anniversary in the U.S. last year. Its original purpose wasn't necessarily to eradicate the itchy illness, but to diminish the incidence and severity; 10 percent of children vaccinated between 12 and 18 months could still contract pox, though these cases are almost always mild. Assuming that getting chickenpox isn't such a big deal, some parents decline the vaccine, and even bring their kids to "pox parties" to intentionally expose them to an infected child. Experts strongly discourage this. "Chickenpox is not always a mild disease," says Dr. Fisher. "It can lead to pneumonia and inflammation of the brain." In fact, most states require that children entering childcare or school be vaccinated or have a documented history of chickenpox.

In the news: To prevent "breakthrough" cases, the CDC recently recommended a second dose for children between ages 4 and 6. Fortunately, it won't necessarily require an additional needle stick. There's a new vaccine called MMRV, a combination of MMR and varicella, which is given on the MMR schedule.

Meningococcal

Meningococcal disease, a cause of bacterial meningitis, is one of the scariest childhood illnesses. Within hours, a child can die, become deaf, or lose a limb from gangrene. The newer form of the vaccine, known as MCV4, protects against four of the most common bacterial strains and provides longer-lasting protection than the vaccine it replaced, says Dr. Halsey. The CDC now recommends it for all kids between ages 11 and 12.

Pneumococcal

Pneumococcal disease, most dangerous before age 2, can lead to ear infections, pneumonia, blood poisoning, and bacterial meningitis. The pneumococcal conjugate vaccine (PCV) is given at 2 months, 4 months, 6 months, and 12 to 15 months, and protects against 80 percent of the strains that cause pneumococcal meningitis. As with Hib, the vaccine has been remarkably successful in curbing the disease, notes Dr. Halsey.

Did you know? The vaccine is crucial because pneumococcal bacteria have become resistant to many antibiotics.

Influenza

Updated annually to include the virus strains that are expected to circulate, the flu vaccine is the only one your child will need every year. The CDC recommends getting vaccinated in October or November (though vaccines are still effective as late as January); first-timers age 8 and under need two doses four to six weeks apart. The standard flu shot contains killed flu viruses and is approved for use in kids 6 months and older. Since 2003, healthy children over age 5 have been able to get a nasal spray vaccine instead, which contains a live, weakened virus.

In the news: As of this year, the CDC recommends a flu vaccine for all children between 6 months and 5 years, as well as for their immediate family members. (Kids over 5 who have asthma or other chronic conditions should also get one.) More vaccines will be produced this year than ever before, so there's little chance of a shortage. A recently reported study found that babies whose mothers got a flu shot during the last trimester of pregnancy appeared to be protected from infection during their first six months.

Stay tuned: Clinical trials published earlier this year (now being evaluated by the FDA) found that the nasal vaccine was effective in children as young as 6 months. If approved, this could mean one fewer needle for your little one next flu season.

Hepatitis A

Hepatitis A, a liver disease like Hepatitis B, doesn't become chronic, but it can take about a month for your child to recover. Your child will get two doses between 12 months and 2 years, with at least six months between doses.

In the news: In the past, the vaccine was only given to kids in 11 high-risk states, where the disease occurred at roughly twice the national average. But this spring, the CDC began recommending it for all children. "The vaccine worked so well that the incidence of Hepatitis A in those states was no longer higher than in the rest of the country," Dr. Fisher says. Since it didn't make sense to stop vaccinating, the CDC chose to recommend vaccination nationwide.

Rotavirus

This very common virus is the leading cause of severe diarrhea in infants and young children. Because babies often need to be hospitalized for rehydration, rotavirus has been a priority in the vaccine-development pipeline. A previous vaccine was pulled off the market in 1999 because it increased the risk of intussusception, a rare intestinal blockage.

In the news: This new vaccine was just added to the immunization schedule for 2007. Extensive testing has shown that it doesn't increase the risk of intussusception. "It has a dual role," says Dr. Halsey. "It will prevent most cases of rotavirus, and it will also lessen the severity of the illness in children who still get sick." A bonus: It's a liquid vaccine given by mouth. Timing for this three-dose vaccine will be critical, at least for now. Ideally, a baby should get it at 2 months, 4 months, and 6 months, but he needs to have all three doses by 32 weeks.

HPV

The CDC estimates that more than 20 million people in the United States are infected with human papillomavirus (HPV), the most common sexually transmitted disease. It is the leading cause of cervical cancer, which kills 3,700 women each year. The new three-dose vaccine is recommended for girls ages 11 to 12.

In the news: Because HPV is an STD, the vaccine has sparked controversy. However, clinical trials found that it was 100 percent effective in protecting against the two strains of HPV responsible for 70 percent of cervical cancers. Someday, boys may even get it too. "The goal is to immunize girls before they're sexually active and have been exposed to HPV," says Dr. Bernstein, a member of the American Academy of Pediatrics' Committee on Infectious Diseases. The vaccine series costs $360, but insurance companies will probably cover it.

Q. Do vaccines still contain mercury? I've heard that it increases the risk of autism.

A. "Thimerosal, a mercury-containing preservative, is rarely used now in vaccines," says Dr. Neal Halsey. Only a small number of flu vaccines (in multidose vials) contain thimerosal, but most kids will get one without it. Interestingly, a recent Canadian study published in Pediatrics found that rates of autism, which some advocacy groups claim are linked with thimerosal, rose steadily even after thimerosal was removed from all vaccines in Canada. For more info, go to vaccinesafety.edu.

Q. Can a vaccine have any significant side effects?

A. Vaccine side effects have been monitored very carefully since 1990 through the Vaccine Adverse Event Report System. In rare cases, allergic reactions, seizures, and fevers higher than 104 degrees F. have been associated with vaccines. More common are minor side effects like soreness or swelling at the injection site, or a slight fever.

Q. Can my child get a vaccine if he's sick?

A. It's fine if he has a cold, low-grade fever, or even an ear infection, says Dr. Henry Bernstein. Hold off a day or two if your child's fever is above 101 degrees F. or if he isn't acting like himself.

Q. What happens if my child misses a shot or is a bit off schedule?

A. The CDC publishes a special "catch-up" schedule for missed doses. A child never has to start over.

Q. I'd rather not vaccinate if there is any risk of side effects. Aren't these diseases so rare now that there's no danger in skipping vaccinations?

A. No. "Parents who opt against vaccination are putting their whole community at risk," says Dr. Margaret Fisher. Routine vaccination maintains the "herd immunity" that doctors spent the last century trying to achieve. A deadly disease can still be just a plane ride away.

Q. There seem to be more combination vaccines now. Are they just as safe?

A. Yes. The CDC urges doctors to use these new vaccines -- which undergo additional safety and immunity studies -- to reduce the number of shots and make it easier for kids to get all their vaccines on time. In addition to the new MMRV, there's also a shot containing DTaP, hepatitis B, and polio.

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