More Thoughts About Shots

This is the second in a two-part series on immunizations. Part 1 appeared in the April-May issue and included information on the DTaP and MMR series.

Immunizations are an important part of a child's health as they protect against such diseases measles, mumps, rubella, diphtheria, or tetanus. Each state has immunization requirements which childcare programs follow. Children receive most of their immunizations between birth and five years.

The April--May issue of Healthy Childcare article covered the immunizations that are included in the DTaP and MMR series. Additional immunizations along with the diseases they protect against--both for children and adults--are covered here.

Polio is spread from person to person in stool and saliva. Most people infected with polio show no symptoms. Minor symptoms can include sore throat, low-grade fever, nausea, and vomiting. However, some infected persons will have stiffness in the neck, back, or legs without paralysis. About one of every 1,000 cases causes paralysis. Two types of vaccine have been available since the 1950s, although now, only inactivated polio vaccine (IPV) is recommended in the U.S. Children should receive injected doses at two months, four months, 6-18 months, and a booster at four-six years.

Chickenpox is a highly contagious infectious disease that prior to recent immunization, was very common. Before the varicella vaccine, chickenpox was responsible for an estimated four million cases of illness, 11,000 hospitalizations, and 100 deaths annually. Chickenpox is usually mild, resulting in crops of itchy blisters. However, chickenpox can lead to secondary bacterial infections, dehydration, pneumonia, and central nervous system complications such as aseptic meningitis and encephalitis. Also, people who have had chickenpox can later develop shingles, a quite painful, sometimes disfiguring, nerve inflammation. The  chickenpox immunization, or varicella vaccine, has been added to the list of Centers for Disease Control and Prevention recommended vaccinations. It is recommended that all healthy children receive two doses of the varicella vaccine, the first one at approximately 12-15 months and the second at 4-6 years or before entering kindergarten. Anyone who has had chickenpox does not need to be vaccinated.

There are several types of hepatitis in the United States (see article in HealthyCHILDCare Volume 3, Issue 5). National studies have shown that five percent of Americans--1.25 million people--have been infected with the blood borne hepatitis B virus. Infants and children who become infected with hepatitis B are at highest risk of lifelong infection, often leading to death from liver disease or liver cancer. About 25 percent of children who become infected with hepatitis B can be expected to die of related liver disease as adults. It is estimated that 12,000 children born to hepatitis B virus-infected mothers were infected each year before infant immunization programs began. Hepatitis B vaccination is a series of three shots that can begin immediately after birth. Caregivers should be vaccinated against hepatitis B.

Hepatitis A also is prevalent in the U.S., although much more common in the Southwest and West Coast areas. The vaccine is recommended for children under age two living in areas of high risk. Contact your local health department for more information about your area.

Before Haemophilus influenzae type b (Hib) vaccine became available, Hib was the most common cause of bacterial meningitis in U.S. infants and children. Hib also caused other life-threatening diseases such as pneumonia. One of every 200 children less than five years old contracted Hib disease. About 600 children died annually from Hib infection, and survivors may have deafness, seizures, or mental retardation. Immunization with the Hib vaccine begins at two months of age, with the dosing schedule dependent on the type of vaccine used. Hib vaccine is not routinely given after age 59 months.

Prevnar, a new pneumococcal conjugate vaccine for infants and children to age five, prevents the leading cause of bacterial meningitis in the U.S. Pneumococcal disease also causes 17,000 cases of blood infections and about five million ear infections annually. This vaccine is recommended for children at two, four, six and 12-15 months. Children who start the vaccine at later ages can still benefit, as can those with serious chronic illnesses such as sickle cell disease or diabetes. Encourage families to check with their doctor about this new vaccine. Do not confuse this vaccine with a different one called pneumococcal polysaccharide vaccine, or "pneumonia vaccine," that may be given to some adults and older children.

Immunizations are benefitting from today's exciting advancements in science and medical technology. For example, recommendations for the "flu" shot now include anyone who would like to avoid suffering through influenza and now include children six months and older. Each fall, a new flu vaccine is available that protects against the upcoming flu season's illnesses. Single shot multi-illness vaccines are on the horizon as are vaccine delivery systems utilizing techniques other than needles.

While looking at the immunization records of the children in your care, do not overlook your own vaccine needs. Adults need vaccinations, too, such as tetanus, hepatitis B, and influenza. Take a minute now to think about getting your own shots, as well as seeing to the children in your care.

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

Immunization Action Coalition, 1573 Selby Ave., Ste. 234, St. Paul, MN 55104; 651-647-9009; www.immunize.org. The website includes camera-ready and copyright free materials as well as a list of state mandates on vaccines and vaccine-preventable diseases.

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

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