Vaccines For Life

Vaccination might appear to be a miracle of modern science, but the idea of immunization goes back more than a thousand years to China, where infected cells were inhaled through the nose or scratched into the skin in an attempt to protect against smallpox. The practice took a leap forward in 1796, when an English scientist, Edward Jenner, used a similar virus, cowpox, to create his own successful smallpox vaccine. In the centuries that followed, many more vaccines have been developed and refined—and other diseases such as polio, mumps and measles have been eradicated or close to it. “We should be happy that we live in the age that we do,” says Dr. Eugene Gatti, an immunologist in Marlton. “We can prevent a lot of diseases that would kill us at a very early age.”

Vaccines, although not totally without critics, have become a way of life. Americans receive immunizations almost from the day they are born. Others are timed to various life stages. In most cases, vaccines require years of research before they are released to the public, but as threats to public health arise, some vaccines have been developed or improved with remarkable speed. In 2009, when the H1N1 influenza virus, also known as the swine flu, caused a rash of illness and death, a vaccine was created in the middle of flu season and distributed to health care providers. Currently under development in a more routine manner are vaccines to protect against malaria, HIV and Lyme disease.

Vaccines in widespread use protect us against illnesses such as polio, hepatitis B and measles that could have devastating effects. They may require a single dose or multiple doses and are usually given by injection, though some are available as an ingestible liquid or nasal spray. “When you get a vaccine, you are actually getting a live, attenuated [weakened] or dead virus or bacteria in your body,” says Gatti. The body’s immune system reacts by creating antibodies that could fight against a future infection.

More refined than ever, vaccines today pose little to no health risk for most people, according to Gatti. After receiving a vaccine by injection, people may notice redness or soreness at the site or develop mild body aches or a low-grade fever. Severe reactions like anaphylaxis, which can lead to shock, difficulty breathing and death, and Guillain-Barré syndrome, when the immune system attacks part of the nervous system, are extremely rare.

Most vaccines do not contain live viruses or bactetaining weakened live pathogens, are sometimes given and pose a little more risk, as recipients can infect other people. “You can transmit it through your secretions or your stool or your urine,” says Gatti. For this reason, physicians will usually ask their patients if they live with someone who has a compromised immune system due to chronic illness or other factors before administering a weak live vaccine. Common live vaccines are the MMR (which protects against measles, mumps and rubella) and varicella inoculations.

Getting a vaccine is not like catching the actual illness. “When you get the natural disease, that usually gives you lifetime immunity,” says Gatti, “but vaccines, because they are not the natural disease, can wear off.” That’s why some vaccines require boosters.

Despite their effectiveness, vaccines are not universally accepted. “There is a lot of controversy swirling around a lot of vaccinations that is really unfounded,” says Gatti. In particular, the MMR vaccine came under scrutiny in the late 1990s, when a physician made claims that it was linked to autism. “That has been shown not to be the case,” says Dr. Constantinos Kintiroglou, a West Orange pediatrician with more than 35 years of experience. He explains that the second year of life, when most kids get the vaccine, is also the most common age at which autism diagnoses are made.

Amid such fears, many parents have resisted the MMR vaccine and others—a very risky stance, says Kintiroglou. Children who are not vaccinated might avoid disease because the people around them are vaccinated, confirming the notion that vaccines might be unnecessary. “They have a false sense of security,” says Kintiroglou.

In fact, the purpose of vaccines is to keep diseases out of circulation. When someone does not get vaccinated, that person can become the vehicle that allows a disease to reappear in the general population. There is no federal vaccination law; however, children attending public school in New Jersey are required to get certain vaccines, and more than 95 percent of grade-school children in New Jersey are fully vaccinated. Those who are not usually have religious or medical exemptions. Religious exemptions require a written explanation from a parent. Medical exemptions are commonly made if the child has a severe allergic reaction to the first dose of a vaccine; they require a written note from a licensed medical practitioner.

Vaccines and boosters are manufactured by pharmaceutical companies, but before they can be distributed to health-care providers, they must be approved by the Food and Drug Administration as well as the Centers for Disease Control and Prevention, the government agency that monitors health risks and illnesses worldwide. The CDC makes recommendations about who needs which vaccines.

Described below are the vaccines and boosters recommended for each age group. It is important to maintain family vaccine records; however, if you have no recollection of your vaccination history, your doctor should be able to advise you on which vaccines or boosters you might need. In part, it depends on your sex, age and lifestyle, including where and how often you travel. As a starting point, the CDC offers an online questionnaire at cdc.gov that will help guide you.

VACCINES FOR ALL AGES

Vaccine: DTaP
Protects against: Diphtheria, tetanus and pertussis (whooping cough)
First dose: At two months
Total doses: Five; boosters for adults

Today’s DTaP vaccine is more refined than the 1980s version that sometimes caused severe reactions such as seizures in some babies. Developed in the 1990s, the newer vaccine protects against the three diseases with little to no risk. However, it may not be as potent as the original. “We give boosters now,” says Kintiroglou.

In New Jersey, children entering the sixth grade at a public school are required to have the booster shot Tdap. The Tdap injection protects against the same three diseases as DTaP, but is abbreviated differently to express its different concentration. Adults should have a booster every 10 years.

Senior citizens should also keep up their immunity. “If they haven’t had one or they can’t remember when, then we give them a booster,” says Dr. Lisa Tank, the chief of geriatrics at Hackensack University Medical Center. Her patients are at an age when they might have more time to enjoy outdoor activities like gardening, putting them at increased risk for tetanus stemming from dirty cuts. So she always recommends they get protection.

Vaccine: Flu
Protects against: Influenza
First dose: At six months
Total doses: One each year

The influenza pandemic of 1918 killed at least 20 million people worldwide. In New Jersey, the first case was reported at Fort Dix. Because the disease was so contagious, state officials banned all public gatherings. An influenza vaccine wasn’t available until the 1940s and was not widely used until the 1970s, when President Gerald Ford pushed a national vaccination program.

“Everybody should get the flu shot,” says Gatti. For a time, annual immunization was recommended prior to flu season only for the very young, very old and those at high risk. “But now we realize if we vaccinate the population, we really reduce the spread and epidemic of flu,” says Gatti. However, each season there are still some flu-related deaths. “Any of us can get pneumonia from the flu and die very easily,” says Gatti.

The flu shot is different each flu season—which can start as early as October and last until May, usually peaking in January or February. At the end of each winter, the CDC examines the strains that are making people sick and selects which ones will be included in the shot next season. The injectable vaccine does not contain a live virus and does not pose significant risks of causing illness, though some people might develop mild body aches or a low-grade fever. The shot is approved for children six months and older.

Another version of the flu vaccine, a nasal spray, contains weakened live viruses. “It might be a little more effective than the injectable,” says Kintiroglou, since the body has more exposure and therefore a stronger chance of developing antibodies. The CDC has approved it for people between age 2 and 49; however, pregnant women and individuals with chronic heart or lung disease, asthma, diabetes or a compromised immune system should not take the nasal spray. People who aren’t feeling well, or have had other vaccines in the previous four weeks, should wait until they are feeling better. Neither vaccine guarantees the recipient won’t get sick, but the nasal spray will ease the symptoms and severity. It is usually recommended to patients who are particularly adverse to injections.

In New Jersey, the flu vaccine is required for children in state-licensed day care centers and preschools, but not for older children in public schools.

Vaccine: Varicella
Protects against: Varicella zoster
virus (chicken pox)
First dose: Between 12 and 15 months
Total doses: Two; boosters for adults

The varicella zoster vaccine protects against the virus that causes chicken pox, which is most recognizable by the rash it causes, but also can lead to other conditions like brain swelling and pneumonia. The vaccine contains weak live varicella zoster, so there is some risk. “At the worst case scenario, we see localized reactions—little pimples around the injection site,” says Kintiroglou.

The vaccine wears off over time, so a booster is recommended every 10 to 12 years. People who have been vaccinated but contract the disease usually have a milder case. Those who have had the natural disease have lifetime immunity—and don’t need the vaccine.

BABIES AND YOUNG CHILDREN

Vaccine: HepB
Protects against: Hepatitis B
First dose: Birth to two months
Total doses: Three

Most babies get the HepB vaccine right after birth or before they leave the hospital. The hepatitis B virus can lead to chronic liver infection, liver cancer or liver failure. “There are many people who once they get hepatitis B, they never get rid of it,” says Gatti. “Once they become chronic carriers, they are prone to spread it to the population as they get older.” The disease can be transferred from mother to baby during childbirth or through needle sharing or intimate contact. Gatti says the vaccine is safe and effective.

Vaccine: RV
Protects against: Rotavirus
First dose: At two months
Total doses: Three

The RV is a liquid vaccine that is given orally. It protects against the leading cause of vomiting and severe diarrhea among children, a virus that can result in death. The original rotavirus vaccine was associated with a potentially fatal bowel blockage called intussusception in some babies. For the past 15 years, physicians have been using a safer, more refined RV vaccine. “It seems to be well tolerated, and it has made a big difference,” says Kintiroglou.

Vaccine: Hib
Protects against: Haemophilus
influenzae type b
First dose: At two months
Total doses: Four

The Hib vaccine protects against the bacteria that can cause bacterial meningitis, an infection of the membranes surrounding the brain and spinal cord and epiglottitis, a form of croup that can be life threatening. “This particular vaccine is really definitive of how vaccines work,” says Kintiroglou, since it has almost eradicated the disease. “It has made a tremendous difference.”

Vaccine: PCV
Protects against: Pneumococcal bacteria
First dose: At two months
Total doses: Four

The pneumococcal conjugate vaccine protects against several strains of pneumococcal bacteria, the culprit in many conditions, from an ear infection to serious illness. “Pneumococcal can cause infections anywhere, from the nervous system to the lungs to the bloodstream,” says Kintiroglou. Examples include potentially fatal conditions such as bacterial meningitis; pneumonia, an infection in the lungs; or bacteremia, a blood infection. See PPSV for adult version.

Vaccine: IPV
Protects against: Polio
First dose: At two months
Total doses: Four

The first polio vaccine, a shot, became available in 1955, much to the relief of parents nationwide who lived in fear that their children might fall victim to the virus, which lives in the throat and intestines and can lead to paralysis (as it did in 1921 with a future president, Franklin D. Roosevelt). However, a second version, which was given orally, contained weak live strains, and some patients were thought to have contracted the disease from it. “There were a few cases every year,” says Kintiroglou. More refined vaccines followed. Since 2000, the injectable IPV (inactive polio vaccine) has been used in the United States and poses no risk of causing the actual illness.

Vaccine: MMR
Protects against: Measles, mumps
and rubella
First dose: Between 12 and 18 months
Total doses: Two

Although an unfounded autism controversy surrounds the MMR vaccine, the injection actually has a “very good track record,” says Kintiroglou. It protects against three diseases that can lead to serious conditions such as encephalitis, swelling of the brain; meningitis, swelling of the covering around the brain or spinal cord; and pneumonia.

Vaccine: HepA
Protects against: Hepatitis A
First dose: Between 12 and 23 months
Total doses: Two

Hepatitis A is a liver disease usually spread through contaminated food and water. It can lead to liver failure and blood, kidney and pancreatic disorders. The vaccine is not required for public school children. It is recommended for people with chronic liver disease and those with plans to travel to a country where there is a high risk of contracting the disease.

PRETEENS, TEENS AND ADULTS

Vaccine: MCV
Protects against: Meningococcal disease
First dose: At age 11
Total doses: Two

The meningococcal conjugate vaccine protects against bacteria that can cause bacterial meningitis as well as blood infections. In the United States, about 1,000 people each year get meningococcal disease.

Between 10 and 15 percent of those cases result in death. Some survivors suffer devastating effects such as the loss of limbs, permanent deafness and various problems with their nervous systems. People ages 16 through 21 are at high risk for contracting the disease, which is why many colleges and universities require freshmen to get vaccinated.

Vaccine: HPV
Protects against: Human papillomavirus
First dose: Age 11 or 12
Total doses: Three

The HPV vaccine protects against the most common sexually transmitted disease, the human papillomavirus. The virus can be exchanged through close contact, not necessarily intercourse. About 40 strains of the virus exist; however, the vaccine covers the four most dangerous ones. The virus can cause genital warts and various kinds of cancer in both men and women. Since HPV has been most commonly linked to cervical cancer, the vaccine, approved in 2006, was at first only marketed toward females.

However, it is now also recommended for males. There are two available brands: Gardasil can be given to males and females; Cervarix is only for females.

The vaccine is recommended for children around the age of 12, but also teens and males and females in their early 20s. It is most effective if a person receives it before becoming sexually active; however, since HPV is a sexually transmitted disease, the vaccine has been met with resistance and the rate of vaccination nationwide has lagged. In the United States, 33 percent of all females and 7 percent of all males are vaccinated. In New Jersey, 32 percent of all females are vaccinated. The number of males vaccinated in New Jersey was not available at press time. According to the CDC, vaccination rates would be much higher if the vaccine was given routinely with other inoculations.

“The big question is the timing,” says Kintiroglou. Parents are concerned that by allowing their tweens and young teens to receive the vaccine they might be implying it is permissible to have sex. Kintiroglou adds that parents and guardians should have a serious conversation with their kids about sex and point out that the vaccine protects against only one kind of STD.

In New Jersey, the vaccine is not required; however, public schools distribute information about HPV to the parents and guardians of students in grades 7 through 12.

MATURE ADULTS

Vaccine: Shingles
Protects against: Varicella zoster virus
First dose: After age 60
Total doses: One

Only people who have had chicken pox are at risk for shingles. Shingles is caused by the same virus, which lives dormant in the nerve endings. “As you get older, or whenever your immunity is compromised, shingles can flare up,” says Dr. Tank. Shingles is known for its rash, which looks like small blisters and can feel like burning. “The most debilitating thing about it is the pain that comes with shingles, even after the rash is gone,” says Tank. The pain is caused by the inflammation of the nerve endings. “It can affect your quality of life and take you away from doing your day-to-day activities,” she says.

The vaccine doesn’t prevent adults from getting shingles. “It reduces the duration of the shingles and it reduces the intensity,” says Tank. Even people who have had shingles should get the vaccine. “Just because you’ve already had shingles doesn’t mean you aren’t going to get it again,” says Tank.

The vaccine contains a weak live virus, so recipients may get a mild form of shingles.

Vaccine: PPSV
Protects against: Pneumococcal bacteria
First dose: After age 65
Total doses: One

The PPSV shot, or pneumococcal polysaccharide vaccine, protects against 23 strains of pneumococcal bacteria, which can cause serious conditions like bacteremia, a blood infection, or bacterial meningitis. Patients who get the PCV injection as children should still get the PPSV shot after age 65, says Tank. The elderly, whose immune systems might not be as robust as they once was, are particularly vulnerable to pneumonia, and the shot helps. “It doesn’t prevent it completely,” says Tank, “but it does decrease the severity.”