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Medically Speaking
"Are Your Family’s Vaccines Up-to-date?"
Part 1 of a 2 part series: Childhood Vaccines—What’s New?
By Margaret Trexler Hessen, M.D., specialist in infectious diseases & member of the Delaware County Medical SocietyRecently several schools in the area have noted cases of chickenpox among their students, and the school medical departments have sent home notes recommending an update on varicella (chickenpox) vaccine. “But my child had Chickenpox vaccine,” you say. The catch here is the fact that a second dose, making a series of two doses for children and adolescents, was recently recommended by the CDC (Centers for Disease Control and Prevention) based on recommendations by the ACIP (Advisory Committee on Immunization Practices). As this recommendation was made official only a few months ago, most children have not yet had a second dose and may not be fully protected against this disease.
It is not unusual, when a vaccine is relatively new, to “discover” the need for booster doses as more long-term experience is gained over the lifetime of the early recipients. Although chickenpox is usually considered to be more of a nuisance than a health threat in young children, it can rarely be complicated by severe bacterial infection of the viral lesions, blood clotting disorders, and encephalitis. It can cause severe—even fatal—illness in previously healthy adults and in people with weakened immune systems. It’s worth a second dose to prevent illness years down the road when the child of 2007 is an incompletely protected adult at risk for severe disease from an accidental exposure to someone with chickenpox.
Broader application of another well-established vaccine, that against Hepatitis A, has also been added to the routine vaccination schedule. Hepatitis A is a highly contagious viral infection of the liver that is transmitted by fecal contamination of food and water. It is usually mild in children, and may even pass unnoticed. However, in older people and in pregnant women it can be severe, even life-threatening. This vaccine used to be given only in situations in which exposure to Hepatitis A had recently occurred (e.g. an outbreak) or when increased risk of exposure was anticipated (e.g. travel to under-developed countries).
Starting in 1996, the recommendations were expanded to include routine immunization of children living in communities with high rates of the disease. In 2006, the ACIP recommended that all children in the United States receive Hepatitis A vaccine in the hope of eradicating the disease from the United States. This immunization is given as a series of 2 doses, the first to be given at 12 months of age.
Influenza vaccine, which must be renewed each year, is now recommended for all children under the age of 5 years (previously 2 years), in addition to children of all ages with certain health conditions. Two doses are required for the initial injectable immunization; yearly boosters are given in a single dose.
Other changes in the newest vaccine guidelines for children and adolescents include the addition of two new immunizations, preventive against rotavirus infections and human papilloma virus (HPV). Rotavirus infection is a common cause of gastroenteritis (vomiting and diarrhea) in infants. Although it is usually not severe, it can occasionally cause severe dehydration requiring hospitalization; indeed it is one of the more common causes of hospitalization in infants. A new vaccine has been licensed recently, and a series of 3 doses is recommended for children from 2-6 months old.
Human papillomavirus is a sexually transmitted virus that causes venereal warts and, much more importantly, cervical cancer after long-term infection. A vaccine has been developed that protects against infection with the most prevalent strains of this virus. This immunization, administered in a series of 3 doses over 6 months, is recommended for adolescent girls starting at age 11. The idea is to vaccinate early enough to prevent HPV in sexually active teenagers and adult women, with the ultimate goal of preventing cervical cancer later in life.
As noted, the immunizations above are additions to the previous standard regimen which includes the following vaccines: MMR (measles/mumps/rubella), IPV (polio), DTaP (diphtheria, tetanus, acellular pertussis), Hib (Hemophilus influenzae), pneumococcus, Hepatitis B, and meningococcal meningitis. Significant side effects of all of these vaccines are rare, but do occur.
In each case, your child’s doctor can evaluate the need for these vaccines based on your child’s age, health status, previous response to vaccines, etc., and can advise you as to the potential risks and benefits for your child. It’s wise to review vaccine status on a yearly basis during childhood in order to keep your child up to date on older vaccines that require periodic boosters, and to take advantage of new vaccines or new recommendations for older immunizations as they are made.
Read Part 2 of this ArticleNote: this article is presented through the efforts of the Delaware County Medical Society and is intended for informational purposes only, the contents should not be intended as medical advice. “You and Your Doctor – Preserve the Relationship”.
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