Immunizations in Children and Adolescents
Published December 2008 / Reviewed September 2012
Immunizations have proven to be the most effective disease prevention activity in all of medicine. Many illnesses which caused severe suffering and death are now but a memory, thanks to immunizations. They also have been demonstrated to be extremely safe with very rare serious side effects. Over the past several years a number of newer vaccines have been approved for administration to infants and toddlers. As a result, it is now possible to prevent diphtheria, tetanus, whooping cough, polio, hepatitis (both A and B), meningitis, and other invasive hemophilus influenza type B diseases, pneumococcal pneumonia and meningitis, measles, mumps, rubella, chickenpox, and diarrhea caused by rotavirus (the most common form of diarrhea in infants and young children), Meningococcal meningitis, and cervical cancer. How fortunate we are to live in an age when our children are spared so many illnesses.
The Center for Disease Control and Prevention (CDC), funded by the Federal Government is responsible for recommending which immunizations should be given at specific ages and monitoring vaccine effectiveness and safety. In addition, the Food and Drug Agency (FDA) also certifies vaccines as being safe and effective before they are recommended by the CDC. The CDC and FDA make their determinations based on numerous carefully controlled studies comparing vaccines to placebos. The CDC and FDA staff of unbiased scientists, who are experts in their fields, review these studies very critically before making their decisions. Finally, the Vaccine Adverse Events Reporting System (VAERS) is in place to provide physicians a system to report any adverse reactions to vaccines. Thus, there are three different, very effective programs in place to ensure vaccine safety and effectiveness.
Some parents are concerned about the number of immunizations administered simultaneously to infants and toddlers. Fortunately, through ingenious research, some of it conducted here in Rochester, scientists have been able to develop vaccines to prevent an increasing number of diseases. Since many of these illnesses affect infants and toddlers severely, it is important to immunize children in the first four months of life. Again, numerous studies have shown that infants are able to develop antibodies to many vaccines administered simultaneously, without any adverse affects. In fact, the old pertussis (whooping cough) vaccine contained inactivated whole pertussis bacteria consisting of over a thousand antigens, while the new acellular pertussis vaccine contains only a few of the most important antigens necessary to develop immunity. As a result, children receiving four or five injections simultaneously now are exposed to many fewer antigens than they were twenty years ago. Thus the vaccine schedule developed by the CDC, and approved by the American Academy of Pediatrics (AAP), provides optimum protection for children. Delaying vaccines is not recommended since it puts children at risk for contracting a life threatening illness. Thus parents should always have their children immunized at the times recommended by the CDC and the AAP.
Recently, some parents with children with autism have been concerned that their child's illness was due to an immunization. Some felt that autism was caused by a specific vaccine; others blamed a preservative in some vaccines called thimerosal. Unfortunately, autism becomes apparent between six and twenty-four months of age, the same time that children are receiving most of their immunizations, leading parents to blame the vaccines as the cause of their child's disease. However, numerous carefully conducted studies have failed to demonstrate any connection whatsoever between immunizations and autism. In fact, most scientists feel that autism is caused by a genetic defect; some of the research on this theory is being conducted here in Rochester. Also, although never proven to be detrimental, thimersol has been removed from children's vaccines since it contains mercury, which is toxic in much, much higher doses than was present in the vaccines.
Recently, several new vaccines have been developed for adolescents to prevent meningococcal meningitis, whooping cough, and cervical cancer. Although these illnesses occur less frequently than the diseases prevented by immunizations for infants and toddlers, they are very serious illnesses which should be prevented. Meningococcal meningitis, in particular, can cause death in a period of one to two days from the onset of the illness. Usually these vaccines are given around ages 11 to 13. The HPV vaccine (developed by scientists at the University of Rochester Medical Center) which prevents cervical cancer must be administered in three doses over a period of six months. Earlier this year the CDC recommended that a second dose of Meningococcal meningitis vaccine be given between 16 and 18 years of age if the first dose was administered at 11–12 years of age. Therefore, parents should be aware of the immunization schedule recommended for adolescents and be sure that their teenagers are immunized appropriately.
In 2008 the CDC recommended that all children (ages 6 months thru 18 years) receive the "flu" vaccine which protects against influenza types A, B, and H1N1. Although rarely life threatening, except for those over 65 (30,000 to 40,000 senior citizens die every year due to the flu), flu is a nasty disease with high fevers, runny nose, cough, aches and pains, tiredness, and malaise which usually lasts a week, causing children to miss a week of school and adults to miss a week of work. It has become clear that flu is easily transmitted from child to child in day care and school settings, and then transmitted to their adult caretakers. Therefore, by giving all children the flu vaccine, we should reduce flu in both children and adults. Since the strains of flu virus causing disease change every year, the flu vaccine needs to be administered annually each fall and early winter. Young children need two doses of the flu vaccine to develop good immunity; older children need only one. Flu vaccine is available in injectable (for all children) and nasal spray (for children over five) forms. Most insurance policies cover both types similar to other childhood vaccines. Many pediatricians and family physicians have provided special "flu vaccine clinics" to ensure that their patients are immunized prior to the start of flu season in December or January.
In late 2011 the CDC recommended that HPV vaccine should be given to boys and young men ages 12 thru 24 to prevent genital warts and transmission of HPV to their partners. The AAP has agreed with this recommendation. Therefore, both boys and girls should receive three doses of this vaccine.
Some parents feel that it is not necessary to immunize their children since the diseases that immunizations prevent are rare in this country thanks to generally high levels of immunized children. However, this has been shown to be very dangerous since there have been many instances of unimmunized children from foreign countries coming to the USA with a serious vaccine preventable illness and spreading it to unimmunized children in their communities leading to outbreaks of life threatening infections. Since immunizations have been proven unequivocally to be safe and effective, there is no logical reason to withhold or delay immunizations from children or adolescents. As a pediatrician in practice for nearly forty years, I have had the good fortune to witness a huge decline in terrible illnesses such as polio, meningitis, whooping cough, hepatitis, and many others. I'm grateful that it is possible to immunize my patients, my own children, and my grandchildren against so many serious illnesses.
For further information regarding immunizations for children and adolescents, parents should go to the following websites:
www.cispimmunize.org (Child Immunization Support Program)
About the Author
Thomas K. McInerney, M.D.
Thomas K. McInerney, M.D. is a pediatrician practicing in the Panorama Pediatric Group since 1971 and is also professor and Associate Chair of Pediatrics at the Golisano Children's Hospital and Department of Pediatrics at the University of Rochester Medical Center.
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