Fall 1998 Volume Two Number One

• Oh,no! Again? Not Another Shot!!
—a look at childhood vaccinations.

Those of you with infants have probably noticed the proliferation of pokes that your children receive when they come in for well child check-ups. We thought it might be helpful to discuss the why's and wherefore's for today's vaccines.

For background, no preventive health care intervention has been more successful and cost effective than the vaccinations that we give to your children. How many of you have seen a case of polio, tetanus, diphtheria, measles, German measles or mumps?

These illnesses were common in the first half of this century. Let's not lose sight of the fact that despite the minor side effects from these vaccines, they have contributed tremendously to decreasing infant and child mortality and morbidity in the current generation.

Meningitis, a success story

The vaccination against Haemophilus Influenza type b (Hib) was introduced approximately 13 years ago. Before its introduction, there were nearly 12,000 cases per year of meningitis caused by Hib.

Five percent of those children died and 15% to 30% developed serious neurological problems. Currently, the incidence of invasive Hib disease has decreased to approximately 300 cases per year. It has become rare to see a child with bacterial meningitis. This is a true success story!

First of all, do no harm

With the introduction of the oral polio vaccine in the 1950s, the number of cases of poliomyelitis dropped sharply. After forty years of use, in fact, the only cases of polio each year were a dozen or so cases caused by the rare activation of polio from the live oral vaccine.

Recently, it was concluded that even those few cases were too many. For this reason, we have changed at least the first two vaccinations of the series to the injected, inactivated polio vaccine. Once administered nationwide, this should hopefully eliminate the rare case of polio caused by the oral vaccine.

A pox on chickenpox!

The varicella (chickenpox) vaccine was approved about four years ago. What have we learned so far?

• In general, the vaccine is quite safe. With over eight million doses administered, adverse reactions are extremely rare. There have been only a handful of allergic reactions to the vaccine.

• The vaccine works. It has produced protective antibody in the recipient 86 percent of the time. This is comparable to other live vaccines. In cases where the vaccine has "failed", most cases had less than fifty lesions, a very mild case of chickenpox.

• It is too early to have information on how the vaccine has affected the overall incidence of chickenpox. Vaccination rates around the country vary tremendously. In Minnesota, approximately 30% of eligible children have been vaccinated to date. As use of the vaccine increases, we expect the number of cases to fall quickly.

• How long does it last? One of the biggest questions asked about the vaccine is how long the immunity will last. In the original studies done on the vaccine from the 1960s, the level of protective antibodies has stayed high with time (over 30 years!). It is expected that as the data comes back from the larger population it will mirror this data.

• It appears that the incidence of shingles, a sequelae of chickenpox, is lower in children who were vaccinated compared with those who contract the disease naturally.

So, should your child get the chicken pox vaccine? The answer is a definite yes.

A shot against ear infections? You've got to be kidding!

Researchers are diligently working on a polyvalent vaccine against pneumococcus. A pneumococcal vaccine has been around for quite a while but it does not provide much protection against the types of bacteria which cause the majority of ear infections.

Recently, a heptavalent (five types) pneumococcal vaccine was approved which broadens the spectrum of bugs covered. This is the first step in developing a vaccine that is effective in preventing the major cause of ear infections.

What? No more shots?

Lest you think that we like giving all these shots to your children, we don't! Scientists are working on other routes of giving vaccine which doesn't involve a needle. A Cholera vaccine has been developed which can be administered on the skin surface with a patch! Also, they are working on a nasal spray vaccine. Of course, these all will take time to be developed. So until then, we'll just have to put up with a little crying and tears.

— Howard Bach, MD