Tag: prematurity

Has the United States’ Infant Mortality Rate Ranking Been Dropping as We Vaccinate More Kids?

Of all of the myths about vaccines that confuse and scare some parents, those about infant mortality rates can be especially hard to easily put aside.

After all, why doesn’t the United States rank better for infant mortality rates since most parents do vaccinate and protect their kids?

Vaccines and Infant Mortality Rates

That’s actually fairly easy to answer.

“Globally, the infant mortality rate has decreased from an estimated rate of 64.8 deaths per 1000 live births in 1990 to 30.5 deaths per 1000 live births in 2016.”

WHO on Infant Mortality Situation and Trends

Vaccine-preventable diseases don’t have much effect on infant mortality rates in the United States these days.

What does?

  • birth defects
  • premature births
  • SIDS
  • maternal complications of pregnancy
  • injuries

Think about it… If vaccines did increase infant mortality rates, then why would infant mortality rates be dropping as we vaccinate more kids?

Has the United States’ Infant Mortality Rate Ranking Been Dropping as We Vaccinate More Kids?

Do you know what has been dropping?

The Wisconsin Coalition for Informed Vaccination is pushing myths about SIDS and vaccines.
The Wisconsin Coalition for Informed Vaccination is pushing myths about infant mortality rates and vaccines.

The infant mortality rate.

In fact, infant mortality rates continue to drop and are now at their lowest levels ever.

While it is good news that the rate is dropping, most folks think they can be better.

For one thing, some states, like Mississippi, Louisiana, Alabama, Arkansas, and West Virginia, etc., have much higher infant mortality rates than others. Why? Much of those differences, can be explained by socio-economic factors. That’s also though to explain much of the differences in infant mortality rates between the U.S. and other developed countries, most of which have universal health care.

New Jersey, although they have ranked high for autism rates, has lower than average rates of infant mortality.
New Jersey, although they have ranked high for autism rates, has lower than average rates of infant mortality.

Another big difference is that many countries count infant mortality rates using different criteria than the United States.

For example, it is estimated that at least 40% of the differences between infant mortality rates in the United States and other countries is due to those countries not counting extremely preterm births among their statistics.

But why has the United States’ infant mortality ranking fallen relative to other developed nations?

Most European Countries had much higher infant mortality rates than the US in the 1960s and 70s, which affected relative rankings, even as all countries saw infant mortality rates fall.
OECD data shows that most European Countries have historically had much higher infant mortality rates than the US, which have affected relative rankings, even as all countries have seen infant mortality rates fall.

Although anti-vaccine groups try to tie this to ‘routine vaccination,’ it is easy to see that other countries have historically had much higher infant mortality rates than the United States. As they have caught up, the United States’ ranking has dropped relative to theirs, even though all have seen infant mortality rates drop.

Infant Mortality Rates in the Pre-Vaccine Era

But if you really want to understand the relationship of vaccines to infant mortality rates, you just have to look back to the pre-vaccine era. Back then, now vaccine-preventable diseases did have a big effect on infant mortality rates in the United States and elsewhere.

In 1910, for example, the most common causes of death for infants under 1 year were:

  1. diarrhea and enteritis
  2. premature birth
  3. congenital debility
  4. bronchopneumonia
  5. pneumonia
  6. malformations
  7. bronchitis
  8. convulsions
  9. injuries at birth
  10. whooping cough
  11. tuberculosis
  12. meningitis
  13. measles
  14. accident
  15. diphtheria

Although advances in modern medicine would help decrease the mortality from many of those diseases, it was vaccines that truly worked to make sure they were no longer a big part of our infant mortality statistics.

How will we continue to decrease our infant mortality rates?

Most experts think that it will require better access to health care for all members of society.

What to Know About Infant Mortality Rate Rankings

Infant mortality rates are not linked to vaccines.

More Infant Mortality Rate Rankings

Vaccines for Premature Babies

It is easy for the parents of a premature baby in the NICU to get overwhelmed by all of the things that might be going on, especially if they are there long enough for their baby to get their two month vaccines.

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

Ventilators, TPN, jaundice lights, feeding tubes, oxygen, apnea monitors, etc. – is this really a time to be thinking about vaccines?

Since premature babies can have an immature immune system and are at greater risk for infectious diseases, including vaccine-preventable diseases, it is actually a great time to make sure that your baby gets vaccinated and protected.

Vaccine Recommendations for Preterm Babies

What vaccines do premature babies need?

Which ones should you delay or skip?

“In the majority of cases, infants born prematurely, regardless of birth weight, should be vaccinated at the same chronological age and according to the same schedule and precautions as full-term infants and children”

ACIP Vaccination of Premature Infants

Not surprisingly, it is recommended that you not delay or skip any vaccine just because your baby was born premature.

You also shouldn’t wait to vaccinate your preterm baby according to any corrected or age-adjusted schedule. Premature babies get vaccinated according to their chronological age, just like everyone else.

There is one exception.

If a preterm baby also has a birth weight less than 2,000g AND their mother is known to be negative for hepatitis B infection, then they can delay their first dose of hepatitis B vaccine until they are 1 month old or at hospital discharge (whichever is sooner). The hepatitis B vaccine can be safely given if the mother is hepB positive or her status isn’t known. That dose just isn’t counted and is later repeated, because of the concern that it might not work as well in low birth weight, premature newborns.

Vaccines Work for Premature Babies

Does that mean that other vaccines for premature babies might not work as well either?

Many studies have shown that vaccines work well in premature babies.

The World Health Organization does recommend that for Prevnar, “pre-term neonates who have received their 3 primary vaccine doses before reaching 12 months of age may benefit from a booster dose in the second year of life.” That doesn’t apply in the United States though, as we give a routine booster to all toddlers at 12 to 15 months and studies have shown this schedule works well for preterm babies. That’s good, because preterm babies are thought to be at much higher risk for invasive Streptococcus pneumoniae infections.

Otherwise, remember the advice of the AAP, including that “medically stable preterm babies weighing more than 4.4 lbs. at birth should be treated like full-term babies and receive the first dose of the hepatitis B immunization according to the recommended schedule.”

What To Know About Vaccines For Your Preterm Baby

Vaccines are safe, effective, and very necessary for premature babies.

More About Vaccines For Your Preterm Baby

Infant Mortality Rates and Vaccines

How can the Unites States have such high infant mortality rates if we vaccinate so many of our kids?

Many countries with similar immunization schedules have lower infant mortality rates than the United States.
Many countries with similar immunization schedules have lower infant mortality rates than the United States.

That’s like asking why you didn’t harvest any apples when you planted so many orange trees…

Infant Mortality Rates and Vaccines

Infant mortality rates are not really linked to vaccine preventable diseases. Instead, the infant mortality rate in the United States is influenced by:

  • birth defects
  • premature births
  • SIDS
  • maternal complications of pregnancy
  • injuries

And the United States has a higher infant mortality rate than some other industrialized countries not because we vaccinate more kids, but rather because we use different methods to calculate the infant mortality rate. Most other countries don’t include extremely premature babies in their infant mortality rates.

Fortunately, infant mortality rates continue to drop and recently reached their lowest level ever.

In 2016, the infant mortality rate in the United States was 5.87 infant deaths per 1,000 live births, just slightly below, but not significantly different than the rate of 5.9 in 2015. It was at 6.14 in 2010 and as high as 6.89 in 2000.

More on Infant Mortality Rates and Vaccines