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Vaccinations



Girl Receives VaccinationAs an ER doctor with young children, I frequently get asked about my stance on vaccinations.  And I try to approach this topic with sensitivity because I am acutely aware of the controversy surrounding this issue.


In short, I think vaccinations are necessary and appropriate.  My children have all been fully vaccinated, as have I (more or less).  However, I do take issue with the vaccination "schedule" and some of (my perception) the unnecessary vaccinations.  It would be naive to think that corporate profit and monetary gain played no role in vaccine recommendations.  And applying unilateral law to large populations of diverse individuals is fraught with significant complications.  I understand that it has been decided that the relatively small threat to a few does not outweigh the potential benefit of the whole, so we accept the risks of mass vaccinations as a society.  However, it is disconcerting that when those (relatively few) individuals share their stories of suffering, big PhARMA and other huge corporate interests systematically proceed to discredit them, villanize them, and silence them.


The American Academy of Pediatrics (AAP) has the following recommendations:


2011 Vaccination Schedule


Birth: 

Hepatitis B.  I honestly don’t see the point in this under normal circumstances.  Hep B is a disease that’s spread by exchange of bodily fluid.  If Mom doesn’t have it, baby won’t have it.  Since baby isn’t having sex or doing IV drugs anytime soon, I do not think right after birth and before hospital discharge is an ideal time to expose a brand new baby’s immune system to Hep B vaccine.


2 months: 

DTaP (diphtheria, tetanus, pertussis), PCV (pneumococcal), IPV (inactivated poliovirus).  Agreed.  I think it’s important to start this series of vaccination, although I would probably (in retrospect) give only one exposure at a time to my 2 month old.  Meaning, I would make 3 different appointments, and have the vaccinations spread out over the entire month.


Hib (haemophilus influenza type b) – I am on the fence about Hib.  I know that this vaccine has purportedly prevented many ear infections and things, but I’m not sold on its necessity across the board.  And after 1 year, this bug is really no longer a threat.  So, I am going to expose my child (to even the most remote change of adverse reaction) for protection of an illness that only affects him/her for a few months of life anyway?


Rotavirus (RV) – I’m not impressed.  Diarrhea can be supported if acquired.  And this vaccine doesn’t even prevent N/V/D in general, just maybe if the causative organism happens to be this particular virus.  We know many viruses cause these general symptoms, so what’s the point?


Hep B – As mentioned before, I do not see the need at the age of 2 months.   The only reason it’s given is because it’s combined with other age appropriate vaccinations in the same vile.  So one shot entails a vaccine to all the bugs, including Hep B.  If you do not want to have Hep B given at this time you should ask for individual shots instead of the all in one that is usually given.


4 months: 

DTaP, PCV, IPV – All of these are fine.  I would suggest that you may want to consider spreading them out over a few visits as described earlier.


Hep B – I believe this is a safer point to receive the Hep B vaccination.  This is especially true since Hep B is contained in the formulation of some of the above listed vaccines.


RV – pass.


6 months:

DTap, PCV, Hep B, IPV – All are appropriate to provide at 6 months.


Hib and RV - pass.


12 months:

PCV – Appropriate at this time. 


Hep B.  – I would probably wait until closer to 2 for the final dose of this vaccine.


MMR – I would absolutely wait until closer to 2. 


Varicella - I wouldn’t get this vaccination. 


Hep A - I wouldn’t get this until the child is closer to starting kindergarten because Hep A is not particularly dangerous to young children.  It’s when we get older when Hep A becomes very uncomfortable.  Most of the world where this disease is common, the children are exposed early, and are frequently asymptomatic (without symptoms, or experience very mild GI upset (small tummy ache)).


18 months: 

Final Hep B and DTaP – Appropriate.  I would get MMR (measles, mumps, rubella) now.  I would not (and do not) get yearly flu shots.


Prekindergarten:

DTaP, IPV, Hep A series, MMR #2 – Appropriate.  I do suggest that your spread these vaccinations out over a couple/few months.  I still am not sold on the necessity of varicella.  I do not think the risk across the board is high enough to warrant meningococcal or another PCV.


Age 7-10: 

None


Age 11-12:

Updating Tdap reasonable.  I do not agree with HPV vaccine necessity.  And I’m not sold on even meningococcal.  But, children at this age (and body mass) are better able to tolerate the toxins injected into their body, AND there are less vaccines for the immune system to deal with.  I don’t like that it’s required, but it may not be worth fighting the schools for lack of compliance.


Age 13 – 18:

I would probably consider meningiococcal for pre-college freshmen if s/he hasn’t already received the vaccine.


Adults:

The vaccination schedule for adults is more ambiguous and individualized.  In general, adults in developed countries should have received the standard childhood vaccinations.   Specifically they should be up-to-date on:  Tdap (5 doses), MMR (2 doses), Hep A (2 doses), Hep B (3 doses); plus or minus varicella (chicken pox).  Tdap is updated every 10 years.  Pneumococcal is recommended after age 65 year old (which is probably a good idea).



Travel Vaccinations:


When you decide to travel, it’s important to do specific research on your destination’s infectious disease issues, and if a vaccine (or prophylactic medication) is available, consider utilizing it.  Some countries *require* travelers to receive (and show proof of) the completion of certain immunizations prior to entry and/or departure.

Travel Vaccinations

In developed countries, if all the standard vaccinations are up-to-date, life is easier when it comes time to travel.  It is likely that you will need boosters of IPV and Tdap.  Maybe consider having MMR, Hep A, Hep B titers drawn to make sure you’re immune.  Typically typhoid vaccination is recommended – which I agree with.  Meningococcal should be considered, but I think I actually decided against it for my family when we went to Ethiopia based on the risk/benefit ratio and our expected destination and scheduled activities.  Yellow fever may be necessary – and if the destination is endemic, I would recommend getting this vaccine (although it does have a higher incidence of adverse side effects than is typical of vaccines).  And of course, although no a vaccine, Malaria prophylaxis should be considered.


Overall, it is just too complicated to generalize travel vaccinations.  There are just so many factors at play.  A great website for obtaining information is:  Netdoctor.co.uk.


Of course there are always populations that should receive more (or less) vaccinations – so be sure to make an educated decision with the help of your trusted physician!




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