Thoughts About Shots

This is the first in a two-part series on immunizations and includes information on vaccines which have been routinely given for a number of years. Part Two, in the June-July issue, will include information on additional vaccines.

It is hard to worry about something you have never seen. It is even harder to practice prevention for that unseen disease when it means discomfort for a family member, especially a child. Because the average parent today has not experienced the scourge of measles, mumps, rubella, diphtheria, or tetanus, a false sense of security can develop. Why put our children through that pain if those germs are gone now?

Viruses and bacteria that cause vaccine-preventable diseases and death still exist and can be passed to those not protected by vaccines. Vaccine-preventable diseases have a costly impact, resulting in doctor visits, hospitalizations, and premature death. Sick children also suffer from missed school days, while parents lose time and money from absenteeism at work.

As a childcare provider, you are a source of health prevention information for families. However, you have an even greater responsibility when immunizations are involved. Each state has immunization requirements which its residents must follow. Children receive most of their immunizations between birth and five years. By reminding parents of upcoming immunizations, childcare providers assist each child to develop immunity, to better ensure the health of other children in the center, and to meet state public health laws. Most states conduct random reviews of immunization records in childcare programs. Non compliance with immunization laws can result in fines and program closure.

DTaP Series This series of vaccinations protects against three diseases-diphtheria, tetanus, and pertussis-and has been used since the mid-1940s. It is recommended that the first vaccine series be given at 2 months, 4 months, and 6 months of age; a booster at 15-18 months of age; and again at 4-6 years of age.

Diphtheria is serious disease caused by poison or toxin produced by certain bacteria. A membrane forms across the tonsils or back of the throat, often obstructing breathing. The toxin of the disease is absorbed, affecting organs distant from the site of the invasion. It can lead to breathing problems, paralysis, and heart failure. Death, which occurs in up to 20 percent of cases, is highest in the very young and the elderly. Disease surveillance reports show that although diphtheria is rare in the U.S., the bacteria continue to be passed along. It is common in many parts of the world and, as with other infectious diseases, is only an airplane ride away.

Tetanus is infectious, but not contagious. This means that a person can get the illness from bacteria in the environment, but it does not spread from one person to another. It causes muscle rigidity and spasms, which may interfere with breathing. Fractures of the spine or long bones may result from prolonged contractions and convulsions. Most cases today develop from minor wounds that are not properly managed through removal of the foreign material and careful cleansing. If vaccination against tetanus were stopped, persons of all ages would be susceptible to these bacteria widely found in soil and street dust. Almost all reported cases of tetanus involve persons who either have not been vaccinated, or have completed their tetanus primary series, but not had a booster in the preceding 10 years. This is a shot adults continue to need every 10 years.

Pertussis is more commonly known as whooping cough, and it is still found worldwide. Young infants not immunized are most at risk of acquiring pertussis. The most common complication, and the cause of most pertussis-related deaths, is secondary bacterial pneumonia. The prolonged coughing and vomiting spells associated with pertussis make it difficult for children to drink, eat, and breathe. Concern about the safety of this vaccine helped spur development of the newer acellular vaccine. It is effective and associated with fewer and milder adverse reactions, such as fever. Pertussis vaccine is not given to those seven years of age or older.

MMR Series This series of vaccinations protects against measles, mumps, and rubella, and have been available since the mid-late 1960s. Each of these diseases is highly contagious, and can have serious complications. It is recommended that the first vaccine series be given at 12–15 months of age, with a booster at 4-6 years of age.

Measles, another serious disease still present worldwide today, begins with fever, followed by cough, runny nose, conjunctivitis, ("pink eye") and a generalized rash. Approximately 30 percent of reported measles cases have one or more complications, which often includes diarrhea, ear infections, croup, or pneumonia. These complications are more common among children less than five years and adults greater than 20 years. Death occurs in one to two cases per 1,000 reported cases in the U.S. Measles occurring during pregnancy results in a higher risk of premature labor, miscarriage, and infants of low birth weight.

Before the mumps vaccine was introduced, mumps was a major source of permanent deafness in childhood. Although mumps is without symptoms in up to 20 percent of cases, most often it is recognized by tender, swollen salivary glands in the cheeks. Other serious complications include encephalitis, paralysis and seizures resulting from central nervous system involvement. Adults can experience serious side effects of mumps disease, such as swelling of the testes in males and an increase in spontaneous miscarriage in pregnant female adults who contract mumps in their first trimester.

Rubella, sometimes called "German Measles," is probably best known for Congenital Rubella Syndrome (CRS), the multiple congenital defects in the baby that can occur if an unvaccinated mother contracts this disease during the early part of her pregnancy. Complications include premature delivery, miscarriage, stillbirth, and an array of congenital defects such as cataracts, heart defects, mental retardation, and deafness. The lifetime cost of one case of CRS today is estimated to be greater than $200,000. Rubella is identified by a rather faint rash that begins on the face and progresses from head to foot accompanied by swollen glands behind the ears and in the neck. As many as 50 percent of the cases may be so mild that they go unrecognized.

Immunizations are benefitting from today's exciting advancements in science and medical technology. For example, the DTaP vaccine now offers needed protection without the use of whole cell vaccine, which caused many children to experience high fever. Additional vaccines along with a complete immunization schedule will be discussed in Part 2 of this series.

American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60007-1098; 847-434-4000; www.aap.org.

National Network for Immunization Information, 99 Canal Center Plaza, Ste 210, Alexandria, VA 22314;
877-341-6644; www.immunizationinfo.org

The complete childhood immunization schedule
can be found at: www.cdc.gov/nip/

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