Today our children have only to endure a series of pricks at the doctor’s office to be spared not just polio but a host of childhood diseases.

The American Academy of Family Physicians recommends that all adults over age 50 should get the flu vaccine each fall.

Despite the emphasis placed on childhood immunization, about 20 percent of American children still go unvaccinated.

On the television reality show Survivor, contestants strive each week to win the challenge so they can gain immunity–the prize that protects them from being banished from the island by their fellow contestants. Immunity confers power and confidence. They know that as long as they hold it, they are invulnerable to attack and are guaranteed survival for at least another week.

Real immunity, from diseases that can make us sick or even kill us, is a far greater prize, but one that many take for granted.

Immunization is one of the great triumphs of public health. In the 19th century, smallpox was a major scourge, devastating families with illness and death. The development of an effective vaccine resulted in the eradication of smallpox worldwide. The 20th century saw the tragedy of the polio epidemic miraculously arrested by the polio vaccine that has eradicated polio in the Western world.

Today our children have only to endure a series of pricks at the doctor’s office to be spared not just polio but a host of childhood diseases that for their parents were the stuff of childhood: measles, mumps, rubella, whooping cough. Now even chickenpox can be avoided with the varicella vaccine. It’s hard to imagine that childhood could be complete without a bout of chickenpox.

The varicella vaccine was added to the Recommended Childhood Vaccination Schedule in 1996. The vaccine is from 70 to 90 percent effective and is expected to prevent most of the four million cases of chickenpox annually in the United States.

Other recently introduced vaccines that are recommended for children include pneumococcal conjugate vaccine and hepatitis A and B.

As the list of vaccines grows, so too does the number of shots required. Many vaccines have to be administered in multiple doses at set intervals to ensure immunity.
In an effort to simplify the childhood immunization process, a number of vaccines can be combined and given as one shot. DPT combines diphtheria, pertussis and tetanus, MMR combines measles, mumps and rubella, making the schedule easier for both parent and child.

Currently the Recommended Childhood Vaccines and ages are:

• Diphtheria, tetanus toxoids and pertussis (DPT): 2, 4, 6 and 15 months and 4-6 years.
• Haemophilus influenzae type b, (Hib): 2, 4, 6 and 12 months
• Inactivated polio: 2, 4, 6 months and 4-6 years
• Pneumococcal conjugate (PCV): 2, 4, 6 and 12 months
• Measles, mumps, rubella (MMR): 12 months, 4-6 years.
• Varicella: 12 months
• Hepatitis A: 24 months-18 years (Recommended in selected states or regions, and for certain high-risk groups)
• Hepatitis B: Birth, 1, 6, months..

[For more detailed information see “Recommended Childhood Immunization Schedule - 2001,” Morbidity and Mortality Weekly Report, Jan.12, 2001]

Many Children Slip Thru Cracks
Despite the emphasis placed on childhood vaccinations in the United States, many children still go unvaccinated. Vaccination levels currently hover around 80 percent.

The reasons for failing to immunize children are many. They may involve a reluctance to vaccinate children for religious or cultural reasons, concern about possible side effects of vaccines, philosophical opposition or lack of access to health care because of poverty.

States generally require routine childhood vaccinations for all children entering kindergarten. Some day care centers also require proof of immunization. An increasing number of families home school their children, however, and if some of these families choose not to vaccinate their children they may reach adulthood without standard immunizations.

Health officials in the United States insist that every child has a right to be vaccinated and to enjoy protection against the world’s preventable diseases. Failure to maintain high levels of immunization was blamed for the measles epidemic in the United States in 1989-1991. The epidemic resulted in 55,467 measles cases that required 11,251 hospitalizations and resulted in 136 deaths.

Although some parents worry about serious side effects from vaccines, such reactions are rare. Far more serious are the possible complications of the diseases they protect against, as the 136 deaths attributed to the 1989-1991 measles epidemic attests.

Vaccinations Not Just For Kids
Although most adults have received standard vaccinations in childhood, there are some immunizations that need boosters, some that are given in adult years and others that were not available when today’s adults were young.

The tetanus and diphtheria shots given in childhood need to be updated with a booster every 10 years to ensure continued protection.

Most adults have had or been exposed to chickenpox. For those who haven’t been exposed, however, the varicella vaccine now available can help ward off a future case. Chicken pox tends to be a more serious illness in adults than in children and is more likely to be accompanied by pneumonia or encephalitis.

Adults over age 65 or those with health problems that increase their risk of infection, are advised to be immunized against pneumococcal pneumonia. It’s a one-time shot that confers lifelong protection.

Vaccination against influenza has the disadvantage of needing to be renewed annually, because of the different strains of flu that circulate each year. The vaccine is about 90 percent effective in young, healthy adults but only about 40 percent effective in the frail elderly. Some 20,000 persons die each year in the United States as a result of the flu and its complications.

The American Academy of Family Physicians now recommends that all adults over age 50 should get the flu vaccine each fall. Studies show that deaths are most likely to occur in adults over age 50. Large-scale vaccination of adults will prevent much unneeded illness and loss of work time.

Hepatitis A and B vaccinations are recommended for adults in specific high risk groups.

Hepatitis A affects 143,000 persons in the United States each year and 10 million persons worldwide. The disease poses a greater threat to travelers than typhoid fever, cholera or yellow fever. New vaccines available since 1995 offer protection for 20 years or longer. Outside of rest and sound nutrition there is no treatment for those who contract hepatitis A.

Hepatitis B, a major cause of acute and chronic liver disease, kills an estimated five thousand persons in the United States each year. It’s transmitted mostly among adolescents and young adults. Health care workers, injection drug users, those with multiple sexual partners and others classified at high risk for the disease should be vaccinated.

Although we still fear cancer and heart disease, many of the diseases that killed our ancestors have been tamed by vaccination. We hold the power of immunity against a great many of the world’s killer diseases, but to claim our immunity we have to ensure we take the relatively simple steps required to vaccinate ourselves and our children.

REFERENCES:
Dorothy Borton, “Fighting the Flu,” Nursing, October 2000.
L. Boyer-Chuanroong, “Adolescents are the Orphans of Immunization Process,” Journal of Public Health, September 1997.
Charles Marwick, “New Recommendations for Adult Immunization,” JAMA, December 15, 1999.
“Children’s Immunization Campaign Launched at World Economic Forum, Hepatitis Weekly, February 14, 2000.
Charlotte LoBuono, “Steps to Improve Immunization Rates,” Patient Care, May 15, 2000.
Michael McDonnell and Frederick Askari, “Immunization,” JAMA, December 10, 1997.
Gustav Nossal, “The Biotechnology Revolution and World Health,” Public Health Reports, March-April 1998.
Mary Desmond Pinkowish, “The Bright Spot: Immunization in 1998,” Patient Care, August 15, 1998.
“Recommended Childhood Immunization Schedule – United States, 2001.
Robert Sindelar, “Primer on Vaccination,” Drug Topics, May 18, 1998.