Expert Advice

Childhood vaccines

August 16, 2007|By Holly Selby

As the first day of school approaches, parents are checking to make sure their children are up to date on their vaccines. By the time Maryland children enter kindergarten, they are required to have been vaccinated against 11 diseases -- diphtheria, pertussis, Hib (haemophilus influenza), pneumococcus, tetanus, polio, measles, mumps, rubella, hepatitis and chicken pox.

And, this year, both the Centers for Disease Control and Prevention and the American Academy of Pediatrics are recommending that children receive four new vaccines: a booster for chicken pox, rotavirus, hepatitis A and the human papillomavirus, says Julie Yeh, assistant chair of pediatrics at the Greater Baltimore Medical Center.

Could you describe the new vaccines, beginning with the rotavirus vaccine?

That is an oral vaccine given to infants to prevent rotavirus, a gastrointestinal infection that causes severe vomiting and diarrhea. That, in turn, can result in dehydration. The vaccine is given at 2, 4 and 6 months of age.

And the new recommendation for a chicken pox booster?

The recommendation is that children under 13 years of age receive a chicken pox booster. It is called the varicella vaccine, and previously it was given at age 1. Now the new recommendation is to give a booster [a second shot] between ages 4 and 6.

Hepatitis A is caused by a virus that can be spread by close personal contact or sometimes by eating or drinking contaminated food or water. Could you describe the vaccine for this serious liver disease?

Previously, the hepatitis vaccine was recommended to be given to children living in areas that were at high risk for hepatitis. But beginning last year, it was recommended that the two-dose vaccine be given to every child between the ages of 12 [months] to 23 months. A "catch-up" vaccine can be considered for those over age 2 [who did not receive the vaccine].

What about the human papillomavirus vaccine?

Beginning this year, pediatricians are recommending that girls receive the human papillomavirus (HPV) vaccine at age 11 to 12. The vaccine is given in three shots -- the first one and two others at the second and sixth months.

They also are recommending catch-up vaccines for girls who are older than that as well -- up to age 26. ...

The idea is to give the vaccine to girls before they acquire HPV, which is a sexually transmitted virus. It covers four strains of the HPV virus -- the main ones responsible for causing cervical cancer. The thought is, if you prevent girls from becoming infected with the virus, you are preventing the cancer.

Are these new vaccines required?

It will likely be a matter of time that these recommendations will become requirements as well. For teens, the HPV vaccine is currently not required for high-school entry. However, in Maryland, all college students who live on campus are required to be vaccinated against meningococcal disease, a serious infection of the fluid around the brain and spinal cord.

What do you tell parents who express concerns about side effects or reactions to vaccines?

You mean parents who fear vaccines cause autism? I tell them that the evidence from research done by the medical community hasn't demonstrated a relationship between autism and the use of vaccines. So I recommend [vaccines]. I vaccinate my own son; I wouldn't give a vaccine to my patients that I wouldn't give to my child. And the risk of these illnesses outweighs any theoretical risk of developing autism.

What about those who fear that administering the HPV vaccine might encourage sexual activity?

There is no evidence to suggest that administering the HPV vaccine promotes sexual activity. The discussion of sexual health and abstinence should always be part of the routine health visit. It is the responsibility of the parents and physicians to promote abstinence as well as educate about safe sexual practices.

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