Childhood Immunization: Navigating the Vaccine Conversation Vaccines have been a hot topic in recent years. To gain some clarity on this important area of child health, we spoke with BCHP pediatrician Dr. Dori Anchin. We hope the following Q&As are helpful and informative for your family and ease any anxiety you may be feeling about how best to keep your child healthy and protected.
How do we know that vaccines and their ingredients are safe?
Before vaccines are recommended for routine use in children, they undergo several phases of safety and efficacy checks that are carefully overseen. After vaccines are introduced, there are various surveillance systems in place to ensure that there are no safety concerns that arise after licensure.
Why does my child need so many vaccines early in life?
Infancy is one of the most vulnerable times in childhood. The infant immune system is not mature and does not function in the same way that an adult’s immune system does. This immune immaturity causes the infant to be unable to adequately fight certain very dangerous, sometimes lifethreatening infections. Vaccines are given as early as they can be given to both provide a proper immune response and protect against these very serious infection risks. Multiple doses (boosters) are required in infants to provide strong, durable responses (“immune memory”) for these infections.
Can my child get too many vaccines at once?
Antigens are the components of the vaccines that stimulate the immune response. The number of antigens in all the vaccines combined at any one time are far less than what a typical infant would encounter in any given day in their usual environment. There is no evidence that the routine vaccine schedule will overwhelm the immune system and cause serious side effects or decrease efficacy.
What side effects can I expect from vaccines?
Common side effects of childhood vaccines are generally mild and may include fever, swelling or redness around the injection site, and irritability or crankiness. Rare but serious events have occurred with certain vaccines, and these can be reviewed with your doctor, but for the vast majority of children, the risk of not vaccinating far outweighs any risk associated with giving the vaccine.
Can I delay or skip vaccines?
Delaying or skipping vaccines is not recommended, because this puts your child at risk for acquiring the diseases that the vaccines are meant to prevent during an age of high vulnerability.
If other children are vaccinated, does my child really need to be?
Yes, they do. First, herd immunity requires upwards of 95 percent of the community to be vaccinated for certain diseases to be protective against the risk of significant community transmission. When too many people do not vaccinate, herd immunity fails. Plus, it has been shown that an unvaccinated child who contracts illnesses such as measles, rubella, and varicella (chickenpox) when they are older generally has worse outcomes.
Does my child need the flu shot this year? If so, when is the ideal time?
Yes, it is recommended to get the flu vaccine every year. Flu viruses are always developing mutations in their surface proteins that allow them to escape detection by antibodies developed from previous infection or vaccination. Generally, it is recommended to get a flu vaccine in either September or October. This timing supports a vaccine response before the flu virus starts to widely circulate, balanced with how long the flu vaccine remains effective for, which is about five to six months.
How do I know that the vaccine schedule is right for my child?
The U.S. childhood vaccine schedule is a result of a scientific, multi-step, evidence-based process led by the ACIP, which is then approved by several other professional organizations, including the American Academy of Pediatrics (AAP). Among the items considered in this process are the burden of disease in a specific age group, safety, efficacy, and risk versus benefit. The schedule as determined in this fashion is the best way we can protect our patients.
My child has had a reaction to a previous vaccine. Does that mean they can’t get more?
There are only a few reactions that would mean that a child cannot get another dose of a certain vaccine. The most universal contraindication to any vaccine would be severe allergic reaction (anaphylaxis) after a previous dose. Other vaccine-specific contraindications, such as severe immunodeficiency, can be discussed with your pediatrician. Of note, mild illness with low grade fever, current antibiotic therapy, or a family history of adverse reactions are not contraindications to giving vaccines.
If my child is healthy and we lead an active lifestyle, do I have to give vaccines?
Yes, even if a child is healthy, they are still at risk for vaccine-preventable illnesses and should be vaccinated according to the AAP schedule of childhood vaccines.
I’ve heard that some vaccines wane over time. How do I know that my child is still protected?
There are many mathematical models, in addition to different types of immunity measurements in vaccinated people, and studies on rates of breakthrough disease, that help us determine the proper timing for vaccines so that protection is achieved and maintained over time. While protection can never be 100 percent guaranteed, the AAP childhood vaccine schedule integrates these data to ensure that protection is as ideal as it can be.
If my child has already had the disease, why do they still need a vaccine?
Many vaccine-preventable diseases are infections that do not give you long lasting immunity from future infection. These include pertussis (whooping cough), pneumococcal infection, HPV (human papillomavirus), and influenza. Illnesses that confer immunity and would exempt you from needing a vaccine are MMR (measles/mumps/rubella), varicella (chickenpox), and hepatitis A and B.
I want to be able to ask my pediatrician questions about vaccines without being judged. What should I know before I bring it up with my pediatrician?
We know that our parents always have their children and family’s best interests in mind. As pediatricians, we also have your child’s best interests in mind. Candid, open conversation in which parents and children can ask questions and express concerns, and where doctors are allowed to explain their reasons for recommending a vaccine, are crucial to a healthy working relationship that builds trust and mutual respect.