Immunization is an effective way to keep our families and communities safe from disease. But some parents have questions about vaccines. It’s important that parents have the science-based information they need before immunizing their children or signing a religious exemption to immunization. This presentation, answering parents’ most frequently asked questions, is based on information provided by the Centers for Disease Control and Prevention (CDC) as well as the Oregon Health Authority. A glossary and list of reference research studies will appear at the end of this presentation.
Vaccines provide the immunity that comes from natural infection without the consequences of natural infection. Vaccines have been around for centuries. The first vaccine was developed in the late 1700s by Edward Jenner to prevent smallpox. Now, over 200 years later, smallpox has been wiped off the face of the earth and we no longer need to be immunized against it.
Today there are vaccines to prevent several deadly diseases including measles,rubella, diphtheria and polio. Before vaccines, these diseases killed millions of people.
Immunizations are so vital to a child’s health, every state has laws requiring children to be immunized before they can attend school. Oregon law states that children must be immunized before attending public or private school, preschool, child care and Head Start.
However parents who have objections to vaccines can sign a religious exemption to one or all school immunizations. Oregon Law defines “religion” for the purpose of immunization requirements to be “any system of beliefs, practices or ethical values.”
In the past decade, the rate of parents who have signed religious exemptions to immunizations has doubled statewide.
These are the religious exemption rates for kindergarteners in 2010-12. How did your county stack up?
Before signing a religious exemption to immunization, parents should know that some people cannot be vaccinated because of medical conditions or age, and exposure to any vaccine-preventable disease could be fatal for them. To keep disease out of a community, there must be a certain number of people immunized. For example, to keep whooping cough or measles out of a school, 92 to 94 percent of the students must be immunized. In the event of an outbreak, inadequately vaccinated children may be excluded from school and must be cared for in their homes.
By far, most Oregon parents keep their children up-to-date on their immunizations. But a few parents sign a religious exemption to immunization, often for diverse reasons. Some question vaccines’ effectiveness; others wonder whether vaccines are safer than the diseases they prevent. And some parents haven’t seen the diseases that vaccines prevent in their lifetimes, so they aren’t convinced vaccines are even necessary.
Nothing is risk-free. People may experience side effects after a vaccination; the most common is redness and swelling at the injection site.
Vaccines must undergo rigorous testing before they are licensed. Then, they are monitored continually to ensure their safety.
Before administering any immunization, healthcare providers must always provide a Vaccine Information Statement each and every time. These statements discuss the risks and benefits of each vaccine.
Many parents are concerned because their children get more shots than they did when they were kids. But today’s advanced technology means that we can protect people against more diseases than ever. Numerous studies have determined that simultaneous vaccination with multiple vaccines won’t overwhelm a body’s immune system.
Today’s vaccine are more effective than ever. The pertussis---or whooping cough---vaccine that most parents and grandparents received had about 3000 antigens, the ingredient that stimulates a body’s immune system; today the combined pertussis, diphtheria and tetanus vaccine has five. There are less than 130 antigens in all the routinely recommended childhoodimmunizations combined.
A CDC committee of doctors and scientists, the Advisory Committee on Immunization Practices (ACIP), continuously evaluates research and takes great care to ensure that children get their shots at the ages when the vaccines are most effective. This is the schedule their own children follow.Successfully combining some vaccines into one shot, like the measles-mumps-rubella or MMR vaccine, means kids have fewer shots, fewer office visits and less discomfort.
It’s hard to see an infant get a shot, but babies are strong. Most babies are born with some immunity from their mothers, but that immunity wanes even with breast feeding. Many of the diseases that vaccines prevent occur in very young infants, so it’s important that they develop their own sturdy immune systems with the help of immunization.Vaccines don’t weaken the immune response, they boost it.
Some parents believe that it’s more “natural” for children to get immunity from a disease rather than by a vaccination. But natural infection can come at a high price. Chickenpox, for example, can lead to pneumonia and other serious complications. Before the chickenpox vaccine, about 100 children died every year in the US from the disease.A child may have a mild case or even no symptoms at all, but he or she could pass on the disease to a child who can’t be immunized because of age or medical condition and could develop serious complications.
The diseases that vaccines prevent are dangerous. Many vaccine-preventable diseases, such as polio, are no longer around so we have forgotten how horrible they are. Some dangerous diseases are still prevalent. In 2010, over 9,000 people in Californiacaught whooping cough (pertussis) and 10 infants died.Diseases are just a plane ride away. Measles is making a comeback in Europe with over 30,000 cases in 2010. In the first 10 months of 2011, there were 115 measles outbreaks in 36 countries. The largest outbreak was in France. Measles germs can linger in a room or airplane for hours after a sick person has passed through.Diseases that seem mild can be dangerous for even healthy kids. During the 2010-11 influenza season, 136 children died from influenza in this country—all from strains that could have been prevented by a seasonal flu shot.
This is Grace, a newborn from Roseburg, Oregon who caught whooping cough from her mom, who is a teacher. Grace had to spend a week in the hospital but thankfully recovered. Her mother wants to tell all parents to get a pertussis booster before their babies are born so they are protected.
Three committees---the Advisory Committee on Immunization Practices, which advises the CDC; the American Academy of Family Physicians; and the Committee on Infectious Diseases, which advises the American Academy of Pediatrics---collaborate to create the vaccine schedule. Each committee is composed of 10-15 physicians and scientists with extensive experience and education. Their goal is to develop a safe, effective vaccination schedule that will keep the greatest number of people healthy.During the first years of life, children can receive as many as 26 separate inoculations and up to five shots at a time. It’s hard for a parent to watch their children get several shots in one visit, but spacing the shots out can be harmful.
The biggest problem with delaying shots is that it increases the time a child is susceptible to diseases like whooping cough, measles and Hib meningitis. Parents who make the choice to delay shots are taking an unnecessary risk without deriving benefit.
Another problem with an alternative schedule is that it’s untested. Every time a new vaccine is added to the recommended schedule, it’s tested to make sure it doesn’t interfere with the immune response or safety of the existing vaccines and vice-versa.
Some parents think that spacing out vaccines will mean fewer shots at one time, and therefore less pain for the child. But researchers have found that children experience similar amounts of stress (measured by the cortisol hormone) whether they are getting one or two shots at the same visit. So children are equally stressed out whether they are getting one shot or more. Separating or spacing out vaccines will create additional visits to the doctor, which will likely only increase the trauma of getting shots. And more visits to the doctor mean greater expense and more time off work for parents.
The CDC estimates that every year some substances in vaccines cause about 200 people to suffer severe allergic reactions.But even children with allergies may be able to get immunized. Talk to your health care provider.
The preservative in vaccines that concerns many parents is thimerosal, which contains mercury. The mercury in thimerosal the same mercury that is stored in the earth’s surface and found in the water we drink. It quickly processes out of the body. Thimerosal is still used in multi-dose vials of influenza vaccine but was removed from all childhood vaccines by the spring of 2001. The typical breast-fed infant will ingest almost 400 micrograms of mercury during the first six months of life, which is more than twice the amount of mercury that was contained in all childhood vaccines combined before thimerosol was removed.
For the past 80 years, vaccines have contained an adjuvant, aluminum salts, that enhances the immune response. Some parents are concerned about aluminum in vaccines, but the facts are reassuring.The amount of aluminum in vaccines is far less than that which babies face every day. Aluminum is prevalent in the air, water and food we eat. Breast fed babies consume about 10 milligrams of aluminum in their first six months, far more than the 4 milligrams of aluminum that is in the vaccines they receive during that time.Very large quantities of aluminum can be harmful to people. If you have questions about aluminum, ask your health care provider.
Hepatitis B is around and can be serious. It causes about 5,000 deaths a year in the U.S.Almost all children and more than half of adults infected with hepatitis B virus will not have symptoms—but they’re contagious. About a million people in the United States are chronically infected with hepatitis B virus. Hepatitis B is spread through blood and other body fluids. The virus can live on objects for up to 7 days. Babies and children can catch hepatitis B at birth from an infected mother, as well as from human bites, touching an infected person’s cuts or sores, sharing personal items or from ear piercing needles that haven’t been cleaned properly. About 25 percent of hepatitis B infections are from an unknown source.When infants and young children are infected with hepatitis B, they have a 90 percent chance of developing a long-term infection. One in four of these children will have liver disease as an adult, including liver cancer.Severe allergic reactions to the hepatitis B vaccine are extremely rare.
Many parents are afraid that vaccines cause autism but science has not shown this link.
A 1998 study claiming that the MMR vaccine caused autism was later discredited. A subsequent study compared the rates of autism in children vaccinated according to the recommended schedule with the rates in children who had chosen to delay or withhold vaccines. There was no difference between the groups. Delaying or withholding vaccines didn’t lessen the risk of autism.
The pharmaceutical industry doesn’t have the best reputation. But vaccines aren’t drugs and don’t make nearly the amount of money that the pills we see advertised on television do. One reason is that people take prescription pills every day, and most vaccines are given just a few times in one’s lifetime. Second, vaccines are subject to higher regulatory standards than drugs. They must be thoroughly tested on tens of thousands of people before they are approved by the FDA. The HPV vaccine, for example, was tested on 30,000 women. And vaccines are continually monitored by a post-licensing system. As of June 2011, more than 35 million doses of HPV vaccine have been distributed in the US.The CDC has safety monitoring systems in place to catch any problems after a vaccine has been licensed.
As Oregonians, we cherish our independent spirit, but we also care deeply about our neighbors. Immunization keeps our families and communities safe from disease.
For more information about vaccine safety, ask your health care provider or the Oregon Immunization Program.
This presentation is based on information from the Centers for Disease Control and Prevention and the Oregon Health Authority, as well as Vaccines and Your Child: Separating Fact from Fiction by Paul A. Offit, MD and Charlotte A. Moser.
Vaccine Safety in Oregon Information provided by the Oregon Health Authority, Public Health Division.
Vaccines have been used to prevent disease for over 200 years.
Today, vaccines have been developed to prevent several diseases: Whooping Measles Mumps Rubella cough Meningococcal Polio Chickenpox Diphtheria disease Pneumococcal disease Rotavirus Influenza Tetanus Hepatitis Human Hib A&B Papillomavirus
Immunizations are so important,children are required to be vaccinated before attending childcare or school.
Are vaccines safe?Vaccines are tested before they are licensed, thenmonitored to ensure their safety.
Are vaccines safe?Healthcare providers must provide a VaccineInformation Statement, which discusses the risks andbenefits of each vaccine.
Are so many shots safe for my baby? Numerous studies have determined that simultaneous vaccination with multiple vaccines won’t overwhelm a body’s immune system.
Are so many shots safe for my baby? Today’s vaccines are more effective and contain fewer antigens than ever.3500300025002000 Antigens15001000 500 0 Pertussis in 1960 DTap today Todays immunizations combined
Are so many shots safe for my baby?•A CDC committee takes great care to ensure that childrenget their shots at the ages when the vaccines are mosteffective.•Combining vaccines into one shot means kids have fewershots, fewer office visits and less discomfort.
Are infants too young to get shots? •Most babies are born with some immunity from their mothers. •Many of the diseases that vaccines prevent occur in very young infants. •Vaccines don’t weaken the immune response, they boost it.
Isn’t it better to gain immunity naturally by getting the disease?•Natural infection can come at a high price.•A child may have a mild case or even no symptoms at all, buthe or she could pass on the disease to a child who can’t beimmunized.
Are the diseases that vaccines prevent really dangerous?•Yes. Many vaccine-preventable diseases are no longer seen onthis continent so we have forgotten how horrible they are.•Some dangerous diseases are still prevalent.•Disease is just a plane ride away.•Even diseases that seem mild can be dangerous for healthykids.
Why are immunizations given on aschedule? What is the harm in spacing shots out?
Why are immunizations given on aschedule? What is the harm in spacing shots out?Delaying shots can make children susceptible to disease for longer periods of time.
Why are immunizations given on aschedule? What is the harm in spacing shots out?There is no data to support safety and effectiveness of an alternative schedule.
Why are immunizations given on aschedule? What is the harm in spacing shots out?Alternative schedules mean more shots, more office visits and more stress for kids.
Are there harmful ingredients in vaccines?Some people have allergic reactions toingredients found in vaccines. Egg proteins Antibiotics Yeast proteins Gelatin Ask your health care provider!
Is there mercury in vaccines?Thimerosal was removed from childhood vaccines in 2001.
What about aluminum in vaccines? Is it harmful?•Aluminum salts have been in vaccines for 80years.•Aluminum is in the air, water and the food weeat.•Babies who are breastfed consume about 10milligrams of aluminum in their first sixmonths, compared to 4 milligrams in the allthe vaccines they receive during that time.
Why does a newborn get a hepatitis B vaccine?• Hepatitis B is around!• Not everyone with hepatitis B knows they’re infected.• Outcomes tend to be worse in young people.• The vaccine is safe.
Why should people trust a system that makes money for drug companies?•Vaccines aren’t a big moneymaker.• Vaccines are held to a higher regulatory standardthan drugs.
As Oregonians, we cherish ourindependent spirit, but we also care deeply about our neighbors.Immunization keeps our families and communities safe from disease.
For more information about vaccine safety:• Ask your health care provider• Call the Oregon Immunization Program 971-673-0300• Visit the Oregon Immunization Program’s website healthoregon.org/imm
This presentation is based on informationfrom the Centers for Disease Control andPrevention and the Oregon HealthAuthority, as well as Vaccines and YourChild: Separating Fact from Fiction by PaulA. Offit, MD and Charlotte A. Moser(Columbia University Press, 2011).
Glossary• AAFP: American Academy of Family Physicians.• AAP: American Academy of Pediatrics.• Adjuvant: An agent that may stimulate the immune system and increase the response to a vaccine; from the Latin word to aid.• ACIP: Advisory Committee on Immunization Practices.• Antigen: An antigen is any substance that causes your immune system to produce antibodies against it.• Autism: is a developmental disorder that affects the brain’s normal development of social and communication skills.
Glossary, cont.• CDC: Centers for Disease Control and Prevention.• DTaP: diphtheria, tetanus, pertussis vaccine.• Hib: haemophilus influenzae type b, a bacterium that causes severe disease in young children.• HPV: human papillomavirus.• MMR: measles, mumps, rubella vaccine.• Thimerosal: a mercury-containing organic preservative used in some flu vaccines but taken out of routine childhood vaccinations in 2001.
References and Related Studies• Glanz, J.M., D.L. McClure, D.J. Magid, et al. “Parental Refusal of Pertussis Vaccination is Associated with an Increased Risk of Pertussis Infection in Children.” Pediatrics 123 (2009): 1446-1451.• Honda, H., Y. Shimizu, and M. Rutter. “No Effect of MMR Withdrawal on the Incidence of Autism: A Total Population Study.” Journal of Child Psychiatry and Psychology 46 (2005): 572-579.• Hviid, A., M. Stellfeld, J. Wohlfahrt. and M. Melbye. “Association Between Thimerosal-Containing Vaccine and Autism.” Journal of the American Medical Association 290 (2003): 1763-1766.• Kelso, J.M. and J.T. Li. “Adverse Reactions to Vaccines.” Annals of Allergy Asthma and Immunology 103 (2009): S10-S14.• Offit, P.A. and R.K. Jew. “Addressing Parents’ Concerns: Do Vaccines Contain Harmful Preservatives, Adjuvants, Additives or Residuals?” Pediatrics 112 (2003): 1394-1401.• Offit, P.A., J. Quarles, M.A. Gerber, et al. “Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?” Pediatrics 109 (2002): 124-129.• Ramsay, D.S. and M. Lewis. “Developmental Changes in Infant Cortisol and Behavior Response to Inoculation.” Child Development 65 (1994): 1491-1502.