KIDS' STUFF
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strains of disease. It is given at two, four and six months and boosted
at 15-18 months. The older polysaccharide vaccine (PPSV23) can
be given after age two to children with underlying medical condi-
tions. It does not generate adequate immunity in those less than
two years of age. There has been an overall decrease in pneumonia
and invasive pneumococcal disease in adults, infants and children
since the PCV 13 was added to childhood vaccines.
Hepatitis A is often a mild, self-limited disease in young children
who contract it from exposure to contaminated food or water. How-
ever, the recent type in Kentucky and southern Indiana was a much
fiercer, lethal strain. Older children and adults can have symptoms
that last anywhere from two to six months. Fulminant hepatitis
can occur in those with underlying liver disease. Two vaccines are
licensed to be given as young as 12 months and boosted (Havrix)
six to 12 months later or (Vaqta) six to 18 months later.
Invasive meningococcal disease has a 10-15% fatality rate with
another 15-20% of infected individuals surviving with neurological
damage, limb loss and deafness. The disease progresses rapidly
from minor flulike symptoms to overwhelming sepsis in 24 to 48
hours. Ten percent of the population are asymptomatic carriers.
Strains B, C and Y cause the most illness in the U.S. with a peak
incidence in infants less than four months old and 15 to 24-year-
old adolescents and young adults. Two vaccines are licensed for
the MenACWY strains. Both vaccines are currently given at age 11
years and boosted at age 16. MenVeo is actually licensed down to
age two months, and Menactra is licensed down to nine months.
In general, the meningococcal vaccines should not be given at the
same time as the pneumococcal vaccines since there is interference
with immunogenicity.
Two meningococcal type B vaccines are currently available.
Trumenba is given in three doses at zero, one to two months, and
six months in the three-dose series. It can be given in two doses
at zero and six months in certain instances. Bexero is given in two
doses one month apart. Currently, these two vaccines are recom-
mended to be given to teens age 16 through 18 before entrance to
college. They may be given to children age 10 years and older with
a compromised immune system. European countries have a greater
incidence of disease from Type B and the vaccine is already being
given in 32 countries to infants starting at two months of age.
Human papilloma virus (HPV) is the most common sexually
transmitted disease in the U.S. Most carriers are asymptomatic
but can still transmit the disease. One does not have to have sexual
intercourse to become infected. It is the primary cause of genital
warts and implicated in 90% of anorectal cancer, 70% of cervical
cancer, 30% of oral and esophageal cancer, as well as penile cancer.
The HPV vaccine is licensed down to age 9 and has recently been
expanded up to age 45. Individuals less than 15 years of age receive
two vaccines 6-12 months apart because younger adolescents have
a better antibody response. After age 15, three doses are needed to
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LOUISVILLE MEDICINE
complete the series at zero, one to two months, and six months. A
friend of mine recently asked a surgeon she works with if she should
give the vaccine to her children. His response was priceless: “Duh!
It’s a cancer shot!”
Two doses of the MMR (measles, mumps and rubella) and
chickenpox vaccine are required for school entrance and generally
given at 12-15 months and repeated at four to six years. There were
1.2 million deaths from measles worldwide and a reported 89,000
deaths in 2016. Prior to 1963 in the U.S., when the first measles vac-
cine was developed, 500 children per year died from measles. Major
complications from measles include acute encephalitis, resulting in
permanent brain damage, and rarely SSPE (Subacute Sclerosing Pan-
encephalitis) which can occur seven to 11 years after infection and
causes a degenerative neurologic disorder characterized by behav-
ioral and intellectual degeneration. Sequelae of mumps can include
orchitis, oophoritis, thyroiditis, glomerulonephritis, myocarditis,
transverse myelitis, pancreatitis, encephalitis, thrombocytopenia and
hearing loss. The main complication that can result from rubella is
Congenital Rubella Syndrome (CRS). This devastating syndrome
causes a constellation of congenital anomalies in all trimesters and
is the only known cause of autism. Fetal death can result in the first
two trimesters of pregnancy.
Chickenpox is not without its own set of possible complications.
Aside from a generalized painful pruritic rash, it can result in skin
infection, pneumonia, central nervous system involvement such as
acute cerebellar ataxia, encephalopathy, stroke, thrombocytopenia
and more rarely glomerulonephritis and hepatitis. Shingles, which
can cause loss of sight or hearing in complicated cases, universal-
ly follows chickenpox at some point, unless shingles vaccination
(Shingrix) is successful.
Serious events occurring after vaccines are extremely rare. Fe-
ver, soreness and swelling at the site, and prolonged crying tend to
be reported more frequently. Febrile seizures and anaphylaxis are
extremely rare. No links have ever been found to SIDS or neuro-
logical disease after vaccination. Current egg allergies are no longer
considered a contraindication to vaccination since egg antigen
exposure in the newer vaccines is minimal.
In summary, all 50 states require vaccines for entrance into
public schools. Forty-six states allow religious exemption while
only four states allow medical exemption from vaccines. Fifteen
states allow exemptions based on personal beliefs. Since the current
measles epidemic, several state legislatures are moving to stop that
exemption. The goal of immunization is to control transmission
of infection, eliminate disease, and eradicate the disease-causing
pathogen. Children cannot protect themselves, therefore we as
responsible adults must make decisions regarding our children’s
health based on scientific knowledge and research, instead of fear
and misinformation.
Dr. Daly is a pediatrician practicing at Brownsboro Park Pediatrics.