This is an update and modification of an old post titled Immunizations. It seems particularly relevant now given the politicization of the whole subject of immunization in the last few years.
Many parents are concerned about the number of immunizations that are recommended for their children and whether all these shots may have some serious long term side effects. Public health recommendations that ignore these concerns have created an adversarial situation that is not helpful for parents or for their children.
To put this in perspective, lets look at the current immunization recommendations for infants and children Number of shots will be placed in parenthesis.
Newborns: Hepatitis B (One shot)
Two Months: Hepatitis B, Tetanus-Diphtheria-Pertussis, H-flu, Pneumonia, Polio, Rotavirus (Six shots). That’s a lot of needle sticks for a baby! Fortunately there are combined vaccines that reduce the number of shots. Using the combined vaccines reduces the number of shots at two months from six shots to three shots.
Four Months: Same as two months except no Hepatitis B (three shots using combined vaccines)
Six Months: Hepatitis B, Rotovirus, Tetanus-diptheira-Pertussis, H-flu, pneumonia, Polio, flu shot, COVID-19 (four shots using combined vaccines) Another COVID-19 vaccination is recommended 4 weeks after the first one.
One Year: Polio, flu shot, Measles-Mumps-Rubella, Chicken pox, Hepatitis A (Four shots using combined vaccines).
Four Years: Tetanus-Diphtheria-Pertussis, Polio, Measels-Mumps-Rubella, Chicken pox (three shots using combined vaccines).
Nine Years: HPV vaccine. Second dose in 6 months to 1 year. HPV vaccine prevents infection with the wart virus also called human papilloma virus. HPV is the main cause of cervical cancer in women. It is transmitted through sexual intercourse. Given at age 9, the immunity is lifelong so immunizing children (girls and boys) means that as adults, when they become sexually active, there will be much less transmission of HPV and much less cervical cancer in women.
That’s a lot of shots, even with the combined vaccines, not even counting the HPV vaccinations recommended at age nine.. So one question is: Is the benefit of all these shots worth the discomfort to the children (not to mention the parents)? Another question is: Are there risks (other than temporary discomfort) to giving all these immunizations? A third question is: Does delaying immunizations for babies reduce any risks?
Let’s take these questions one at a time.
Vaccines clearly save children’s lives, so the answer to the first question is an unqualified yes! Most parents have never seen a case of polio, or diphtheria, or tetanus (lock jaw). The reason is that vaccines prevent them. These were devastating diseases that killed or paralyzed many infants and children. They have not gone away. If the immunization rate falls, we will see them again. We already have in communities where the immunization rate has fallen below a critical level. In times past, many children died from pneumonia caused by a class of bacteria called pneumococcus. The pneumonia shot has virtually eliminated this disease.
I have my own story about the Hemophilus influenza vaccine (Hib). Until this vaccine came out, I saw at least one child a year with a serious infection from this bacterium. It caused meningitis, joint infections and pneumonia. The sickest child I ever cared for had H-flu meningitis. Since the vaccine came out, I have never seen another case.
Rotavirus is a common cause of severe diarrhea and dehydration in infants, and some die from this. The rotavirus vaccine prevents this disease
Some parents wonder why we give vaccines for measles, mumps, rubella (german measles) and chicken pox. Most adults over 60 had these infections in childhood and recovered just fine. Unfortunately, lots of people did not do just fine. Measles can cause infection of the brain and pneumonia, Many people actually died or were permanently disabled by measles. The same story holds for chicken pox. Rubella (german measles) is a mild, self-limited illness except if a pregnant mother catches it. In that case it causes severe birth defects in the baby.
Another question parents often have is why we give hepatitis B vaccine to all children. Hepatitis B is transmitted by sexual intercourse or by needle stick, but it can also be transmitted to a baby during birth. The recommendation used to be that we gave hepatitis B vaccine only to babies of high risk mothers. That did not work very well because it was impossible to reliably identify high risk mothers. If you know for sure that neither parent has a chance of having hepatitis B, then it is reasonable to delay this vaccine until the child is older. The only way to be sure is for both parents to test negative for hepatitis B antibodies. Since you don’t know and cannot control what sexual experience your child will have later in life, this vaccine should at least be given before puberty.
A final question that parents have is about the COVID-19 vaccine for children. Why do we need to give the vaccine when most children have only mild disease? There are two reasons to give the COVID vaccine to babies. One reason is that although most children have only mild disease, some children get very sick and have to be hospitalized. The other reason we immunize babies and children for COVID-19 is to protect vulnerable adults that they may be exposed to. Most hospitalizations for COVID-19 now are older people and people who have other risk factors such a suppressed immune system, diabetes, COPD and other chronic diseases.
Now lets talk about risks of vaccines. I’m not talking about mild reactions such as a little irritability, low grade fever, or mild swelling at the site of the shot. That type of reaction is fairly common and self limited. The real question most parents have is about long term serious risks to immunizations. Here are some questions frequently asked by parents.
1. Do immunizations increase the risk that my child will get autism? The answer is no. There is one study often quoted by anti-vaccine groups that reported an association between childhood immunizations and autism. It turns out that the author of the study faked a lot of his data. It has been thoroughly discredited and in fact the journal that published it retracted it. Several very large well designed studies that were designed to answer this question found absolutely no connection between childhood immunizations and autism.
2. Do all these immunizations overstimulate children’s immune systems and increase the risk of autoimmune diseases later in life? The answer again is no. In order for the immune system to work properly, it is stimulated by literally thousands of environmental substances called antigens during a child’s life. It makes antibodies against these antigens so that children develop immunities to viruses and bacteria in the environment. The vaccine antigens represent a tiny fraction of all the antigens in the environment, certainly not enough to cause overstimulation. Studies have shown no connection between immunizations and autoimmune diseases such as multiple sclerosis, lupus, or rheumatoid arthritis
3. What about the mercury preservative in vaccines. Does that cause any long term problems? The preservative thimersol, which does contain some mercury, has been removed from all vaccines since 1992. There was no evidence that this caused any problems, but it is nonetheless not an issue anymore.
4. Did some children have severe reactions to the pertussis (whooping cough) vaccine?
The old pertussis vaccine was called a whole cell vaccine. It contained the entire inactivated pertussis germ. There were very rare serious reactions with this vaccine, including high fever and sometimes seizures. Now the pertussis vaccine does not contain the whole germ. It is called an acellular vaccine. Since the acellular vaccine was added to the diphtheria and tetanus vaccines (now called the DTaP vaccine), serious reactions were eliminated.
5. Can COVID-19 vaccine cause decreased fertility or other long term chronic disease?
A tiny number of adolescents who received the COVID-19 vaccine developed some inflammation of the lining around the heart. None of these children were hospitalized and all recovered completely. This did not happen when 6 month old children got the vaccine. There is no evidence whatever that COVID-19 vaccines decrease fertility in women or men. That is one of those pieces of misinformation that grow on the internet like weeds. We have seen no ill effects from the COVID-19 vaccine in infants.
6. Is there any benefit to delaying vaccines until children get older? Once again the answer is an emphatic no. There is no evidence of any health benefit to delaying immunizations. All of the diseases we immunize children against are most dangerous in infancy. Pertussis (whooping cough) and diphtheria killed many infants before we had vaccines to prevent them. All the other diseases we immunize against have a much higher chance of causing death in infants. If you delay your child’s immunizations, you are depending on everyone else getting immunized to protect your child. Not only is that not fair, but in some communities the immunization rate for infants has gotten low enough that you don’t even have that protection.
Bottom Line: Immunizations for infants and children are safe and effective. They prevent diseases that used to kill or maim many infants and children. The only downside is the discomfort of multiple shots, which can be significantly ameliorated by using combined vaccines. Delaying vaccines until children are older is dangerous for the child and provides no health benefits.