What to Expect the First Year (115 page)
Read What to Expect the First Year Online
Authors: Heidi Murkoff
Measles, mumps, rubella (MMR).
Children get two doses of MMR, the first between 12 and 15 months, and the second between ages 4 and 6 (though it can be administered any time as long as it is 28 days after the first one). It's recommended that the MMR be given early (between 6 months and 12 months) if a baby will be traveling internationally during that time. The vaccine prevents (not surprisingly) measles, mumps, and rubella.
Measles is a serious disease with sometimes severe, potentially fatal, complications. Rubella, also known as German measles, is often so mild that its symptoms are missed. But because it can cause birth defects in the fetus of an infected pregnant woman, immunization in early childhood is recommendedâboth to protect the future fetuses of girl babies and to reduce the risk of infected children exposing pregnant women, including their own mothers. Mumps rarely presents a serious problem in childhood, but because it can have severe consequences (such as sterility or deafness) when contracted in adulthood, early immunization is recommended.
Reactions to the MMR vaccine are usually very mild and don't usually occur until a week or two after the shot. Some children may get a mild fever or rash (which will go away on its own and is not contagious or concerning in any way). Studies have repeatedly and definitively shown there is absolutely no link between the MMR vaccine and autism or other developmental disorders.
Varicella vaccine (Var).
A dose of varicella vaccine is recommended between 12 and 18 months and another at age 4 to 6. A child who already had chicken pox (aka varicella) doesn't need to be immunized against it (you usually can't catch it again). The vaccine appears to prevent chicken pox in 70 to 90 percent of those who are vaccinated once, and the second dose pushes the protection rate close to 100 percent. The small percentage who do get chicken pox after receiving a single dose of the vaccine usually get a much milder case than if they hadn't been immunized.
Varicella was until recently one of the most common childhood diseases. Highly contagious through coughing, sneezing, and breathing, chicken pox causes fever, drowsiness, and an itchy blisterlike rash all over the body. Though usually mild, it occasionally causes more serious problems such as encephalitis (brain inflammation), pneumonia, secondary bacterial infections, and in rare instances, even death. Those who contract the disease when they are older are much more likely to develop serious complications. And the disease can be fatal to high-risk children, such as those with leukemia or immune deficiencies, those who take medications that suppress the immune system (such as steroids), and newborns born to unvaccinated mothers.
The varicella vaccine is very safe. Rarely, there may be redness or soreness at the site of the injection. Some children also get a mild rash (just a handful of spots) a few weeks after being immunized.
For the most up-to-date facts on vaccine safety, as well as the latest immunization recommendations for your child, visit the CDC website at
cdc.gov/vaccines
or go to
WhatToExpect.com
. You can also download the VIS (Vaccine Information Statement) on each vaccine, available at the CDC website. The doctor or clinic, by law, will provide the appropriate VIS whenever a shot is given, but checking it out ahead of time will allow you to read up on vaccine benefits, risks, side effects, and contraindications.
Haemophilus Influenzae type b vaccine (Hib).
Your child should get the Hib vaccine at 2, 4, and 6 months, with a fourth dose at 12 to 15 months. (One brand of the vaccine calls for only three doses, at 2 and 4 months and between 12 and 15 months of age.)
The vaccine is aimed at preventing the deadly Hib bacteria (which has no relation to influenza, or “flu”), the cause of a wide range of very serious infections in infants and young children. The disease is spread through the air by coughing, sneezing, even breathingâand before the introduction of the vaccine, thousands of children contracted serious infections of the blood, the lungs, the joints, and the covering of the brain (meningitis). Hib meningitis frequently led to permanent brain damage and killed hundreds of young children every year.
The Hib vaccine appears to have few, if any, side effects. A very small percentage of children may have fever, redness, and/or tenderness at the site of the shot.
Hepatitis B (hep B).
Your child needs three doses of this vaccine. It's recommended that the first be given shortly after birth, the second at 1 to 2 months, and the third at 6 to 18 months. If the hepatitis B vaccine is administered in combination with other vaccines, doses are given at 2, 4, and 6 months instead, in addition to the newborn dose (receiving one “extra” dose of the hepatitis B vaccine is not harmful in any way). If prenatal testing showed that you are a carrier of hepatitis B, your baby will receive a shot of immunoglobulin right after birth, in addition to the newborn dose of hep B vaccine, to prevent him or her from becoming infected by you.
Hepatitis B, a chronic liver disease, is spread through contact with the blood or other body fluids of an infected person. Those who become infected with the disease can have serious problems such as cirrhosis (scarring of the liver) or liver cancer. Nearly 5,000 people die from complications of chronic hepatitis B each year in the U.S. Thanks to the hep B vaccine, your child will probably never have to worry about catching this devastating disease.
Side effects of the hep B vaccineâslight soreness and fussinessâare not common and pass quickly.
Hepatitis A (hep A).
Two doses of the vaccine for hepatitis A are recommended for children between 12 months and 2 years living in high-risk states, mostly in the western U.S., or in high-risk countries (check with your doctor to see if you are living in a high-risk area). The first dose is given when a child is 12 months of age, and a booster dose is given at 24 months of age or at least 6 months after the first. The vaccine can also be given to older children in high-risk areas if they didn't receive it earlier.
Hepatitis A is a liver disease that affects 125,000 to 200,000 people a year in the U.S., about 30 percent of them children under age 15. The virus is spread through personal contact or by eating or drinking contaminated food or water. Symptoms of the illness in children over 6 years include fever, loss of appetite, stomach pain, vomiting, and jaundice (yellow skin or eyes). Although hep A infection rarely has the lifelong implications hep B infection often has, it's still a significant contagious illness that can be easily and safely prevented with immunization in early childhood.
Side effects, such as tenderness at the injection site or a low-grade fever, occasionally occur and are not harmful.
Pneumococcal conjugate vaccine (PCV).
Children should get the PCV vaccine at 2, 4, and 6 months, with a booster given at 12 to 15 months.
The PCV vaccine protects against the pneumococcus bacterium, a major cause of serious or invasive illness among children. It is spread through person-to-person contact (touch) and is most common during the winter and early spring. Large studies and clinical trials have shown that the PCV vaccine is extremely effective in preventing the occurrence of certain types of meningitis, pneumonia, blood infections, and other related, sometimes life-threatening infections. Though the vaccine wasn't intended to prevent ear infections, it's somewhat effective in preventing those caused by these same bacteria.
Side effects, such as low-grade fever or redness and tenderness at the injection site, occasionally occur and are not harmful.
If you've adopted an older baby, you'll need to pay extra attention when it comes to vaccinations. Because some adoption agencies don't have accurate records, it's hard to know which vaccinations, if any, your little one has already received. If you are adopting your baby from a foreign country, he or she may not have been immunized on a schedule recommended in the U.S. Even if there is a vaccination record for your overseas baby, it's no guarantee of adequate protection, since in many developing countries, vaccines may not be uniformly stored or administered properly.
To determine the level of immunity your baby has against a vaccine-preventable disease, the pediatrician can do a blood test to measure antibodies. If the test shows a lack of antibodies for any disease, your baby will be vaccinated. Don't worry about the potential of your baby being vaccinated for the same disease twice. Any adverse reactions to the shots (which are usually minor and quite rare) are still safer than contracting a disease.
Internationally adopted older babies will also need to be screened for a variety of infectious diseases they are at higher risk of having been exposed to, such as TB and hepatitis B.
The vast majority of concerns parents have about immunizationâthough perfectly understandableâare unfounded. Don't let the following myths keep you from immunizing your baby:
Myth:
Giving so many vaccines all at onceâeither during the same visit or in a combo shotâisn't safe
.
Reality:
Current vaccines are just as safe and effective when given together as when given separately (the MMR and DTaP combo vaccines have been used routinelyâand safelyâfor years). More combo shots are being used these days, such as one that combines DTaP, polio, and hep B in a single shot. The best part about these combo vaccines is that they mean fewer total shots for your babyâsomething you'll both likely appreciate. Getting different shots at the same visit doesn't present a safety or effectiveness issue either.
Myth:
If everyone else's children are immunized, mine can't get sick.
Reality:
Some parents believe that they don't have to immunize their own children if everyone else's children are immunizedâbecause there won't be any diseases around to catch. That so-called “herd” theory doesn't hold up. First of all, there's the risk that other parents are subscribing to the same myth as you, which means their children won't be immunized either, creating the potential for an outbreak of a preventable disease. Second, unvaccinated children put vaccinated (as well as unvaccinated and not-fully-vaccinated) children at risk for the disease. Since vaccines are about 90 percent effective, the high percentage of immunized individuals limits the spread of the disease but does not eliminate it completely. So not only might you be putting your own child at risk, but other children as well. Something else to keep in mind: Some diseases, like tetanus, aren't transmitted person to person. An unvaccinated child can contract tetanus after being cut by a rusty object or having contaminated soil seep through a scratchâso even universal immunization of the “herd” won't be protective.
Myth:
Vaccines have wiped out childhood diseases, so my child won't get sick.
Reality:
Wondering why you should bother having your child immunized against diseases that seem to be a thing of the past? The truth is that many of these diseases are still around, and can harm unvaccinated children. In fact, between 1989 and 1991, lapsing rates of MMR vaccinations among preschoolers in the United States led to a sharp jump in the number of measles casesâwith 55,000 people becoming sick and 120 dying. In 2006, an outbreak of mumps occurred in a few Midwest states, affecting more than 4,000 people. Experts believe that outbreakâthe first in 20 yearsâstarted with an infected traveler to the United States from England (where vaccination rates are lower), but was able to spread in the U.S. due to incomplete vaccinations. A mumps outbreak in 2010 in the New York area affected more than 2,000 children and teenagers, a number of whom suffered serious complications as a result. Pertussis is definitely still around, causing severe disease and many deaths yearly, sometimes at epidemic proportions. And experts say 2014 saw the most measles cases since 1996âmostly striking unvaccinated children and adults.
Myth:
One vaccine in a series gives a child enough protection
.
Reality:
Skipping vaccines puts your child at increased risk for contracting the diseases, especially measles and pertussis. So if the recommendations are for a series of four shots, for example, make sure your child receives all so he or she is not left unprotected.
Myth:
Multiple vaccines for such young children put them at increased risk for other diseases
.
Reality:
There is no evidence that multiple immunizations increase the risk for diabetes, infectious disease, or any other illnesses. Neither is there any evidence of a connection between multiple vaccines and allergic diseases.
Myth:
Shots are very painful for a baby.
Reality:
The pain of a vaccination is only momentary and not significant, compared with the pain of the serious diseases the immunization is protecting against. And there are ways of minimizing the pain your baby feels. Studies show that babies who get shots while they are being held and distracted by their parents cry less, and those who are breastfed immediately before or during the immunization experience less pain. You can also ask your baby's doctor about giving a sugar solution just before the shot (to reduce the pain) or applying a numbing cream an hour earlier.
Myth:
There's mercury in vaccines.
Reality:
Most of the recommended childhood vaccines (MMR, IPV, varicella, and PCV, for instance) never contained mercury (thimerosal) at all. And, since 2001, all routinely recommended vaccines have either been mercury-free or (in the case of the flu vaccine, for instance) have contained only extremely small amounts of mercury. How small? Around 12.5 micrograms per doseâand to put that number into perspective, 6 ounces of canned chunk white tuna contains 52.7 micrograms of mercury. Most important, many studies have proved that this extremely low level of thimerosal doesn't cause harm and the type of mercury used in the flu vaccine is expelled from a child's body faster than the mercury found in fish, leaving little chance for a buildup. Thimerosal-free flu vaccines are available, too, so ask the baby's doctor if you're still concerned.
Myth:
Vaccines cause autism or other developmental disorders
.
Reality:
Despite numerous large-scale studies that have thoroughly discredited a link between autism and vaccines (including one from the Institute of Medicine based on years of data), it's a controversy that just doesn't go awayâat least as long as internet legends and celebrity-driven misinformation keep getting passed around. Even a federal court ruled that routine childhood immunizations (including the MMR vaccine that gets all the press) are not (repeat, not) linked to autism and there is no evidence to back up the claims that suggest otherwise. The entire vaccine-autism scare began in 1998 when a British doctor published one study (involving only 12 children) that suggested a possible link between the MMR vaccine and autism. The journal that published the study (
The Lancet
) retracted it in 2004, and in 2010 it was found that the doctor responsible for that faulty study actually fudged the data, manipulated the outcomes, and misreported results in his research (his medical license was subsequently revoked). In 2011, the
British Medical Journal
called the flawed study “an elaborate fraud.” In other words, there was never any credibility to the theory that vaccines cause autism. They don't and they never did.