FA3: BENEFITS OF VACCINATION FOR CHILDREN UNDER TWO YEARS OLD

Introduction:

Since the first successful case of developing a smallpox vaccine for an 8-year-old kid in 1796, vaccines have been increasingly used to control and cure widespread diseases. According to the article “Vaccination Requirements for California, Kindergarten, and All Vaccines,” in order to apply for kindergartens in California, all children have to be fully vaccinated. Scientists proposed the Herd Immunity Theory, in which a more vaccinated population (95%) will have a higher chance of stopping disease spreading. Therefore, all parents and children’s caregivers are responsible for having their children vaccinated following an immunization record. On the other side, some refuse to have their children immunized because of vaccines’ side effects, the appearance of mercury-containing preservative such as thimerosal, and the risk of the MMR series inducing Autism during children’s early developments. As a result, there are controversies about whether children under age two should be vaccinated or not.

How Do Vaccines Work?:

Vaccines were invented by using an inoculated technique in which Edward Jenner utilized cowpox viruses obtained from cows and injected viruses into humans’ bodies to treat smallpox viruses. After attenuated (alive but weak) or inactivated (dead) viruses/bacteria are injected into children’s bloodstream, specialized white blood cells (WBCs) are stimulated to create antibodies. Antibodies, which are specialized proteins, identify and stimulate other special cells to engulf foreign viruses/bacteria in the infected bodies. When the battle is over, the antibodies still remained and carry memories so that they will defeat the same pathogens if they meet again. Consequently, vaccines are considered to be effective.

Vaccine Components:

There are a lot of components in a vaccine container. According to “Vaccine Ingredients” from Centers for Disease Control and Prevention (CDC) website, a vaccine might contain either partially functioned or inactivated viruses/bacteria, gelatin and sugars as stabilizers to keep vaccines safe when stored, aluminum containing adjuvants to elevate the vaccines strength, egg protein so-called albumin, bovine, serum, formaldehyde to kill any foreign viruses that entered during packaging, and preservative. Thimerosal which is mercury-based preservative is added only in multiple-dose containers of Influenza vaccines. The most concerned elements, that also one of the reasons the parents stepping away from vaccinations, are the toxicity of thimerosal and adjuvants in vaccines.

Vaccines For Younger Than 2 Year Old Children:

In order to save parents’ time from doctor visits and to limit a shot that children have to get, combined vaccines in one shot are preferred. For instance, a DTaP shot includes kid Diptheria, Tetanus, and acellular Pertussis vaccines. An MMR vaccines consist of Measles, Mumps, and Rubella viruses. Certain vaccines are injected to children at different suggested ages. After twelve hours of birth, newborns will be injected with Hepatitis B vaccines (HBV). The next two months, they will be received series of DTaP, Polio, HBV, Rotaviruses, Haemophilus influenzae type B bacteria (Hib), and Pneumococcal conjugate vaccine (PCV13). When reaching the fourth month, the injection series are repeated excluding the HBV vaccines. At the sixth month, same series with two-month infants except adding Influenza vaccines. The  Polio, HBV, and Influenza vaccines at this point are good for the next seven months. In addition to those vaccines, infants are likely to be introduced to MMR, Varicella so-called chickenpox, and Hepatitis A (HAV) beginning of one year old. (Table 1)

Vaccine	Birth	1 mo	2 mos	4 mos	6 mos	9 mos	12 mos	15 mos
Hepatitis B1 (HepB)	←1stdose→	←2nddose→			←3rd dose→
Rotavirus2(RV) RV1 (2-dose series); RV5 (3-dose series)			←1stdose→	←2nddose→	Seefootnote 2
Diphtheria, tetanus, & acellular pertussis3(DTaP: <7 yrs)			←1stdose→	←2nddose→	←3rddose→			←4thdose→
Haemophilus influenzaetype b5 (Hib)			←1stdose→	←2nddose→	Seefootnote 5		←3rd or 4thdose, See footnote 5→
Pneumococcal conjugate6(PCV13)			←1stdose→	←2nddose→	←3rddose→		←4th dose→
Inactivated poliovirus7(IPV)(<18 yrs)			←1stdose→	←2nddose→	←3rd dose→
Influenza8(IIV; LAIV) 2 doses for some: See footnote 8					Annual vaccination (IIV only)
Measles, mumps, rubella9(MMR)							←1st dose→
Varicella10 (VAR)							←1st dose→
Hepatitis A11 (HepA)							←2 dose series, Seefootnote 11→
Meningococcal13 (Hib-Men-CY ≥ 6 weeks; MenACWY-D≥9 mos; MenACWY-CRM ≥ 2 mos)			See footnote 13

 

	Range of recommended ages for all children		Range of recommended ages for catch-up immunization		Range of recommended ages for certain high-risk groups		Range of recommended ages during which catch-up is encouraged and for certain high-risk groups		Not routinely recommended

 

Table 1: Vaccines record for children from birth to the 15^th month cited from “Recommended Immunization Schedule for Persons Age 0 Through 18 Years.”

Other Types of Vaccines:

Besides the recommended vaccines in the record, there are other types of vaccines such as rabies for those who are bitten by unimmunized animals. Also, vaccines are used when travelling to tropical or subtropical countries like Japanese encephalitis, typhoid, meningococcal, or yellow fever. Additionally, Tdap and Td series including Diptheria, adult Tetanus, and acellular Pertussis are modified for parents and children’s caregivers to avoid unintentionally spreading bacteria to their children (“Vaccination Recommendations”). All kinds of vaccines establish our immune systems to be able to defend against all possible diseases.

Why Follow Vaccination Record When No Outbreak?

By the time children reach age two, they have been injected with DTaP, Polio, HBV, HAV, Rotaviruses, Hib, PCV13, Influenza, MMR, and Varicella vaccines. Their immune systems are capable of defending against those contagious pathogens. However, the immunization schedule should be followed tightly. After the battle of Japanese fought against Pertussis known as whooping cough epidemic, the number of immunized children was 80% and no death reported in 1974. Because the case numbers went down to 10%, the Japanese governments put an end to vaccination campaign. Five years after, another whopping cough epidemic killed forty one unvaccinated children and other 13,000 cases suffered from whooping cough. When the vaccines were introduced again in 1981, the number of infections decreased tremendously (“Why Immunize?”). Therefore, being vaccinated is not only to protect themselves, but also to shield others from infections.

Who Shouldn’t  Get Vaccinated?

However, not every kids are qualified to get vaccines, some with immunodeficiency like AIDS, leukemia, or cancer patients under radiology/chemo-treatments should not be immunized. Vaccines comprise alive viruses  will harm those patients because their immune systems aren’t strong enough to destroy the injected viruses. Even if the viruses are partially functioned or dead, they can’t gather white blood cells to defend. In a case of immunodeficiency, David Vetter, so-called Bubble Boy, who was isolated in a bubble zone for his entire life (Figure 1).

 

Figure 1: David Vetter, Bubble Boy, on the left and Dr. Wilson on the right (Dotinga).

He couldn’t directly contact with another person or touch anything that hadn’t been sterilized. His symptoms named Severe Combined Immunodeficiency (SCID). David was susceptible to any type of diseases and minor infections because his immune system was under enormous shortage of WBCs. There was no treatment for him back then. Even if he went under bone marrow transplant, he died at twelve years old (Mcgeady). Those who are anaphylaxis to vaccine’s components shouldn’t get vaccinated. They will get intense allergic reactions such as hives, swelling face/throat, dropping blood pressure, trouble breathing, fast heartbeat, dizziness, and weakness. If not treated immediately, they will be in serious health conditions or even death. Plus, women shouldn’t get vaccines containing alive viruses during pregnancy. Also, flu vaccines shouldn’t be given to Guillain-Barré Syndrome patients who have serious paralyzing illness. Moreover, those who are mild sick or serious sick should wait until they are better to get vaccines. Therefore, if there is any doubt in your health condition, you should consult to the doctor before getting vaccinated.

Flu Vaccines For Egg-allergic Children?

Some children are allergic to a particular vaccine or to its component. Because flu viruses are incubated in chicken eggs, egg protein also known as ovalbumin is a part of Influenza and Yellow Fever vaccines. For every 0.5 ml of flu vaccine, there is 0.7 µg of ovalbumin. Furthermore, egg-allergic children don’t have life-threatening reactions to the flu vaccines. Physicians might ask a few questions regarding how severe the reactions get (Figure 2). Alternatively, doctors might apply a small sample of egg and observe how the children’s skin react within 30 minutes (“Prevention and Control of Influenza”). Another option, care providers might divide the flu vaccines into two injections: 10% for the first time, and the rest will be administered if no further reactions occur after a 30-minute interval (Chung, Howe, Owens, Webb). Consequently, egg-allergic children are safe to receive flu shots. Additionally, Flublok, which is approved by Food and Drug Administration (FDA), is a suggested product for egg-allergic adults from 18 to 49 years old because it contains no egg protein and no preservative (Flublok).

Figure 2: Questions map that physician would ask an egg-allergic patient.

Cited from “Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011.”

Negative Side Effects:

One of the reasons that some refuse to have their children immunized because of vaccines’ side effects. Any medicines have their own negative effects which are commonly at mild level and go away automatically. They become serious when a patient abuse in using medicines or perhaps a person has anaphylaxis. Depending on each infant’s immune system, vaccines might induce certain degrees of unwanted symptoms. According to CDC, a possibility of getting mild level of side effects is low. It’s lower in moderate level, and it’s considered rare if life-threatening effects occur.

DTaP vaccine’s possible side effects
Mild level (happen 1 to 3 days after shot)	– Swelling, being sensitive at injection area, or having fever develop in 1: 4 ratio (1 out of 4 children); last from 1 day to a week – Bad-tempered behaviors in 1:3 cases – Losing interest in eating from up to 3 days in 1:10 cases – Vomiting in 1:50 cases
Moderate level	– Keep crying at least 3 hours in 1:1,000 cases – Seizing 1:14,000 cases – Raising body temperature more than 105oF in 1:16,000 cases
Life-Threatening level	– Intense allergic reactions (hives, swelling face/throat, trouble in breathing, fast heartbeat, dizziness, and weakness) in 1: 1,000,000 cases – Brain damage permanently, long-term seizures, coma, or lowered consciousness developed in a very rare case.

 

Polio vaccine’s possible side effects
Mild level	– Soreness at injection site for some people
Look for symptoms minutes or hours after the shot:	– Go to emergency if having intense allergic reactions, very high fever, or behavior changes

 

HBV vaccine’s possible side effects
Mild level	– Sore at injection site in 1:4 cases -Raising body temperature to 99.9oF or higher in 1:15 cases
Life-Threatening level	-Intense allergic reactions in 1: 1 million cases

 

HAV vaccine’s possible side effects
Mild level (last from 1 to 2 days)	– Soreness at injection site 1: 6 cases – Headache in 1:25 cases – Losing interest in eating in 1:12 cases
Life-Threatening level	– Intense allergic reactions to latex within a few minutes to hours after the shot (very rare)

 

Rotaviruses vaccine’s possible side effects
Mild level (go away on their own)	– Becoming irritable – Having mild diarrhea – Vomiting after getting a dose
Life-Threatening level	– Blocking bowel (with stomach pain, non-stop crying, legs pulled up to chest level, vomiting, or blood in stool) -> require surgery in 1:20,000 to 1:100,000 cases – Intense allergic reactions a few minutes/ hours  after the shot

 

Hib vaccine’s possible side effects
Mild level after the shot, last 2 or 3 days	– Redness, warmth or swelling at injection site – Fever
Life-Threatening level	– Intense allergic reactions

 

 

PCV13 vaccine’s possible side effects
Mild level	– Drowsy after shoot in 1:2 – Losing appetite temporary – Having redness/tenderness at injection site – Swelling at injection site in1:3 – Raising body temperature over 102.20F in 1:20 cases – Fussiness or irritation in 8:10
Life-Threatening level (very rare)	– Intense allergic reactions

 

 

 

In activated Influenza vaccine’s possible side effects
Mild level (start after the shot, last 1 or 2 days)	– Might feel dizzy after the shot -> sitting or lying down for 15 minutes will help – Soreness, swelling, and redness at injection site – Fever, headache, itchy
Moderate level	– Fever inducing risk of seizures if getting PCV13 vaccine at the same time
Life-Threatening level	– Intense allergic reactions in 1: 1,000,000 cases – Low chance of associated with Guillain-Barré Syndrome in 1:1,000,000 cases.

There are two types of Influenza vaccines: alive or dead viruses. The weak-virus-containing vaccines are sprayed into a person’s nose while the dead-virus-containing vaccines, also called flu shot,  are injected into muscles. In addition, administering dead viruses doesn’t induce flu in a healthy person. There is a possibility of getting serious problems after vaccination, but it’s still better than being unprotected from flu viruses. Flu viruses don’t stay in one form and rather differentiate into different strains such as type A, B, and C. Although vaccines can’t prevent all types of flu viruses, vaccination stops three or four different types. It is our best choice to train our immune system.

MMR vaccine’s possible side effects
Mild level (within 6 to 14 days after the shot)	– Fever in 1:6 cases – Mild rash in 1:20 cases – Swelling of glands in the cheeks or neck in 1:75 cases
Moderate level	– Temporary pain and stiffed joints, mostly in teens or women 1:4 – Seizing after fever in 1: 3,000 cases – Temporary low platelet count leading to bleeding disorder in 1:30,000 cases
Life-Threatening level (very rare)	– Intense allergic reactions in 1:1 million – Being deaf, long-term seizures, coma, or lowered consciousness – Brain damage permanently

Varicella (chickenpox) vaccine’s possible side effects
Mild level	– Soreness or swelling at injection site in 1:5 cases – Fever in 1:10 – Mild rash 1:25
Moderate level (very rare)	– Seizing induced by fever
Life-Threatening level (very rare)	– Intense allergic reactions to gelatin or antibiotic neomycin – Pneumonia – Serious brain reactions and low blood count

 

 

 

 

 

Although vaccines have some side effects, they possibly occur at very low rate and go away after a few days. To prevent any moderate cases getting worse, parents or caregivers should check on their children more frequently after their vaccinations, and seek for immediate emergency if any life-threatening symptoms occur. Moreover, no direct connection between vaccinations and causing Life-Threatening symptoms (“Vaccines and Side Effects: The Facts”). Furthermore, after vaccines are distributed into marketplace, vaccine batches are still monitored often. If any batch turns bad, the vaccine’s strength isn’t enough to stimulate a strong immune response to fight off the pathogens. The vaccines will be recalled. Children vaccinated with recalled vaccines should receive another shot from new batch (“FAQ about Vaccine Recalls”).

Risks That Unvaccinated Children Have?

The children who are not vaccinated fully will become more susceptible to viruses if an outbreak truck. They are unprotected from the viruses/bacteria causing the outbreak. For example, unvaccinated children will easily catch Haemophilus influenzae type b (Hib) bacteria from a vaccinated one who doesn’t carry any symptoms of Hib meningitis (“If You Chose Not To Vaccinate…”). That person carry the bacteria but still being fine because Hib vaccines protect them from being infected to disease. Furthermore, parents or caregivers of unvaccinated children should notice doctors or nurses about the latest immunization records of their children. If there is an epidemic in the area, the unprotected children will be isolated so that they don’t spread contagious diseases to others.

Is It Necessary to Have Thimerosal as a Preservative?

Thimerosal is a chemical compound that consists of a small amount of mercury. For every 0.5 ml dose, there is 50 micrograms (mcg) equivalent to 25 mcg of mercury (“Thimerosal Content in Some US Licensed Vaccines”). Since 1930s, it has been popularly used as a preservative to protect vaccines’ container from being contaminated (“Vaccines and Side Effects”). A vaccine container mostly gets contaminated if it’s in multiple-dose container because new syringes are inserted in the container multiple times, they also bring the outside bacteria/fungi in. When the vaccine substances being ruined by bacteria/fungi, the toxicity of mercury will play an important role which is to prevent those foreign pathogens growing and keep the vaccine effective. However, there are other reports that prove the preservatives can’t remove all the unwanted pathogens in multiple-dose vaccines. The contamination is caused mostly by drawing vaccines many times from one container regardless of preservative presence (Bernier, Simon).

No Linkage Between Vaccines and Autism Development:

Parents and caregivers question about the toxicity of Thimerosal presence in vaccines. In “Thimerosal Content in Some US Licensed Vaccines” chart, there is no trace amount of mercury in children’s routine vaccines anymore except in multiple-dose vaccines (25 mcg mercury), DT vaccines (<0.3 mcg mercury), and Tetanus Toxoid (25 mcg mercury). Parents and caregivers may ask for single-dose of Influenza or Meningococcal vaccines to avoid mercury toxicity as much as possible. Another hypothesis is that MMR vaccines cause Autism Spectrum Disorder (ASD) in children. The research was based on data analysis of 60% children who have ASD injected with MMR vaccines (Singh, Lin, Newell, and Nelson). In fact, the hypothesis follow a one way direction of saying most ASD children receive MMR vaccines, but doesn’t prove that other way which is vaccines directly lead to ASD. On the other hand, there are other environmental factors that cause Autism in children such as parents’ ages at the time of pregnancy, nutrition during fetal development, infection, and prematurity (“Environmental Factors in Autism Initiative”). Also some medical circumstances like Fragile X syndrome, tuberous sclerosis, Rett’s syndrome, congenital rubella syndrome, or Angelman’s syndrome could lead to ASD (“Prenatal and Infant Exposure to Thimerosal”).

Respond to the concerns, many research (published or non-published) have been reviewed. As a result, Thimerosal presence in vaccines and MMR vaccines do not relate to ASD in children’s early development. From the Institute of Medicine (IOM), the Immunization Safety Review Committee resolved: “The body of epidemiological evidence favors rejection of a causal relationship between the MMR vaccine and autism … The body of epidemiological evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism.” The possible relationship is in theory only and no studies prove direct connection between vaccines and ASD. Moreover, CDC studies of both ASD and non-ASD children, regardless of their genders, show that Thimerosal containing vaccines receiving during pregnancy or childhood doesn’t induce to ASD symptoms (“Prenatal and Infant Exposure to Thimerosal”)(Gerber and Offit).

Conclusion:

In order to protect your children and other kids, a responsibility as parents and caregivers is to have your children fully vaccinated. Following the immunization schedule, children will be protected if there is an outbreak. Vaccines have a very low rate of life-threatening side effects which is too low that raising another hypothesis in which those serious effects could be caused by other factor. Vaccines contain none or tiny amount of thimerosal, and especially no direct connection to Austim development. Vaccination is the best method to train our immune systems shielding against pathogens. Acknowledging that everyone need to be protected from diseases, Obamacare Preventive Care offers free immunizations, shots, screenings, and tests. Are your children immunized?

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