Tag: combination vaccines

Do Kids Really Get 72 Doses of Vaccines?

Most parents vaccinate their kids according to the recommended immunization schedule.

They know that’s the best way to keep them protected.

Do Kids Really Get 72 Doses of Vaccines?

Saying kids get 72 doses of vaccines is a propaganda too to scare parents.
Saying kids get 72 doses of vaccines is a propaganda tool to scare parents.

While kids do get more vaccines than their parents did, that’s only because we have more vaccines available to protect them from more now vaccine-preventable diseases.

Do they get their kids 72 doses of vaccines?

That sounds like a lot…

It sounds like a lot because it is an inflated number that is meant to scare parents.

Kids today do routinely get:

  • 13 vaccines, including 5 doses of DTaP, 4 doses of IPV (polio), 3 or 4 doses of hepatitis B, 3 or 4 doses of Hib (the number of doses depends on the vaccine brand used), 4 doses of Prevnar, 2 or 3 doses of rotavirus (the number of doses depends on the vaccine brand used), 2 doses of MMR, 2 doses of Varivax (chicken pox), 2 doses of hepatitis A, 1 doses of Tdap, 2 or 3 doses of HPV (the number of doses depends on the age you start the vaccine series), 2 doses of MCV4 (meningococcal vaccine), and yearly influenza vaccines
  • protection against 16 vaccine-preventable diseases, including diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, chicken pox, pneumococcal disease, hepatitis A, hepatitis B, meningococcal disease, HPV, rotavirus, Hib, and flu
  • about 28 doses of those vaccines by age two years (with yearly flu shots)
  • about 35 doses of those vaccines by age five years (with yearly flu shots)
  • as few as 23 individual shots by age five years if your child is getting combination vaccines, like Pediarix or Pentacel and Kinrix or Quadracel and Proquad
  • about 54 doses of those vaccines by age 18 years, with a third of that coming from yearly flu vaccines

How do you get a number like 72?

You can boost your count to make it look scarier by counting the DTaP, MMR, and Tdap vaccines as three separate vaccines each, even though they aren’t available as individual vaccines anymore.

To boost the Vaccine Doses for Children a bit more, they add pregnancy doses too.
To boost the Vaccine Doses for Children a bit more, they add pregnancy doses too.

This trick of anti-vaccine math quickly turns these 8 shots into “24 doses.”

It’s not a coincidence.

Anti-vaccine folks want to scare you into thinking that vaccines are full of toxins, that kids get too many vaccines, that we give many more vaccines than other countries, and that this is causing our kids to get sick.

Can an unvaccinated child really get tetanus after a toe nail injury?
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)

None of it is true.

At age four years, when your preschooler routinely gets their DTaP, IPV, MMR, and chicken pox shots before starting kindergarten, how many vaccines or doses do you think they got? Two, because they got Kinrix or Quadracel (DTaP/IPV combo) and Proquad (MMR/chickenpox combo)? Four, because they got separate shots? Or Eight, because you think you should count each component of each vaccine separately?

Know that even if you do want to count them separately, it really just means that with those two or four shots, your child got protection against eight different vaccine-preventable diseases – diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, and chicken pox.

Vaccine-preventable diseases that have not disappeared, something that the “72 doses” sites don’t ever warn you about.

What to Know About Anti-Vaccine Math

Many websites use anti-vaccine math to inflate vaccine dose numbers and scare parents away from vaccinating and protecting their kids.

More on Anti-Vaccine Math

Avoiding the Most Common Vaccine Errors

Although it would be great if mistakes never ever happened, the best we can do is to understand that mistakes do sometimes happen and take steps to avoid them.

How can we avoid mistakes and errors about vaccines?

Avoiding Vaccine Errors

It can help to:

  • understand the 7 Rights of vaccine administration, including that you give the Right vaccine to the Right patient at the Right time by the Right route at the Right injection site and then follow it with the Right documentation
  • use a screening checklist to help avoid giving vaccines that are contraindicated
  • double check vaccines that look alike or have names that sound like, such as DTaP and Tdap
  • double check expiration dates
  • make sure you aren’t giving live vaccines within 28 days of each other, unless they are given at the same time
  • make sure you aren’t giving the wrong dosage amount for the patient’s age, as some vaccines have different formulations depending on the age of the patient, including flu shots, hepatitis A, and hepatitis B vaccines
  • be careful so that you don’t give a combination vaccine, such as Pediarix, Pentacel, Kinrix, Quadracel, or ProQuad, inappropriately

That we are have a 4-day grace period does help avoid the need to revaccinate some kids when vaccines are given a little too early.

“With the exception of rabies vaccine, ACIP allows a grace period of 4 days (i.e., vaccine doses administered up to 4 days before the recommended minimum interval or age can be counted as valid). However, if a dose was administered 5 or more days earlier than the recommended minimum interval between doses, it is not valid and must be repeated. The repeat dose should be spaced after the invalid dose by the recommended minimum interval.”

Ask the Experts About Scheduling Vaccines

In many cases, as long as vaccine doses were administered less than or equal to 4 days before the minimum interval or age, then they can still be counted and are considered valid.

Common Vaccine Errors

It’s easier than you think to prevent vaccine errors.

Especially if there are more than one child in the room getting vaccines, either the tray itself or the vaccines should be labeled with each child's name so that they don't get the wrong vaccines.
Especially if there is more than one child in the room getting vaccines, either the tray itself or the vaccines should be labeled with each child’s name so that they don’t get the wrong vaccines. Photo by Vincent Iannelli, MD

When are you most likely to make a vaccine error?

When you are doing something that isn’t routine, which most commonly happens when folks delay or skip some vaccines and are now playing catch-up.

In addition to the tips above, remember that:

  • the first dose of the rotavirus vaccines must be given by 15 weeks
  • the rotavirus vaccine series must be completed by 8 months (32 weeks)
  • ProQuad, the MMR and chicken pox combination vaccine, is not licensed for kids who are older than 12 years, although if a teen or adult did get ProQuad, it could be considered an off-label dose and could still count.
  • Kinrix and Quadracel, the DTaP and polio combination vaccines are only licensed for the 5th dose of DTaP and 4th dose of polio in children who are 4 to 6 years old, so wouldn’t be appropriate for an 18-month-old, even if he needs both (DTaP and polio) vaccines. Earlier doses can sometimes count as off-label doses though.
  • the combination vaccines Pediarix and Pentacel are only licensed up through age six years, but don’t necessarily need to be repeated if given to older kids.
  • children and adolescent’s get a pediatric dose (0.5ml) of the hepatitis A vaccine, while older teens, who are at least 19-years-old, get an adult (1.0ml) dose. Since most kids get vaccinated when they are younger, many pediatricians may not have the adult version of the hepatitis A or even realize that there is a different version.
  • children and adolescent’s get a pediatric dose (0.5ml) of the hepatitis B vaccine, while older teens, who are at least 20-years-old, get an adult (1.0ml) dose. Since most kids get vaccinated when they are younger, many pediatricians may not have the adult version of the hepatitis B vaccine or even realize that there is a different version.

Most importantly, even when giving vaccines on schedule, be sure to triple check everything. This is especially important if multiple kids in the same room are getting immunizations.

Also remember that vaccine errors should be reported to the ISMP National Vaccine Errors Reporting Program (VERP) or VAERS, with the correct dose repeated if necessary.

What to Know About Common Vaccine Errors

Although none of these vaccine errors are very common (hundreds of millions of doses of vaccines are given in the United States each year), understanding which ones occur the most often can help to make sure that they don’t happen in your office.

More on Common Vaccine Errors

Your Baby’s First Vaccines

Your baby’s first vaccines are very important.

While they don’t provide instant protection, they do start your baby on the path to eventually getting protected from 16 different vaccine-preventable diseases.

Your Baby’s First Vaccines

Rotavirus vaccines are associated with a very small risk of intussusception, but that is not a good reason to miss the benefits of this vaccine.
The rotavirus vaccine will be among your baby’s first vaccines. Photo by Vincent Iannelli, MD

After the birth dose of the hepatitis B vaccine, your baby’s first vaccines when you visit your pediatrician for their two month check up will include:

  • DTaP – diptheria – tetanus – pertussis
  • IPV – polio
  • Hepatitis B
  • Hib – haemophilus influenzae type b
  • Prevnar 13 – pneumococcal disease
  • Rotavirus

Sound like too many? Those vaccines work to protect your baby against eight vaccine-preventable diseases! Before these vaccines were routine, when infants got fewer immunizations, they got more disease.

And it doesn’t mean that your baby has to get six shots.

The rotavirus vaccine is oral – your baby drinks it.

And many of the other vaccines can be given as a combination vaccine, either Pediarix (combines DTaP-IPV-HepB) or Pentacel (combines DTaP-IPV-Hib), to reduce the number of individual shots your baby needs to get even more.

While that still means multiple injections, there are things you can do to minimize the pain during and after the vaccines, from breastfeeding and holding your baby to simply trying to get them distracted.

Your Baby’s Next Vaccines

After their first vaccines at two months, your baby will complete their primary series of vaccines with repeated dosages of the same vaccines at four and six months.

Why do we need to repeat the same vaccines?

Because that’s often what it takes to help us build up an immune response to a vaccine, especially at this age.

These first vaccines prime the immune system, which when followed by a later booster vaccine, provide good protection against each disease.

start your baby on the path to eventually getting protected from 16 different vaccine-preventable diseases.
Ari Brown, MD explains why you shouldn’t delay or skip your child’s vaccines.

And the requirement of multiple dosages of a vaccine is a small price to pay to be able to skip the symptoms and risk of more serious consequences that come from getting a natural infection and natural immunity.

Did your baby have a reaction to their first set of vaccines?

While some fever, pain, and fussiness is not unexpected, be sure to tell your health care provider if your baby had a reaction that you think was more severe, like a high fever or non-stop crying for several hours.

Can you expect a reaction to your baby’s second set of shots if they had a reaction to the first? Probably not. Side effects, even those that are serious, rarely happen again, even when the same vaccines are given.

Your Baby’s Vaccines

While you certainly shouldn’t skip or delay any of these vaccines, you should know that:

  • the routine age for starting these vaccines is at two months, but
  • if necessary, they can be given as early as when a baby is six weeks old.
  • the routine interval between dosages of the primary series of these vaccines is two months, but
  • if necessary (usually as part of a catch-up schedule), these vaccines can be usually be given as soon as four weeks apart, although the third dose in the series of DTaP, IPV, and Hepatitis B vaccines shouldn’t be given any sooner than at age six months.
  • infants who will be traveling out of the United States should get an early MMR vaccine – as early as six months of age

And if your baby is at least six months old during flu season, then they will also need two doses of the flu shot given one month apart. The minimum age to get a flu shot is six months, and kids get two doses during their first year of getting vaccinated against the flu to help the vaccine work better.

Learn more about if you are on the fence. Your baby needs to be vaccinated and protected.

What to Know About Your Baby’s First Vaccines

Your baby’s first vaccines are safe and necessary to start them on a path to eventually getting protected from 16 different vaccine-preventable diseases.

More on Your Baby’s First Vaccines

Updated February 7, 2018

Making Shots Hurt Less

Vaccines are one of the greatest achievements in public health.

Holding your child, if possible, can make getting shots less painful.
Holding your child, if possible, can make getting shots less painful.

Vaccines work. Vaccines are safe, with many benefits and few risks. Vaccines are necessary.

The great majority of us understand all of those things, but there is still one thing about most vaccines that most of us don’t like.

Shots can hurt.

Fortunately, there are many things we can learn to do to reduce the pain and anxiety that can be associated with getting vaccines.

Making Shots Hurt Less

Did you know that you can also do things that make getting a shot more stressful than it has to be?

“A smile goes a long way, especially between parents and their children. Children often take their parents’ moods into account when experiencing the world around them. Hugs, cuddles, soft whispers, and a calm, reassuring attitude will help ease children through the vaccination process. Remain upbeat and relaxed before, during, and especially after shots. Let your child know everything is ok.”

CDC on 9 Things to Make Shots Less Stressful… For You and Your Baby

In addition to staying happy and calm, you can help your child by:

  • preparing them in advance so they know what to expect, but be honest and avoid telling them that “it won’t hurt” when you know that it will, at least a little bit
  • making sure your pediatrician uses combination vaccines to decrease the number of shots that your child has to get at each visit
  • not delaying or skipping any vaccines, so that your child doesn’t have to get shots over multiple visits or get caught up on a lot of shots when they are older
  • distracting them right before and during their shots
  • holding them, if possible, while they get their shots (why wouldn’t you be able to hold your child? If you don’t hold your child well, it will just prolong the whole thing and could lead to a needle getting batted away or a needle-stick injury…)
  • if nursing, breastfeed during the shots, or if that isn’t possible, right after the shots are given
  • considering the use of a numbing cream (they can give you a prescription if they don’t have any in the office, and just bring it to your next visit) if your child is really anxious about getting their shots

What’s the best way to help your child? It is probably to have someone that who is confident and has experience giving kids vaccines.

What should you avoid?

Don’t give your child a pain reliever before their shots. One study said that it might decrease the immune response to the vaccine, it probably won’t decrease the pain from the vaccine, and your child might not need it. Do give a pain or fever reliever afterwards if necessary though.

You also shouldn’t joke about taking your child to the doctor for a shot if they misbehave, or that the doctor is going to use a really big needle, etc.

What about commercial tools, like the Buzzy or Shot Blocker? While some people swear by them, they likely “work” as a sort of distraction.

What to Know About Making Shots Hurt Less

While needles and shots can be painful, there are ways to reduce the pain and anxiety that are associated with vaccines, so that your kids can get vaccinated and protected with minimal stress.

More on Making Shots Hurt Less

Combination Vaccines

Few parents actually like their kids to get shots.

It isn’t that they are afraid of what’s in the shots or that they don’t recognize the benefits of vaccines.

It’s that shots can hurt, especially when you have to get multiple shots at one time.

Today’s combination vaccines help to reduce the number of shots that kids have to get at each visit. No, they aren’t all combined into one shot yet, but they are greatly reduced.

Examples of combination vaccines include:

  • Comvax – combines Hib and Hep B (discontinued)
  • Kinrix – combines DTaP and IPV
  • Quadracel – combines DTaP and IPV
  • MenHibrix – combines Hib-MenCY (discontinued)
  • Pediarix – combines DTaP, Hep B, and IPV
  • Pentacel – combines DTaP, IPV, and Hib
  • ProQuad – combines MMR and varicella

Combination vaccines are really nothing new though.

We have been using them since the individual vaccines for diphtheria, pertussis, and tetanus were combined into the DTP vaccine in 1949. And the measles, mumps, and rubella vaccines were combined in 1971.

We don’t typically think of those as combination vaccines though because you can’t get them separately anymore.

What to Know About Combination Vaccines

Combination vaccines can decrease the number of shots that your kids need to get at each visit to their pediatrician.

More on Combination Vaccines

Updated February 7, 2018