Dr. Belmund Catague, a family physician with MedFirst Primary Care, chats with Texas MD about safeguarding children, preventing diseases with immunizations, and the facts behind vaccines.
Texas MD:What vaccines are commonly given now and how are they typically administered?
Dr.Catague:Vaccine administration is usually given by intramuscular or subcutaneous injection, but rotavirus is given by oral administration, and the influenza vaccine can be given through a nasal route. Some of the doses can vary, depending on the manufacturer of the specific immunization, but the vaccination schedule for infants to 6-year-olds is agreed upon by the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP) and the Centers for Disease Control. Vaccinations for measles, mumps, rubella (MMR), diptheria, tetanus, polio, and Hepatitis A and B are common. Children are also usually administered rotavirus, rotatrix, rotateq and influenza vaccines, amongst a number of others. Some children with sickle cell or an immune deficiency may also need specific meningitis coverage. These patients would need the MCV at 2-, 4-, and 6-months-old, as well as between 12- and 15-months-old.
Texas MD:Why are these vaccines important for children?
Dr. Catague:Immunizations are one of the most effective directives we utilize as a society to prevent disease, morbidity, and ultimately, death. Vaccines effectively prevent disability. Most Americans now have never seen individuals in a wheelchair due to polio, or lost an infant due to meningitis. We receive some immunity from our mothers during the last trimester of pregnancy through the placenta, but we need vaccinations during the first months after birth in order to develop antibodies against deadly, preventable diseases. Before Hepatitis B became part of the routine immunization schedule, around eight children out of every 100,000, in 1990, were being infected with this disease, but by 2000, the rate had dropped to around one case per 100,000 children. This is just one example of how vaccines have reduced the rate of infection.
“There is no medical link between vaccines and autism. The research conducted in 1998 that started this controversy has been disproved.”
Texas MD: Are there side effects, and if so, what are some common symptoms?
Dr. Catague:Vaccines are safe. Any adverse side effects are usually minor and may include a fever that subsides the next day, mild headache, or a local rash or soreness at the injection site. There are rare instances of systemic reaction, but this risk must be weighed against the risk of being infected with measles, which, during an outbreak, is 35 times higher in an unvaccinated individual than in a vaccinated person.
Texas MD:What are dangers or drawbacks of delaying these vaccines, or not giving them at all?
Dr. Catague:There are definitely dangers in not vaccinating, including paralysis, brain damage, hearing loss or death. As for delaying vaccines, a study published in the Journal Pediatrics noted the incidence of post-vaccination seizures, while still low, was 2.65 percent when administered between 12- and 15-months-old, and it increased to 6.53 percent if administered between 16- and 23-months-old. This is one studied consequence of delaying the vaccine schedule. In the 2014 measles outbreak in the United States, 69 percent of the cases were due to unvaccinated patients. Some parents believe there is enough herd immunity to keep their child safe even if not vaccinated, but with more and more parents refusing vaccines, large scale outbreaks, as seen in Disneyland this past year, can and do occur.
Texas MD: Is there any valid medical link between vaccines and autism?
Dr. Catague: Simply put, no. There is no medical link between vaccines and autism. The research conducted in 1998 that started this controversy has been disproved. Despite any celebrity discussion, internet speculation, and persistent concerns in the media, there is no reason to believe vaccines cause autism.
Texas MD: What can physicians tell parents who want to delay or not give these vaccines?
Dr. Catague: Parents may want to delay vaccines for various reasons. Some think they should delay them because they are afraid the MMR vaccine may cause pain, while others are afraid of overloading the immune system with multiple vaccinations at once, and some people may have religious objections. I would advise physicians to have an open dialogue, noting that an overwhelming amount of data shows that vaccines save lives. Address any questions and concerns with facts. Multiple agencies, including the World Health Organization, the Institute of Medicine, the AAFP and AAP, agree on our current vaccination schedule. There is no evidence that we should investigate further for a delayed vaccination schedule.
Texas MD: Do these vaccines pose a risk to children with auto-immune diseases, and, if so, how?
Dr. Catague:Vaccines are safe. The only contraindications are with vaccines for MMR, varicella, and influenza for patients with severe, symptomatic HIV or who have known severe immunosuppression, due to chemotherapy for cancer treatment. Of course, if a patient did have an anaphylactic systemic reaction in the past to a vaccine, then this is also a contraindication. For the flu vaccine, if the patient ever developed Guillain-Barre Syndrome, a neurologic disease which causes weakness in the extremities, within six weeks of administration, then this is also a contraindication.
Texas MD: What is something surprising about vaccines, or something that many people may not know about vaccinations?
Dr. Catague: Despite the seeming trend of more parents refusing vaccines, according to a 2009 survey of parents, just over 93 percent with a child younger than 6-years-old had or would be vaccinating their children. We have to understand that those parents who refuse vaccines are a small minority, and we need to continue to vaccinate children. The states that allow for philosophical and religious exemptions have higher rates of vaccine-preventable diseases than states with religious exemptions only, which makes intuitive sense. The more chances people have to refuse vaccines, the higher the rate of preventable disease. Some parents are concerned about the ingredients, such as aluminum in the Hepatitis B vaccine. And while an infant may receive 1,125 micrograms of aluminum in this vaccine, by 6-months-old that child will have consumed approximately 6,700 micrograms in breast milk, 37,800 micrograms in infant formula, or 116,000 micrograms in soy-based formula. It is a matter of context based on facts, and we should keep that in mind since vaccines are one of the best ways to keep your child healthy.