The timing of vaccines and the vaccines which are given are
carefully chosen to protect not only the most vulnerable members
of our society, but also the entire human population on earth.
Those most vulnerable to disease include infants, small children,
pregnant women and anyone with a compromised immune system.
An exception to the preceding statement can be found if we look
at the 1918 flu pandemic. Twenty million people died because that
particular strain of flu caused what we think was a cytokine storm
in the 20–40 age group, or those with the healthiest immune system.
(Even healthy individuals need vaccines.)
The hepatitis B vaccine is given at birth because hepatitis B may
be asymptomatic in many, including pregnant women. Eighty to 90%
of infants infected during the first year of life will develop chronic
active hepatitis as compared to five to 10% of healthy adults who
contract hepatitis B. Chronic hepatitis B infection can progress to
cirrhosis and hepatocellular carcinoma more frequently in infants.
In 2015, hepatitis B resulted in 887,000 deaths worldwide. Hepatitis
B vaccine at birth is boosted at one to two months of age and again
at six to 18 months.
Polio is a virus for which there is no cure. Globally, due to polio
vaccination, 16 million people are able to walk who would have
otherwise been paralyzed. Polio vaccine has prevented up to 1.5
million childhood deaths. In 1988, there were 350,000 reported cases
of polio in 125 countries. Statistics from 2018 report only 33 cases.
Diphtheria and tetanus are extremely rare but still occur. There
were five cases of diphtheria reported in the past decade in the U.S.
Globally, 7,100 cases were reported in 2016. Diphtheria attacks
the respiratory tract presenting as a membranous nasopharyngeal
obstructive laryngotracheal bronchitis which can quickly progress
to airway obstruction, myocarditis, heart block and cranial or pe-
ripheral neuropathy. Diphtheria is treated with antibiotics. There
is no cure for tetanus. Tetanus enters the body through an open
wound. There are fewer than 50 cases of tetanus in the US annually.
The WHO reports that in 2015, 34,000 newborns died from tetanus
due to unsanitary delivery conditions in underdeveloped nations.
This was actually a 96% decrease in the number of newborn deaths
compared to 1988. People who recover from tetanus do not develop
immunity.
Recently, a 6-year-old unvaccinated child in Oregon cut his
forehead while playing on a farm. Within a week, he developed
involuntary muscle spasms, trismus and respiratory distress. He was
diagnosed with tetanus and spent 50 days in the hospital, 30 of those
days in the ICU on a ventilator. The total cost of hospitalization was
$800,000. He received tetanus immune globulin and DTaP in the
hospital and spent 17 days at a rehabilitation center. Parents were
informed that surviving tetanus did not confer immunity however
they declined all further immunizations.
DTaP vaccination is recommended at two, four and six months,
boosted at 15 to 18 months and again at ages four to six. The initial
series may be completed at 12 months as long as six months has
KIDS' STUFF
elapsed between the third and fourth doses. Tdap is given at ages
10 to 12 and again at age 16. Children between seven and 10 years
of age who have not completed their primary series may receive a
single dose of Tdap. All adults who will be in contact with a newborn
must be vaccinated with Tdap to protect the new baby from infection.
So far as grandparents, not all Medicare D plans cover the cost of
the vaccine and doctors for adults will stress how important it is to
spend this money for the health of their new grandchild (repeated
at 10 years for adults).
Rotavirus is the most common cause of diarrhea in infants and
children resulting in 215,000 deaths globally per year due to dehy-
dration, electrolyte imbalance and acidosis. Rotavirus can survive
for days to months on fomites such as toys that are not sanitized
after use. Since its introduction in 2006-2008, hospitalizations due
to rotavirus have decreased by 75% and emergency room visits in
the US have decreased by 50,000/year. Two vaccines are available
for rotavirus vaccination. Rotarix is a two-dose series given at two
and four months. RotaTeq is a three-dose series given at two, four
and six months. The first vaccine must be given before 15 weeks
of age, and the last dose must be given before eight months of age.
Pertussis, or whooping cough, begins as a mild respiratory illness
and progresses to paroxysmal coughing spasms characterized by an
inspiratory gasp (whoop) and repeated cough on the same breath.
Symptoms may last two to three months. Adolescents and adults
can experience syncope, weight loss, sleep disturbance, inconti-
nence, pneumonia and rib fractures. Sixty-six percent of infants
with pertussis require hospitalization, and complications are more
severe and can include hypoxia, apnea, pulmonary hypertension,
encephalopathy and death. In 2012, there were 48,000 cases of
pertussis reported in the US, the highest in 50 years. California,
the epicenter of the anti-vaccination group, had 12 infant deaths
in that year.
The hemophilus influenzae type B (HiB) bacteria can cause
pneumonia, bacteremia, meningitis, epiglottitis, septic arthritis,
cellulitis, otitis media, purulent pericarditis and death from over-
whelming sepsis. Before the introduction of the HiB conjugate
vaccine in 1987, HiB was the most common cause of meningitis in
infants and epiglottitis in young children. Since the introduction of
the vaccine, HiB disease has decreased by 99% in children younger
than five years. At the present time, it occurs in children who are
under-immunized and infants who are too young to have completed
their primary series. The vaccine is given at two, four and six months
and boosted at 15-18 months.
Once a vaccine for HiB became available, strept pneumoniae
became the most common cause of respiratory-related illness and
invasive blood borne illness in children. Nasopharyngeal carriage
ranges from 20-50% in industrialized countries to 90% in under-
developed areas. Prevnar 13 (PVN 13) is a conjugate vaccine that
was licensed in 2010 conferring immunity to the most common 13
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