A few days ago as I read the newspaper, I started thinking about how lucky we are to live at this time in history. The obituaries told of those who had recently passed — 81 years old, 85 years old, 87 years old, 92, 93, 95. Indeed, the “baby” of the group had been 63 years old. When the 95-year-old woman was born in 1919, the life expectancy was 53.5 for males and 56 for females; she had lived almost four decades longer than was expected at the time of her birth. Babies born in 2014 enjoy a life expectancy of about 79 years (76 for males and 81 for females).
How much these people had witnessed over the course of their lives! During their eight or nine decades on this earth, they witnessed a world war and the Cold War, the Great Depression (1929-39) and the Great Recession (2008-09), the first humans in space, the advent of computers and the Internet, and the launch of McDonald’s. They experienced drug store soda fountains, penny candy, loaves of bread that each cost less than a dime, and gas that cost 20 cents a gallon — and, they came to know a world with vaccines.
The oldest woman mentioned was born in 1919. At that time the smallpox vaccine was available and the whole cell pertussis vaccine was relatively new, having been developed five years earlier, in 1914. By the time the 87-year-old was born in 1927, the diphtheria vaccine had been recently licensed. Even when the 63-year-old was born in 1951, the only additional vaccines were tetanus and the influenza shot. The tetanus, diphtheria and pertussis vaccines had just been combined into the DTP vaccine in the late 1940s, and it wasn’t until four years later, in 1955, that the polio vaccine was first licensed.
As I sat with the newspaper in front of me thinking about these people, I realized that in addition to the memories of soda fountains and penny candy, they also took with them the memories of diseases that once ravaged our communities. These people knew the horrors of polio and not understanding how it was spread. Indeed, some of them probably weren’t allowed to swim in the summer; others may have remembered Franklin Delano Roosevelt’s call for people to send their dimes to the White House to fund research into the disease.
They probably knew people deaf from mumps, heard of relatives who died during the influenza pandemic of 1918, and, themselves, experienced childhood diseases like measles and chickenpox. Indeed, they probably knew people who died from or were forever changed by their brush with meningitis before the advent of vaccines for pneumococcus, Haemophilus influenzae type b, and meningococcus.
Because we don’t see these diseases as often today, we don’t share the memories of our older relatives. The diseases may not seem that bad, but the next time you talk to an older relative, ask about the soda fountains and the penny candy — and ask if they remember the diseases we prevent with vaccines.
If you or your family members are planning any international travel this summer, you may be at risk for infections not typically encountered in the U.S. Because one of the best ways to be prepared is by being knowledgeable, we thought we’d highlight some infections that travelers might encounter while traveling abroad.
Cholera is caused by a bacterium that infects the intestines causing diarrhea and vomiting. Severe disease occurs in 1 of 20 infected individuals and is characterized by profuse, watery diarrhea, vomiting and leg cramps, often leading to dehydration and shock if not immediately treated. Each year, between 5,000 and 7,500 infected individuals around the world die from cholera. People can be infected by consuming food, water or shellfish contaminated with the bacteria.
Cholera most commonly occurs in Africa and Asia, but cases have been imported in the U.S. and Australia. Because cholera does not typically occur in standard tourist accommodations, the vaccine isn’t usually recommended for travelers. However, travelers who plan to wander “off the beaten path” or engage in high-risk behaviors, such as eating raw or undercooked shellfish and drinking un-bottled water, might be recommended to receive the vaccine.
Hepatitis A is caused by a virus of the same name and causes inflammation of the liver (hepatitis). Symptoms can include fever, nausea, vomiting and yellowing of the skin (jaundice); however, many people do not know they are infected until their symptoms start, usually about two weeks after exposure. Hepatitis A is transmitted through food or water contaminated with sewage.
Hepatitis A is fairly common in other parts of the world, including Asia, Central America, South America, Southern Europe, the Mediterranean Basin, the Middle East, the Caribbean and Mexico. Because hepatitis A occurs even in standard tourist accommodations, travelers are often recommended to receive this vaccine before their trip.
Typhoid occurs when people ingest food or water contaminated with the bacterium, Salmonella typhi. Once ingested, the bacteria infect the intestines, causing fever, stomach pain, low heart rate and a rash. Without treatment, severe disease, including shock and death, occurs in about 1 of 5 infected people. Travelers can protect themselves by avoiding ice, unpeeled fruits, undercooked meats, shellfish, salads or food from street vendors.
Typhoid commonly occurs in Mexico, East Asia, South Asia, South America and Africa. The typhoid vaccine is recommended for travelers going to high-risk areas who will be staying for more than six weeks as well as those who will be staying in rural areas or small towns. Travelers who plan to eat uncooked foods, unpeeled fruits and drink un-bottled water during their trip are also recommended to receive this vaccine.
Dengue is caused by a virus of the same name and is spread by mosquitos. Travelers infected with dengue often experience fever, nausea, vomiting, headache, rash, and pain in the eyes, joints and muscles. Severe infection can include stomach pains, persistent vomiting, nose or gum bleeding, and, in about 1 of 100 cases, death.
Dengue is common in tropical and subtropical regions, such as the Caribbean, Central America, South America, Western Pacific Islands, Australia, Southeast Asia and Africa. A vaccine is not available to prevent dengue. However, travelers can protect themselves by preventing mosquito bites, such as by wearing long-sleeved shirts, long pants and hats, using insect repellent, and sleeping in beds covered with mosquito netting.
Japanese encephalitis virus (JEV) is transmitted through mosquito bites. JEV causes encephalitis (inflammation of the brain). Symptoms typically include fever, stiff neck, nausea and vomiting. About 1 of 4 infected individuals experience severe infection that leads to a coma and death.
JEV occurs in many countries in the Far East, including Japan, China, India, Vietnam and Thailand, among others. The JEV vaccine is not recommended for all travelers. Instead, travelers’ destination, length of stay and planned activities determine if they should receive the Japanese encephalitis virus vaccine.
Malaria is caused by a parasite transmitted by mosquito bites. Symptoms typically appear within seven to 30 days after infection and include influenza-like illness, fever and chills. In some cases, symptoms may develop up to one year after the initial mosquito bite. In the absence of treatment, severe illness and death can occur.
Malaria is common in many parts of Africa, Central America, South America, the Caribbean, Asia, Eastern Europe and South Pacific. Unfortunately, a malaria vaccine is not available; however, preventive medicine, to be taken before, during and after the trip, may be prescribed. Travelers who think they might have malaria should seek medical attention as soon as possible to begin treatment, even if they were taking preventive medications. Travelers can also prevent malaria by protecting themselves against mosquito bites.
Yellow fever is also caused by a virus transmitted by mosquitos. Yellow fever causes inflammation of the liver (hepatitis) and severe bleeding (hemorrhage). Symptoms of yellow fever can include fever, muscle pain, chills, headache and yellowing of the skin or eyes (jaundice).
Yellow fever occurs mostly in Africa and South America. Many of the countries in these parts of the world require proof of vaccination for entry. In addition to receiving the vaccine, travelers can also protect themselves from yellow fever by preventing mosquito bites. The risk of yellow fever varies depending on the travel destination. So, it’s important to consult a travel medicine specialist prior to departure.
Vaccines save lives and every day around the world, immunization advocates, healthcare professionals, and public health and government agencies work to bring vaccines to those who need them. For one week in April, known as World Immunization Week (WIW), these efforts are celebrated. In 2014, WIW will be held from April 24 to April 30; the theme will be “Are you up to date?”
As part of WIW, National Infant Immunization Week (NIIW) will be celebrated in the U.S. from April 26 to May 3. NIIW has been held each year since 1994 to highlight the importance of vaccines, particularly for maintaining the health and well-being of children less than 2 years of age. Celebrate NIIW in your family by making sure children up to 2 years of age are up to date on their vaccines.
Some people wonder why babies need to be protected from hepatitis B, a disease commonly thought of as a sexually transmitted disease (STD). However, hepatitis B is transmitted through blood, and many people don’t even know they are infected. So, sometimes children are unknowingly infected. In addition, some babies are infected during birth if their mothers are infected. Because these babies have a high risk of developing chronic liver disease or liver cancer and because the vaccine will protect them if given immediately after exposure, the birth dose of hepatitis B vaccine has been an important means of combatting this disease. For these reasons, babies receive the hepatitis B vaccine shortly after birth or prior to being discharged from the hospital.
Between 1 to 2 months of age, infants should receive their second dose of hepatitis B vaccine. At the 2-month well visit, babies will receive multiple vaccines that prevent a variety of diseases. The first vaccine they will receive is the rotavirus vaccine, which is an oral vaccine that prevents the most common cause of diarrhea and dehydration in infants. The other vaccines received during this visit are given as shots and include those that prevent Haemophilus influenzae type b (Hib), pneumococcus, polio, diphtheria, tetanus and pertussis.
During the 4- and 6-months well visits, infants should receive most of the same vaccines they get at 2 months, except hepatitis B. In some cases they may not need a rotavirus vaccine at 6 months, depending on which version of the vaccine they received previously. At 6 months old, babies may need a dose of influenza vaccine, depending on the time of year. If they get the influenza vaccine, they will need another dose one month later.
Infants should receive their third doses of polio and hepatitis B vaccines between 6 and 18 months of age.
At 12 months of age, infants should receive two doses of hepatitis A vaccine, spaced six months apart. During the 12- to 15-month visit, infants should receive their fourth doses of Hib and pneumococcal vaccines, as well as first doses of chickenpox, measles, mumps and rubella vaccines.
At 15 to 18 months of age, infants should receive their fourth dose of the DTaP vaccine, which prevents diphtheria, tetanus and pertussis.
Every year the U.S. Centers for Disease Control and Prevention (CDC) updates the recommended immunization schedules for children and adults. The recently released 2014 recommended immunization schedules don’t contain major changes, but it’s always good to make sure everyone in your family is up to date.
With the exception of the hepatitis B vaccine, which is typically given in the hospital after birth, vaccines are most often given during children’s well-visits. More specifically, children receive vaccines at visits scheduled around 2 months, 4 months, 6 months, 12 to 15 months, and 15 to 18 months of age. Children typically get vaccines again around the start of school, between 4 and 6 years of age. Between 11 and 12 years of age, adolescents receive vaccines they did not receive previously, such as those to prevent human papillomavirus (HPV) and meningococcus, as well as a booster dose of Tdap, which protects against tetanus, diphtheria and pertussis.
The Vaccine Education Center (VEC) provides a simplified, printer-friendly immunization schedule for children up to 2 years of age that can easily be printed for reference before heading to your baby’s next well-child visit. A similar online version provides hyperlinks to additional information about each vaccine and the diseases it prevents. Immunization schedules are also available in our baby, teen and adult immunization booklets.
During some visits, children will receive more vaccines than during other visits. Studies have shown that children can safely receive multiple vaccines at one time. For more information related to this topic, check out the VEC’s Q&A sheet, “Too Many Vaccines: What You Should Know.”
It’s important to prepare for vaccines before it is time for the shots to be administered. Simple things like bringing a favorite toy or blanket are often enough to keep children calm during their vaccinations. It’s also important to remember that children can tell when their parents are nervous, so parents should be sure their questions are answered and they are comfortable with their children being vaccinated. Other age-appropriate ideas for improving vaccine visits can be found here:
Although it might be uncomfortable to watch children get needles, the protection provided by those few seconds of pain often lasts a lifetime.
For more information about the recommended immunization schedule, such as who should receive vaccines, or why so many vaccines are necessary, check out the Q&A sheet, “Recommended Immunization Schedule: What You Should Know”
For questions about vaccine safety topics, check these resources:
A new scientific paper is published about every 20 seconds; this means thousands of papers are published every day. Although most of these papers are reviewed by other scientists prior to publication, some describe studies that are more robust than others. In addition, most people don’t read the actual studies, but rather hear about them through media reports. Since some of these studies report science that may be important for keeping us safe and healthy, it’s important to understand the essential components of a sound study.
Studies typically include two groups, the control group and an experimental — or treatment — group. These groups are similar with one exception. Participants in the control group are not subjected to the experimental procedure. Controls are important because they provide information about what would occur without any outside influence. This allows scientists to determine whether the results would have occurred anyway.
Ask yourself: Did the study contain a control group that did not receive treatment and an experimental group?
Randomization, or the act of randomly assigning study participants to control and experimental groups, is an important tool used to avoid bias in the study. Scientists can use computer software or a pre-determined formula to assign participants to the control or experimental group.
Ask yourself: Were the study participants put into control and experimental groups in a random manner?
Double-blind studies are those in which both the scientists and study participants are unaware of who is assigned to the control and experimental groups. Double-blind studies are important for avoiding bias among both the scientists and study participants. While double-blind studies are the best option, sometimes, it’s impossible to design a study in this way. For example, if a new medication for end-stage cancer patients is being tested and a particular patient has exhausted all other treatment options, it would be unethical to withhold a medication that might help. In this case, it is likely that both the researcher and the patient would know that he or she was in the experimental group. Studies in which the scientist, but not the participants, knows who is in the treatment group can still be informative.
Ask yourself: Were both the scientists and study participants unaware of who was assigned to the control and experimental groups?
Many factors, such as genetics, environmental factors, lifestyle choices, income and race, can influence the results of a study. For this reason, studies often use large sample sizes to account for differences among individuals in a population.
Ask yourself: Was the study completed using a large number of study participants?
Sometimes a study may suggest a result that is different from previous studies. Therefore, it’s important for studies to be repeated multiple times by different scientists in a variety of populations. When study results can be reproduced, it ensures the results were real and not just an anomaly of one particular experiment. A study’s results should only be widely accepted after they have been reproduced.
Ask yourself: Was the study the first of its kind or was it repeated numerous times with similar results?
Because people typically read about studies in media reports, it’s important to evaluate the story for the details mentioned above. If these details are not reported, consider seeking out additional information to gain a better understanding of the study’s scientific merits.
A guest article by Lynn Bozof, president of the National Meningitis Association
My son Evan was a college junior when he lost his life to meningococcal disease, which is often referred to as bacterial meningitis. He was a pitcher for his college baseball team and in excellent health. He called me on an otherwise ordinary Wednesday morning in March 1998 to say he had a terrible migraine. When the symptoms worsened, I suggested he go to the emergency room. Within hours, Evan was in intensive care. For weeks, he struggled to fight the infection. We watched helplessly as Evan endured amputation of all four limbs and finally lost his struggle 26 days after that phone call.
As a parent who lost a son to meningococcal disease, my heart goes out to the students and families affected by the recent meningitis outbreaks at Princeton University and the University of California, Santa Barbara (UCSB).
When Evan became ill, I had no idea that adolescents and young adults have a higher risk for meningococcal disease or that the disease could be so deadly or debilitating. Although it is rare, meningococcal disease leads to death in 10-14 percent of cases, and among those who survive, one in five suffer long-term complications such as organ or brain damage, hearing loss or limb amputations.
I soon met other parents with similar stories as well as disease survivors managing lifelong health consequences from their illness. Although there was a vaccine in use by the military at the time, vaccination was not yet recommended as it is today for preteens and teens. No parent should have to endure watching their child suffer or lose a child to a potentially preventable illness. We formed the National Meningitis Association (NMA) in 2002 to prevent other families from experiencing the same loss or devastation.
So much has changed since then. The U.S. Centers for Disease Control and Prevention now recommends routine vaccination of kids when they are 11-12 years old, with a booster at age 16, to help protect them from meningococcal disease. These vaccinations help prevent the majority of cases among adolescents that are caused by four strains of the disease.
All 12 cases in the recent outbreaks (eight at Princeton and four at UCSB) were caused by serogroup B meningococcal disease, which is not covered by current vaccines. While the affected students have survived, one — a lacrosse player at UCSB — lost both feet to the infection. Others are suffering from residual neurological affects.
Although none of the Princeton or UCSB students died, B-strain meningococcal disease can be deadly. NMA Mom on Meningitis (M.O.M.) Alicia Stillman lost her 19-year-old daughter, Emily, to serogroup-B meningococcal disease in February 2013. Emily was a sophomore at a small private liberal arts college. Like Evan, her symptoms began with a severe headache. Emily passed away within 36 hours despite medical efforts to save her life. Emily had been vaccinated. Alicia takes some comfort in knowing she did everything in her power to protect Emily at that time, but she would have given anything for an opportunity to further protect Emily. (Watch Alicia share her story.)
Emily’s case and those at Princeton and UCSB remind us that it is critical for everyone — students, faculty, families and healthcare professionals — to learn about the symptoms of meningococcal disease and seek prompt medical attention. It is especially important because the infection can be mistaken for flu, other viral infections, or migraines.
NMA supports the decisions at Princeton and UCSB to make the serogroup B meningococcal vaccine, currently approved for use in Europe, Canada, and Australia, available to students and faculty to protect them during this outbreak. We hope that one day soon, vaccines will be used routinely in the U.S. to provide the broadest protection possible.
We encourage all parents to:
NMA works to protect families from the potentially devastating effects of meningococcal disease by educating the public, medical professionals and others about the disease and its prevention. The NMA network also provides critical emotional support for families who have been affected by meningococcal disease.
Here’s what we know about influenza and the influenza vaccine:
Despite this, many people still choose not to get the influenza vaccine every year.
Increasing evidence suggests other potential benefits to getting the influenza vaccine:
Patients who have or are at risk of developing cardiovascular disease are at increased risk of suffering complications from influenza. In fact, influenza infection has been shown to be a risk factor for both fatal and nonfatal cardiovascular events, such as atherosclerosis (a hardening of the arteries). Recent studies have suggested that these patients are not only less likely to get influenza following vaccination; they are also less likely to suffer a heart-related event than unvaccinated patients with heart problems. While these findings are exciting, additional studies need to confirm these results.
Many studies have shown that influenza immunizations prevent mothers from getting influenza during pregnancy. However, studies have also shown that newborns of mothers who were immunized against influenza also benefit from immunization. While further studies are needed, current understanding is that babies of immunized mothers are less likely to be infected with influenza, less likely to be born prematurely, and less likely to be of low birth weight.
Many people live with pneumococcal bacteria in their nose and throat without getting sick. However, if their mucous membranes are compromised because of an infection, such as influenza, the bacteria can cause an infection, such as pneumonia. Pneumonia as a result of influenza infection is one of the most severe complications of influenza; however, a recent study found that vaccinated children and adults were less likely to get pneumonia or be hospitalized with pneumonia when compared with unvaccinated people. Because this is a preliminary study, other studies must be completed to confirm the results.
Although these studies need to be confirmed, they suggest that the influenza vaccine may do more than prevent influenza especially in some high-risk groups — something else to consider when thinking about getting the influenza vaccine.
With Thanksgiving approaching, November is a time when we pause to reflect on what we’re thankful for. We often think about family and friends, but many technologies exist on which we rely — electricity, television and the Internet among them. In this same vein, we thought we’d take this time to reflect on another important technology on which we’ve come to rely — vaccines.
The numbers of people who suffered and died from vaccine-preventable diseases before vaccines were available afford us a snapshot of what the world might be like if vaccines were not available.
Before the chickenpox vaccine was available in 1995, 4 million people were infected with chickenpox and 100 died every year in the U.S. alone. In the 10 years following introduction of the vaccine, the number of people infected with chickenpox decreased to about 400,000 each year with few deaths.
With the recommendation for a second dose of chickenpox vaccine, the number of cases of chickenpox decreased to fewer than 40,000 per year. Unfortunately, the chickenpox vaccine is still not an option for many people in the world because of competing economic needs throughout the world.
Today, 80 to 90 million people, approximately the current population of Germany, still get chickenpox every year.
In the early part of the 20th century, diphtheria was one of the most common killers of young children. In fact, in 1921, before the vaccine was routinely available, more than 200,000 people in the U.S. were infected with diphtheria. Almost 16,000 people died from diphtheria that year — about the same number of people as the entire population of Concord, MA. Today, because of high vaccination rates, diphtheria has been virtually eliminated in the United States.
Every year before the Hib vaccine was available, about 25,000 children in the U.S. suffered severe disease caused by Hib infection. Affecting mostly children, the disease led to meningitis, bloodstream infections, pneumonia, joint infections and epiglottitis (swelling of the epiglottis, the tissue that covers the trachea [windpipe] when swallowing).
To put this number in perspective, more people were infected with Hib than the number of people who died in the tsunami in Minamisanriku, Japan, in 2011. Unlike the tsunami, which was an act of nature that couldn’t be prevented, severe infection caused by Hib can be prevented.
Today, fewer than 25 cases of Hib and fewer than five deaths occur in the U.S. every year due to the availability of the Hib vaccine.
An estimated 3 to 4 million cases of measles occurred every year in the U.S. prior to the availability of the measles vaccine, causing about 100,000 people to be hospitalized and 500 to 1,000 to die each year. Most cases occurred in children aged 5 to 9.
The first measles vaccine was licensed in 1963. With that, and eventually the development of a better vaccine, the incidence of measles decreased by more than 98 percent.
Unfortunately, measles still occurs in other parts of the world and cases are being imported into the U.S. due to international travel. In fact, 159 cases of measles have been reported so far in the U.S., putting 2013 on track to have the highest number of measles cases in more than a decade.
The mumps vaccine first became available in 1967. Just three years earlier, about 212,000 cases of mumps occurred in the U.S. — two times the number of people who can fit in the new Dallas Cowboys stadium in Arlington, TX.
Although mumps infections resolve on their own, some people infected with the virus can become permanently deaf. Today, fewer than 500 cases of mumps occur in the U.S. annually. Unfortunately, mumps still imposes a heavy burden in other parts of the world, with about 700,000 cases occurring worldwide each year.
In 1950, five years before the first polio vaccine became available 3 million people were infected with polio. As a result, 20,000 to 30,000 people became paralyzed — about twice as many as the number of people who die from slip-and-fall accidents every year.
Polio was eliminated from the United States by 1979, and, natural infections have been eliminated from all countries around the world except three: Afghanistan, Pakistan and Nigeria.
Efforts directed toward eradication, that is, worldwide elimination, are dedicated to making this the second disease to have this distinction (the first was smallpox). For this reason, we continue to vaccinate with the polio vaccine.
Almost 60,000 people in the U.S. were diagnosed with rubella in 1969. Fortunately, a vaccine was introduced shortly thereafter, causing the incidence of rubella to rapidly decline in the U.S.
In 2004, rubella was declared eliminated from the U.S. Today, fewer than 10 cases per year occur in this country.
So as we have come to rely on electricity, televisions and the Internet, so too, have we come to rely on the availability of vaccines, without which our lives and our daily worries would certainly be different. Therefore, this Thanksgiving, don’t forget to include vaccines on your list of things for which you are grateful.
When talking with parents about vaccines, sometimes we hear that the influenza vaccine is not necessary. Unfortunately, infection with influenza virus is not without risk. In fact, last year more than 160 children died from influenza. About half of them were previously healthy children who had no risk factors for severe disease. The following is information about why it’s important to protect your children during influenza season.
High-risk children, that is, children with certain underlying medical conditions, are more likely to suffer complications and die from influenza. For this reason, it’s especially important for these children to be vaccinated. Examples of children considered to be at increased risk are those who have been diagnosed with the following conditions:
Household contacts and caregivers of children in these groups should also receive a dose of seasonal influenza vaccine to decrease the chance that these children will be exposed to influenza.
The influenza vaccine is not recommended for infants less than 6 months of age. For this reason, anyone who comes in regular contact with the infant – such as household members and childcare providers – should receive a dose of influenza vaccine. By doing so, parents and other contacts reduce the baby’s chances of being exposed to influenza.
Sadly, each year some previously healthy children are infected with influenza and die. Because all children are at risk of suffering complications caused by influenza, the influenza vaccine is recommended for all children 6 months of age and older.
In addition to receiving the influenza vaccine, here are a few other things you and your family can do to decrease the spread of influenza this seaon:
Get your family and yourself vaccinated this year before influenza arrives in your community. Please refer to the “Ask the VEC” section for an answer about when is the best time to receive the influenza vaccine.
Vaccines on the Go: What You Should Know contains several different sections:
Formatted with two tabs, this section provides information about vaccines found on the recommended vaccine schedule and the diseases they prevent:
Information found in the vaccine tab includes the type of vaccine and possible side effects, special considerations for vaccine recipients, and reasons to get the vaccine. Buttons are provided at the bottom of the page so users can find the vaccine on the schedule, save notes or questions for the next doctor’s visit, access related VEC-produced Q&A sheets (where applicable), or email the VEC with questions.
Designed in three sub-sections, the safety section of Vaccines on the Go: What You Should Know provides information about general safety concerns (e.g., autism and chronic diseases), vaccine ingredients (e.g., aluminum and thimerosal), and the recommended schedule (e.g., altering the recommended schedule). Additional resources, including links to VEC downloadable materials and websites, are provided in a second tab.
The schedule section is divided into two sub-sections: vaccines recommended for children up to 2 years of age and those recommended after 2 years of age. Users can also download copies of age group-specific vaccine booklets produced by the VEC. Parents who’d like a graphic of the recommended schedule for babies up to 2 years of age can download it onto their mobile phones from the appropriate sub-section.
The videos section of Vaccines on the Go: What You Should Know provides access to VEC-produced videos, including “Vaccines: Separating Fact from Fear” and “Vaccines and Your Baby.”
Other sections of the app include "Types of Vaccines," "Games," "Glossary," and "Notes for the Doctor." The "Types of Vaccines" section provides information on how vaccines are made and lists examples of each type. Three different vaccine-related games are provided in the "Games" section (see more in spotlight section). The "Glossary" section provides definitions to words that are commonly used throughout the app and are also hyperlinked so that tapping the word makes the definition appear. And, the “Notes for the Doctor” section allows users to keep track of notes and questions to ask at the next doctor’s visit. Calendar reminders can also be set for your next appointment.
Measles outbreaks continue to occur in European and African countries, as well as several parts of Canada. Because travel to the United States is common from these areas, measles outbreaks have also been reported in multiple U.S. states. Outbreaks of other vaccine-preventable diseases are also occurring throughout the world, including mumps outbreaks in the United Kingdom and U.S., and rubella in Japan and Poland. Fortunately, you can protect yourself from these diseases by getting the MMR vaccine. Here’s what you should know about the MMR vaccine and the diseases it prevents:
Measles is caused by a virus of the same name and spreads through respiratory droplets that hang in the air when a person coughs or sneezes. Symptoms of infection typically include:
Due to the highly contagious nature of this disease, international travelers, college students and medical professionals who are not immune to measles are at high risk of infection. Complications occur in about 3-of-10 people infected with measles, mostly adults and children younger than 5 years old, and can include:
Mumps is caused by the mumps virus, which spreads through coughing, sneezing or contact with the saliva of an infected person. Symptoms typically include:
Like measles, mumps causes more severe illness in adults than children. Complications can include:
Rubella, or German Measles, is caused by rubella virus and spreads in the same manner as the mumps virus — coughing, sneezing or contact with the saliva of an infected person. Half of those infected with rubella do not experience any symptoms. However, if a person has mild disease, the symptoms typically include:
Complications of rubella are more common in adults than children, and can include:
Rubella is most damaging to the developing fetus. If a pregnant woman becomes infected with rubella virus before the 20th week of pregnancy, the virus can infect the fetus causing congenital rubella syndrome (CRS). Outcomes of CRS can include miscarriage, fetal death or premature birth. Often, if a baby survives the pregnancy, he or she is born with devastating birth defects, such as:
In the United States, the vaccines that prevent measles, mumps and rubella are available in the combination vaccine known as MMR. The MMR vaccine is an example of a live, “weakened” viral vaccine, which is made through cell-culture adaptation. In cell-culture adaptation, measles, mumps and rubella viruses are grown repeatedly in cells in the laboratory. As the viruses adapt to growing in the lab, they become less able to grow in people. When the vaccine viruses are injected into a person, they replicate fewer than 20 times, rather than the thousands of times that the virus typically replicates during an infection. As a result, the vaccine virus causes an immune response that is strong enough to protect a person from disease, but not strong enough to cause illness.
Possible side effects of the MMR vaccine are minor and may include:
Because the MMR vaccine does not cause serious, permanent side effects, the benefits of the vaccine far outweigh the potential risks.
Although polio has been eradicated from many countries, transmission has never been interrupted in Nigeria, Pakistan and Afghanistan. The result is that outbreaks continue to occur, not only in these countries, but also where immunization rates are not sufficient to stop the spread when travelers with polio enter the country. For example, an outbreak of wild-type polio virus is occurring in Kenya and Somalia. In Somalia, the 25 cases reported thus far are the first in the country since 2007. The six cases reported in Kenya are the first since 2011. Immunization campaigns are ongoing in these countries, and others are planned for Ethiopia, Yemen and other countries located within the horn of Africa.
Because polio is just a plane ride away, it’s important to learn about polio and the vaccine that prevents it. Here’s what you should know:
Polio is a highly contagious disease that is caused by a virus of the same name and is spread through contact with contaminated food, hands and other objects that touch a person’s mouth. Polio is so contagious that virtually every susceptible person will become infected when exposed to the virus. Most infected individuals (about 95 of 100 people) experience no symptoms. However, some (about 5 of 100 people) experience mild symptoms that typically include sore throat, abdominal pain, nausea, vomiting, abdominal pain and constipation. A small number of people (less than 1 of 100 people) may experience severe symptoms such as paralysis and muscle aches and spasms. Paralysis can be life-long, and a small number of people (about 1 of 10 people who suffer severe disease) die.
Two types of polio vaccine are commonly used. In some countries, including the U.S., the polio vaccine is inactivated, often referred to as IPV. This vaccine is given as a shot. An oral polio vaccine (OPV) containing live, weakened polio viruses is used in some other countries.
Because the oral polio vaccine can on occasion revert to wild-type and cause paralysis, eventually all countries will switch to the inactivated version. However, in countries in which the virus has been difficult to control, the benefits of contact immunity and the ease of administering the oral version to large and difficult-to-reach populations has necessitated continued use of OPV.
Summer is a time when many families travel, so here are some tips for getting ready and keeping your family healthy during and after the trip.
Once you choose your travel destination, learn as much as you can about it, from the local laws and culture to safety and security concerns. It’s also important to learn about any potential health risks. Both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) provide travel notices to keep travelers informed about weather and health conditions. Because these travel notices often contain important health-related information, be sure to check them before leaving for your trip.
Depending on your destination and the travel notices issued by the CDC and WHO, you may need to receive vaccines prior to your trip. An easy way to make sure you are prepared for your trip is to visit a travel clinic where you’ll find healthcare providers who are very knowledgeable about health needs before, during and after travel. The International Society for Travel Medicine provides an online travel clinic locator to help you find a clinic near you.
In addition to addressing any vaccines needs, clinic providers will talk to you about your planned activities, length of stay, and other factors to consider as you prepare for travel. Because some vaccines require multiple doses and most vaccines take a couple of weeks to provide optimal protection, travelers should visit a travel clinic well in advance of their trip, even up to a few months before leaving.
You can learn more about vaccine recommendations for travelers by reading this month’s Ask the VEC.
Packing a “smart suitcase” means not only packing the right clothes but also being prepared for anything. For this reason, travelers are recommended to pack a travel health kit. The CDC offers a list of items that should be a part of your kit, including first aid equipment, bug spray, sunscreen and prescription medicines you take on a daily basis. Losing your passport and other travel documents is one of the worst things that can happen to a traveler. So be sure to put a copy of these documents in every suitcase you bring on your trip, as well as leave a copy with a friend or family member.
May is hepatitis awareness month, so we wanted to take the opportunity to provide information about this condition. Hepatitis, or inflammation of the liver, can occur as a result of infection with hepatitis virus. Symptoms include fever, fatigue, nausea, vomiting, abdominal pain, loss of appetite, jaundice, dark urine and discolored feces. Five different viruses can cause hepatitis in humans, commonly referred to as hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E. However, these viruses are not all transmitted by the same route.
Infection with hepatitis A and E typically occurs by consuming food or water contaminated with one of these two viruses, either due to poor sanitation or by contamination from someone who is infected, such as food handlers who do not wash their hands properly after using the restroom.
Hepatitis B, C and D typically occur through contact with an infected person’s blood. Although uncommon, hepatitis C can also be transmitted during sex.
About 4.4 million Americans suffer from chronic hepatitis infection, and about 75 out of 100 people don’t know they’re infected. Some people are at higher risk of getting infected with one or more types of hepatitis:
People at risk of becoming infected with hepatitis A or E include international travelers who travel to places with high incidence of hepatitis A or E, such as Central America, Africa and Asia. Those who consume contaminated food or water are also at risk of becoming infected. Household contacts of international adoptees are also at risk of becoming infected with hepatitis A because these children often don’t have any symptoms.
People at risk of becoming infected with hepatitis B include healthcare workers, people with sexually transmitted diseases (i.e., HIV/AIDS), men who have sex with men, and international travelers who travel to places with high incidence of hepatitis B (Asia, Africa and the Middle East). Infants born to mothers infected with hepatitis B and people who are in close personal contact with someone infected with hepatitis B are also at risk. Because many people do not know they are infected with hepatitis B – and because the quantity of virus in the bloodstream is high – they can infect others who come into contact with personal care items that may contain tiny, even unnoticeable, amounts of blood, such as on razors, washcloths and toothbrushes.
Healthcare workers, people with sexually transmitted diseases (i.e., HIV/AIDS), injected drug users, people on hemodialysis, and infants born to mothers infected with hepatitis C are at risk of becoming infected with hepatitis C. People who received blood transfusions before July 1992 or received clotting factor before 1987 are also at risk.
Injected drug users, people who receive multiple blood transfusions, and men who have sex with men are at risk of becoming infected with hepatitis D. Those who are already infected with hepatitis B are also at risk of becoming infected with hepatitis D because hepatitis D virus requires hepatitis B virus to replicate and cause disease.
Vaccines are only available to prevent hepatitis A and B.
To learn more about the vaccines available to prevent hepatitis, read this month’s Trivia Corner.
As parents, we want to do what’s best for our children, but no matter how protective we are, all babies eventually get their first bruise or scrape. When that happens, we can’t help but feel anguish at the sight of the scrape and typically feel that we could have done more to prevent it. The truth is we couldn’t.
Besides providing love, food, clothing and shelter, we also protect our children. In the pre-vaccine era, vaccine-preventable diseases affected entire villages, killing many in their wake. Fortunately, today as parents, we can prevent our children from suffering some of the harshest infections by vaccinating them. In fact, babies in the United States can be protected from 14 different diseases by the time they are 2 years of age.
Unfortunately, parents in some other countries do not have this opportunity. Although immunizations prevent about 2 to 3 million deaths every year, 22 million infants globally are not fully immunized with routine vaccinations. As a result, every year more than 1.5 million children younger than 5 years of age die from vaccine-preventable diseases around the world
During gestation, a baby receives maternal antibodies through the placenta. After birth, if the baby is breastfed, she will continue to receive antibodies in breast milk. Known as passive immunity, the protection provided by either of these types of antibodies is only short-term, lasting no more than a few weeks or months. Passive immunity is also limited in that it only protects against some diseases, leaving a baby susceptible to other diseases.
In contrast, vaccines allow a baby’s immune system to make its own antibodies; this is called active immunity. Because antibodies produced through active immunity remain in the form of immunologic memory, they last much longer and offer more complete protection compared with that provided by passive immunity.
Some parents, concerned about vaccine safety, request an alternative vaccination schedule or choose to forego vaccinations for their children. Although these decisions are made with the best of intentions, parents should realize that this decision is not without risk. First, separating or withholding vaccines increases the time during which their baby is susceptible to the diseases that vaccines prevent. Second, because the changes in scheduling are often unique only to that baby, they have not been tested. Finally, evidence suggests that stress associated with getting multiple vaccines does not induce greater levels of cortisol, a stress hormone, than the stress of getting one vaccine. So taking the baby in for multiple visits will induce more stress during the period of time over which the vaccines are spread.
Decisions to delay or withhold vaccines also contribute to decreased immunization rates, thereby decreasing the amount of protection available to those in the community who cannot receive vaccines for health reasons or for infants who are too young to get certain vaccines. The concept of protecting non-immune members of a community by maintaining high immunization rates in those around them is called herd immunity.
Although as parents, we can’t prevent our babies’ first scrapes and bruises, we can protect them in many other important ways. Immunizations are one of them.
Watch “Vaccines and Your Baby” to learn more how vaccines work and the diseases vaccine prevent.
Vaccines go through rigorous testing prior to being made available to the public. In fact, vaccines are typically studied for 10 to 15 years (sometimes longer) and are tested in tens of thousands of individuals. The process of developing, approving and manufacturing a vaccine can be described in distinct stages:
An idea for a vaccine typically starts in a research lab located in a university, medical center or small biotech company. During this time, scientists determine if their concept will work and develop tests to measure success. If the ideas seem promising, the vaccine will be tested in animal models. Part of the scientific process involves presenting findings at meetings and in scholarly journals during which time other scientists evaluate the quality of the science. If the idea continues to show promise, a pharmaceutical company may take over the project to expand the studies to manufacturing and product development research, as well as begin evaluations in humans.
This stage of vaccine development is typically the longest, often spanning five to 10 years.
Although the main focus of phase I studies is to determine if the vaccine candidate is safe and generates an appropriate immune response, phase I trials also determine:
Phase I trials are typically performed in fewer than 100 healthy adults and usually take about one to two years to complete. An exploratory investigational new drug (IND) application is filed with the Food and Drug Administration (FDA) during this phase.
Phase II studies continue to evaluate the safety of a vaccine, but this time, the studies are performed in hundreds of people who more closely represent the intended target group. The final dose and methods for manufacturing the vaccine are also determined during phase II studies. Scientists must also ensure that vaccine manufacturing is consistent in order to avoid discrepancies between one batch of vaccine and another.
Phase II studies can take as little as two years to be completed, but often more time is necessary. The FDA and the pharmaceutical company communicate regularly during this stage of vaccine development and either can decide to discontinue vaccine development at any time.
This is the last stage of vaccine development before a company submits paperwork to license a vaccine. Phase III studies test the vaccine in thousands or tens of thousands of people who are similar to those for whom the vaccine is intended. If the vaccine is intended for an age group that typically receives other vaccines, “concomitant use studies” must be done to ensure that neither vaccine decreases the effectiveness of the other. Once phase III studies are completed, the company reviews all the data and submits a licensing request to the FDA. If the FDA’s own evaluation of the data determines that the vaccine is safe and effective, the vaccine is licensed.
Phase III studies typically take about three to four years to complete.
Once a vaccine is licensed by the FDA, experts from the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) review the data to determine if the vaccine is safe, effective and necessary. They determine who should receive it and provide this information in the form of vaccine recommendations. The vaccine schedule is a compilation of these recommendations.
Because very rare side effects may not be seen until a vaccine is given to a much larger population, scientists continue to monitor vaccines after licensure. The Vaccine Adverse Event Reporting System (VAERS) and Vaccine Safety Datalink (VSD) are two long-term monitoring systems in place to monitor for adverse events caused by vaccines. VAERS is a reporting system that allows anyone to report an adverse event, but cannot determine if a vaccine caused the event. If an adverse event is suspected, scientists use the VSD to compare the event’s incidence in people who have and have not received the vaccine.
Check out “The Journey of Your Child’s Vaccine” infographic that was recently created by the Centers for Disease Control and Prevention (CDC) to describe the stages of vaccine development, approval and manufacture.
The Centers for Disease Control and Prevention (CDC) recently released the 2013 recommended immunization schedules for children and adults. No major changes were made to the recommended childhood immunization schedule; however, the format of the schedule was revised so that recommendations for children from birth to 18 years of age can now be found in one, easy-to-read chart instead of two charts.
The recommended adult immunization schedule was revised to reflect recently-changed guidelines on who should get the pertussis-containing vaccine, known as Tdap, in order to protect themselves and those around them:
While these changes are not extensive, the schedule can be intimidating because of its complexity. Parents reasonably question whether it is necessary and safe for babies to receive so many vaccines at once, and misperceptions, such as the belief that the schedule is a one-size-fits-all approach, often add to their concerns.
The good news is The Institute of Medicine (IOM) recently performed an extensive examination of the recommended childhood immunization schedule. Their findings were published on January 16, 2013 and showed no evidence of safety concerns associated with the current schedule.
The Vaccine Education Center (VEC) at The Children's Hospital of Philadelphia also has a variety of resources to address some of these questions and misperceptions:
As always, if you have questions about the vaccine schedule or other vaccine-related questions that you can’t find the answer to on our websites or printed materials, feel free to email us at contactPACK@email.chop.edu.
While the vaccine schedule can seem intimidating, it is well-tested and proven to safely and effectively protect our babies from many of the diseases that we, our parents and our grandparents had to suffer.
While vaccines used to be thought of as something that could be checked off the parenting “to do” list after kids entered kindergarten, that is no longer the case. Since 2005, several vaccines have been recommended for teenagers and young adults including the Tdap, influenza, HPV and meningococcal vaccines.
The Tdap vaccine provides protection against three vaccine-preventable diseases: tetanus, diphtheria and pertussis. Even though teenagers were vaccinated as children with a vaccine against diphtheria, tetanus and pertussis, immunity wanes over time. In fact, current pertussis outbreaks have been linked to waning immunity in this age group. Teenagers and young adults can also transmit pertussis to infants who are too young to be vaccinated. For these reasons, a booster dose of Tdap is recommended for teenagers.
The HPV vaccine protects against human papillomavirus (HPV), one of the most common sexually transmitted diseases in the world. Each year, 6 million new HPV infections occur in the United States and half of these occur in girls and young women between 15 and 24 years of age. Two HPV vaccines are available, but differ in the type of protection they provide:
Both HPV vaccines are offered as a series of three shots; the second dose is given two months after the first, and the third dose is given six months after the first dose.
The meningococcal vaccine prevents meningococcal disease, a particularly deadly disease that can kill within hours of infection. Teens are recommended to receive this vaccine due to their increased risk of infection. Most teens should get two doses of meningococcal vaccine: one dose between 11 and 12 years of age and a second dose at 16 years of age. If a teenager receives the first dose between 13 and 15 years of age, he or she should receive a booster dose between 16 and 18 years of age. One dose of meningococcal vaccine is recommended for any 16- to 18-year-old who has not previously been vaccinated.
Because college freshmen and students up to 21 years of age living in dorms are at increased risk of meningococcal infection, a dose of meningococcal vaccine is particularly important for this group.
The influenza vaccine is recommended for everyone 6 months of age and older. Typically, the types of influenza virus circulating each year change, so the seasonal influenza vaccine tends to change as well. Therefore, even if a teenager received the seasonal influenza vaccine the year before, he or she may not be protected against the types of influenza that are circulating during the current influenza season. For this reason, the influenza vaccine is recommended annually.
This month we welcome Laura Scott as a guest author. Scott is a co-founder and executive director of Families Fighting Flu (FFF), a national nonprofit organization dedicated to informing the public about the severity of influenza, as well as increasing vaccination rates to reduce the number of hospital visits and deaths caused by this vaccine-preventable disease. Scott is also a public speaker and advocate for families who have lost a child due to influenza.
Parents want to keep their children healthy and ensure they institute good habits into their everyday routine, such as brushing teeth twice a day, getting exercise and eating enough fruits and veggies. Taking preventive measures — like getting an annual flu vaccine — to help guard against different types of infections (some potentially deadly) is also critical in order to stay healthy. This very important habit should not be overlooked!
Influenza, or the “flu,” is a serious and highly contagious disease that is often confused with the common cold. Symptoms tend to develop quickly (usually one to four days after a person is exposed to the virus) and can be more severe than the normal cough and congestion of a cold. In fact, the flu can lead to serious and even fatal complications, particularly in children. Each year more than 20,000 children are hospitalized due to flu and tragically, most years, more than 100 children die from the disease.
As executive director of the national, non-profit organization Families Fighting Flu, I hear all too often that “it’s just the flu” or “we’re healthy, we don’t need to get the flu vaccine.” But, our organization, comprised mainly of families who have either lost a child to the flu or whose child became seriously ill due to the disease, understands the potential risks all too well. We are committed to educating others about the importance of annual flu vaccination for everyone 6 months of age and older, as per guidelines issued by the Centers for Disease Control and Prevention (CDC). Through our educational initiatives, we share our unique, first-hand perspectives about the devastating losses of our children — a 15-month old toddler, a 4-year old ballerina, a 17-year-old high school basketball player — in the hopes that we can prevent others from experiencing such tragic loss.
Martin was an energetic, healthy 15-year old from Nazareth, PA, who loved baseball. He wasn’t feeling well one day, but insisted on trying out for the high school baseball team. When he got home that evening he complained of leg pain from running during tryouts, and then in the middle of the night, began vomiting and developed a 102 degree fever. His parents rushed him to the emergency room to find out that Martin tested positive for influenza. Additionally, Martin developed a condition called Compartment Syndrome, which limited his blood circulation and caused severe pain in his legs. The running he did the day before during tryouts escalated the condition. Martin was rushed into surgery, but tragically, his heart stopped beating, and he died from complications of the flu. His mom, Diane, reflects: “Martin was a healthy and active boy who loved baseball, but he wasn’t vaccinated against the flu. I urge all parents to take the one, simple step of getting your entire family vaccinated. It could literally save a life.”
“We all know the flu does not discriminate. According to the CDC, between 2004 and 2012, 43 percent of United States children who died from the flu were perfectly healthy beforehand,” notes Adrienne Randolph, MD, MSc, founding chair of the Pediatric Acute Lung Injury and Sepsis Investigator’s (PALISI) Network, director of the RSV and Asthma Research Study Center at Boston Children’s Hospital, and Families Fighting Flu medical advisor. “The flu vaccine is safe and effective, and is the single best way to protect yourself and your family from the flu.”
It is not too late to get vaccinated this season. The flu virus tends to spread from October to May, with most cases occurring in January or February. However, vaccinations can be given at any time during flu season — even getting a vaccination later in the season (December through March) can still help protect you from influenza.
Following these tips can prevent the spread of germs and help keep your family healthy during flu season:
Staying healthy should be a priority, and at this time of the year, an influenza vaccine should be at the top of your list. Protect yourself and your family … please get your flu vaccine every year.
Each year, Families Fighting Flu works to provide information about the importance of flu vaccination. You can find the following resources on their website:
We would like to hear from you. Please use our online form to contact us with questions or comments.