August is National Immunization Awareness Month, and it’s also time to start sending kids back to school. Read below about three important vaccines to keep in mind for kids of all ages this year — and the risks that can be posed when these immunizations fall by the wayside.
Sarmistha Hauger, MD, assistant professor of pediatrics, recently took care of a 6-month-old unvaccinated infant with H. influenza type b (Hib) meningitis at Dell Children’s Medical Center. Hib meningitis is caused by Haemophilus influenzae type b bacteria. This is not the same as the flu (influenza), which is caused by a virus. Meningitis is an infection of the lining of the brain and spinal cord, and it can lead to pneumonia, brain damage, deafness, seizures and death.
Hib meningitis usually affects children younger than five years old. Risk factors include ear infections, sinus infections and sore throat. Attending day care and being in other congested crowds may enhance the risk for children younger than two years old. This risk is greatest in the first month of day care attendance. In early stages, a child usually feels unwell with fever, headache and vomiting, similar to many other common and mild illnesses. As the disease progresses, symptoms include irritability, refusal to eat, blotchy, pale skin or a stiffness of the neck or body with jerky movements.
The Centers for Disease Control and Prevention (CDC) recommends the first vaccine dose at 2 months of age, followed by doses at 4 months and possibly also 6 months depending on the brand of vaccine used. A final booster dose should be given at 12 to 15 months.
Because Hib meningitis is caused by a bacteria, it can be treated with antibiotics. However, delay in diagnosis or treatment can lead to worse outcomes. About half of children with Hib meningitis recover without complications when identified and treated early. However about 15-25 percent are left with mild neurological impairment, and 20 to 40 percent have significant neurological impairments such as epilepsy, semi-paralysis and hearing loss.
Human Papillomavirus (HPV)
Every year in the U.S., about 14 million people become newly infected with HPV, which is spread by vaginal, anal or oral sex. HPV vaccination can begin as early as 9 years of age, although generally 11 to 12 years of age is recommended. It’s best to vaccinate adolescents well before sexual activity may occur, and studies have shown that HPV vaccines do not result in increased sexual activity among adolescents who receive them. Another reason to encourage early vaccination: younger adolescents 9 to 14 years old produce a higher level of antibodies which are more effective against HPV compared to older adolescents.
Most of the time the immune system fights off the virus without any symptoms of the infections, but some strains of HPV can cause cancer and genital warts. Virtually all cases of cervical cancer are caused by HPV, and infection can cause cancer of the genitals in men and women, as well as cancer of the throat, mouth, tongue and tonsils.
The CDC reports that the HPV vaccine is as safe as other vaccines given in the preteen and teenage years. The most commonly reported side effects of the vaccine are fainting, localized pain at the injection site and dizziness. Reports of blood clots have been fully investigated and found that the patients reporting this had other known risk factors of developing blood clots, such as taking oral contraceptives. Ultimately, the benefits of cancer prevention far outweigh the risks and potential side effects of the HPV vaccine for both boys and girls.
“HPV vaccination is like using a seatbelt,” says Dr. Hauger. “It’s not because you know that you are going to get into an accident, but that you may get into an accident. The idea about vaccinating with HPV before any anticipated exposure is that you have that immunity seatbelt on before it’s needed.”
One of the most contagious viruses known to man is measles. It spreads in the air from coughing or sneezing and can survive on surfaces for up to two hours. Measles first attacks the respiratory system and leads to fever and rash. Severe complications include pneumonia, brain swelling and death. There is no cure and no treatment — the only prevention is the measles vaccine.
The CDC recommends that children get two doses of the vaccine, given together with the vaccine for mumps and rubella. The first dose should be given at 12 to 15 months of age and the second dose at 4 to 6 years of age. Two doses of the vaccine are 97 percent effective in preventing measles.
Unfounded fears that autism is caused by vaccines like the measles, mumps and rubella (MMR) vaccine remain strongly rooted even though the original author of this idea, Andrew Wakefield, has since been found fraudulent and stripped of his medical license. Autism Speaks, a national advocacy group for children with autism recognizes that vaccines do not cause autism based on extensive verifiable research over the past two decades. The American Academy of Pediatrics has a comprehensive list of this research and has determined there is no link between autism and the MMR vaccine, the preservative thimerosal or from multiple vaccines given at once.
Some families believe that the herd immunity will protect their child. Herd immunity is when the majority of the population is vaccinated so that the probability of an outbreak or infection is rare. However, most people don’t know that if the number of people vaccinated drops below 95 percent of the population, herd immunity falls apart, and outbreaks can occur.
Outbreaks due to refusal to vaccinate in the U.S. are seen most predominantly in Minnesota, where measles cases for 2017 already outnumber those in the entire U.S. in 2016. So far in 2017 there have been 79 cases of measles reported in Minnesota, primarily from Somali-American children whose rates of vaccination has dramatically dropped since 2008. Of the 79 cases, 90 percent were confirmed to be unvaccinated. Although parents initially avoided MMR vaccines because of a fear of autism, a 2010 study of Somali-American children versus non-Somali-American children in Minnesota revealed identical rates of autism, unaffected by vaccination status.
The impact of measles is also being felt globally: Europe is experiencing a measles outbreak which has resulted in 33 deaths since the beginning of 2017. There have been over 10,000 cases of measles reported in Romania and Italy.
What could this mean for Texas? If parents in Austin and other Texas cities choose to avoid vaccinating their children, outbreaks could become a real-life danger here. Measles is not always a mild, self-limited disease leading only to ear infections and diarrhea: permanent brain damage can occur in about one of every 1,000 cases.
Final Thoughts on Vaccinating Children
In developed countries, these diseases have been virtually extinct for so long that their devastating impacts have been forgotten.
In Texas, parents can obtain a waiver for vaccinations by downloading a form, having it notarized, and presenting it to the child’s school or child-care facility. A physician’s signature is not required. Many parents are not aware of how easy it is to obtain this waiver, and may not be aware of the potential danger to their children who are in close proximity with unvaccinated children. Information is available from the Texas Dept of Health State Services for parents to find out current vaccination rates for entire school districts, but finding this information for individual schools is challenging.
“Parents have a right to know vaccination rates in their children’s schools,” Hauger says.