Vaccines & Infectious Diseases
What vaccines are on the childhood vaccine schedule?
Members of Immunity Education Group support the concept of vaccination as an important public health measure and acknowledge the benefits which vaccines and other modern advances have afforded us by helping to reduce or eliminate many serious diseases. Smallpox and polio are two examples of potentially serious infections which have been eradicated or are no longer prevalent around the world (except for some cases of polio that remain in a few select nations in central Asia and Africa and cases of vaccine-induced polio). Infant meningitis caused by Haemophilus influenzae type B bacteria (Hib) and diphtheria are also no longer threats to American children. Other less-serious but potentially problematic diseases have been reduced or virtually eliminated, such as measles, mumps, rubella, and chicken pox. However, vaccination is a complex medical intervention which should only be offered with informed consent and without social or financial penalties for those who decline this procedure for themselves or their families. There should be an open discussion between each patient and their trusted medical professional about all risks and benefits, without coercion, so that a conscientious decision can be reached for each individual. In addition to informed consent, we believe in the right to freedom of religion involving medical decisions, and the right to a free and equal education for all children without discrimination. Legislation which makes vaccines, or any medical treatment, mandatory for school attendance or employment is incompatible with these basic human and constitutional rights.
2016 CDC Recommended Vaccine Schedule
In the United States, vaccination begins on the day of birth with the first hepatitis B vaccine. It continues with 8 vaccines being administered at each infant check up at 2, 4, and 6 months of age, including the first flu shot at 6 months. By the time an infant is one year of age, 32 doses of vaccination are completed; this makes up almost half of the entire vaccination schedule being completed in the first year alone. 38 more doses of vaccination are recommended by the time a child reaches 18 years of age. The CDC recommends 49 doses of 14 vaccines by Kindergarten and 70 doses of 16 vaccines by the end of childhood (18 years of age).
Vaccines and Infectious Diseases
Vaccine-preventable diseases are at an all-time low in the United States thanks to advances in living conditions, sanitation, lifestyle choices, and modern medicine (including vaccines). Below is a brief description of the current state of each infectious disease which we still vaccinate against in the United States, in order of appearance on the CDC recommended vaccination schedule. (We are also working toward providing a deeper commentary into each disease that will be available in the months to come. For more information on vaccine risks and side effects, click HERE or check our Educational Tools section, under One-pagers).
Hepatitis B is a virus which infects the liver, causing liver failure in rare instances, and eventual liver cancer in some. Most adults (over 95%) who catch Hepatitis B recover without consequence. When it occurs in children, it is more likely to cause serious, lifelong problems; fortunately, the disease is virtually unheard of in American children and is partially treatable with strong prescription medication. Hepatitis B is a blood-born illness, which means it can only be transmitted through contact with the blood of an infected individual into the bloodstream of another person. This can occur through sexual contact, blood transfusions (extremely rare, and blood products are carefully screened), sharing of IV drug needles, contamination from tattoo needles which are not properly sterilized, and in extremely rare circumstances, through the sharing of other bodily fluids. Yet, the hepatitis B vaccine is on the recommended CDC infant vaccine schedule and is mandated for all schoolchildren in states like California and many others. The controversy surrounding hepatitis B vaccine is this: the CDC makes it very clear that the disease is not transmitted through casual day-to-day contact among American children, so why the need for the vaccine? The CDC answers this discrepancy by citing research that shows there are a small number of cases diagnosed each year among older children and young teens without apparent risk factors. In addition, infants born to a mother who is hepatitis B positive can become infected during birth, and living with a household member who is a chronic carrier of the disease also puts a child at about a 30% of eventually contracting the disease. However, these numbers are so small and the circumstances so narrow, it hardly makes sense to warrant three doses of a vaccine for all American babies. The CDC recommends 3 doses of hepatitis B vaccine starting on the day of birth, completed by 6 months.
Haemophilus influenzae type B (HIB):
Hib is a bacterial infection which previously caused thousands of cases of meningitis and bloodstream infections each year in the United States. Precise rates of this disease were not tracked prior to the introduction of this vaccine in 1987, but estimates show it affected about 1 in 5,300 children under 5 years of age, or about 1 in 600,000 people in our whole population. Now Hib is virtually eradicated; less than 25 cases are discovered each year in our country and it is treatable with antibiotics. The CDC recommends 4 doses of Hib vaccine between 2 and 15 months of age.
Pneumococcal infection is caused by the bacteria streptococcus pneumoniae. These bacteria cause a very wide range of disease severity, from simple cold symptoms to an ear infection to pneumonia or, more seriously, a bloodstream infection or meningitis. While the CDC estimates that pneumococcal infection causes thousands of severe cases of illness nationwide each year, the true number of yearly cases in the U.S. is unknown because it is so common that most cases are not even reported, it varies greatly in severity, and it is not a reportable disease. Pneumococcal infection is treatable with antibiotics. The CDC recommends 4 doses of pneumococcal vaccine (known by the brand name Prevnar-13) between 2 and 15 months of age, and 1 dose for all adults 65 and older.
Diphtheria is a bacterial infection that previously caused illness and some death in the United States a century ago. Prior to the vaccine’s introduction in the late 1940s, about 1 in 83,000 people in our population died from diphtheria. It was has been eradicated from the U.S. for over three decades, and there is an occasional case every few years. Diphtheria had a fatality rate between 4% and 10% during its peak and continues to occur in some developing countries. Symptoms include a severe cough and breathing difficulty, and diphtheria is treatable with antibiotics and anti-toxin infusions. The CDC recommends 6 doses of diphtheria vaccine given throughout childhood as part of the combination shot DTaP or Tdap between 2 months and 12 years of age. DTaP/Tdap is required in all states for school entry. Tdap is also recommended by the CDC for all pregnant women during the third trimester of each pregnancy
Tetanus is, perhaps, one of the most feared diseases we vaccinate for today, yet it shouldn’t be. In the 1940s, prior to the vaccine, tetanus killed about 1 in 200,000 people in the United States. Tetanus is now extremely rare. Only about 1 young child and about 5 older kids or teens catch tetanus every year in the U.S., often from a severe wound or bite which introduces dirt and bacteria deep into the body. Between 50 and 100 adults cases occur each year. Some rare cases are a surprise, with no recent wound. Symptoms include “lockjaw” and nerve/muscle spasms and dysfunction; about 10% of cases are fatal. Tetanus can respond to anti-toxin infusions and antibiotics if treated early. The CDC recommends 6 doses of tetanus vaccine given throughout childhood as part of the combination shot DTaP and Tdap between 2 months and 12 years of age. DTaP/Tdap vaccine is required in all states for school entry. Tdap is also recommended by the CDC for all pregnant women during the third trimester of each pregnancy.
Pertussis (Whooping Cough):
Pertussis is a complicated disease and its vaccine is the source of much discussion and debate in the health community across the nation. Historically, this disease caused about 2000 deaths every year in the United States in the 1940s prior to the vaccine; this was about 1 in 77,000 people in the population. Now, pertussis kills about 20 infants each year in the U.S.; all such fatalities occur in those who are three months and younger. In older infants and children, where it is more common, pertussis isn’t fatal, and is rarely serious. This bacterial illness is treatable with antibiotics (if caught early). Pertussis continues to be a challenge in America because the vaccine doesn’t work as well as most vaccines (about 85% effective at its peak), it wears off fairly soon (within two years of the primary series and after each booster dose), and there is some bacterial resistance to the vaccine. This means vaccinated children and adults can still become infected and spread the disease to others. The CDC recommends 6 doses of pertussis vaccine, in the combination shot DTap or Tdap, given at 2 months through 12 years of age. Significant immunity is not achieved until after the third dose; this is why fatalities occur in young infants despite vaccination. Tdap is also recommended by the CDC for all pregnant women during the third trimester of each pregnancy with the claim of providing some immunity for the baby during the early susceptible months. However, the effectiveness of these maternal antibodies in a newborn is unknown.
Polio is a virus that has been eradicated from the United States for over 35 years. Before the vaccine was developed in 1955, polio killed or paralyzed about 1 in 100,000 Americans. It continues to occur in some parts of central Asia and Africa. 95% of cases are asymptomatic; 4% experience mild fever and stomach upset. About 1% suffer paralysis. There is no known anti-viral treatment other than life support until the paralysis wears off. Physical therapy is the most effective treatment. Interestingly, the injected vaccine we now use in the U.S. and many developed countries doesn’t actually provide intestinal immunity or prevent the transmission of the disease. It prevents the neurological complications. Vaccination, therefore, does not help a population’s herd immunity; it simply protects individuals in case the disease returns. The oral, live polio vaccine provides better herd immunity, yet is no longer used in most developed countries (including the U.S.) because the vaccine itself can cause paralytic polio. The CDC recommends 4 doses of the injected polio vaccine between 2 months and 5 years of age.
Rotavirus is an intestinal viral infection that causes vomiting, diarrhea, and (occasionally) dehydration in infants and children. It usually passes harmlessly with no specific treatment. Rarely, infants will become dehydrated and require IV fluids and a short hospitalization. About 10 infants die every year in the U.S. from dehydration. The CDC recommends this live, oral vaccine given as 2 or 3 doses (depending on the brand) between 2 and 6 months.
The flu virus infects millions in the United States every year. For most individuals, it is a mild to moderate illness that passes without consequence. For those with immune disorders or cardiac and lung disease, it can be more serious. Each year in the U.S., about 100 pediatric fatalities and around 1000 to 2000 adult deaths are reported. A common misconception that is perpetuated by the media every year is the following often-used quote: “As many as 30,000 Americans die every year from the flu.” This number is more than ten times the actual reported deaths. This high number is actually the annually reported number of deaths from both the flu and bacterial pneumonia combined. Because some pneumonia cases are a complication of the flu virus, the two statistics are grouped together by diseases researchers. The CDC recommends the flu vaccine for all pregnant women during flu season during each pregnancy. 2 doses are also given to all infants starting at 6 months of age and continued yearly until age 18. *One particular controversy with this vaccine is that it is the only U.S. vaccine that still contains thimerosal, a mercury-based preservative. At this time, more than half of the doses made each year in the U.S. contain mercury. Consumers can and should request a mercury-free formulation, particularly during pregnancy and young childhood. The easiest way to make sure your health care provider is providing you with a mercury-free dose is to get dosed with a single-dose vial or prefilled syringe from the manufacturer. These are free of mercury. Large, ten-dose vials do contain mercury as a preservative. The live-virus nasal flu vaccine is also an option, and does not contain mercury.
Measles is a viral illness that is no longer considered endemic in the United States, meaning it only occurs in small isolated outbreaks initiated by foreign travelers (as a comparison, chicken pox is an example of an endemic disease, one that is continuously present within a country). Measles causes fever, cough, and a characteristic rash. Most cases pass without complications, but some sufferers will develop pneumonia or an ear infection. Before we had a vaccine, which was introduced in 1963, measles killed about 400 Americans every year (1 in 500,000 people in our country). The fatality rate of the disease back then was 1 in 10,000 cases.
Measles all but disappeared in the decades following widespread vaccination, with an average of 128 cases each year over the past 20 years. In 2000, the CDC declared measles eliminated from the U.S., despite the fact that there were 85 cases in the U.S. that year. The CDC’s definition of “elimination” is simply that the disease is no longer endemic. And measles continues to fit this definition today. Some try to claim that measles was completely eliminated and now it’s back with a vengeance, but the data don’t support that theory. No child has died of measles in the United States since 2002.
The last time we had a large outbreak in the U.S. was in 1989 to 1991. Out of the 55,000 identified cases in that three-year period, there were 123 fatalities (about 1 in 500 reported cases). This unexpectedly high fatality gave rise to the misconception that measles is a very serious and dangerous disease. Realize, however, that historically 90% of measles cases were so mild that they weren’t even reported; only about 10% sought medical care. And it is only these 10% which get factored into the fatality rate of 1 in 500. When the CDC mentions this statistic, they are very careful to emphasize that it is a rate known only for reported cases, not total cases.
While no direct treatment is known, high dose Vitamin A is recognized by the World Health Organization and the American Academy of Pediatrics as a way to reduce complications of the illness. The CDC recommends 2 doses of measles vaccine, only available in the combination shot MMR, at 1 year and 5 years of age. It was previously available as a solo vaccine from 1963-2007, but the vaccine manufacturer chose to end production.
Mumps is a virus that causes fever, sore throat, and swollen cheeks. It is very rare in the United States and mainly occurs in periodic college-age outbreaks. There is no known treatment. Fatalities are virtually non-existent, and complications like sterility and deafness are rare. Prior to the vaccine’s introduction in 1967, mumps was fatal or caused a complication in about 1 in 2 million people in our population.
The CDC recommends 2 doses of mumps vaccine, only available in the combination shot MMR, at 1 year and 5 years of age. In the U.S., all 50 states require just one dose of mumps, but because it is only available in a combination shot, all children must receive an additional dose to qualify for measles immunity. In other words, every child must receive an extra dose of mumps vaccine to satisfy school requirements, simply because no solo vaccine exists.
Rubella, or German measles, is a virus that causes fever, rash, and some joint pain. It has been virtually eradicated from the United States, and the less than 5 yearly cases pass harmlessly. It can, however, cause birth defects if a susceptible woman catches the illness during pregnancy. There is no known treatment. Prior to the first use of the vaccine in 1963, rubella caused about 1 fatality for every 9 million people in the U.S.; the rate of rubella birth defects was about 1 in 20,000 pregnancies.
The CDC recommends 2 doses of rubella vaccine, only available in the combination shot MMR, at 1 year and 5 years of age. In the U.S., all 50 states require just one dose of rubella, but because it is only available in a combination shot, all children must receive an additional dose to qualify for measles immunity. In other words, every child must receive an extra dose of rubella vaccine to satisfy school requirements, simply because no solo vaccine exists.
Chicken pox (Varicella):
Varicella is a virus that causes the classic spots (rash) and fever that is well-known to most people. Vaccination has reduced the number of cases dramatically, but it is still considered endemic in the United States. Fatality from chicken pox occurs in only 1 out of every 65,000 cases, yet it is a more serious illness for some who are immunocompromised. Prior to beginning the vaccination program in 1995, varicella caused about 1 death for every 2.3 million people in the U.S. Treatment with a prescription anti-viral medication may reduce the severity of the illness. The CDC recommends 2 doses of the chicken pox vaccine given at 1 and 5 years of age, but only one dose is required for school entry in most states. And because this is a live virus vaccine, the CDC recommends recently vaccinated individuals stay away from immunocompromised people for a few weeks after vaccination.
Hepatitis A is a viral form of food poisoning which results in vomiting, diarrhea, and yellow skin/eyes. Symptoms don’t usually start until about 4 weeks after exposure (usually from a restaurant or from contaminated food or water in a developing country). There is no known treatment other than symptom support. The illness is so mild in children that many cases pass unnoticed. The CDC recommends 2 doses of Hepatitis A vaccine at 12 months and 18 months of age.
Meningococcal is a form of bacterial meningitis which is extremely severe. We are fortunate as a society that it has always been fairly uncommon, even before the vaccine was recommended for widespread use around 2006. Each year in the U.S., about 2000 cases are reported, and about 250 fatalities occur. Most cases occur during infancy and then peak again during the later teen and college years. Treatment with antibiotics can help if begun early. The CDC recommends 2 doses of meningococcal vaccine at age 11 or 12 years and again at age 16. Even though the disease occurs in younger children, an effective vaccine for infants has not yet been developed. At this time, it is only routinely given to older children.
Human Papillomavirus (HPV):
HPV is a virus that can cause genital warts, which, in some rare cases, can lead to cervical and penile cancer. It is the most common sexually-transmitted infection, and it is estimated that unprotected sexual contact with several partners is very likely to result in becoming a disease carrier. Most who contract the virus do not develop cancer. Some will develop visible warts, but for many, the virus is only detectable with a microscope. Pap smears detect the virus and early treatment can eliminate it before it progresses. Approximately 10,000 cases of cervical cancer occur in adults each year in the U.S. from all strains of HPV, with about 3500 fatalities. The HPV vaccine only helps protect against two of the many cancer-causing strains. There are many more circulating strains which the vaccine does not protect against. The CDC recommends 3 doses of HPV for both boys and girls around 11 or 12 years of age, with susceptible populations advised vaccination at 9 years of age.