What to Expect the Toddler Years (194 page)

Caution should be taken in administering MMR to a child if he or she is sick with anything but a mild cold, one with an impaired immune system (from medication, cancer, or another condition), one who has recently had a blood transfusion, one who has a severe allergy to gelatin or the antibiotic neomycin, or one who had a severe allergic reaction after the first dose of MMR.

Haemophilus Influenzae type b vaccine (Hib).
This vaccine is aimed at thwarting the deadly
Haemophilus influenzae
type b (Hib) bacteria (which has no relation to influenza, or “flu”) that is the cause of a wide range of very serious infections in infants and young children. Prior to the introduction of the vaccine, Hib was responsible for about 12,000 cases of meningitis in children in the United States annually (5 percent of them fatal) as well as other blood, skin, and heart infections. The disease is spread through the air by coughing, sneezing, even breathing—and if the bacteria get into the lungs it can spread to the brain and other organs.

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. Your child should get the Hib vaccine at two, four, and six months, with a fourth dose at twelve to fifteen months. (One brand of the vaccine calls for only three doses, at 2 and 4 months and between 12 and 15 months of age.)

As with other vaccines, Hib vaccine should not be given to a child who is very ill (mild illness isn’t a problem), or who might be allergic to any of the components (check with your doctor).

Polio vaccine (IPV).
Immunization has virtually eliminated polio (aka infantile paralysis), once a dreaded disease, from the United States. Polio is caused by a virus that is spread through contact with the feces of an infected person (such as when changing diapers). It can cause severe muscle pain and paralysis within weeks (though some children with the disease experience only mild cold-like symptoms or no symptoms at all).

Children should receive four injections of inactivated polio vaccine (IPV)—the first at two months; the second at four months; the third at six to eighteen months; and the fourth at four to six years—except in special circumstances (such as when traveling to countries where polio is still common, in which case the schedule may be stepped up).

The IPV is not known to produce any side effects except for a little soreness or redness at the site of the injection and the rare allergic reaction. Your doctor will likely delay administering the IPV if your child is very ill. A child who had a
severe
allergic reaction to the first dose generally won’t be given subsequent doses.

Varicella vaccine (Var).
Varicella, or chicken pox, 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 blister-like rash all over the body. Though usually mild, it occasionally causes more serious problems such as encephalitis (a brain disease), pneumonia, 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.

A dose of varicella vaccine is recommended between twelve and eighteen months and another between ages four and six. A child who already had chicken pox does not need to get the vaccine. It appears that the vaccine prevents chicken pox in 70 to 90 percent of those who are vaccinated. The small percentage who do get chicken pox after receiving the vaccine usually get a much milder case than if they had not been immunized.

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 (about five spots) a few weeks after being immunized.

Hepatitis B (hep B).
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. Luckily, vaccination at birth or shortly thereafter means your child will probably never have to worry about catching hepatitis B.

Three doses of the vaccine are needed. It is recommended that the vaccine for hepatitis B be given at birth (it may be delayed for premature infants), at one to two months and six to eighteen months. (If a combo vaccine is administered, the doses are given at two, four, and six months instead.) Side effects—slight soreness and fussiness—are not common and pass quickly.

Hepatitis A (hep A).
Hepatitis A is also a liver disease. It affects 125,000 to 200,000 people a year; about 30% of them are children under age fifteen. The virus is spread through personal contact or by eating or drinking contaminated food or water. Symptoms of the illness in children over six include fever, loss of appetite, stomach pain, vomiting, and jaundice (yellow skin or eyes). Severe hepatitis A can cause liver failure.

Two doses of the vaccine for hepatitis A (hep A) are recommended for children between twelve months and two years and for older children living in high-risk states and countries, mostly in the western United States (check with your doctor to see if you are living in a high-risk area). The first dose is given when a child is twelve months of age and a booster dose is given at twenty-four months of age or at least six months after the first.

Pneumococcal conjugate vaccine (PCV).
The pneumococcus bacterium is a major cause of illness among children, responsible for some ear infections, meningitis, pneumonia, blood infections, and other illnesses. It is spread through person-to-person contact 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 ear infections, meningitis, pneumonia, and other related life-threatening infections. Children should get the vaccine at two, four, and six months, with a booster given at twelve to fifteen months. Side effects, such as low-grade fever or redness and
tenderness at the injection site, are occasionally seen and are not harmful.

Influenza.
The influenza, or “flu,” is a seasonal illness spread through sneezing, coughing—even breathing or touching a surface with the virus on it. The influenza virus causes fever, sore throat, coughs, headache, chills, and muscle aches. Complications can range from ear and sinus infections to pneumonia and even death. Influenza is different from most other diseases because the viruses are always changing, meaning that immunity acquired one year may not protect against future influenza viruses. That’s why a yearly vaccine is recommended, and it can reduce the chances of getting the flu by up to 80 percent during the season.

One dose yearly beginning around October or November is recommended for children six months of age and older. Children younger than nine years of age receiving the vaccine for the first time need two doses at least four to six weeks apart. Once your child is over five years of age, he or she can receive the yearly FluMist, an influenza vaccine that is delivered as a nasal mist instead of a shot.

Rotavirus (Rota).
Rotavirus is an intestinal virus that is extremely contagious, spreading easily through contact with contaminated hands or objects and through the air, and infecting nearly all children by the time they’re five years old. The disease, which commonly appears between the months of November and May, triggers more than 400,000 doctor visits and 55,000 hospitalizations for diarrhea, vomiting, and dehydration each year in the United States. Rotavirus can even be fatal, accounting for twenty to sixty deaths each year in the U.S. Symptoms include fever, upset stomach, and vomiting, followed by diarrhea that lasts from three to eight days. Studies show that the vaccine prevents 75% of cases of rotavirus and 98% of severe cases of the disease. Doses of this vaccine (a liquid given by mouth) are given at two, four and six months.

Rabies.
Both human rabies immune globulin (HRIG) and rabies vaccine are available; both are reserved for use when there has been an exposure (by bite, scratch, even lick) to a rabid, or possibly rabid, animal (see page 662).

Most worries about immunization—though perfectly understandable—are unfounded. Don’t let the following myths keep you from immunizing your child.

Myth:
Giving so many shots all at once isn’t safe.

Reality:
Studies have shown that vaccinations are just as safe and effective when given together as they are when given separately. There are many combination vaccines that have been used routinely for years (MMR, DTaP). More combo shots are being used these days, such as one that prevents DTaP, polio, and hep B in a single shot. Researchers are continuing to develop combo vaccines that may become approved for use in the near future. But the best part about these combination vaccines is that they mean fewer total shots for your child—something you’re both likely to appreciate.

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 immunized—since there won’t be any diseases to catch. That 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 children at risk for the disease (vaccines are about 90 percent effective; the high percentage of immunized individuals limits the spread of the disease)—so not only might you be hurting your child, you might also be hurting your child’s friends. Third, unvaccinated children can catch whooping cough (pertussis) not only from other unvaccinated children, but also from adults. That’s because the vaccine that protects against it isn’t given after age seven and immunity has largely worn off by adulthood. The disease, while still highly contagious, is so mild in adults that it’s usually not diagnosed—which means that adults who don’t realize they have whooping cough can inadvertently spread it to children, who are much more vulnerable to its effects.

As antiquated as they sound, many of these diseases are still around. 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 cases. Fifty-five thousand people became sick and 120 died. And just as recently as 2006, an outbreak of mumps occurred in a few Midwest states, affecting over four thousand people. Experts believe this outbreak—the first in twenty years—started with an infected traveler to the United States from England (where vaccination rates have been lower in recent years), but was able to spread due to incomplete vaccinations.

Myth:
One vaccine in a series gives a child enough protection.

Reality:
Researchers have found that 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
the necessary shots 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 to date that there is a connection between multiple vaccines and allergic diseases such as asthma. Finally, there is no substantiated evidence that vaccines cause autism or other developmental disorders.

Once your toddler reaches a certain age, he or she has likely smartened up to the fact that most doctor visits might include a shot. And this realization may create lots of pre-visit anxiety—and lots of in-office kicking and screaming. To help prepare the toddler in your life for those inevitable immunizations, while also minimizing the fears and tears of both of you:

Ahead of time, explain to older toddlers that the shot will keep them healthier.