A Look At Each Vaccine by Paul A. Offit, MD (www.chop.edu)
 

Although over 25,000 cases of pertussis (or whooping cough) are reported to the Centers for Disease Control and Prevention (CDC) every year, and influenza remains a common childhood infection, most diseases prevented by vaccines are rare. If vaccine-preventable diseases are rare, then the benefits of vaccines are not as great as they were several decades ago. Therefore, it is worth re-examining the benefits and risks of each vaccine to determine if they are still of value.

In this section we will discuss the risks and benefits of all vaccines routinely recommended for children. Although we will discuss each vaccine individually, several combination vaccines are available:

• DTaP (includes vaccines against diphtheria, tetanus and pertussis)
• TriHIBit (includes vaccines against diphtheria, tetanus, pertussis and Haemophilus influenzae type b (Hib))
• MMR (includes vaccines against measles, mumps and rubella)
• MMRV (includes vaccines against measles, mumps, rubella and varicella)
• PEDIARIX (includes vaccines against diphtheria, tetanus, pertussis, hepatitis B virus and polio)
• COMVAX (includes vaccines against Haemophilus influenzae type b (Hib) and hepatitis B)
• TWINRIX (includes vaccines against hepatitis A and hepatitis B)

Other vaccines such as pneumococcus and varicella (chickenpox) are currently given individually, but new combinations are being studied.

We will also describe vaccines recommended for use only in special circumstances such as those that prevent rabies, meningococcus, tuberculosis and anthrax.

Finally, we will describe vaccines occasionally used for travel to developing countries such as cholera, typhoid fever, yellow fever and Japanese Encephalitis virus vaccines. Also see Vaccines for Travelers.

Types of Vacine
 

Anthrax Vaccine

The anthrax vaccine is recommended for military personnel likely to be exposed to anthrax spores during a bioterrorist attack. The vaccine was also recommended for postal workers who served areas that were the target of letters that contained anthrax spores. The vaccine is given as a series of six shots. After the first shot, the vaccine is given two weeks, four weeks, six months, 12 months, and 18 months later. [read more..]

Cholera Vaccine
The cholera vaccine is generally not required or recommended for travel anywhere in the world, with perhaps a few local exceptions. For some traveling to a specific area within a particular country, local authorities may require that you receive the two-dose vaccine. Cholera is a bacterium (Vibrio cholera) that attacks the intestines, causing diarrhea in about 5 percent of those infected. Sometimes quite severe, the diarrhea and subsequent loss of fluids can cause people to go into shock, and die. [read more..]

DTaP: Diptheria, Tetanus and Pertussis Vaccine
Diphtheria vaccine
The diphtheria vaccine is contained in a preparation called "DTaP" (the "D" in DTaP stands for diphtheria). DTaP vaccine is given as a series of five shots, at 2 months, 4 months, 6 months, 15 to 18 months, and again at 4 to 6 years of age.

The dangers associated with diphtheria come from the toxin released by the bacterium, Corynebacterium diphtheriae. The toxin makes it difficult for children to breathe and swallow, but it also attacks the heart, kidneys and nerves.

Tetanus vaccine
The tetanus vaccine is contained in a preparation called DTaP (the "T" in DTaP stands for tetanus). DTaP vaccine is given as a series of five shots, at 2 months, 4 months, 6 months, 15 to 18 months, and again at 4 to 6 years of age.

Tetanus is another disease caused by a toxin-releasing bacterium, Clostridium tetani. Unlike most vaccine- preventable diseases, tetanus is not a disease that you catch from someone else. The bacteria live in the soil and usually enter the body following a puncture wound of the skin. Items likely to be contaminated with the tetanus bacteria include nails or pieces of glass that were lying on the ground. Once under the skin, the bacteria make a toxin that causes muscle spasms. If these spasms affect the throat and jaw (lockjaw), they can interfere with breathing, causing suffocation. The tetanus toxin can also damage the heart.

Pertussis vaccine
The pertussis vaccine is contained in a preparation called DTaP (the "P" in DTaP stands for pertussis). DTaP vaccine is given as a series of five shots, at 2 months, 4 months, 6 months, 15 to 18 months, and again at 4 to 6 years of age.

Pertussis (widely known as whooping cough) is one of the most contagious diseases around. Caused by a bacterium (Bordetella pertussis), whooping cough makes children cough uncontrollably. With the cough so hard and so persistent children oftentimes can't catch their breath. Children make a "whooping" sound when they attempt to breathe in against a windpipe severely narrowed by mucus. Pneumonia or seizures can also develop.

Pertussis is unusual in that most children catch the disease from adults and not other children. It is estimated that every year in the United States between 600,000 and 900,000 adults and adolescents get pertussis! [read more..]

Hepatitis A Vaccine
The hepatitis A vaccine is given to people who are traveling to parts of the world where hepatitis A virus infections are common. The hepatitis A vaccine is also now recommended for all children living in the United States.

The hepatitis A vaccine should be given as a series of two shots — the second administered six to 12 months after the first. Children receiving the first shot should be at least 1 year old.[read more..]

Hepatitis B Vaccine
The hepatitis B vaccine is given to prevent the severe liver disease that can develop when children or adults are infected with hepatitis B virus. The hepatitis B vaccine is given as a series of three shots. The first dose is given between birth and 2 months of age. The second dose is given one to two months after the first dose. The third dose is given between 6 months and 18 months of age.    [read more..]

Hib Vaccine
Haemophilus influenzae type b (Hib) is a bacterium that infects the lining of the brain, causing meningitis. Meningitis is caused by several different bacteria. However, before the Hib vaccine, Hib was by far the most common cause of meningitis. Children with meningitis often have fever, stiff neck and drowsiness. Symptoms can progress to include coma and death. Some children recover from the disease but are left permanently paralyzed, deaf, blind or mentally retarded. Other diseases caused by Hib include:

• Sepsis (bloodstream infection)
• Epiglottitis (severe swelling of the epiglottis, a tissue that closes off the windpipe during swallowing)
• Arthritis (infection of the joints)
• Osteomyelitis (infection of the bones)
• Pneumonia (infection of the lungs)          [read more..]

Human Papillomavirus Vaccine
In June 2006 a new vaccine for human papillomavirus was licensed and recommended for use in the U.S. The vaccine will prevent most cases of cervical cancer. [read more..]

Influenza Vaccine
The influenza vaccine is given to those who are at high risk of developing severe influenza. For children 6 months to 9 years of age that are receiving the influenza vaccine for the first time, a series of two shots is administered, separated by one month. For children who have already been vaccinated with influenza vaccine, or are over 9 years of age, a single influenza shot is administered yearly.

The Centers for Disease Control and Prevention (CDC) recommends that all children between 6 months and 18 years of age receive the influenza vaccine and that all family contacts of children less than 5 years of age receive the vaccine.  [read more..]

Japanese Encephalitis Virus Vaccine
The mosquito-borne virus, Japanese encephalitis virus (JEV), does not just occur in Japan. JEV also occurs in many regions of the Far East. However, the United States does not recommend the JEV vaccine for everyone traveling to the Far East. Rather, the vaccine is recommended only for people who travel to the Far East and engage in certain high-risk activities. The JEV vaccine is given as a series of three shots and can be administered to anyone over 1 year of age: the second shot is given seven days after the first, and the third is given 30 days after the first.   [read more..]

Meningococcus Vaccine
A new meningococcal vaccine was licensed in early 2005.

About one in 20 children with meningitis caused by meningococcus and about one in three children with bloodstream infections (i.e., sepsis) caused by meningococcus will die from the infection. Death from sepsis can occur within 12 hours of the beginning of the illness — it is one of the most rapid and overwhelming infectious diseases known to man!

The bacterium, Neisseria meningitidis, primarily targets children under 1 year of age. Because meningococcus is contagious, outbreaks can occur in childcare centers and schools. Cases also occur in high schools and on college campuses.   [read more..]

MMR: Measles, Mumps and Rubella Vaccine
MMR: measles vaccine
The measles vaccine is contained in a combination vaccine called MMR (measles, mumps and rubella, also known as German measles). MMR is given as a series of two doses at 12 to 15 months of age and at 4 to 6 years of age.

MMR: mumps vaccine
The mumps vaccine is contained in a combination vaccine called MMR (measles, mumps and rubella, which is also known as German measles). MMR is given as a series of two doses at 12 to 15 months of age and at 4 to 6 years of age.

MMR: rubella vaccine
The rubella vaccine is contained in a combination vaccine called MMR — measles, mumps and rubella (German measles). MMR is given as a series of two doses at 12 to 15 months of age and at 4 to 6 years of age.   [read more..]

Pneumococcus Vaccine
Pneumococcus is a bacterium that causes several different types of serious infections in children. But by far the most common is pneumonia. Children with pneumonia develop high fever, cough, and rapid, difficult breathing. Sometimes the bacteria cause pus to accumulate not only inside the lung, but between the lung and the chest wall (called an empyema). The empyema can compress and collapse the lung. Although the vast majority of children with pneumonia recover, the disease is occasionally fatal.

Much like Haemophilus influenzae type b (Hib), pneumococcal bacteria (Streptococcus pneumoniae) affect the most defenseless of the population (infants and toddlers). The diseases caused by pneumococcus include meningitis, bloodstream infections and pneumonia. Before the pneumococcal vaccine was first introduced for use in all infants in the United States in 2000, every year pneumococcus caused about 700 cases of meningitis, 17,000 cases of bloodstream infections and 71,000 cases of pneumonia. The reason that infants and young children are at greatest risk of serious infection is that they are unable to develop immunity to the sugar (or polysaccharide) that coats the bacteria, something that older children do naturally over time.  [read more..]

Polio Vaccine
The inactivated polio vaccine (or IPV) is now the only vaccine given in the United States to prevent polio. IPV is given as a series of four shots, at 2 months, 4 months, 6 to 18 months, and again at 4 to 6 years of age.   [read more..]

Rabies Vaccine
The rabies vaccine is given to prevent the progressive, invariably fatal, disease, rabies. A total of five shots are given in the shoulder muscle: the first shot is given immediately after exposure to a rabid animal, then again three days later, seven days later, 14 days later and 28 days later.   [read more..]

Rotavirus Vaccine
The Centers for Disease Control and Prevention approved a rotavirus vaccine for use in the United States in 2006. The vaccine, called RotaTeq, is given as a series of three doses by mouth at 2 months, 4 months and 6 months of age and can be given with other vaccines typically administered at those times. A second vaccine, called Rotarix, was approved for use in June 2008 and is given as a series of two doses by mouth at 2 months and 4 months of age.   [read more..]

Shingles Vaccine
In October 2006 the CDC recommended a new shingles vaccine for adults 60 years of age and older in the U.S. The vaccine will prevent much of the pain and suffering caused by shingles.

Shingles is a disease caused by the reactivation of chickenpox virus. Shingles most often occurs in elderly people and people with weakened immune systems. Common symptoms of shingles include a rash, usually along a nerve path, and severe pain. Sometimes the pain can last for months.   [read more..]

Smallpox Vaccine
Smallpox is a virus. Symptoms of smallpox infection begin with a two- to five-day period of high fever, malaise and backache followed by the development of a rash. The rash begins in the lining of the mouth and throat as well as on the face and forearms before spreading to the trunk and legs. The rash starts with red bumps that are flat to the skin, but progresses to raised bumps, blisters and finally scabs. The time from the beginning of the rash to the formation of scabs is about two weeks.

The rash of smallpox feels like it is deeply embedded in the skin. Residual, life-long pockmarks on the skin often occur following resolution of the illness.

About 30 percent of people infected with smallpox will die from the disease.   [read more..]

Tuberculosis Vaccine
The tuberculosis (TB) vaccine is rarely used in the United States. It is only recommended for those children living with someone who is actively infected with TB and who either cannot take antibiotics to treat the infection or is infected with a strain of TB that is highly resistant to all antibiotics. The TB vaccine is given as a single shot.   [read more..]

Typhoid Vaccine
The typhoid vaccine is not required for international travel. The typhoid vaccine should be used only by people traveling to high-risk areas who will be:

• Staying for more than six weeks
• Staying in rural areas or small towns
•  Choosing to eat uncooked foods and unpeeled fruits, and drink non-bottled water

There are two forms of the typhoid vaccine that are available in the United States, each one most effective when given at a particular age. Although the vaccines are both fairly effective in preventing typhoid (ranging from 50 percent to 80 percent effective), you should still heed the warning "boil it, peel it or forget it."    [read more..]

Varicella (Chickenpox) Vaccine
In 1998, an 8-year-old girl was seen in the Emergency Department of a hospital. For several days she had low-grade fever and blisters appearing over her entire body. The girl had chickenpox. At first her mother was relieved at the diagnosis. Chickenpox is, after all, a mild infection. But then the child had progressive difficulty breathing. Her breathing became rapid, shallow and difficult. A chest X-ray showed that she had pus between her lungs and chest wall (called an "empyema"). The pus caused one lung to be constricted. The child was admitted to the intensive care unit, but it was too late. She died the next day. Before the chickenpox vaccine, about one child in this country would die every week from chickenpox — most of these children were previously healthy.

The varicella vaccine is given to prevent chickenpox and the severe, and occasionally fatal, consequences of chickenpox. This vaccine is given to children between 12 and 15 months and again between 4 and 6 years of age. Children, adolescents and young adults who have received only one dose should also get a second dose. For previously unimmunized adolescents (13 to 18 years old) or adults, the vaccine is given as a series of two shots, separated by four to eight weeks.    [read more..]
 

Yellow Fever Vaccine
The yellow fever vaccine is required for entry into many countries in Africa and South America. The vaccine is also used in countries where yellow fever occurs, but the vaccine is not required for entry. The vaccine is given as a single shot to anyone greater than 9 months of age, and may be given as a booster dose every 10 years for those who are at continued risk.     [read more..]

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