Anya Koutras, MD, IBCLC, is a family medicine physician at Colchester Family Practice and an associate professor of family medicine at the University of Vermont. Colchester Family Practice is a certified medical home, working in collaboration with Milton, South Burlington and Hinesburg Family Practices.

Why do we need vaccinations?

Before vaccines, parents of the early 20th century in the United States could expect that every year, polio would paralyze 10,000 children, rubella would cause birth defects and mental retardation in 20,000 newborns, diphtheria would be one of the most common causes of death in school aged children and pertussis (whooping cough) would kill thousands of infants. Before 1984, a bacterium called Hemophilus Influenza type B (HIB) would cause meningitis in 15,000 children each year, leaving many with permanent brain damage. And now in the 21st century, over 8 million people worldwide are walking who would otherwise have been paralyzed since the incidence of polio has declined over 99%. But we are not free and clear of the need for vaccinations. In 2008 alone, 1.7 million children worldwide under the age of 5 died from vaccine-preventable diseases. In 2009, there were over 17,000 cases of pertussis in the U.S.  And for 2012 in Vermont, there have already been 320 cases of pertussis, which is likely an underestimate.

Doesn’t our immune system fight infection better than vaccines?

The immune system is an amazing aspect of humans that creates antibodies against things that are “foreign” or not originally from the body, such as bacteria and viruses. When the body sees these bacteria and viruses again, the antibodies react from “memory”, and quickly destroy the bacteria or viruses. The problem with this near perfect system, however, is the actual bacteria and viruses in whole, live forms can make the human body very ill before these antibodies can be made. And the illnesses they cause can harm or even kill people.

Vaccinations are made from only a fraction of the inactivated or dead virus or bacteria. The body will still make antibodies to the virus or bacteria in the vaccine, but without the serious illness or risk of death that the actual diseases cause.

What happens if we don’t vaccinate?

Up to 1 in 20 individuals who get any vaccine, may not mount a necessary “immune response” to the vaccine, which means they are virtually unprotected. But fortunately because of a concept called Herd Immunity, these individuals are still protected so long as those around them are also vaccinated. This extra insurance, however, gets broken down when fewer individuals get vaccinated. And there can be an outbreak of disease if a very large group of individuals does not get vaccinated. Last year, 222 individuals in the U.S. contracted the measles and nearly 40% of these individuals got measles while traveling in other countries. They then brought the disease to the U.S. and as a result, 17 measles outbreaks occurred in various U.S. communities.

Why do children get more vaccinations than their parents did at those ages?

We have developed many more vaccines to keep our children and adults healthy over the past few decades. Children are one of the most vulnerable populations to preventable diseases, which is why we have the goal to vaccinate them early. The CDC (Centers for Disease Control and Prevention) now recommends vaccinations for children against 14 preventable infections. The good news is that we’ve made vaccinations much more efficient as far as ingredients. Thirty years ago, children received seven vaccines that contained more than 3,000 bacterial and viral proteins. Today there are only about 150 bacterial and viral proteins in 14 vaccines. Furthermore, studies have NOT shown any adverse effects or less immune protection by giving children several vaccinations at the same time.

Are there new vaccination recommendations for 2012?

There are updates every year from the CDC, which is why it is important for health care providers to refer to and share these references with patients. Included in the new recommendations are:

  • Influenza is recommended for all ages and 2 doses at least 4 weeks apart for those < 8 years old getting the flu shot for the first time.
  • Human Papilloma Virus (HPV) Vaccine is now recommended for boys in addition to girls.
  • Meningitis vaccine is recommended at age 11-12 for those at risk and a booster at age 16 of a boost at least 8 weeks later if given between ages 13-15.
  • Tdap for a one-time booster to protect against Pertussis (whooping cough), then back to an every 10 year Tetanus (Td) booster.
  • Anyone in contact with a child < 12 months old on a regular basis, is highly recommended to get a Tdap booster to provide a cocooning effect to better protect baby.
  • Pregnant women with a need for a Tdap booster are recommended to wait until after 20 weeks of pregnancy to increase the amount of passive immunity to baby following birth.
  • Shingles vaccine, which is still currently recommended for those > age 60 is now FDA approved for those > age 50.
  • HPV vaccine can be given to men up to age 21 or up to age 26 if high risk.
  • Hepatitis B is recommended for adults < 60 who have diabetes and in adults > 60 with risks.

Who needs to get a flu shot?

EVERYONE! Well really, everyone over 6 months old. Influenza alone causes on average 200,000 hospitalizations and 36,000 deaths EACH year. And the majority of deaths occur in people over 65. Pregnant women are highly encouraged to get the flu vaccine. Pregnant women will pass their immunity to their baby in the form of flu antibodies that will persist up to several months after delivery. Surprisingly, schools don’t require children to get the flu shot nor do most workplaces of their employees. But there is no doubt that the overall health of communities is greatly improved with something as simple as a flu shot. Fortunately, most local pharmacies now administer flu shots, and at low cost. The flu vaccine protects against three influenza viruses that research indicates will be most common in the upcoming season. And because it takes the body 2 weeks after the flu shot to form antibodies that protect one from getting sick, it’s best to get it as early as possible in the season. The viruses in the vaccine are inactivated so they can’t make you “get the flu” but you can have some mild side effects from the shot. Common side effects from the flu vaccine include soreness, redness or swelling at the site of the shot, low grade fever and aches.

Anya Koutras, MD, IBCLC, is a family medicine physician at Family Medicine Colchester and an associate professor of family medicine at the University of Vermont. Family Medicine Colchester is a certified medical home, working in collaboration with Milton, South Burlington and Hinesburg Family Practices. 

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