TO VACCINATE OR NOT TO VACCINATE
FROM THE FLU SHOT TO MMR, PEDIATRICIAN DR. JESSICA GRANT ANSWERS OUR QUESTIONS
ABOUT A STICKY SITUATION

THE FAMILY GROOVE: Are vaccines safe?
Dr. Jessica Grant: By and large, vaccines are considered very safe. The most
common side effects are soreness at the injection site, fever, and, with some
vaccines, slight rash. These symptoms resolve in one to two days and are
considered a small price to pay for protection from very serious illnesses. There
are more serious side effects (such as neurological problems), but these are
extremely rare (less than one per one million doses). Allergic reactions can occur
but also are very rare. 

It is important to remember that vaccines prevent severe diseases and even death. We often forget how scary these illnesses are because they have become so uncommon in the United States. However, by looking at the past and at other countries where these vaccines are not available, we can see how serious these illnesses can be. Preventing them requires vaccination of all children. For example, measles often occurs in children when they are too young to receive the vaccine. It's only because we immunize all other children around new babies that we are able to prevent measles outbreaks.

TFG: Is there a link to autism?
JG: That's the million dollar question. The hype has largely focused on the MMR vaccine because it's a live vaccine, meaning that it contains very weak versions of the same viruses that cause measles, mumps and rubella. Most pediatricians don't believe there is a link between vaccination and autism. Many studies have been done to investigate this issue, and the American Academy of Pediatrics, the Institute of Medicine and the Center for Disease Control and Prevention have all concluded that there is no scientifically-proven link between the vaccine and autism. 

We now think that it only appeared that autism and vaccines were related because of the timing of both. Autism is often diagnosed initially in children between 18 and 30 months of age because this is when the signs become apparent. Since the MMR vaccine is given at 12-15 months of age, it may appear the two are related. But this timing doesn't mean that the vaccine causes autism. In fact, evidence is mounting that autism is determined early in pregnancy. In addition, autism is being diagnosed more often but probably not because there more cases, but rather because there is improved awareness and screening practices. A recent study found no increase in the incidence of autism in children who received MMR when compared to children who did not receive the MMR vaccine.

Parents should rest assured that the Centers for Disease Control and Prevention, the National Institutes of Health, and the Food and Drug Administration continuously study vaccine efficacy and safety. We also must remember that measles is still a common illness in other countries, and with world travel as common as it is, without routine vaccination, we will very likely see measles outbreaks in this country again. Furthermore, before vaccination, nearly everyone contracted measles, and there were many deaths from the disease each year. Because of this, the vast majority of pediatricians strongly support vaccination of all children with the MMR vaccine.

TFG: What immunizations are necessary to start school?
JG: Vaccine requirements vary by state and even by school in some cases. However, in general, schools require the following standard immunizations:

		DTaP (for diphtheria, tetanus, and pertussis). By kindergarten, children have had five DTaP vaccines. They need a booster every 10 years thereafter.
		Polio vaccine. By kindergarten, children have four IPV vaccines.
		Hepatitis B. This is a 3 vaccine series, given over six months.
		MMR (measles, mumps, and rubella).  By kindergarten, children need two of these. No further boosters are needed.
		Varicella (chicken pox). Currently children get this only once as long as they receive it when they are toddlers or younger.
		Hemophilus influenza B. Children will receive three vaccines.
		Pneumooccal vaccine is often not required by schools but is heavily recommended by pediatricians.
		HPV vaccine is the newest of the recommended vaccines. It prevents against human papillomavirus, which can cause genital warts and cervical cancer. It's now a routine vaccine for all 11-year-olds. It is given as a 3 vaccine series, similar to hepatitis B.  Though it is now recommended by the American Academy of Pediatrics, no schools currently require it. However, the legislature in Michigan is currently debating passing a law requiring HPV vaccine for all adolescents in school. Stay tuned.
		Meningococcus. This is currently recommended for adolescents who will live in close quarters (college dorms or the army). Some colleges require it.

TFG: Should our children receive the flu vaccine?
JG: The flu vaccine is available to anyone over six months of age. The vaccine, similar to other vaccines, works by generating antibodies which will fight off the infection if you are exposed to the flu. However, because the flu virus changes a little each year, scientists try to predict what the virus will be like each winter and update the vaccine to protect against the virus that will be going around that year. This means that it may not be as effective as other vaccines, and it must be given again each year (ideally in October).    

Influenza is a serious illness, which can cause complications like dehydration, pneumonia and even death. At the best, as we all know, it causes extreme misery. The flu vaccine is highly recommended for certain children (those less than three years old or those with chronic medical conditions like sickle cell disease, heart conditions or asthma), because these children are the ones most likely to become seriously ill with influenza. However, any child can receive the vaccine (except those with an egg allergy). There are very few common side effects (soreness at the site of injection, low grade fevers and body aches), though there is a very small chance of more serious side effects which your pediatrician can explain. The flu vaccine is made of dead virus, meaning it cannot cause the flu. Because side effects are minimal, many pediatricians consider it wise to vaccinate children to prevent illness, complications, and missed days of school.


Columbia University College of Physicians and Surgeons graduate, Dr. Jessica Grant is a pediatrician with the Montefiore Medical Group in the Bronx.