| Some
parents wonder if vaccines are still necessary. Yes!
Vaccines are still necessary! Because several of the
diseases that vaccines prevent have almost disappeared, or occur
in low numbers, many parents of young children today have never
seen a case of measles, mumps, rubella (German measles), polio,
diphtheria, or tetanus. If we don't see these diseases, it can be
hard to understand why it is still important to protect against
them. But without vaccines, epidemics of vaccine-preventable diseases
could return, putting the health of our children and the community
at higher risk.
San Diego is a very mobile community, with many tourists, immigrants and international business travelers. We have several major military bases, numerous universities, and a multi-million dollar visitor industry. The border with Mexico is the busiest international crossing in the U.S. with an estimated 6 million legal border crossings per month. With so many people on the move, it is important to realize that outbreaks of these diseases are highly possible in our community. We may not see a disease in our neighborhood, but the bacteria and viruses responsible are still around. Since the 1990s, there have been major outbreaks of diphtheria in the countries of the former Soviet Union when political events led to the breakdown of immunizations. While the World Health Organization's goal is to eradicate polio from the face of the earth within the next decade, as of 2007 polio is endemic to 4 countries (Nigeria, India, Pakistan, and Afghanistan). Also, the following countries have reported imported polio cases or cases related to an importation in the past 6 months: Angola, Burma (Myanmar), Chad, the Democratic Republic of the Congo (DRC), Niger, and Sudan. Of these countries, DRC and Burma (Myanmar) had previously been polio-free for over 5 years.
- Polio would
paralyze 10,000 children;
- Rubella (German
measles) would cause birth defects, including mental retardation,
in as many as 20,000 newborns;
- Measles would
infect about 500,000 children, killing 500;
- Diphtheria
would be one of the most common causes of death in school-aged
children;
- The bacterium
Haemophilus influenzae type b (Hib) would cause meningitis
in 10-13,000 children, leaving many with permanent brain damage,
and
- Pertussis
(whooping cough) would kill 8,000 children, mostly under the age
of one year.
The development
and widespread use of vaccines has reduced and, in some cases almost
eliminated, many diseases that killed and disabled children and
adults in our grandparents' generation. Below is some general information
about the diseases vaccines prevent, and about the tremendous impact
vaccines have had. For reference, we have also included a link to
the numbers of cases of vaccine preventable diseases reported to
the County per year 1990-2005:
Vaccine Preventable Disease Cases Reported in San Diego
County
We have tried to provide a representative sampling of the
information available about vaccine preventable diseases and immunizations.
We encourage you to link to the web sites listed under Other
Resources for the latest scientific information and vaccine
research summaries.
Chickenpox
(Varicella)
Chickenpox is an infection caused by the varicella virus, and is
highly contagious. The rash begins as red bumps that turn into blisters
and cover the entire body. There are usually as many as 200-500
blisters during a single infection. Chickenpox is very contagious.
Imagine 100 people sitting in a room together for several hours
talking. If only one person in the room has chickenpox, and the
other 99 have never been infected with chickenpox or vaccinated
with the chickenpox vaccine, then up to 89 persons will get chickenpox!
Before the varicella vaccine was recommended for use in all children
in 1995, about 4 million children were infected every year. One
child and one adult in this country would die every week from chickenpox.
In addition, chickenpox caused about 10,000 hospitalizations and
100 deaths a year - most of these hospitalizations and deaths occurred
in previously healthy young children. It's important to realize
that chickenpox can cause severe disease in children.
The varicella vaccine is given to prevent chickenpox and the severe,
and occasionally fatal, consequences of chickenpox. These can include
severe infection of the skin, swelling of the brain, and pneumonia.
Chickenpox vaccine should be given to children who have not had
chickenpox disease. Two doses of the vaccine are now recommended
for children between 12 months and 12 years of age. The first dose
is usually given at 12-15 months of age and the second dose between
4-6 years of age. Two doses have always been recommended for children
13-18 years of age.
Current outbreaks have shown that most of the children had had either no doses or one dose of chickenpox vaccine - but not the recommended two doses. Ninety-nine percent of people develop immunity after two doses.
For the more information about chickenpox (Varicella) and the Varicella
vaccine:
Children’s
Hospital of Philadelphia: Chickenpox (Varicella)
Centers
for Disease Control and Prevention (CDC): Varicella Vaccine Information
Statement
For the
testimony of one mother, read:
"Chickenpox claimed
the life of my son, Christopher"
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Diphtheria
Diphtheria is a respiratory disease caused by a bacteria. It is
spread by coughing and sneezing. The toxin released by the bacterium
causes difficulty breathing and swallowing. It also attacks the
heart, kidneys, and nervous system. It can lead to airway obstruction,
coma, and death if not treated. In the 1920s, diphtheria was a common
cause of death in children and adolescents. At its peak, about 150,000
cases of diphtheria occurred in the United States every year! The
diphtheria vaccine, first used in the United States in the early
1940s, has virtually eliminated the disease. Now we see less than
2 cases a year in the U.S. Diphtheria toxoid (contained in DTaP
and Tdap vaccines) can prevent this disease.
Several manufacturers produce vaccines which protect against diphtheria.
DTaP is generally given at 2, 4, 6 and 12-15 months of age, with
another at 4-6 years before the child starts school. Booster doses
are recommended starting at about 11-12 years, and every 10 years
thereafter. The first booster is with the improved Tdap vaccine,
and subsequent booster doses are with Td vaccine.
There are nations still having outbreaks of diphtheria. Please check
the Travel Immunizations and Medications
section of our website for links to up-to-date information on your
destinations before you travel, as well as a list of local private
travel physicians, and much more.
For the more information about diphtheria and the vaccines that
protect against it:
Children’s
Hospital of Philadelphia: Diphtheria
Centers
for Disease Control and Prevention:
Tdap Vaccine Information Statement
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Haemophilus influenzae type b (Hib)
The bacteria Haemophilus influenzae type b (or Hib) causes
a severe bacterial infection, occurring primarily in infants. It
can cause meningitis, bloodstream infections, arthritis, bone infections,
skin and throat infections, pneumonia and other diseases.
Children with meningitis often have fever, stiff neck, and drowsiness.
Symptoms can rapidly progress to include coma and death. Some children
recover from the disease but are left permanently paralyzed, deaf,
or mentally retarded. This disease can be serious in children under
age 1, but there is little risk of getting the disease after age
5. Hib meningitis causes death in one out of 20 children. It is
spread by coughing and sneezing.
The Hib vaccine is given at 2, 4, 6 and 12-15 months of age. Although
the Hib vaccine prevents what was once the most common cause of
bacterial meningitis, it does not prevent all causes of meningitis.
Other causes of meningitis include pneumococcus and meningococcus.
See sections below on pneumococcal and meningococcal vaccines.
For more information about Hib and the Hib vaccine:
Children’s
Hospital of Philadelphia: Hib
Centers
for Disease Control and Prevention:
Hib Vaccine Information Statement
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Hepatitis A
Hepatitis A is a virus that causes disease of the liver. Symptoms
include tiredness, fever, jaundice (a yellowing of the eyes or skin),
nausea, loss of appetite and vomiting. Young children are much less
likely to develop symptoms when they are infected with hepatitis
A virus so the disease is often not recognized until the child's
caregiver becomes ill with hepatitis A. The hepatitis A virus is
found in the stools of infected people.
The hepatitis A vaccine given in two doses: one at 12-23 months
of age and the second 6-12 months later. The Advisory Committee
on Immunization Practices (ACIP) recommended nationwide administration
of hepatitis A vaccine to children 12-23 months of age at its Oct.
27, 2005 meeting. Prior to this recommendation, many states including
California had programs to immunize children 2 through 18 years
of age. Those programs will continue.
For more information about hepatitis A and the hepatitis A vaccine:
Children’s
Hospital of Philadelphia: Hep A
Centers
for Disease Control and Prevention:
Hep A Vaccine Information Statement
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Hepatitis B
Hepatitis B is a serious public health problem that affects people
of all ages in the United States and around the world. Each year,
more than 78,000 people contract hepatitis B in the United States.
The Hep B virus attacks the liver and can lead to severe illness
(including liver cancer), liver damage, and, in some cases, death.
The best way to be protected from hepatitis B is to be vaccinated
with hepatitis B vaccine, which has been proven safe and effective.
The vaccine is given in a series of three doses over a period of
6 months. It is often given at birth, 2 months and 6 months of age.
For the more information about hepatitis B and the hepatitis B vaccine:
Children’s
Hospital of Philadelphia: Hep B
Centers
for Disease Control and Prevention:
Hep B Vaccine Information Statement
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Human Papilloma Virus
In June 2006, the Food and Drug Administration (FDA) announced the
approval of a human papillomavirus (HPV) vaccine. This is the first
vaccine developed to prevent cervical cancer, precancerous genital
lesions (sores) and genital warts due to HPV types 6, 11, 16 and
18. Strains 16 and 18 are the cause of 70% of cervical cancers and
6 and 11 cause 90% of genital warts. The vaccine will have the biggest
impact if given before a woman becomes sexually active. All women,
even if vaccinated, should follow recommendations for routine PAP
testing. The vaccine is approved for use in females 9-26 years of
age.
On average,
there are 9,710 new cases of cervical cancer and 3,700 deaths attributed
to it in the United States each year. Worldwide, cervical cancer
is the second most common cancer in women; and is estimated to cause
over 470,000 new cases and 233,000 deaths each year. HPV is the
most common sexually-transmitted infection in the United States.
The Centers for Disease Control and Prevention estimates that about
6.2 million Americans become infected with genital HPV each year
and that over half of all sexually active men and women become infected
at some time in their lives.
For the
more information about HPV and HPV vaccine:
Children’s
Hospital of Philadelphia: HPV
Centers
for Disease Control and Prevention: HPV
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Influenza
Influenza (flu) is a very contagious respiratory disease. According
to the CDC, every year in the United States, on average, 5-20% of
the population gets the flu, more than 200,000 people are hospitalized
from flu complications, and about 36,000 people die from it.
Flu viruses spread mainly from person to person through coughing
or sneezing of people with influenza. Sometimes people may become
infected by touching something with flu viruses on it and then touching
their mouth or nose. Most healthy adults may be able to infect others
beginning 1 day before symptoms develop and up
to 5 days after becoming sick. That means
that you may be able to pass on the flu to someone else before you
know you are sick, as well as while you are sick.
Symptoms of the flu include high fever, headache, extreme tiredness,
dry cough, sore throat, runny or stuffy nose and muscle aches. Complications
of the flu can include bacterial pneumonia, ear infections, sinus
infections, dehydration and worsening of chronic medical conditions,
such as congestive heart failure, asthma or diabetes. Stomach symptoms
such as nausea, vomiting and diarrhea occur rarely in adults.
The single best way to prevent the flu is to get a flu vaccination
each year. There are two types of vaccines:
The "flu shot" – an inactivated vaccine (containing
killed virus) that is given with a needle. The flu shot
is approved for use in people 6 months of age and older, including
healthy people and people with chronic medical conditions.
The nasal-spray flu vaccine – a vaccine made with live, weakened
flu viruses that do not cause the flu (sometimes called LAIV for
“Live Attenuated Influenza Vaccine”). LAIV is approved
for use in healthy people 5 years to 49 years of age who are not
pregnant.
About two weeks after vaccination, antibodies develop that protect
against influenza virus infection. Many people get flu vaccine in
October or November, but it’s important to remember that since
the flu season often lasts until the following March or later, it’s
not too late to get flu vaccine in December or even January or later!
Flu vaccines will not protect against flu-like illnesses caused
by non-influenza viruses.
For the more information about the flu and flu vaccine:
Children’s
Hospital of Philadelphia: Flu
Centers
for Disease Control and Prevention:
Flu Vaccine Information Statement (flu shot)
Centers
for Disease Control and Prevention:
Flu Vaccine Information Statement (nasal-spray flu vaccine)
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Measles
Before measles immunizations were available, nearly everyone in
the United States got measles. There were about 3-4 million cases
each year. An average of 500 measles-associated deaths was reported
each year between 1953 and 1963. Widespread use of the vaccine (which
is called Measles-Mumps-Rubella or MMR, and protects against three
diseases) has led to more than a 98 percent reduction in measles,
but the disease is still dangerous. Some people who get measles
develop encephalitis, and 1 out of 1,000 people with measles can
die.
The vaccine which protects against measles is called MMR, for Measles-Mumps-Rubella,
and protects against three diseases. It is given at 12-15 months
of age, with a booster at 4-6 years of age, generally when the child
starts school. There is also a combination vaccine called MMRV which
combines MMR and varicella (chickenpox) vaccines.
Measles still occurs throughout the world, and is frequently imported
into the United States.
Stopping measles vaccination would probably lead to the return of
massive epidemics similar to those that occurred in the pre-vaccine
era.
In 2008, San Diego County saw the first local outbreak of measles since 1991.Twelve cases were reported and some 70 people were quarantined at their homes to interrupt the spread of the disease.
For the more information about measles and the MMR vaccine:
Children’s
Hospital of Philadelphia: Measles
Centers
for Disease Control and Prevention:
MMR Vaccine Information Statement
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Meningococcus
Meningitis is an infection of the fluid of a person's spinal cord
and the fluid that surrounds the brain. People sometimes refer to
it as spinal meningitis. Meningitis is usually caused by a viral
or bacterial infection. Viral meningitis is generally less severe
and persons usually recover without specific treatment, while bacterial
meningitis can be quite severe and may result in brain damage, hearing
loss, or learning disability. For bacterial meningitis, it is also
important to know which type of bacteria is causing the meningitis
because antibiotics can prevent some types from spreading and infecting
other people. Before the 1990s, Haemophilus influenzae type
b (Hib) was the leading cause of bacterial meningitis, but
new vaccines being given to all children as part of their routine
immunizations have reduced the occurrence of invasive disease due
to H. influenzae. Meningitis caused by Streptococcus
pneumoniae has also been greatly reduced since the introduction
of pneumococcal conjugate vaccine in 2000. Today, Neisseria
meningitidis is the leading cause of bacterial meningitis.
Some forms of bacterial meningitis are contagious. The bacteria
are spread through the exchange of respiratory and throat secretions
(i.e., coughing, kissing).
High fever, headache, and stiff neck are common symptoms of meningitis
in anyone over the age of 2 years. These symptoms can develop over
several hours, or they may take 1 to 2 days. Other symptoms may
include nausea, vomiting, discomfort looking into bright lights,
confusion, and sleepiness.
There are two types of meningococcal vaccine available in the U.S.,
MPSV4 (Meningococcal polysaccharide vaccine quadravalent) and MCV4
(Meningococcal conjugate vaccine tetravalent). Both can prevent
4 types of meningococcal disease (called serogroups A, C, Y and
W-135), including 2 of the 3 types most common in the U.S. (serogroups
C and Y). There is no vaccine for the third type most common in
the U.S. (serogroup B). Both vaccines work well, protecting about
90% of those who get it. MCV4 is newer, having been approved in
2005 and is expected to give better, longer-lasting protection.
MCV4 is recommended for all children at their routine preadolescent
visit (11 to 12 years of age). For adolescents who have not gotten
MCV4 previously, a dose is recommended at high school entry. Other
adolescents who want to decrease their risk of meningococcal disease
can also get the vaccine. Other people at increased risk for whom
routine vaccination is recommended are college freshmen living in
dormitories, microbiologists who are routinely exposed to meningococcal
bacteria, U.S. military recruits, anyone who has a damaged spleen
or whose spleen has been removed; anyone who has terminal complement
component deficiency (an immune system disorder), anyone who is
traveling to the countries in which meningococcal disease regularly
occurs, and those who might have been exposed to meningitis during
an outbreak.
For more information about meningitis and the meningitis vaccine:
Children’s
Hospital of Philadelphia: Meningitis
National Foundation for
Infectious Disease: Meningitis
Centers
for Disease Control and Prevention:
Meningococcal Vaccine Information Statement
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Mumps
Mumps is caused by a virus and usually causes swelling in the salivary
or parotid glands, just below the ear, lasting for 7-10 days. Mumps
can cause meningitis, inflammation of the testicles or ovaries,
inflammation of the pancreas and permanent deafness. A multistate
outbreak of mumps occurred in the U.S. in 2006. Forty-five states
reported 5,783 confirmed or probable mumps cases. Many of the cases
occurred among college students living in dormitories.
The vaccine which protects against Mumps is called MMR, for Measles-Mumps-Rubella,
and protects against three diseases. It is given at 12-15 months
of age, with a booster at 4-6 years of age, generally when the child
starts school. Another version of the vaccine, the combined MMRV,
includes protection for measles-mumps-rubella and varicella (chickenpox).
For the more information about mumps and the MMR vaccine:
Children’s
Hospital of Philadelphia: Mumps
Centers
for Disease Control and Prevention:
MMR Vaccine Information Statement
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Pneumococcal Disease and Vaccine (children)
Before the introduction of the pneumococcal vaccine for children,
every year parents of children less than 5 years of age (in the
United States) could count on this bacteria causing 700 cases of
meningitis and 13,000 cases of bloodstream infections. Pneumococcus
also causes many ear infections.
Meningitis is the most severe type of pneumococcal disease. Of children
under 5 years with pneumococcal meningitis, about 5% will die of
their infection and others may have long-term problems such as hearing
loss.
Children with pneumonia have a high fever, cough and rapid breathing.
The bacteria can cause pus to accumulate inside the lung, and outside
of it as well - this accumulation can collapse the lung. Many children
with pneumonia become ill enough to be hospitalized. Many children
with pneumococcal pneumonia or blood stream infections will be ill
enough to be hospitalized; about 1% of children with blood stream
infections or pneumonia with a blood stream infection will die of
their illness.
The pneumococcal vaccine (called PCV7) is very effective in protecting
against pneumococcal disease in children. It is recommended for
all children under 24 months of age, and certain children at highest
risk of infection (such as those children with certain illnesses
like sickle cell anemia, HIV infection, chronic lung or heart disease)
from 24-59 months of age. Persons with cochlear implants appear
to be at higher risk for pneumococcal pneumonia and should receive
the PCV7 and PPV23 (see Pneumococcal Disease
and Vaccine (adults) below) vaccines as appropriate for their
age.
For more information about pneumococcal disease and vaccine for
children:
Children’s
Hospital of Philadelphia: Pneumococcus
National
Foundation for Infectious Diseases: Pneumococcal
Centers
for Disease Control and Prevention:
PCV7 Vaccine Information Statement
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Pneumococcal Disease and Vaccine (adults)
Until 2000, infections with the bacteria Streptococcus pneumoniae
caused 100,000-135,000 hospitalizations for pneumonia and 60,000
cases of invasive disease which included 3,300 cases of meningitis.
Disease figures are now changing due to the introduction of the
conjugate vaccine (see Pneumococcal Disease
and Vaccine (children) above). The rate of invasive disease
has decreased significantly but death still occurs in 14% of adults
hospitalized with invasive disease.
The best way to protect against this disease is vaccination. A single
dose of pneumococcal vaccine (called PPV23) is recommended for most
persons 65 years of age and older. Persons two years of age and
older with certain high risk conditions (such as splenic dysfunction
or removal, Hodgkin's disease, or chronic kidney failure) are also
recommended one dose with a second dose at age 65. PPV23 vaccine
is underused; many infections could be prevented through better
use of PPV23 vaccine among adults.
For more information about pneumococcal disease and vaccine for
adults:
National
Foundation for Infectious Diseases: Pneumococcal
Centers
for Disease Control and Prevention:
PPV23 Vaccine Information Statement
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Polio
Polio is caused by a virus and is very contagious. It affects people
differently - some don't feel sick at all, others complain of sore
throat, fever, stomach pain or vomiting, stiff neck or headache.
The virus does its damage by first reproducing itself in the intestines,
then traveling through the bloodstream where it can infect the brain
and spinal cord. The paralysis associated with polio occurs when
the virus reproduces and attacks the nervous system. Only about
one in ten people who were paralyzed by polio recovered - most were
confined to wheelchairs or iron lungs for the rest of their lives.
Through a continuing global polio eradication effort, the plan is
to eliminate polio by the year 2008. The Western Hemisphere was
declared polio free in 1991. However, due to international travel,
the virus has been imported on a few different occasions from countries
that still suffer from the disease. Travelers to countries still
experiencing polio disease should be appropriately vaccinated. Please
check the Travel Immunizations and Medications section of our website
for links to up-to-date information on your destinations before
you travel, as well as a list of local private travel physicians,
and much more.
Since January 1, 2000, the inactivated polio vaccine (or IPV) is
the only vaccine given in the United States to prevent polio, while
previously OPV or polio drops were used. The IPV form, recommended
by the Centers for Disease Control and Prevention (CDC) and the
American Academy of Pediatrics (AAP), does not, and cannot cause
paralysis.
For the more information about polio and the Polio vaccine:
Children’s
Hospital of Philadelphia: Polio
Centers
for Disease Control and Prevention:
Polio Vaccine Information Statement
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Rotavirus
This virus causes severe diarrhea, often accompanied by vomiting,
fever, and dehydration, mostly in babies and young children. It
is easily spread by contact with feces (stool) of an infected person
and can also be spread on contaminated hands and objects.
It is the leading cause of diarrhea in infants and young children
in the United States (U.S.) and worldwide. Almost all children in
the U.S. are likely to be infected with rotavirus before their 5th
birthday. Each year in the U.S., rotavirus is responsible for more
than 400,000 doctor visits; more than 200,000 emergency room visits;
55,000 to 70,000 hospitalizations; and between 20 and 60 deaths.
While it’s very important that you wash your child’s
hands, better hygiene and sanitation have not significantly reduced
rotavirus disease. The best way to protect against rotavirus is
with vaccination.
Rotavirus vaccine will not prevent diarrhea or vomiting causes by
other viruses but it is very effective against rotavirus disease.
Studies indicate the vaccine will prevent about 74 percent of all
rotavirus cases, about 98 percent of severe cases, and about 96
percent of hospitalizations due to rotavirus.
The vaccine is given by mouth. The first dose of rotavirus vaccine
should be given between 6-12 weeks old and two additional doses
are given at 4-10 week intervals. Children should get all three
doses before 33 weeks old.
For more information about rotavirus disease and vaccine:
Children’s
Hospital of Philadelphia: Rotavirus
Centers
for Disease Control and Prevention:
Rotavirus Vaccine Information Statement
Note: On
February 13, 2006: FDA issued an alert regarding cases of intussusception
in infants vaccinated with RotaTeq® (rotavirus) vaccine.
Intussusception is a disorder in which one part of the intestine
- usually the small intestine - slides inside another part. This
is sometimes referred to as "telescoping" because it's
similar to the way a collapsible telescope folds together. Intussusception
is much more common in children, particularly in infants younger
than 1 year, than in adults.
For most cases of intussusception in children, the cause is unknown;
it occurs spontaneously. Or it may be triggered by a viral infection
or a growth in the intestine, such as a polyp, lymph node or tumor.
In the past, some cases of intussusception seemed to be associated
with a version of the rotavirus vaccine (RotaShield). That vaccine
was removed from the market in 1999.
The alert states it is unknown if the vaccine caused the 28 new
cases. FDA issued the notification to encourage reporting of any
additional cases of intussusception to help assess if there is association
with the newly licensed rotavirus vaccine RotaTeq®.
Summary:
- Rotavirus
is a serious illness.
- It is unknown
if the vaccine caused the 28 new cases.
- The notice
does not mean there is a problem with the RotaTeq® vaccine.
CDC continues to support the Advisory Committee on Immunization
Practices’ recommendation for routine immunization of all
U.S. infants with three doses of RotaTeq® administered orally
at ages 2, 4 and 6 months.
For more information,
please see the following links:
Immunization Action Coalition: Rotavirus Q&A
Food and Drug Administration: Notice About Intussusception and Rotateq® Vaccine
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Rubella (German Measles)
The rubella virus is transmitted by the respiratory route (for example,
an infected person coughing and/or sneezing). It is also known as
German measles. It causes a mild rash on the face, swelling of glands
behind the ear, occasionally a short-lived swelling of small joints
(like the joints of the hand), and low-grade fever. It tends to
be a mild disease in children and young adults.
But not always! In the year before vaccination started, 20,000 babies
were born with birth defects because of rubella's capacity to damage
the developing child. If a woman is infected with rubella in the
first trimester of her pregnancy, the chance that the unborn child
will be permanently harmed by the virus is about 85 percent! Rubella
virus causes deafness, blindness, heart defects or mental retardation.
The vaccine which protects against rubella is called MMR, for Measles-Mumps-Rubella,
and protects against three diseases. It is given at 12-15 months
of age, with a booster at 4-6 years of age, generally when the child
starts school. There is also a version of MMR which is called MMRV
and includes Varicella (chickenpox) vaccine.
Rubella vaccine is a unique example of vaccinating one person to
protect another. We vaccinate girls so that, if they become pregnant
as adults, their unborn children will be protected against the devastating
effects of rubella virus. We vaccinate boys to help stop the spread
of rubella in the community.
For more information about rubella and the MMR vaccine:
Children’s
Hospital of Philadelphia: Rubella
Centers
for Disease Control and Prevention:
MMR Vaccine Information Statement
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Shingles (Herpes Zoster)
Shingles, also called herpes zoster or zoster, is a painful skin
rash caused by the varicella zoster virus (VZV). VZV is the same
virus that causes chickenpox. After a person recovers from chickenpox,
the virus stays in the body. Usually the virus does not cause any
problems; however, the virus can reappear years later, causing shingles.
It’s estimated that 1 million cases of shingles occur in the
U.S. each year. Herpes zoster is not caused by the same virus that
causes genital herpes, a sexually transmitted disease.
Shingles usually starts as a rash on one side of the face or body.
The rash starts as blisters that scab after 3 to 5 days. The rash
usually clears within 2 to 4 weeks. Before the rash develops, there
is often pain, itching, or tingling in the area where the rash will
develop. Other symptoms of shingles can include fever, headache,
chills, and upset stomach.
Very rarely, shingles can lead to pneumonia, hearing problems, blindness,
brain inflammation (encephalitis) or death. For about 1 person in
5, severe pain can continue even after the rash clears up. This
pain is called post-herpetic neuralgia.
As people get older, they are more likely to develop post-herpetic
neuralgia, and it is more likely to be severe. Anyone who has recovered
from chickenpox may develop shingles, including children. However,
shingles most commonly occurs in people 50 years old and older.
The risk of getting shingles increases as a person gets older.
Shingles cannot be passed from one person to another. However, the
virus that causes shingles, VZV, can be spread from a person with
active shingles to a person who has never had chickenpox through
direct contact with the rash. The person exposed would develop chickenpox,
not shingles. Shingles is not spread through sneezing,
coughing or casual contact. A person with shingles can spread the
disease when the rash is in the blister-phase. Once the rash has
developed crusts, the person is no longer contagious. A person is
not infectious before blisters appear or with post-herpetic neuralgia
(debilitating, chronic pain after the rash is gone). The risk of
spreading shingles is low if the rash is covered. People with shingles
should keep the rash covered, not touch or scratch the rash, and
wash their hands often to prevent the spread of VZV.
In 2006, the Food and Drug Administration (FDA) licensed a new vaccine
to reduce the risk of shingles (herpes zoster) in persons 60 years
of age and older. Children should not receive shingles
vaccine. In clinical trials, the vaccine prevented shingles in about
half the people 60 years and older. It can also reduce the pain
associated with shingles. A single dose of shingles vaccine is indicated
for adults 60 years and older.
For more information about shingles (herpes zoster) disease and
vaccine for adults:
Centers
for Disease Control and Prevention:
Shingles Vaccine Information Statement (VIS)
Food
and Drug Administration Q&A About Shingles Vaccine
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Tetanus
Tetanus is a disease caused by a harmful protein called a toxin.
This toxin attacks the muscles and causes them to painfully constrict.
If the toxin affects the muscles of the throat, breathing can be
so difficult that the child will suffocate. Tetanus is different
from other vaccine preventable diseases because it is not a disease
that you catch from someone else. The bacteria live in the soil
and usually enter the body following puncture of the skin. Items
likely to be contaminated with the tetanus bacteria include nails
or pieces of glass that were lying on the ground. Also, gardening
is an activity that exposes people to tetanus. Once under the skin,
the bacteria make a toxin that causes muscle spasms. If these spasms
occur in the throat, they can interfere with breathing, causing
suffocation. In addition, the toxin can also damage the heart. Fractures
of the spine or long bones such as the femur (thigh bone) may result
from sustained muscle contractions and convulsions that tetanus
can cause.
It's part of children's nature to play and be adventurous and, as
they can often injure themselves, it's important to immunize them
against tetanus. Hand washing and bathing do little once the bacteria
actually get under the skin.
Although tetanus bacteria are everywhere, tetanus is an uncommon
cause of disease in the United States. But it's not as rare as you
may think. Thirty-seven cases were reported in the U.S. in 2001.
Death occurs in about 11% of cases, especially persons over 60 years
of age. Pregnant women should be up-to-date with tetanus vaccination
to protect their babies from getting what is called neonatal tetanus.
Neonatal tetanus usually occurs as a result of tetanus infection
of the umbilical stump.
There are several vaccines which protect against tetanus. DTaP is
generally given at 2, 4, 6 and 12-15 months of age, with another
at 4-6 years before the child starts school. Booster doses are recommended
starting at 11-12 years and every 10 years thereafter. The first
booster is with the improved Tdap vaccine, and subsequent doses
are with the Td vaccine.
For the more information about tetanus and the vaccines that protect
against it:
Children’s
Hospital of Philadelphia: Tetanus
Centers
for Disease Control and Prevention:
Tdap Vaccine Information Statement
Centers
for Disease Control and Prevention:
DTaP Vaccine Information Statement
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Whooping Cough (Pertussis)
Before pertussis (whooping cough) immunizations were available,
nearly all children developed pertussis. In the United States, prior
to pertussis immunizations, more than 200,000 cases of pertussis
were reported each year with up to 9,000 pertussis-related deaths.
Pertussis can be a severe illness especially for babies and young
children. Pertussis illness is characterized by lengthy coughing
spells as the child tries to bring up thick mucous. The child may
turn blue during the coughing spell. Vomiting or gagging and exhaustion
follow the coughing episode. The illness can last for weeks. In
infants, pertussis can cause pneumonia and lead to brain damage,
seizures and mental retardation.
In San Diego County, we had a record-high 371 cases reported in
2005. This was more than triple the total of the previous year.
There are several vaccines which protect against pertussis. DTaP
is generally given at 2, 4, 6 and 12-15 months of age, with another
at 4-6 years before the child starts school. There is an improved
Td (tetanus and diphtheria) vaccine called Tdap (tetanus, diphtheria
and acellular pertussis) available for persons 10 through 64 years
of age. Tdap is the first vaccine to protect teenagers and adults
against pertussis. Only one Tdap booster is recommended at this
time; the recommended age is 11-12 years for teenagers and adults
should receive a single dose of Tdap to replace the next tetanus
booster. Adults who have or will have close contact with an infant
less than 12 months of age (such as parents, grandparents less than
65 years of age, child care providers and health care providers)
could receive a Tdap booster at an interval shorter than 10 years
to reduce the risk of transmitting pertussis to the infant.
For more information about pertussis and the vaccines that protect
against it:
Children’s
Hospital of Philadelphia: Pertussis
Centers
for Disease Control and Prevention:
Tdap Vaccine Information Statement
Centers
for Disease Control and Prevention:
DTaP Vaccine Information Statement
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