HEALTH NEWS: Imminizations-Why?

by Anne B. Bowyer, MSN, FNP Greene Family Medicine
Published: April 24, 2008

Immunizations are one of the most effective ways we have to prevent and protect individuals and the community at large from highly contagious and often serious illnesses.  Thanks to successful immunization programs in our country, many once dreaded and feared illnesses, such as smallpox, diphtheria and polio are happily a nightmare of the past.  However, in developing countries this is unfortunately not the case!  Diseases are much more apt to be global in our world today, thanks to easy travel, immunization programs in our country help reduce the chance of children and adults acquiring certain illnesses and transmitting them to fellow community members.
How do they work?
Our immune system is amazing! It is constantly building up protection from outside “invaders” with antibodies that seek out and destroy unwelcome viruses or bacteria. Immunizations work by “tricking” our immune system or rather giving our immune system a mini workout.
A small “introduction” of a virus or bacteria by way of an immunization stimulates our body to build up protective antibodies against the bacteria or virus but does not cause our bodies to become ill.  How marvelous!  In the future, if our body is exposed to the undesired bacteria or virus our immune system’s ever ready antibodies quickly “remember and recognize” the invader, multiple rapidly and destroy the invader thanks to its previous mini introduction through a vaccine.  Truly remarkable!
What are the vaccine requirements and why? 
Children should start receiving recommended vaccines within the earliest months of their lives since many of the illnesses they protect against are much more serious in vulnerable young children.  In most states, documentation of vaccinations is required before entry into kindergarten, not only to protect the individual child, but to prevent the spread of highly contagious illnesses throughout the school community.
According to the Virginia Department of Health, the following vaccines are required for kindergarten entry:
•Diphtheria, Tetanus and Pertussis vaccine (DTap, DTP or TDap) -a minimum of three doses, and a child must have at least one dose of this vaccine on or after the fourth birthday.
•Haemophilus Influenzae type b vaccine (Hib) -this is ONLY require for children up to five years of age. Unvaccinated children between the ages of 15 months and 5 years of age are only required to have one dose of this vaccine.
• Hepatits B vaccine - a complete series of three doses of this vaccine is required.
• Measles, Mumps and Rubella vaccine (MMR) - a minimum dose of two measles, one mumps and one rubella vaccine (typically the vaccine is given as a combined vaccine).
• Pneumoccal vaccine (PCV)-vaccine is only required for children less than two years of age. 
*Polio vaccine- a minimum of three doses in the series is required with the third dose being administered on or after the fourth birthday.  If a child has received a total of four doses prior to the fourth birthday this is considered adequate immunization.
•Varicella (chickenpox) vaccine-one dose required at 12 months or older. 
The number of required and recommended vaccines has increased through the years but many of these vaccinations can now be given in combination formula decreasing the total number of shots the child needs to receive.
Side effects?
Immunizations sometimes cause a local irritation (tenderness, redness, mild swelling) at the injection site or a low-grade fever.  These are not considered a serious reaction to the immunization, but more the immune system at work.  Often giving your child the correct dose of Tylenol helps relieve this local reaction and fever.
Everybody hates shots!!  Cool band-aids, “Wow you were so brave!” hugs and kisses go a long way to help as well!  The “kindergarten shots” are a milestone event!  Celebrating with a special book or ice cream cone on the way home can ease the experience.
Reasons to avoid vaccines?
Serious allergic reaction to a certain substance is a definite reason to avoid a particular vaccine.  Be sure to let your health care provider know if you have a serious allergic reaction to eggs, gelatin, neomycin or streptomycin, or if you have had a serious reaction to a specific vaccine in the past. Certain vaccines that contain these ingredients should be avoided.  Additionally, children and adults who have a weakened immune system generally should not receive a live virus, as they may be at risk of contracting the infection.  There are definite exceptions to this recommendation.  The MMR and varicella vaccine should be postponed for a time in folks who have recently received a blood transfusion or blood products, as the vaccine is not as effective.
It is not necessary to delay vaccines for current or recent mild illness; recent antibiotic treatment; previous mild or moderate redness; swelling at immunization site; previous fever after immunization less than 104.9; or family history of adverse reaction to immunization.
Severe side effects to vaccines very rarely occur, but unfortunately vaccines do carry this rare risk.  For the most part, a serious reaction to a vaccine generally occurs shortly after receiving it, to several hours later. Serious reported side effects include severe body rashes, difficulty in breathing, very high fevers, seizures and loss of consciousness.  Any and all adverse reactions to a vaccine should be reported to Adverse Events Reporting System (1-800-822-7967 or http://www.vaers.org)
Concerns?
As with all medications, vaccines carry a risk / benefit potential.  There have been two hotly debated vaccine safety concerns that often leave some parents scratching their heads.
Thimerosal, a derivative of mercury at one time was a preservative ingredient in many vaccines.  In 1999, several expert groups recommended no longer using Thimerosal as a preservative due to the concern of potential unsafe mercury levels in some infants.
Thimerosal-free vaccines are available now in the United States but this was based on precaution rather than known harm from Thimerosal.  There has also been concern regarding a possible relationship between certain vaccines and the subsequent development of autism.  There is no scientific evidence in studies showing a causal link relationship of receiving a vaccine and later developing autism.  More information about any potential link between vaccines and autism is available at the National Immunization Program web site at:
http://www.cdc.gov/od/science/iso/concerns/mmr_autism.htm
Paying for immunizations?
Vaccines are available for every child in our country!  Vaccine for Children is a program that covers the cost of vaccines if a child is uninsured or under insured.  This program provides vaccines for eligible persons under the age of 19 at hospitals, clinics, community health centers, participating private doctor’s offices and even some school health facilities. 
More information?
Your doctor’s office is a great resource for more information regarding immunization questions, concerns and school requirements. 
Children entering Kindergarten are required to be current on all their immunizations before they can attend school. 
This article is one in a series of monthly columns by Greene Family Medicine where doctors will answer your health-related questions. If you have any questions that you would like to ask a doctor for this column, please send them to: Greene Family Medicine, Attention: Paige Herndon, 140 Stoneridge Drive, Suite 100, Ruckersville, Virginia 22968