In Hamilton County and surrounding regions there are numerous vaccines available but which ones do infants, children, and adults really need and why?
What is a Vaccine
American Heritage Science Dictionary defines a vaccine as a preparation of a weakened or killed pathogen (or a portion of its structure), such as a bacterium or virus, that stimulates the body’s immune system to produce antibodies that destroy pathogens. Scientists typically make vaccines by destroying or weakening a sample of the pathogen with heat or chemicals. Most vaccines are given orally or by intramuscular or subcutaneous injection.
What is Required
According to Dr. Valerie A. Boaz, Health Officer at the Chattanooga-Hamilton County Health Department, some vaccines are only recommended but several are required.
For school and daycare entry, : 1) DTaP (or a formulation of DTaP), 2) Polio, 3) MMR, and 4) Varicella (chicken pox) are all required at specific ages. The Hib (Haemophilus Influenza) vaccine is required for daycare entry. For school entry only to kindergarten or seventh grade, the Hepatitis B vaccine is required, says Boaz.
She further notes that certain vaccines may be required for college entry based on local policy or possible exposure (i.e., students majoring in a healthcare field or a freshman living in a dorm). These can include Hepatitis B, Tetanus/diphtheria, MMR, and Meningococcal.
What do Vaccines Prevent
Once parents know the names of vaccines that are required, the next step is to find out what they help prevent:
- DPT, currently known as DTaP, is a vaccine which protects against Diphtheria (a serious bacterial infection of the throat), Tetanus (commonly known as “lock jaw”), and Pertussis (commonly known as “whooping cough”). Five doses are recommended for children between the ages of 2 months and 4 to 6 years. “A new and recently licensed formulation of this vaccine is Tdap,” Dr. Boaz says. “Tdap is licensed for use in adolescents and adults. Previously, there was no pertussis-containing vaccine licensed for use beyond age 6 years.”
- MMR vaccine provides protection against measles (commonly known as “7-day measles” or “hard measles”), mumps, and rubella (commonly known as “3-day measles” or “German measles”.) Two doses are recommended between the ages of 12 months and 4 to 6 years.
- Polio vaccine is given by injection beginning at age 2 months. Three to four doses are required by age 4 to 6 years.
- HIB vaccine protects against Haemophilus influenzae, type b, a bacteria which can cause serious infections in children under the age of 5. Three to four doses are given between 2 months through 59 months of age. According to Dr. Boaz, a significant decline in childhood Haemophilus infections has been noted since this vaccine was licensed in 1985.
- Varicella vaccine protects against chicken pox disease. Dr. Boaz says in the past, one dose was recommended but because some cases of chicken pox still occur in vaccinated children, many providers are now giving two doses.
- Hepatitis A vaccine was recommended for all children in 2005 based on the successful implementation of this childhood vaccine in high incidence areas, says Dr. Boaz. An initial dose is recommended beginning at 12 months of age and a booster dose is given at least 6 months later.
- Hepatitis B vaccine was added to the childhood immunization schedule in 1991; it is given as a three dose series beginning at birth.
New Vaccines
The Pneumococcal conjugate vaccine (brand name “Prevnar”) protects children against serious infections, including meningitis, caused by several strains of the Streptococcus pneumoniae bacterium. Up to four doses are given between the ages of 2 through 59 months.
According to Dr. Gary Meredith, a pediatrician with Pediatric Diagnostic Associates in Chattanooga, Georgia passed a new law in February 2007 which required all children born after January 1, 2006 to receive both a Prevnar and Hepatitis A vaccination in order to attend preschool.
“In addition, Georgia is now requiring a Varivax booster for children entering school kindergarten through fifth grade and for all sixth graders this year,” Dr. Meredith says. “I expect Tennessee to do this as well in the next one to two years.” He notes that Georgia also passed this law in February 2007.
Another recently licensed vaccine is Meningococcal conjugate vaccine (brand name “Menactra”) which protects against serious infections, including meningitis, caused by the bacterium, Neisseria meningitidis. Licensed in 2005 for ages 11 to 55, it is recommended beginning at age 11 through adolescence.
“Due to a higher incidence of occurrence, this vaccine is especially important for previously unvaccinated college freshmen who will be residing in dormitories,” says Dr. Boaz.
One of the latest vaccines on the market is the Human Papilloma Virus (HPV) vaccine (brand name Gardasil) which was licensed in 2006. This vaccine protects females against four types of HPV most commonly linked to cervical cancer and certain cervical infections. Three injections of this vaccine are given over six months; it can be given to females ages 9 to 26 and is recommended to be routinely given to all girls when they are 11 to 12 years old.
Also relatively new to the public is the Rotavirus vaccine (brand name RotaTeq), an oral vaccine given to infants to protect them from rotavirus infections which can cause severe diarrhea and dehydration. Licensed in 2006, this vaccine is given in three doses to those between the ages of 6 to 32 weeks.
Dr. Boaz notes that some vaccines are available in combination form.
Vaccinations – A Necessity
For many parents, vaccinating their child may be a daunting thought but most doctors agree that it is a necessary part of childhood development.
Angel Daugherty, a Chattanooga native, says she felt concerned that her 19-month-old daughter Chloe may have adverse reactions to her required immunizations. “My pediatrician explained what symptoms to watch for and gave me enough reassurance as well as research materials,so that I felt at ease and confident about her receiving necessary vaccinations.”
Chattanooga resident Jessica Boyd, a registered nurse and mother of 10-month-old daughter Azariah, says, “I think vaccinations are good for the population as a whole but I don’t agree with the Hepatitis B vaccine at birth. I think that’s too early. I think we vaccinate children a little too early and we give them too many altogether.”
Dr. Meredith believes vaccines have been markedly improved over the years.
“The routine vaccines that infants receive in the pediatrician’s office are thimerosal free,” he says of the ethylmercury-containing preservative which was once used in vaccines to prevent them from being contaminated with bacteria or fungi. “Childhood vaccines are necessary. Many of these diseases have not disappeared from the earth.”
Dr. Meredith says he still sees cases of chicken pox and whooping cough in Chattanooga every year. “Hemophilius influenzae Type b (Hib) used to be the most common cause of meningitis,” he adds. “If we stop the vaccine then this organism will reemerge as a major pathogen.”
He recalls how Chattanooga saw a measles epidemic in the early 1990’s. “Cases of measles are still being brought to this country from China. Measles can cause death. Without the MMR vaccine our children are at risk,” says Dr. Meredith. “The only disease that has been eliminated from the earth is small pox but we all live in fear that someone will unleash it in biologic warfare.”
Adults Need Vaccinations
Infants and children are not the only ones in need of vaccinations. Dr. Boaz says adult booster doses are recommended when vaccine protection wanes over time, or in the case of flu vaccine, where the virus mutates over time and a vaccine which matches the mutated strain is available.
She says certain vaccines are recommended for adults based on their age, risk of exposure (i.e. occupational or recreational), or health status. The following vaccines are recommended to all adults:
- Pneumonia (pneumococcal polysaccharide) vaccine – One dose usually at age 65; may be given earlier based on health status.
- Tetanus/diphtheria (Td or Tdap) vaccine – A booster every 10 years but may be given at five years if an exposure occurs (i.e., puncture wound, animal bite). One dose (only) of Tdap is recommended in place of one Td booster.
- Influenza (flu) vaccine – Annually; it is encouraged for persons at high risk of influenza complications (i.e., individuals 65 or older or 6 to 59 months old, chronically ill, pregnant, health care worker, or in contact with infants or young children or other high-risk people).
Costs versus Benefits
As for the cost of vaccinations, Dr. Meredith notes that it will cost over $1,000 out of pocket to vaccinate a child from birth to age 5. Costs covered by insurance companies may vary according to carriers and plans.
“Federally-funded programs make vaccines affordable for all children 18 years of age and younger,” says Dr. Boaz.
Of course there are pros and cons to every mandatory vaccine. “Vaccines save lives and especially protect those most vulnerable to complications from serious diseases,” says Dr. Boaz. “Protecting persons from vaccine-preventable diseases also saves money (i.e., medical costs and lost-wage costs). Vaccines are an important, effective, easily-accessible public health tool.”
She says cons may include the brief discomfort of injections and the infrequent occurrence of side effects which are usually mild. “Compared to the discomfort of being ill for several days or dealing with the complications (i.e., hospitalization, disability, or even death) of a vaccine-preventable disease, the cons are minimal,” says Dr. Boaz.