The Vaccine Book: Making the Right Decision for your Child by Robert W. Sears

Read this book if: you want to learn more about vaccines.  (You’ll have to make a decision at the hospital when they give the Hep B vaccine at birth).  Remember you have the right to delay and put baby on an alternative schedule or to deny (depending on state’s laws).

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If you like the summary, support the author by purchasing a copy here.

*Book not complete as of 10/16/16

 

Also, check out the VAERS database (Vaccine Adverse Event Reporting system): https://vaers.hhs.gov/index (Click on VAERs data and can sort through data you are interested in).

 

Chapter 1Haemophilus Influenzae Type B Disease and the HIB Vaccine

HIB can cause meningitis (infection of lining of brain), blood infections, bone infections, severe throat infections that block breathing (epiglottistis), and pneumonia. Affects mostly infants and elderly. Very similar to PC (Ch. 2). Meningococcus (Ch 11) similar but affects any age.

 

Transmitted like common cold; similar symptoms. Mild case – fever; Dr will treat with antibiotics. Most times recover without knowing child had HIB. Moderate case – lethargy, ill appearance, labored breathing, which prompts chest X- ray and blood testing for infection. Oral antibiotics given; if blood results reveals HIB (2 days later), given IV antibiotics at hospital. Severe case – meningitis, pneumonia, epiglottitis; requires hospitaliziation with aggressive antibiotic treatement (ICU). Complications (hearing loss, learning problems, nerve injury) occur in ~25% of survivors; fatality rate – 5% if not treated right away. HIB blood, bone, lung infections less serious but potentially fatal.

 

Common– No, only ~25 cases each year in U.S. – children under 5, most in first 2 years.

 

Vaccine Schedule – 2 months, 4 months, 6 months, 15 months. Used since 1985.

 

Type: (polysaccharide conjugate) made by culturing bacteria from infected person; sugars filtered out to make vaccine.

 

Brands

  • ActHIB (Sanofi Pasteur) HIB sugar/tetanus toxoid, sucrose, saline, formaldehyde* (<.5 mg)
  • PedVaxHIB (Merck) HIB sugar, saline, aluminum* (225mg)
  • Hiberix (GlaxoSmithKline) – HIB sugar/tetanus toxoid, lactose, saline, formaldehyde* (<.5mg)

*Too much aluminum can cause toxic effects; formaldehyde known carcinogen; these amounts probably harmless

 

Combos

  • Comvax (Merck) – HIB/Hep B
  • Pentacel (Sanofi Pasteur) – HIB, DTap, Polio
  • TriHIBit (Sanofi Pasteur) – HIB, DTap; no longer made

 

Side Effects (studied in 10,000 children)

Common: local reactions – 25%; moderate to high fevers ~5%

Severe: No known

Postmarketing Surveillance: swollen lymph nodes, sterile abscess at injection site, extensive swelling of injected limb, allergic reactions, seizures, hyptonic/hyporesponsive episodes, sleepiness, fainting, apnea, hives, rash

Summary: Reactions mild; severe rarely heard of

 

Reasons For/Against Vaccine:

For: Meningitis/blood infections serious. One of safest side effect profiles of vaccines and ingredients purer than those found in most other vaccines.

Against: Severe cases of disease extremely rare (25 cases per year in U.S. in kids under 5). Breastfed babies who do not attend day care at particularly low risk of catching illness.

Options: Make sure receive aluminum free brand or no more than one aluminum containing vaccine at a time. Can also get as combo vaccine (Comvax contains aluminum and has Hep B, which babies don’t need).

 

Chapter 2 – Penumococcal Disease and the Pc Vaccine

Pneumococcus (Pc) is bacterium that causes wild range of illnesses from mild cold symptoms and ear infections to severe pneumonia, bloodstream infections and meningitis. Transmitted like the common cold. Mild case – fever; may treat with antibiotics. Moderate case – lethargy, ill appearance, labored breathing which will prompt chest X-ray and blood testing. If blood results reveal Pc, IV antibiotics administered in hospital for 1-2 wks. Severe case – symptoms of meningitis/bloodstream infection requires hospitalization with aggressive antibiotic treatment (20-30% fatality rate in children); brain damage/hearing loss can occur if treatment delayed. Most serious Pc infections in infants and children less than 5 (highest risk first 2 years), elderly and people with immune disorders.

 

Common- Yes. Common bacterial cause of respiratory infectiosn; most common cause of infant meningitis. Has dozens of different strains; vaccine only covers 7 most common (~2% of severe cases); most serious starin 19A resistant to many antibiotics. Only 64% of identified strains in past few years in new vaccine (so 1/3 not covered).

 

Vaccine Schedule – 2 months, 4 months, 6 months, 15 months. Isn’t given after 2 yr old because severe cases less common.

 

Type: (polysaccharide conjugate); made by keeping strains of Pc germs alive in soy culture. Bacteria broken up and sugars filtered out. Diptheria bacteria grown in yeast culture and purified into toxoid. Combined with aluminum. No way to become infected as isn’t live. Not available in any combo vaccines.

 

Only 1 brand routinely used: Prevnar 13 (Wyeth). Second brand – Penumovax 23 (Merck) is older version given to people with immune disorders or chonic illnesses.

Contains: Pc Sugar/diphtheria toxoid, aluminum*, polysorbate 80, succinate

*Too much aluminum can cause toxic effects

 

Side Effects (studied for safety in 4700 children).

Common: local/systemic reactions (50% of children with 80% showing fussiness/irritability); high fever (5%)

Severe (8% of test infants, possibly unrelated): pneumonia, severe chest cold with wheezing, gastroenteritis. Severe allergic reactions/seizures in <1%

Postmarketing Surveillance: Not yet available for Prevnar 13; For Prevnar 7 (which could be possible with Prevnar 13): rash at injection site, lymph node swelling in injected limb, anaphylactic shock, angioneurotic edema, apnea.

Summary: Pc vaccine reactions more common/bothersome than milder vaccines HIB and polio. Most infants suffere 1 or more local or systemic reaction, but subside in day or 2 wihtout any ill effects. Severe reactions rare.

 

Reasons For/Against:

For: Pc can be serious; occurs mainly in infants, toddlers and elderly. Fairly common (day cares, schools, checkout lines at grocery store – will encounter this germ). Ingredients coparatively safe; serious reactions rare. Strain 19A increasing and resistant to antibiotics.

Against: Getting vaccine will add to emerging strain problem, such as 19A (study from a few yrs ago revealed that infants who received Prevnar 7 vaccine more likely to catch infection from strain 19A and more likely to hae complicated case of pneumonia). Benefit of protection from 13 strains may increase susceptibly to other strains. Note Prevnar 13 (not Prevnar 7) currently used. If baby breastfed and not in group day care, has lower than average risk. Also not effective against 1/3 of strains (but effective against most, including 19A).

Options: Contains aluminum, so do not give with other vaccines containing aluminum.

Commonality: Dr. Sears has seen only 2 serious cases – a 6 month unvaccinated baby who required surgery/IV antibiotics and toddler with bloodstream infection, who required hospitalization for several days. No lasting consequences.

 

Initial hope was the Pc vaccine would decrease and eventually eliminate, but there has been emergence of other strains with Prevnar 7 (will same happen with Prevnar 13?). High rate of irritability caused by vaccine is concerning; some have to stop serious of doses if too extreme –discuss reactions with doctor prior to subsequent doses.

 

Chapter 3 – Diphtheria, Tetanus, and Pertussis Diseases and the DTaP Vaccine

Diphtheria is a very severe throat infection that is caused by a bacterium; the germ secretes a toxin that irritates the lining of the throat and upper lungs, causing severe coughing and breathing difficulty. The diagnosis is made by sending a cotton swab of the throat to a lab for testing.

 

Transmitted like common cold. Mild case – sore throat and visible white coating on tonsils or in nose; may run its course without treatment or worsen. Moderate case progresses into labored breathing as throat and airway become more swollen; swollen neck glands visible – child will be hospitalized in ICU with intravenous antitoxin; most children recover without any long term problems. Severe case (if treatment delayed) – damage to airway and child’s respiratory status deteriorates (10% fatal); heart inflammation and nervous system dysfunction can occur.

 

Many infectious diseases create same symptoms (strep throat, croup, respiratory infections etc), but clue to diphtheria is recent travel to developing nation and white membrane visible in throat or nose.

 

Common – No (max 5 cases a yr in U.S.; last reported case in 2003).

 

Tetanus is an acute infectious disease that is caused by a bacterium that lives in soil and on dirty, rusty metal and can contaminate unsterile needles. Can live within intestinal system of horses, sheep, cattle, dogs, cats, guinea pigs, rats and chicken and pass into the soil in their stool (soil treated with manure can contain the germs). Can be in other than deep, dirty wounds – surgery, burns, crush wounds, dental infections, animal bites, minor wounds and scrapes, self-piercing and tattoos. Toxin enters person’s nerves and causes paralysis throughout entire body; commonly referred to as lockjaw because often first muscles to become paralyzed. Neurological symptoms begin approximately 1 week after an injury.

 

An unvaccinated person can get the vaccine at the time of a deep puncture wound but it isn’t as effective. A tetanus immune globulin injection (TIG) can be given to unvaccinated person to inactivate any tetanus toxin that may develop (made from antibodies that are filtered out of donated human blood units).

 

Two main types of tetanus: Local – affects wound site. Continuous – muscle contractions can persist for several weeks, then gradually dissipate. TIG shot neutralizes toxin in body tissues, but won’t affect toxin bound to nerve cells. Antibiotics are given to kill tetanus bacteria. Mild form fatal in ~1% of cases; rarely can progress into generalized tetanus, in which toxin spreads into spinal cord and brain, affecting entire nervous system. Severity of diseased determined by timing of TIG treatment; patient can be hospitalized in ICU for many weeks, requiring life support. Seizures, heart arrhythmias, and bone fractures from severe muscle spasm can occur.   11% fatality rate. After toxin has run its course (several weeks), months of rehab may be required. In addition to vaccination, proper wound care is a very important preventative measure.

 

Common– No. Most receive proper medical care and have wounds flushed with clean water and disinfectant. U.S. sees 20-50 cases a year in adults >25 who weren’t vaccinated or didn’t keep up with 10 yr booster. ~1 case/yr in kids <5; handful in older children.

 

Pertussis AKA whooping cough is caused by a bacterium that infects the upper lungs; it secretes a toxin that causes severe irritation and damage to the lining of the upper lungs and throat. Symptoms mimic common cold in first week, then cough worsens into prolonged coughing fits that last from 30 sec – 2 min – so severe that person can barely breathe and when breaths are possible, sound like gasping “whoops” (not present in infants <1).

 

Transmitted like common cost and can last 3 months with treatment. Diagnosed from cough description; nasal swab confirms. Infection creates lifelong immunity.

 

Disease severity is variable and age-dependent. Mild case (majority of cases) more of a nuisance than health risk for toddlers, older children and adults – coughing fits every hour or two, but won’t turn blue or have any other breathing difficulty (feels fine in between fits). Oral antibiotics (usually 5 day azithromycin) used so person is no longer contagious, but damage to airway produces weeks of ongoing cough after germ is gone. Cough may last a month or 2 if treatment delayed or go away quickly if treatment in first few days of coughing fits. No longer contagious after antibiotics complete.   Anyone exposed should be treated with antibiotics. Moderate case – coughing spells that cause infant/young child to turn blue; hospitalization/ observation & oxygen treatment during fits until improves (days or weeks). Younger infants are more likely to suffer moderate/severe case. Rarely, pneumonia is a complication, causing fevers and labored breathing in between coughing spells (treated with antibiotics). Older kids & adults may experience rib fractures or hernias from coughing.

 

Common – Yes. ~10k cases/yr in 90s and early 2000s. Dips and rises in 5 yr cycles, probably underreported due to lack of diagnosis. Vaccine doesn’t work as well as others; only 85-90% protective, also harder to spot than most – teens/adults don’t have coughing fits; their coughs look like common bronchitis so they go without treatment and spread disease. Most adults lose pertussis immunity. In various countries, new strains of pertussis not covered by vaccine.

 

Vaccine Schedule for DTaP (pertussis vaccine not available separately) = 2 months, 4 months, 6 months (given when disease most dangerous). Boosters at 18 months, 4-6 yrs, 12 yrs so that older kids wont pass disease to babies. Schedule can be accelerated in case of an outbreak. Pediatric DTaP approved through age 6; after that teen/adult Tdap version used (only 1 dose, which provide partial immunity).

 

Adults & age 7+ can get 1 dose of Tdap at any time – especially new moms after baby is born and dads while mom is still pregnant; this decreases risk of giving to baby in first 2 months when disease would be most serious and cant yet be vaccinated himself. In states with increased rates of pertussis (CA), special allowance for pregnant women to get vaccine during 2nd or 3rd trimester; safety not yet established – product insert makes it very clear it is not known whether Tdap can cause fetal harm if given during pregnancy. Contains less diphtheria and pertussis than child vaccine since adults react with more side effects when given full dose.

 

Type (Inactivated): Diphtheria & Tetanus germs grown in cultures and toxins filter out and purified using formaldehyde; germs discarded. Pertussis bacteria grown and maintained in a culture, filtered and purified and formaldehyde and glutaraldehyde added to make toxins inactive. Three components combined and aluminum is added. Not live – no way to become infected. Brand Infanrix uses cow tissue extract; Daptacel does not and contains lower levels of each of its 4 pertussis components (~1/3 of the amounts in other).

 

Child Brands of DTaP (Tripedia no longer produced so not included):

Daptacel (Sanofi Pasteur) – germ/toxoid components, saline, 2-phenoxyethanol* (.6%), aluminum* (330 mg), glutaraldehyde* (<30 ng), formaldehyde* (<.5 mg)

Infanrix (GlaxoSmithKline) – germ/toxoid compnents, saline, aluminum* (625 mg), polysorbate 80* (100 mg); formaldehyde* (100 mg); glutaraldehyde*

Adult Brands of Tdap (less diphtheria and tetanus):

Boostrix (GlaxoSmithKline): Similar to Infranrix but less aluminum (390 mg)

Adacel (Sanofi Pasteur): almost identical to Daptacel

Controversial Ingredients: Aluminum, Formaldehyde, Polysorbate 90, glutaraldehyde and 2-phenoxyehtanol

*Too much aluminum, polysorbate 80, glutaraldehyde or phenoxyethanol can cause toxic effects; formaldehyde known carcinogen; these amounts probably harmless

Combo Brands (tricky due to age/schedule restrictions): Pentacel– (DtaP, HIB, Polio); Pediarix– (DtaP, hep B, polio); Kinrix– (DtaP/polio); TriHIBit (DTap/HIB)

 

Can get tetanus vaccine or DT/Td vaccine separately from pertussis, but no pertussis vaccine available.

 

Side Effects of DTaP (studied in 49,000 children):

Common: Systemic (~25% of children). Injection site reactions (~25%, more severe with 4th or 5th doses; 3% will swell entire arm for a week)

Severe: 1/1000 infants suffer nonstop crying for 3+ hrs (encephalitis); 1/14,000 have seizure; 1/16,000 fever >105 degrees. Severe allergic reaction in 1/million. Brain injury, coma, severe seizure disorders rarely reported. Any tetanus containing vaccine can very rarely cause brachial neuritis or Guillain-Barre syndrome.

Postmarketing Surveillance: Cyanosis, diarrhea, nodule and mass at injection site, extensive swelling of injected limb and nearby joings, skin infection and abscess at injection site, severe allergic reactions, nonallergic rashes, seizures, including febrile seizures, hypotonic/hyporesponsive episodes, hypotonia, bronchitis, pneumonia, lymph node swelling, bleeding from low platelet counts, encephalopathy, apnea, SIDS, autism.

Summary: Older version of DTap (DTP) caused severe neurological reactions and permanent brain injury. Replaced in mid 90s; newer vaccine well tolerated by most infants – rarely a reaction other than occasional limb swelling in older kids. Main worry is potential severity of neurological side effects, which are rare.

 

Side Effects of Tdap (7000 teens; 5500 adults):

Common: More common systemic reactions with Tdap than DTap because teens/adults react more in general; 25-40% have headache. 25% teens and 10% adults suffer intestinal complaints of nausea, vomiting, diarrhea or abdominal pain. High fever in ~1%. Local reactions similar to DTaP.

Severe: severe anaphylactic in 1/million. 1 adult had severe migraine and paralysis of one side of face, 1 adult suffered nerve compression in neck and one arm and 1 teen developed diabetes.

Postmarketing Surveillance: Similar to DTap with addition of inflammation of heart, facial nerve dysfunction, fainting, inflammation of spinal cord and Henoch-Schnlein purpura.

 

Reasons For/Against DTaP:

For: Pertussis is common and most serious in first 6 months of life, also hard to control since only 85-90% protective. Periodic rises in disease; high vaccination rates are needed to keep under control and prevent infant fatalities. Booster shots help decrease spread. Diphtheria, while extremely rare in U.S, is very dangerous (hazardous during international travel). Tetanus serious when the rare case happens in a child; child is protected when he grows up.

Against: Tetanus mainly occurs in adults. Diphtheria is virtually nonexistent in U.S. Negative press over old DTP vaccine. No pertussis-only vaccine.

Options: Use brand with lower amount of aluminum or without cow extract. Can choose combo vaccines.

 

All three diseases serious, but only one (pertussis) is common in U.S.; infant fatalities do occur. Vaccination rates for DTaP must remain high to keep pertussis at bay. Most cases of pertussis in unvaccinated children – caused by exposure to infected adults, so Tdap a good option.

 

Hepatitis B Disease and the Hep B Vaccine

 

Hep B is a sexually transmitted virus that causes liver damage and sometimes liver failure and cancer. Can be fatal.

———————to be continued————————-

Missing:

Chapter 4 – Hep B

Chapter 5 – Rotavirus

Chapter 6 – Polio

Chapter 7 – Measles, Mumps and Rubella (MMR)

Chapter 8 – Chickenpox/Varicella

Chapter 9 – Hep A

Chapter 10 – Flu

Chapter 11 – Meningococcal

Chapter 12 – HPV

Chapter 13 – Combination Vaccines, Vaccines for Travel, Vaccines for Other Special Situations, Adult Vaccines

Chapter 14 – Vaccine Research Safety

Chapter 15 – Vaccine Side Effects

Chapter 16 – Vaccines & Autism: The Research to this Point

Chapter 17 – Vaccine Ingredients

Chapter 18 – Alternative Vaccine Schedules

 

 

 

My Notes from vaccine workshops w CA Drs:

Types of Vaccines:

Live Attenuated – contains whole, living virus; can give person infection, but rarely happens. Gives immune system best protection; likely need 1 dose & no adjuvants. Ex: Measles, mumps, rubella, varicella, influenza nasal spray, rotavirus, shingles, yellow fever

Inactivated/Whole Cell: Contains whole germ, but has been killed so can’t infect you. Need multiple doses and adjuvant. Ex. Polio, Hep A, Rabies

Recombinant/Toxoid – genetically engineered so doesn’t contain original germ, but matches germs proteins. Ex. Diptheria, Tetanus

Polysaccharide Conjugate – uses sugars from bacteria and bonds them to portions of another germ; no way to become infected from disease. Ex. Hep B, Influenza injection, Hib, Pertussis, Pneumococcal, Meningococcal, HPV

 

Breastfeeding and Avoiding Day Care Can Help Protect Baby From Infection

If baby is breastfeeding, his chance of catching any of the illnesses below is greatly reduced. Breast milk has antibodies that coat the lining of the nose, lungs, and intestines, so most germs that get inhaled or swallowed are killed. Placing a young baby in a group day-care setting significantly increases a baby’s risk of encountering diseases, including HIB, Pc, pertussis, rotavirus, measles, mumps, rubella, chickenpox, Hep A and the flu. An unvaccinated baby in day care is very likely to catch at least one of these infections in his first few years (especially if not breastfed). Parents considering not vaccinating should breastfeed as long as possible and avoid group setting. Not yet known if vaccines moms received as children are passed as protection to the baby via breast milk; they may pass immunity from any disease, not necessarily from vaccines, so shouldn’t rely on this if considering skipping vaccinations.

 

Vaccines are not 100% effective (most 85-99% effective). In a room full of 100 kids, 10 vaccinated will catch disease whereas most unvaccinated would catch.

 

Chart of all vaccines from CDC with brand, type, route and comments: http://www.cdc.gov/vaccines/about/terms/USVaccines.html

 

 

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Jessica