Tag: newborns

What Shots Do You Need to Be Around a Newborn?

We often focus on what vaccines a baby will need once they are born, but it is also important that folks around your new baby get vaccinated too.

What Shots Do You Need to Be Around a Newborn?

To protect their new baby, many parents institute a no visit policy for friends and family members who don't get vaccinated.
To protect their new baby, many parents institute a no visit policy for friends and family members who don’t get vaccinated.

Of course, all of your vaccines should be up-to-date, especially if you plan to be around young kids. That’s how we maintain herd immunity levels of protection for those who can’t be vaccinated and protected, including newborns who are too young to be vaccinated.

In addition to routine vaccines, it is especially important that teens and adults who are going to be around a newborn or younger infant have:

  • a dose of Tdap – now routinely given to kids when they are 11 to 12 years old and to women during each pregnancy (to protect newborns against pertussis), others should get a dose if they have never had one. There are currently no recommendations for a booster dose.
  • a flu shot – is it flu season? Then anyone who is going to be around your baby should have had a flu shot. And for the purposes of keeping a newborn safe from the flu, you can assume that flu season extends from September through May, or anytime that flu shots are still available.

That’s it?

Only two shots?

Yes, only two shots assuming you are either immune or are up-to-date on your other vaccines. If you have been delaying or skipping any vaccines, then you might need an MMR, the chicken pox vaccine, and whatever else you are missing.

Other Precautions Around a New Baby

Unfortunately, there are many risks to a new baby that aren’t vaccine preventable.

Just because everyone is vaccinated and protected, that doesn’t mean that you should have a party welcoming your baby home and invite everyone in the neighborhood. Besides the flu, we get concerned about other cold and flu-like viruses, especially RSV.

That means to protect them, you should keep your baby away from:

  • large crowds, or even small crowds for that matter – in general, the more people that your baby is exposed to, the higher the chance that they will catch something
  • people who are sick
  • cigarette smoke – second hand smoke increases the risk of infections, like RSV

And make sure everyone, even if they don’t seem sick, washes their hands well before handling your baby.

“Parents or relatives with cold sores should be especially careful not to kiss babies—their immune systems are not well developed until after about 6 months old.”

AAP on Cold Sores in Children: About the Herpes Simplex Virus

Because you can sometimes be contagious even if you don’t have an active cold sore (fever blister), some parents don’t let anyone kiss their baby. Most of this fear comes after news reports of babies getting severe or life-threatening herpes infections after a probable kiss from a family member or friend.

When Can I Take My Newborn Out in Public?

When can you take your baby out in public? Most people try to wait until they are at least two months old.

Is that because that’s when they are protected with their two month shots?

Not really, as your baby won’t really be protected until they complete the primary series of infant vaccinations at six months.

Two months is a good general rule though, because by that age, if your baby gets a cold virus and a fever, it won’t necessarily mean a big work-up and a lot of testing. Before about six weeks, babies routinely get a lot of testing to figure out why they have a fever (the septic workup), even if it might be caused by a virus. That’s because younger infants are at risk for sepsis, UTI’s, and meningitis and they often have few signs when they are sick.

Keep in mind that going out in public is much different from going out. You can go for a walk with your baby at almost any time, as long as they are protected from the sun, bugs, and wind, etc., as long as there aren’t people around.

What to Know About Protecting Newborn Babies

Protect your baby by making sure everyone around them is vaccinated and protected, especially with a dose of Tdap and the flu vaccine.

More on Protecting Newborn Babies

What to Do If Your Child Is Exposed to Shingles

Pediatricians often get calls from worried parents because their kids have been exposed to someone with shingles.

Would you know what to do?

Shingles and Chicken Pox

Shingles is definitely contagious.

“A person with active shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before the blisters appear. Once the rash has developed crusts, the person is no longer infectious.”

CDC on Shingles Transmission

Herpes zoster was described as early as 1867, as can be seen in the lithograph from the Atlas der Hautkranheiten, although the connection with chickenpox didn't come until later.
Herpes zoster (HZ) was described as early as 1867, as can be seen in the lithograph from the Atlas der Hautkranheiten, although the connection with chickenpox didn’t come until later.

Not surprisingly, the biggest factor that will determine what needs to be done is whether or not your child is immune to chicken pox (primary varicella). Has your child ever had a natural chicken pox infection or completed a two dose chicken pox vaccine series?

Chicken pox vaccine?

Yes, because while shingles is contagious, you won’t get shingles if you are exposed to someone with shingles, but you can get chicken pox.

Remember, shingles is a reactivation of the varicella zoster virus (VZV), which also causes chicken pox. After a natural chicken pox infection, or less commonly after having the chicken pox vaccine, the chicken pox virus can stay dormant in the dorsal root ganglia of a spinal nerve. And you get shingles if the virus ever reactivates.

The type of exposure also matters.

Shingles is usually thought to be less contagious than chicken pox and requires direct contact with the rash, while it is in the blister phase, to spread disease. You shouldn’t catch the virus by simply being in the same room as someone with shingles. So if their shingles rash was completely covered by clothing, that decreases the chance of any real exposure.

“Not only was the risk of secondary infection with HZ comparable to that of primary varicella, the risk was similar regardless of the anatomic location of HZ. This finding contradicts the assumption that coverage of active skin lesions with dressings or clothing reduces VZV aerosolization and, if substantiated through further investigation, may warrant a change in current recommendations for VZV prevention.”

Bloch et al on Varicella Zoster Virus Transmission in the Vaccine Era: Unmasking the Role of Herpes Zoster

Covering the shingles rash doesn’t eliminate the risk of exposure though.

Another problem is that it isn’t always easy to recognize that someone has shingles, especially when younger children or teens have it.

“Anyone who has recovered from chickenpox may develop shingles; even children can get shingles. However, the risk of shingles increases as you get older.”

CDC on Shingles Clinical Overview

After all, no one expects an infant or toddler to have shingles, but it is important to remember that you can get shingles at any age, it is just more common the older you get.

Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant.
Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant. Photo by Kaoutar Zinelabidine et al.

And since it is often less severe in children and younger adults, who get a lot of rashes anyway, shingles isn’t usually the first thing a parent or many pediatricians will think of as a diagnosis.

That increases the risk of exposure before a diagnosis of shingles is finally made.

What to Do If Your Unvaccinated Child Is Exposed to Shingles

If your unvaccinated child, or incompletely vaccinated child, who has never had chicken pox is exposed to shingles, you should talk to your pediatrician about getting him vaccinated with the chicken pox vaccine. The vaccine should be given as soon as possible and preferably within 3 days of the exposure, but it can work even if it is given as long as 5 days afterwards.

“Vaccination within 3 days of exposure to rash was >90% effective in preventing varicella whereas vaccination within 5 days of exposure to rash was approximately 70% effective in preventing varicella and 100% effective in modifying severe disease.”

ACIP on Prevention of Varicella

This post-exposure vaccination can greatly reduce your child’s chances of developing chicken pox and even if your child does develop chicken pox, it will reduce the severity of the disease.

Otherwise, you should watch your child carefully over the next 10 to 21 days for the development of the classic symptoms of chicken pox, including a rash and fever, keeping him quarantined until after this incubation period so that you don’t expose others.

Certain high risk children who aren’t immune and who can’t get a chicken pox vaccine should get VariZIG (varicella zoster immune globulin) after being exposed to shingles (or chicken pox). This includes:

  • immunocompromised patients
  • hospitalized premature infants born at or after 28 weeks gestation, if their mother wasn’t immune to chicken pox
  • hospitalized premature infants born before 28 weeks gestation, even if their mother was immune to chicken pox
  • pregnant women who are not immune to chicken pox

VariZIG is given as soon as possible and within 10 days of exposure.

What to Do If Your Vaccinated Child Is Exposed to Shingles

If your child has already had chicken pox or two doses of the chicken pox vaccine, then you can likely safely assume that he is protected if he is ever exposed to shingles.

Still, since no vaccine is 100% effective, you should watch him over the next 10 to 21 days in case he does develop any signs or symptoms of chicken pox.

And keep the shingles rash covered to prevent further exposure.

What to Know About Getting Exposed to Shingles

Shingles is contagious and can cause someone to develop chicken pox if they haven’t already had it or aren’t vaccinated and protected.

More on Getting Exposed to Shingles

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