Tag: immunization schedule

Are You on the Fence About Vaccines?

If you have doubts about vaccinating your kids, but you are still doing research, then you are probably what people like to call a fence sitter.

On the Fence About Vaccines

Folks who are on the fence haven’t made a decision yet and are torn between what they see as two difficult options.

In this case, the two options we are talking about are:

  1. vaccinate your kids
  2. don’t vaccinate your kids

What makes those options difficult?

If you spend a little time on the Internet, those two options get complicated quickly and can turn into:

  1. vaccinate your kids – exposing them to toxins and all kinds of vaccine-induced diseases, from autism to SIDS
  2. don’t vaccinate your kids – risking a deadly disease because they are unvaccinated or the possibility that someone will come and force you to get them vaccinated

How do you figure out the truth to help you make the right decision for your family?

The Truth Behind Your Vaccine Decision

Most parents vaccinate their kids on time and on schedule.

These books about vaccines can help with your research about vaccinating and protecting your family.
These vaccine books can help you make the right decision if you are on the fence about vaccines.

Do they all have a hard time making their decision?

Most don’t.

They understand the risks their children face if they aren’t vaccinated.

“When a well-meaning parent like Jenny McCarthy blames vaccines for her child’s autism, placing the fear of God into every parent who has a baby, it’s not only irresponsible – it’s dangerous. Why? It’s simple math: vaccines are less effective when large numbers of parents opt out. And the more who opt out, the less protected ALL our children are.

Celebrity books come and go . . . but the anxiety they create lives on in pediatricians’ offices across the country. A small, but growing number of parents are even lying about their religious beliefs to avoid having their children vaccinated, thanks in part to the media hysteria created by this book.”

Ari Brown, MD responding to Jenny McCarthy appearing on Oprah

That’s not to say that they don’t think about their decision to vaccinate their kids. Or even think twice about it.

But in the end, they know that:

  • vaccines work – even if they aren’t perfect and waning immunity is an issue with a few vaccines
  • vaccines are safe – even if they do have some side effects, which can rarely be severe
  • vaccines are necessary – without them, we would end up in like it was in the pre-vaccine era, even with modern health care, nutrition, and sanitation, etc.

And they know that their decision might affect others around them.

If your research about vaccines has pushed you off the wrong side of the fence and into your pediatrician’s office with a copy of Dr. Bob’s vaccine book demanding an alternative immunization schedule, then you might want to do a little more research.

Misinformed Consent

Most importantly, parents who choose to vaccinate their kids don’t believe the myths and conspiracy theories that might lead them to skip or delay any recommended vaccines.

“If you see a turtle sitting on top of a fence post, it didn’t get there by accident.”

President Bill Clinton

Ironically, the anti-vaccine “experts” and websites that scare some parents often talk about choice and informed consent.

Understand though, that by exaggerating the risks of vaccines and vaccine injury (no, vaccines are not full of toxins), playing down the risks of vaccine-preventable diseases (no, they are not mild diseases that should be thought of as a rite of passage), and ignoring the benefits of vaccines (yes, vaccines do work), they are violating the basic tenets of informed consent themselves.

And that limits your ability to make the right choice for your family.

Making the Right Decision About Vaccines

There is nothing wrong with asking questions and being skeptical about the answers you get.

No one wants to return to the days when reports of measles epidemics made the front page of the New York Times.
No one wants to return to the days when reports of measles epidemics made the front page of the New York Times.

With all of the things you see and hear about vaccines, there is nothing wrong with being a little scared and wanting to do more research, instead of blindly following the advice of your pediatrician.

But remember that if you are going to be skeptical and are not going to blindly follow the advice of someone you know and maybe trust, then don’t blindly believe everything you read on the Internet that says vaccines are bad.

“My husband and I agreed we would just not have our new baby vaccinated until she was at least 1 year old, which seemed like enough time to continue looking for information. Also, we were not concerned that she was at risk of contracting any serious childhood illnesses.

We were wrong.

A week before our baby girl’s first birthday, she was feverish and listless. When she refused to nurse for 24 hours, I took her to see our pediatrician. She was hurriedly admitted to intensive care with the diagnosis of spinal meningitis caused by Haemophilus influenzae, type B, which is a vaccine-preventable disease.”

Suzanne Walther on A Parent’s Decision on Immunization: Making the Right Choice

Suzanne Walther discovered that “it is easy for parents to be misinformed. It is a real challenge to be well informed.”

What questions did she want answers to?

  • Are vaccines really effective at preventing diseases? – Yes, although they aren’t 100% effective, vaccines do work well at preventing and controlling 16 different vaccine-preventable diseases on our childhood immunization schedule. And yes, vaccines did help eliminate smallpox and herd immunity is real.
  • How are vaccines made? – Vaccines are made in a multi-step process that begins with generating the antigens that will go in the vaccine and then moves to releasing and isolating the antigen from the growth medium, purifying the antigen, strengthening and stabilizing the vaccine, and then combining it all into the final vaccine. Unlike videos you may have seen on the Internet, there is nothing scary about this very scientific process.
  • Are they tested for safety? – Vaccines are extensively tested in Phase I, II, and III trials before they are approved and added to the immunization schedule. This entire vaccine development process may take as long as 10 to 15 years.
  • Are there ongoing clinical trials to rule out the possibility that vaccines cause diseases later in life? – Yes, after vaccines are approved and are added to the immunization schedule, ongoing Phase IV studies continue to monitor their safety and efficacy. In addition, Vaccine Adverse Event Reporting System (VAERS), the Clinical Immunization Safety Assessment (CISA) Project, and the Vaccine Safety Datalink (VSD) help make sure vaccines are safe after they are approved.
  • Have allegations of adverse reactions been studied and confirmed or refuted? – Yes. In addition to several Institute of Medicine Vaccine reports, study after study have shown that vaccines don’t cause autism, SIDS, ASIA, or any of the other vaccine induced diseases “they” come up with.
  • And, last but not least, where can I get truthful, clear answers to my questions? – In addition to your pediatrician, there are plenty of vaccine books, sites, and groups that can help you get educated about vaccines.

Today, she might also have had questions about package inserts, aluminum, MTHFR mutations, shedding, vaccine mandates, the CDC Whistleblower, and the HPV vaccine. These and a hundred more have been answered over and over again.

Suzanne Walther learned about vaccines the hard way – after her infant contracted Hib meningitis, a vaccine-preventable disease. She also discovered that you can sometimes delay or wait too long to vaccinate your child.

What will you do to be well informed and to make sure you are making the right choice?

What to Know If You Are on the Fence About Vaccines

It is easy to be misinformed about vaccines, especially if you are on the fence and aren’t sure what to do. Get educated and and be sure you are making the right decision for your family.

More About One the Fence About Vaccines

Vaccine Education for Pediatric Offices

Pediarix, Hib, Prevnar, and Rota vaccines have been prepared for an infant at her well child visit.
Pediarix, Hib, Prevnar, and RotaTeq vaccines have been prepared for an infant at her well child visit. Photo by Vincent Iannelli, MD

Why get educated about vaccines if you work in a pediatric office?

In addition to learning how to give vaccines properly, it can help you answer any questions parents might have and help them understand that vaccines are safe, vaccines work, and vaccines are necessary to protect our kids.

Who needs to get educated about vaccines?

Everyone of course. While it’s great if all of the medical assistants and nurses have done their research about vaccines, you will have missed opportunities to get kids vaccinated and protected if the folks making appointments aren’t.

Learning the Immunization Schedule

How do you know when to give a particular vaccine to an infant, child, or older teen when they come to the office, besides the fact that someone else ordered it or the school says they need it?

You can learn the rules of the immunization schedule.

There is more to it than just looking a child’s age and seeing which vaccines they are due for though.

Has the child missed any vaccines, which means you might need to use the catch-up immunization rules?

Do they have any contraindications or reasons to not get a vaccine today?

“There is no ‘alternative’ immunization schedule. Delaying vaccines only leaves a chil​d at risk of disease for a longer period of time; it does not make vaccinating safer.

Vaccines work, plain and simple. Vaccines are one of the safest, most effective and most important medical innovations of our time. Pediatricians partner with parents to provide what is best for their child, and what is best is for children to be fully vaccinated.”

Karen Remley, MD, Executive Director, American Academy of Pediatrics​

Does the child have any high risk conditions, which mean they might need an early or extra vaccine?

In addition to reviewing the latest immunization schedules, studying a summary of recommendations for child and teen immunizations can help you quickly learn when kids need vaccines.

Giving Vaccines Safely

Once you know when it’s time to give the right vaccine to the right child at the right time, you want to make sure that you are giving it to them properly.

You also want to make sure staff knows how to reduce pain associated with giving shots, keeps thorough records, and disposes of needles and syringes properly.

Storing Vaccines Safely

Vaccines must be stored properly.

For example, while some vaccines must be refrigerated, others must be frozen.

What happens if vaccines aren’t stored at the proper temperature?

If a vaccine gets too warm or too cold, it can lose some of its potency and it probably won’t work well. That can mean vaccinated kids don’t get the immunity you expect and are left unprotected to one or more vaccine-preventable diseases. Hopefully, the office discovers the problem before any kids have gotten the vaccine though and they are just left throwing out some unusable vaccines.

The California VFC Program offers
The California VFC Program offers “Do Not UnPlug” signs so that vaccines don’t get ruined.

Fortunately, there are plenty of resources to help office staff get trained about:

  • appropriate vaccine refrigerators and freezers
  • monitoring vaccine temperature with a digital data logger and certified calibrated buffered thermometer probe
  • vaccine temperature best practices
  • keeping a vaccine inventory log
  • handling vaccine deliveries
  • having a plan for refrigerator failure
  • having a plan for power failure and disasters
  • avoiding preventable errors

Does your office have a plan to keep their vaccines at a safe temperature? What about if the power goes out? Will they still be safe?

Other Vaccine Issues

Anyone who administers vaccines to kids should also know:

  • that they need to provide a copy of the latest Vaccine Information Statement from the Centers for Disease Control and Prevention (CDC) to the child’s parent or guardian before giving each vaccine
  • the answers to common questions that parents ask about vaccines
  • to explain common and more rare side effects that parents might be possible after vaccines, so that they aren’t surprised
  • how to report possible adverse reactions to VAERS
  • how to report a vaccine error to VERP
  • that children, especially teens, should be observed for 15 minutes after they are vaccinated to make sure they don’t develop syncope (fainting)
  • strategies to improve your office’s immunization rates
  • how to counter the bad advice Dr. Sears and the use of an alternative or non-standard, parent-selected, delayed protection vaccine schedule
  • the most common vaccine errors, so you can better avoid them

It is also important for all staff to know their office’s vaccine policy. Does your office have one?

What To Know About Vaccine Education for Pediatric Offices

Vaccines are safe, necessary, and still needed to protect all of our kids from vaccine-preventable diseases. Help make sure everyone in your office is educated about the latest immunization schedule and understands how to give and store vaccines safely.

More on Vaccine Education for Pediatric Offices

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Immunization Schedules from Other Countries

The latest immunization schedule from the CDC and AAP.
The latest immunization schedule from the CDC and AAP.

Why does the United States give so many more vaccines than other countries?

The easy answer might be that we want to protect kids from more vaccine-preventable diseases. Of course, it is much more complicated than that.

But why does it matter?

It still matters because Jenny McCarthy has pushed the idea that we have an ‘autism epidemic‘ in the United States because “other countries give their kids one-third as many shots as we do.”

And some folks still believe her.

They also believe anti-vaccine myths and misinformation linking giving more vaccines to having higher infant mortality rates.

Immunization Schedules from Other Countries

Which vaccines a country routinely gives often depends on the risk a diseases poses to the people that live there. For example, some countries routinely give the BCG and Japanese encephalitis vaccines, but only give the hepatitis B vaccine in high risk situations.

And while many folks still push the myth that the United States gives many more vaccines than other developed countries, you just have to look at their immunization schedules to see that it isn’t true.

Remember that in the United States, children typically get:

  • 36 doses of 10 vaccines before starting kindergarten that protect them against 14 vaccine-preventable diseases
  • at least three or four more vaccines as a preteen and teen, including a Tdap booster and vaccines to protect against HPV and meningococcal disease, plus they continue to get a yearly flu vaccine

So by age 18, that equals about 57 dosages of 14 different vaccines to protect them against 16 different vaccine-preventable diseases. While that sounds like a lot, keep in mind that 33% of those immunizations are just from your child’s yearly flu vaccine.

Immunization Schedules from Europe

How do immunization schedules from European countries differ from the United States?

Austria's immunization schedule for 2017 includes all of the same vaccines as the US schedule.
Austria’s immunization schedule for 2017 includes all of the same vaccines as the US schedule, plus the vaccine for Japanese encephalitis (if high risk).

Surprisingly, they don’t differ by that much, despite what you may have heard or read.

And in many European countries, even if you don’t get more vaccines overall, you do get more dosages at an earlier age, often with two dosages of MMR and the chicken pox vaccine by the time your child is 15 to 24 months old.

The latest immunization schedule from Germany.
The latest immunization schedule from Germany.

Some vaccines, like hepatitis A and chicken pox aren’t routine in every European country, like Iceland and Sweden, but many countries give vaccines that we don’t, like BCG and MenC. And even Iceland and Sweden have recently added the HPV vaccine to their schedule and Sweden may soon add the rotavirus vaccine too.

Immunization Schedules from Other Countries

Many countries, in addition to those in Europe, have vaccine schedules that are very similar to the one that is used in the United States.

The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and Japanese encephalitis vaccines.
The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and   Japanese encephalitis vaccines.

Just look at the immunization schedules for Australia, Canada, Israel, South Korea, or Taiwan, etc.

What about Japan? They must give fewer vaccines than we do in the United States, right? After all, aren’t they the country that banned the use of the HPV vaccine?

Although that myth is still pushed by many anti-vaccine websites, the HPV vaccine is not banned in Japan. It was removed as a vaccine that is actively recommended in 2013, but it still available and is still on the Japanese immunization schedule.

The 2016 routine and voluntary immunization schedule in Japan.
The 2016 routine and voluntary immunization schedule in Japan.

All of our other vaccines are also on the Japanese immunization schedule. In addition, they give infants the BCG and Japanese encephalitis vaccines.

What to Know About Immunization Schedules from Other Countries

Many countries use a similar immunization schedule and give the same types of vaccines as we do in the United States.

More On Immunization Schedules from Other Countries

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: