For kindergarteners, the word "shot" equals terror and often, a full-blown meltdown. But Dr. Charles Terry, who administers booster shots to a significant number of young patients each summer as they prepare for school, says the bigger challenge for pediatricians may be overcoming parents' fears.
Major topics parents are trying to navigate include the general safety of immunizations and worries that there could be a link between vaccines and autism, he says. Largely through the Internet, "people are bombarded with information that includes a lot more opinion than fact," Terry adds. "Pediatricians and family-practice doctors spend a tremendous amount of time trying to allay those fears." A private-practice pediatrician in the Richmond area for 24 years, Terry explains that most vaccines are given to children between birth and age 2, the same period when autism frequently develops. Thus, some people have assumed there's a correlation — but that is scientifically unfounded, he says. Dr. Sean McKenna of Virginia Commonwealth University agrees: "Pediatricians are comfortable saying that there is no relationship between vaccines and autism."
Because vaccines have all but wiped out once-common illnesses, people sometimes see less need for them, says Dr. Danny Avula, deputy director of the Richmond City Health District. "Fifty years ago this country was ravaged … [by] bacteria that would cause pretty serious illness — polio is a good example," he says. "Because we do not see polio anymore, people are hesitant to get the polio vaccine."
Before vaccines were developed, polio would paralyze 10,000 American children every year, according to the Children's Hospital of Philadelphia. In addition, rubella caused mental retardation and birth defects in as many as 20,000 newborns each year, and measles would infect about 4 million children, killing 3,000 yearly. And just 15 years ago, the chicken-pox vaccine was not available, and the disease caused up to 100 deaths nationwide each year, Terry says.
McKenna, an assistant professor of pediatrics, adds that vaccines are "some of the most important work we do" and "one of the greatest success stories of modern medicine." He encourages parents to stay up to date with their children's immunizations. (Free schedule charts are available at cdc.gov/vaccines.) He adds that by the time vaccines reach pediatricians, they often have been tested for up to 10 years.
One new vaccine, released in May, protects children against six additional strains of Streptococcus pneumoniae, the bacteria that has been the leading cause of blood infections, meningitis, pneumonia and even ear infections. Previously, children have received a vaccine that protects them from seven strains of this specific bacteria. Terry recommends that children between ages 2 and 5 receive the new vaccine as a protective booster.
Cautious parents may ask to split up vaccines into a couple of visits, Terry says. For example, five vaccines are traditionally given at the age of 2 months. Though no scientific evidence shows that divvying them has a positive health impact, he says that he makes some exceptions to do so upon request.
Parents also can choose to waive certain vaccines — including hepatitis A and the human papillomavirus (HPV) — that are not required by the state for public school attendance, Terry says. However, he still recommends getting them.
Likewise, doctors recommend flu vaccines, which are also optional, especially for children 2 or younger and for people with chronic illnesses. Terry says parents may request flu shots that do not contain thimerosal, an organic preservative that contains mercury. As a precaution against health risks in general, since 2001 thimerosal has been removed from or reduced to trace amounts in vaccines that are routinely recommended for young children.
Unlike last year, this season's flu vaccine will include strains of immunization to protect against H1N1, Avula says. Dr. Margaret Roberson, head of VCU Student Health, adds that it's vital for college students to get the vaccine because of how affected this age group was by H1N1. And Avula emphasizes that the decision to get a vaccine affects more than the person receiving the immunization: "It protects those who are at greater risk."
Note: Area health departments offer vaccines free or at a reduced cost based on need.