Tag: infants

Are Your Kids at High Risk for Flu Complications?

Everyone should get a flu vaccine each year, as long as they are at least six months old and have no true contraindications.

Everyone needs a flu shot. When will you get yours?
Everyone needs a flu shot. When will you get yours? Photo by Gabriel Saldana (CC BY-SA 2.0)

That has been the recommendation since at least the 2010-11 flu season.

And while most kids get vaccinated, not all do.

Are Your Kids at High Risk for Flu Complications?

There are some kids, those at high risk for flu complications, who definitely shouldn’t skip or delay their flu vaccine.

  • all children aged 6 through 59 months (younger than age 5 years);
  • children who have chronic medical conditions, including pulmonary (such as asthma and cystic fibrosis), cardiovascular (excluding isolated hypertension), genetic (Down syndrome), renal, hepatic, neurologic (cerebral palsy, epilepsy, stroke, muscular dystrophy, and spina bifida, etc.), hematologic (sickle cell disease), or metabolic disorders (including diabetes mellitus and mitochondrial disorders);
  • children who are immunocompromised due to any cause (including immunosuppression caused by medications or by HIV infection);
  • teens who are or will be pregnant during the influenza season;
  • children and adolescents (aged 6 months through 18 years) who are receiving aspirin- or salicylate-containing medications (like for Kawasaki disease) and who might be at risk for experiencing Reye syndrome after influenza virus infection;
  • residents of nursing homes and other long-term care facilities;
  • American Indians/Alaska Natives;
  • children who are extremely obese (body mass index ≥40).

You also shouldn’t skip or delay getting a flu vaccine if your:

  • kids are household contacts of children aged ≤59 months (i.e., aged <5 years) and adults aged ≥50 years, particularly contacts of children aged <6 months;
  • kids are household contacts of someone with a medical condition that puts them at higher risk for severe complications from influenza.

Again, since everyone should get a flu vaccine, these higher risk classes shouldn’t determine whether or not you vaccinate your kids, but they might influence the timing.

Again, don’t skip your child’s flu vaccine because they aren’t in a flu high risk group.

In most flu seasons, about 80% of children with the flu who die are not vaccinated. And many of them will be otherwise healthy, without an underlying high risk medical condition.

Get your child vaccinated against the flu. And if they are in a high risk group, make sure you do it well before flu season starts and maybe as soon as flu vaccine becomes available in your area.

More on Being at High Risk for Flu Complications

What Are the Recommended and Minimum Ages and Intervals Between Doses of Vaccines?

Most parents likely don’t think about the minimum age or minimum intervals between vaccines, as they just get their kids vaccinated according to the routine immunization schedule.

Things don’t always go according to schedule though…

Recommended and Minimum Ages for Vaccines

After their birth dose of the hepatitis B vaccine, your baby’s next vaccines are usually at two months.

Can you get them earlier?

When necessary, many vaccines can be given earlier and faster than the standard schedule.
When necessary, many vaccines can be given earlier and faster than the standard schedule.

Yes. The minimum age for the first dose of rotavirus, DTaP, IPV, Hib, Prevnar, is 6 weeks.

Some other vaccines can be given earlier than their recommended age too, including:

  • the first MMR vaccine, which can be given as early as age 6 months in certain high risk situations, like traveling out of the country or in an outbreak situation, although this dose will have to be repeated once the child is 12 months old
  • the 4th dose of DTaP, which can be given as early as age 12 to 15 months, as long as at least 4 to 6 months have passed since the third dose
  • the 2nd dose of Varivax, which may be given as early as 1 to 3 months after the first dose
  • the Tdap vaccine, which can be given as early as age 7 years, instead of the more typical 11 to 12 years
  • the HPV vaccine, which can be given as early as age 9 years, instead of the more typical 11 to 12 years

Why would you get a vaccine early?

What if you are going to be traveling just before you infant is going to be 2 months old? Or your 9 year old stepped on a rusty nail, and it had been just over 5 years since his last tetanus (DTaP) shot?

Recommended and Minimum Intervals for Vaccines

In addition to earlier ages, you can sometimes get vaccines more quickly, on an accelerated schedule.

For example:

  • the minimum interval between the 1st and 2nd dose of rotavirus, DTaP, IPV, Hib, Prevnar is 4 weeks, instead of the standard 2 months
  • the minimum interval between the 2nd and 3rd dose of rotavirus, DTaP, IPV, Hib, Prevnar is 4 weeks, instead of the standard 2 months
  • the minimum interval between the 1st and 2nd dose of HPV is either 4 weeks (3 dose schedule) or 5 months (2 dose schedule)
  • the minimum interval between the 2nd and 3rd dose of HPV is 12 weeks
  • the minimum interval between the 1st and 3rd dose of HPV is 5 months, instead of the standard 6 months

Why give these vaccines more quickly than usual?

The usual reason is that a child is a little behind and is working to get caught up.

Absolute Minimum Ages for Vaccines

It is important to remember that in some cases, there are some hard and fast rules about minimum ages. That means that if you get these vaccines any earlier, they won’t count and you will likely have to repeat them, including getting :

  • the 3rd dose of hepatitis B before 6 months (24 weeks) or sooner than 8 weeks after 2nd dose and  16 weeks after 1st dose
  • the first dose of MMR, Varivax or hepatitis A before 12 months
  • the 4th dose of Hib before 12 months
  • the 4th dose of Prevnar before 12 months
  • the 4th dose of DTaP before 12 months
  • the 5th dose of DTaP before 4 years
  • the 4th dose of IPV before 4 years

Sticking to the routine schedule helps to avoid vaccine errors, like giving a vaccine too early. In some situations, the 4 day grace period helps if a vaccine is given a little early.

More on Recommended and Minimum Ages and Intervals Between Doses of Vaccines

Can Vaccines Cause Eczema?

Eczema, or atopic dermatitis, can be hard to control.

That’s one of the things that is so frustrating about it.

It’s also often hard to figure out what exactly is triggering a child’s eczema. Is it the soap you are using, your child’s clothes, or something he eat or drank?

What Causes Kids to Have Eczema?

Another frustrating thing for parents, and pediatricians, is that we really don’t know what usually causes kids to have eczema in the first place.

Was it the soap you are using, your child’s clothes, or something he eat or drank?

“Research suggests that genes are the determining causes of eczema and other atopic diseases. This means that you are more likely to have atopic dermatitis, food allergies, asthma and/or hayfever if your parents or other family members have ever had eczema.”

Mark Boguniewicz, MD on What Causes Eczema

Unfortunately, simply knowing that eczema is genetic doesn’t make it any less frustrating for many people.

“There is emerging evidence that inflammation in atopic dermatitis is associated with immune-mediated and inherited abnormalities in the skin barrier.”

Amy Stanway, MD on Causes of atopic dermatitis

You can avoid likely triggers, including harsh soaps and dry skin, etc., and learn the best ways to care for your baby’s skin though.

Can Vaccines Cause Eczema?

Why do some folks associate vaccines with eczema?

“It is unusual for an infant to be affected with atopic dermatitis before the age of four months but they may suffer from infantile seborrhoeic dermatitis or other rashes prior to this.”

Amy Stanway, MD on Atopic Dermatitis

It’s easy to understand when you realize that 60% of kids with eczema have their first symptoms before their first birthday and for some, the first symptoms start around the time an infant is just over four months old.

Many baby rashes, especially if they started before 4 months, are probably not eczema.
Many baby rashes, especially if they started before 4 months, are probably not eczema. (CC BY-SA 2.0)

Did your baby have bad skin before four months?

Many do, but they usually don’t have eczema. In the first week or two, newborn rashes like infantile seborrheic dermatitis and neonatal acne continue to worsen, until they reach a peak at about age six weeks. It isn’t until about three or four months that baby’s begin to have good skin. Unless they start to develop eczema…

So, since the eczema symptoms start after a child’s four or six months shots, then it must be the vaccines, right?

While the correlation is obvious, that obviously doesn’t prove that vaccines cause eczema.

“Vaccinations do NOT cause eczema.”

Amy Paller, MD on Do vaccines cause eczema?

And, not surprisingly, several studies (listed below) prove that they don’t.

A large study of vaccinated vs unvaccinated children, Vaccination Status and Health in Children and Adolescents Findings of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), also found that “the prevalence of allergic diseases and non-specific infections in children and adolescents was not found to depend on vaccination status.”

Can Vaccine Ingredients Trigger Eczema?

Now that we know that vaccines don’t actually cause eczema, what about the idea that vaccines can make a child’s eczema worse?

That’s actually true, but only for the smallpox vaccine.

If someone with eczema gets vaccinated with vaccinia, the smallpox vaccine, or is recently exposed to someone who was vaccinated, they could develop eczema vaccinatum. Fortunately, since smallpox was eradicated, very few people get the smallpox vaccine anymore.

And back before smallpox was eradicated, they actually developed an attenuated version of the smallpox vaccine that could safely be used in kids with eczema!

Other vaccines are not thought to trigger or worsen eczema.

“Parents of atopic children should be encouraged to fully immunize their children.”

Grüber et al on Early atopic disease and early childhood immunization–is there a link?

While many kids with eczema do have food allergies and some vaccines do contain some residual food proteins, including eggs and milk, it is very rare for them to trigger food allergy reactions.

If this has you concerned, remember that even kids with egg allergies can now get the flu shot, and while many kids with eczema have food allergies, the food allergy isn’t usually thought to make their eczema worse. As part of the atopic march, they just have both – food allergies and eczema. Some also have hayfever or asthma.

In addition to your pediatrician, a pediatric allergist can help you with any remaining concerns about eczema and vaccines. A pediatric dermatologist can also be helpful if you are having a hard time getting your child’s eczema under control.

What to Know About Vaccines and Eczema

Vaccines don’t cause eczema and except for the smallpox vaccine, they won’t make your child’s eczema worse. Experts recommend that kids with eczema be fully vaccinated.

More on Vaccines and Eczema

About Those HPV Vaccine Trials in Infants…

Gardasil is already on the immunization schedule, but are they going to make it one of your baby’s first vaccines?

That’s what some anti-vaccine websites are saying…

About Those HPV Vaccine Trials in Infants…

So is this just more anti-vaccine propaganda?

The clinical trial's inclusion criteria makes it clear that they are not studying the HPV vaccines on infants.
This clinical trial’s inclusion criteria makes it clear that they are not studying the HPV vaccines on infants.

Of course it is.

And like most anti-vaccine propaganda, there isn’t even a teeny tiny kernel of truth in their statements about Gardasil being “pushed on infants.”

While there was a study about giving Gardasil to kids who have already had at least three relapses of respiratory papillomatosis caused by HPV 6 or 11, those kids had to be between 1 and 17 years old.

No infants (children under 12 months old) were ever in this study which was supposed to start in 2014 in Budapest, Hungary.

“Recurrent respiratory papillomatosis in children caused by HPV 6,11 can be a life threatening condition resulting in surgical interventions. The maturing and disintegrating papillomas are the sources for the subsequent HPV relapses and immunization might slow down or even prevent this ongoing process.

After an initial immunological and ear-nose-throat (ENT) assessment children with at least 3 relapses in their patient history will be vaccinated with 4-valent HPV vaccine according to the following schedule: 0., 2., 6. months. It will be followed by an immunological and 3 ENT examinations to assess response to vaccination.”

4-valent HPV Vaccine to Treat Recurrent Respiratory Papillomatosis in Children

Will Gardasil work for kids who already have recurrent respiratory papillomatosis, even though they got the HPV infection when they were born?

Hopefully it will.

“Any child presenting with a voice disturbance with or without stridor is recommended to have diagnostic flexible fiber-optic laryngoscopy. Recurrent respiratory papillomatosis should be considered in children when other common pediatric airway diseases either do not follow the natural history or do not respond to treatment of the common disorder.”

Zacharisen et al on Recurrent Respiratory Papillomatosis in Children: Masquerader of Common Respiratory Diseases

But there is already good news about Gardasil and recurrent respiratory papillomatosis.

A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis.
A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis. (CC BY 4.0)

The widespread use of the Gardasil in teens and adults is already decreasing the number of kids being diagnosed with recurrent respiratory papillomatosis!

That makes sense, because if their mom doesn’t have an HPV infection when they are born, the infection can’t be passed on to them, later causing recurrent respiratory papillomatosis.

That’s another benefit of getting vaccinated!

What to Know About Those HPV Vaccine Trials in Infants

The idea that the HPV vaccines are now being tested on infants is just another example of anti-vaccine propaganda. They are using a clinical trial of children and teens with recurrent respiratory papillomatosis to scare you away from vaccinating and protecting your children.

More on Those HPV Vaccine Trials in Infants

Myths About Your Baby’s Immature Immune System

Newborns and infants have immature immune systems, at least as compared to older children and adults.

Premature babies can usually get all vaccines on schedule - at their chronological age, not an adjusted age based on being a preemie.
Premature babies can usually get all vaccines on schedule – at their chronological age, not an adjusted age based on being a preemie. Photo by Vincent Iannelli, MD

That doesn’t mean that their immune system is so immature they they can’t fight off many infections or that they shouldn’t be vaccinated. Even premature babies should usually be vaccinated on time.

Your Baby’s Immature Immune System

So just how immature is their immune system?

“A picture emerges of a child born with an immature, innate and adaptive immune system, which matures and acquires memory as he or she grows.”

Simon et al on Evolution of the immune system in humans from infancy to old age

It is immature enough that the protection that they get from passive immunity and transplacental transfer of antibodies before they are born is considered critical to protect them from many infections.

“After birth, the sudden enormous exposure to environmental antigens, many of them derived from intestinal commensal bacteria, calls for a rapid change to make distinct immune responses appropriate for early life.”

Simon et al on Evolution of the immune system in humans from infancy to old age

Fortunately, their immune system quickly matures and develops, so that as their maternal protection begins to fade, they are “better armed with the maturing innate and adaptive immune systems.”

“The risks are now much reduced by vaccinations, which stimulate protective immune responses in the maturing immune system.”

Simon et al on Evolution of the immune system in humans from infancy to old age

Getting fully vaccinated  on time helps too.

Myths About Your Baby’s Immune Response to Vaccines

Getting vaccinated?

With an immature immune system?

How does that work?

It will likely come as a surprise to some folks, but it actually works quite well!

“Although infants can generate all functional T-cells (ie, Th1, Th2, and cytotoxic T-cells), infant B-cell responses are deficient when compared with older children and adults. Infants respond well to antigens (such as proteins) that require T-cell help for development. However, until about 2 years of age, the B-cell response to T-cell-independent antigens (such as polysaccharides) is considerably less than that found in adults.”

Offit et al on Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?

In fact, we know that:

  • newborns respond well to the birth dose of the hepatitis B vaccine
  • the birth dose of BCG vaccine is effective at preventing severe TB disease
  • infants respond well to the vaccines in the primary series that they get at 2, 4, and 6 months
  • while infants respond well to most vaccines, to “circumvent the infant’s inability to mount T-cell-independent B-cell responses,” we use some conjugate vaccines when necessary, like Hib and Prevnar. This is especially important because their immature immune system puts them at extra risk for Hib and pneumococcal disease. Why? These are “bacteria that are coated with polysaccharides.”
  • older infants and toddlers respond to other vaccines, including MMR and the chicken pox vaccine, once maternal antibodies began to fade and can no longer cause interference.

So vaccines work in babies and young infants, just like they do for older children, teens, and adults.

But that makes you wonder, if anti-vaccine folks don’t think that vaccines work in these younger children and that their immune system is so immature, then how can these vaccines overstimulate their immune system???

They don’t.

Both the immunogencity and safety of vaccines for infants are well studied.

What to Know About Your Baby’s Immature Immune System

Vaccines work well to help protect newborns and infants as their immune system continues to develop and mature.

More About Your Baby’s Immature Immune System