Tag: immunization schedule

Catch-Up Immunization Schedules

It is surprisingly easy to get behind on your child’s immunizations, even if you are trying to stay on schedule.

How do you miss a shot?

Your child could have been sick when they were supposed to get their vaccines, your pediatrician might have been out of one or more vaccines, or you might have simply missed one of your child’s well checkups.

Catching Up On Vaccines

A catch-up immunization schedule
A catch-up vaccination schedule program can help you figure out when to get the vaccines your child has missed.

If your child gets behind and misses one or more vaccines, be sure to get caught up as soon as possible.

If your child needs to get caught up quickly, like to start daycare or school, to travel out of the country, or because of a disease outbreak in your area, you can even use an accelerated immunization schedule, using minimum intervals between doses.

Depending on your child’s age, you might even be able to skip a few doses or vaccines.

For example, with rotavirus vaccines, vaccination should not be started if an infant is already 15 weeks old and the final dose must be given by 8 months of age.

And if your child gets their first dose of Hib after they are 15 months old, they don’t need any more doses. And they wouldn’t need any doses at all if they are already 5 years old.

Prevnar, IPV, and DTaP might also need to given on an alternative schedule when given on a catch-up schedule.

Specifically, your child might be able to skip:

  • the fifth dose of the DTaP vaccine, if the fourth dose was given at age 4 years or older.
  • the fourth dose of the IPV vaccine, if the third dose was given at age 4 years or older.
  • one or more doses of Prevnar, depending on when the other doses were given

Is this a good way to get out of getting some doses or vaccines?

Of course not. In addition to missing out on those vaccines, your child is missing out on the protection from those vaccines.

For More Information on Catch-Up Immunization Schedules

Historical Immunization Schedules

Technically, the first official immunization schedule that was approved by the ACIP, AAP, and AAFP – a harmonized immunization schedule, just like we have today – was published in 1995.

Past Immunization Schedules

Of course, there were immunization schedules before that, including these immunization schedules that were published by the AAP in 1983, 1989, and 1994:

schedule1983s
Eleven doses of four vaccines protected kids against seven vaccine-preventable diseases in 1983.

The Hib vaccine was added in 1985.

schedule1989s
Twelve doses of five vaccines protected kids against eight vaccine-preventable diseases in 1989.

Next came the hepatitis B vaccine and expanded age ranges for the Hib vaccine.

schedule1994s
Seventeen doses of five vaccines protected kids against eight vaccine-preventable diseases in 1989 (plus the later Td booster).

What’s still missing?

Vaccines and protection against rotavirus, hepatitis A, chicken pox, flu, pneumococcal bacteria, meningococcal bacteria, and HPV.

Even Older Immunization Schedules

While the anti-vaccine movement often claims that kids now get too many vaccines (the too many too soon argument), not understanding that they get far fewer antigens than they once did, with far more protection, most of them will be surprised that some children got even more immunizations that the 1980s schedules they long for.

schedule1940s
A schedule of immunizations from a 1948 AAP Round Table Discussion on the Practical and Immunological Aspects of Pediatric Immunizations

So in the 1940s, some children received:

  • 3 doses of the pertussis vaccine
  • 2 doses of the smallpox vaccine
  • 3 doses of the typhoid vaccine
  • 3 doses of a DT vaccine
  • a DPT booster
  • a tetanus booster
  • a typhoid booster
  • 2 pertussis boosters

Some children also received a flu vaccine and pneumococcal vaccine.

With reference to the influence viral vaccine we have endeavored to give it those children who have repeated, frequent, severe upper respiratory tract infection.

Dr. Francis A Garbade – Galveston, Texas 1948

And in 1938, the AAP’s Special Committee on Prophylactic Procedures  Against  Communicable Diseases published a pamphlet,  Routine measures for the prophylaxis of communicable diseases, which became the first Red Book.

Among its recommendations were vaccines to protect against seven infections, including:

  • diphtheria
  • pertussis
  • rabies
  • tetanus
  • tuberculosis
  • typhoid fever
  • small pox

It also mentions vaccines for erysipelas, scarlet fever, staphylococcal infections and chicken pox.

The bottom line is that many kids got a lot more vaccines in the old days than many parents realize or remember.

For More Information on Historical Immunization Schedules:

 

References on Historical Immunization Schedules
Offit, Paul A. Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System? Pediatrics. Vol. 109 No. 1 January 1, 2002 pp. 124-129
Pickering, Larry K. The Red Book Through the Ages. Pediatrics. November 2013, VOLUME 132 / ISSUE 5
Sako, Wallace. Practical and Immunolgic Aspects of Pediatric Immunizations. Pediatrics. 1948;2;722.

Translating Foreign Language Immunization Schedules

It can be hard to enough to read an immunization schedule if you don’t have a medical degree, what with all of the acronyms and all.

DTaP, MMR, and lot numbers, etc.

But what if the immunization schedule is in a foreign language?

foreign-language-immunization-schedules
A Chinese to English immunization record to help make translating records easier.

How much luck will you have reading it then?

Fortunately, there is help for English speakers who get an immunization schedule in Spanish, French, Chinese, or Arabic, etc. And you don’t need your own translator.

Check out the resources below.

For more information:

Vaccine Hesitant Parents

Every parent who skips or delays a vaccine isn’t so anti-vaccine that they believe every anti-vaccine myth and conspiracy theory on the Internet.

Some are simply scared or worried about what they have read or by what friends or family members have told them.

One study by Gust et al. has actually identified up to five categories of parents, including:

  • immunization advocates – the biggest group, who think that vaccines are necessary, safe, and important
  • go along to get alongs – think that vaccines are necessary and safe
  • health advocates – agree that vaccines are necessary, but aren’t so sure that they are safe
  • fence-sitters – slightly agree that vaccines are necessary and safe
  • worrieds – the smallest group, who slightly disagree that vaccines are necessary and strongly disagree that they are safe

The fence-sitters and worrieds, and some of the health advocates, are typically the ones who delay or skip one or more vaccines. They may even follow their own alternative parent-selected, delayed protection immunization schedules.

They are the vaccine-hesitant parents.

But what does it mean to be vaccine hesitant? Some people think of it as a kinder and gentler term, as opposed to someone who is anti-vaccine or a vaccine refuser.

The SAGE Vaccine Hesitancy Working Group says that:

Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific varying across time, place and vaccines. It includes factors such as complacency, convenience and confidence.

If you are hesitant about something, you are “slow to act or speak especially because you are nervous or unsure about what to do.” In general, you need reassurance and advice to address your concerns about what ever you are nervous or hesitant about.

That’s especially true when you talk about vaccine hesitancy. When a parent is worried and wants to skip or delay the MMR vaccine because they have been told it is going to make their child autistic or have read about toxins in vaccines, those are easy concerns for their pediatrician to address and refute.

That’s why many vaccine hesitant parents eventually get their kids caught up on all of their vaccines.

When a parent doesn’t want to believe the overwhelming evidence that vaccines are safe and necessary, then you are moving beyond vaccine hesitancy to someone who is truly anti-vaccine.

That’s not the vaccine hesitant parent though.

One study, “Validity and reliability of a survey to identify vaccine-hesitant parents,” described vaccine hesitant parents as a “heterogeneous group of parents who may purposefully delay or choose select vaccines, have moderate concerns about vaccine safety, and yet still want to trust and receive immunization information from their child’s provider.”

More importantly, the study also said that of vaccine hesitant parents,  “their child’s provider remains in a position of influence, their immunization attitudes are not extreme, and they are a larger group than those who completely reject vaccines.”

That makes it important to truly make dismissing families who don’t vaccinate from pediatric practices a very last resort that is saved for the “entrenched nonvaccinators” and antivaccination activists who are never going to change their minds.

After all, you can’t talk to your pediatrician about vaccines if you are no longer going to a pediatrician who advocates that vaccines are safe and necessary.

For more information:

 

Immunization Schedules

Each year, since 1995, the Advisory Committee on Immunization Practices (ACIP) of the CDC has reviewed the recommended immunization schedule, and it has then been approved by ACIP, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

Before 1995, in 1994, 1989, and 1983, an immunization was simply published as part of the ACIP’s general recommendations.

Looking for an alternative to the ACIP immunization schedule?

According to the American Academy of Pediatrics:

No alternative vaccine schedules have been evaluated and found to provide better safety or efficacy than the recommended schedule, supported by the Advisory Committee on Immunization Practices of the CDC and the Committee on Infectious Diseases of the AAP (the committee that produces the Red Book).

Pediatricians who routinely recommend limiting the numbers of vaccines administered at a single visit such that vaccines are administered late are providing care that deviates from the standard evidence-based schedule recommended by these bodies.

Again, there are no alternative immunization schedules.

For more information:

Disease Friendly Doctors

Some doctors like to refer to themselves as being “vaccine-friendly.”

Of course, that doesn’t mean that they particularly like vaccines.

Rather, it means that they are very willing and happy to follow a non-standard, parent-selected, delayed protection vaccine schedule.

Instead of being vaccine friendly, a better way of thinking about these doctors is that they are disease friendly.

Disease friendly doctors, in delaying or skipping one or more of their patient’s vaccines, put those kids at risk for vaccine-preventable diseases.

For more information:

One-Size-Fits-All Immunization Schedule

Some people say that they are not anti-vaccine, instead they oppose our so-called one-size-fits-all vaccine policy and immunization schedule.

With so much flexibility and exemptions built into the immunization schedule though, it is wrong to call it one-size-fits-all.

For example, infants and toddlers can get their:

  • third dose of IPV and hepatitis B vaccines any time between 6 and 18 months
  • first dose of MMR and the chicken pox vaccines any time between 12 and 15 months
  • fourth dose of DTaP any time between 15 and 18 months
  • first dose of the hepatitis A vaccine any time between 12 and 23 months, getting the second dose six months after the first
  • get their “four year boosters” any time between four and six years of age

Jenny McCarthy who was one of the first to champion the one-size-fits-all argument against vaccines once said that:

Should a child with the flu receive six vaccines in one doctor visit? Should a child with a compromised immune system be treated the same way as a robust, healthy child?

It is easy to see that they don’t have to with our current immunization schedule. Your child’s pediatrician has the flexibility to temporarily delay one or more vaccines if your child has any precautions at the time of the visit, such as  a “moderate or severe acute illness with or without fever.”

There are also medical contraindications that keep some children from getting one or more vaccines on the immunization schedule. For example, children with severe combined immunodeficiency (SCID) should not get live vaccines. They are not treated the same way as children who do not have immune system problems.

This is reaffirmed by the American Academy of Pediatrics:

The schedule is not “one size fits all.”

It is considered the ideal schedule for healthy children, but it has flexibility built in. There are established medical reasons why some children should not receive certain vaccines; for example, allergies to one or more ingredients in the vaccine, or a weakened immune system due to illness, a chronic condition, or another medical treatment. Sometimes a shot needs to be delayed for a short time, and sometimes it may need to be skipped altogether .

Your pediatrician is educated and updated about such exceptions to the immunization schedule. This is one reason your child’s complete medical history is taken at the pediatrician’s office, and why it is important for your child’s health care providers to be familiar with your child’s medical history.

Delaying or skipping one or more vaccine to create a customized alternative vaccine schedule for your child, a non-standard, parent-selected, delayed protection vaccine schedule, isn’t safer than the immunization schedule from the CDC. It simply puts your child at greater risk for vaccine-preventable diseases.

For more information: