Vaccinations
One of the first issues that new parents are expected to address is whether to immunize their beautiful new baby. As with any important decision, the benefits must be weighed against the risks.
Several years ago, the threat of infectious diseases was all too real for most parents. Polio, whooping cough, measles, and bacterial meningitis were universally dreaded by patients (and doctors) for the suffering and death they wrought. Successful vaccination programs have made many people forget the scourges of the not too distant past.
The premise of vaccination, briefly put, is to introduce an antigen to a healthy immune system in order to produce antibodies that will protect that host when it confront that antigen again. Many vaccines use antigens that, on a molecular level, look just like the germ that can cause disease. When the vaccinated person is exposed to the real germ, the resulting antibody response should be enough to keep the host healthy.
Most side effects related to immunization are mild and short lived. Soreness at the site of the injection is the most common untoward effect. Other common problems include drowsiness, irritability, and fever. Fever, with the newer vaccines, occurs much less than it had in the past. Rarely, infants can develop a severe, life threatening reaction. The chances for this type of reaction occurring have been estimated at between 1 in 500,000 to 1 in 2,000,000.
Some people have expressed concerns that the vaccines will overwhelm a
baby's immune system. Babies have basically proven this theory wrong.
Real life experience has shown us that even the cutest babies are tougher
than we might think!
Hepatitis B is the first vaccine offered to babies. Some hospitals immunize
babies in the first few days of life. If the hospital does not give it,
the pediatrician can oblige at the first office visit. Hepatitis B can
cause latent, unrecognized infection in babies who are exposed early in
life, and many of these infants can subsequently develop chronic liver
disease. There is no treatment for this problem (other than transplantation),
so prevention is the preferred therapy. Timing for this vaccine is, optimally,
the first dose in the first few days of life, the second dose 1 or 2 months
later, then the third dose 6 to 18 months after the first one.
The Dta (D=Diphtheria; T=Tetanus; aP=acellular Pertussis) vaccine is offers at around 2 months old, and repeated at 4 months, 6 months, 18 months, and a booster at 4 to 6 years. Diphtheria can cause a nasty, life-threatening throat infection in babies. Tetanus can make the muscles uncontrollably spasm (hence the term "lockjaw"). Pertussis, also known as whooping cough, can cause coughing spasms sever enough to deprive babies of oxygen. Unfortunately it has made a comeback in recent years, and needs our vigilance to keep it from stealing the breath from our most vulnerable fledglings.
The polio vaccine is also offered at 2 and 4 months of age. Boosters
are given between 6 and 18 months old, and again at 4 to 6 years. Since
the only cases of polio that occurred in the Western Hemisphere during
the 1990's were due to the oral (live virus) vaccine, the year 2000
saw a return to the injectable (non-live) version of the vaccine. Avoiding
a few cases of polio is worth the extra pinches.
The Hib vaccine is also offered at 2, 4, and 6 months and a booster after
12 months old. It protects against some of the more aggressive staring
of a bacteria called "pneumococcus." This bacteria is the
most common cause of meningitis, bloodstream infections (sepsis), lung
infections (pneumonia), and ear infections. It is most effective in lessening
the incidence of meningitis and bloodstream infections, fairly good about
preventing bacterial pneumonia, but not very effective about preventing
ear infections.
The chicken pox vaccine is offered at 12 months old, since the protective
elements of the maternal antibodies have most likely disappeared. Again,
before the vaccine, almost everyone contracted chicken pox. It was well
know to almost everybody. Since the introduction of the vaccine, fewer
and fewer people are getting the disease, so eventually it will be s familiar
to the general public as polio now is.
The MMR vaccine protects against Measles, Mumps, and Rubelia (also called
German Measles). It is usually given around 15 months, although it can
be given as early as 6 months old in the event of a measles epidemic.
Like the chicken pox vaccine, it is a live virus vaccine. These immunizations
use attenuated, or weakened, strains of the viruses. Recently, the FDA
(Food and Drug Administration) approved a vaccine that combines the MMR
with the chicken pox. It should be available soon.
Ideally, all the vaccines that are necessary can be combined into one syringe, so that one injection would suffice for each visit. Unfortunately, it hasn't worked out that elegantly. Combining some of the vaccines has interfered with the adequate antibody production. Consider this a work in progress.
Another horizon in vaccine development is a vaccine against meningococcus, the third most common cause of bacterial meningitis. This has been used is England with promising results. Right now, it is only on the drawing board for American babies.
More information on vaccinations can be found at www.cdc.gov/nip.
