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Answers to Questions (Transcript)

April 17, 2002

Immunizations: What Parents and Caregivers Need to Know

Dr. Nanette Gilpin, M.D.
Department of Pediatrics, Christie Clinic
Champaign, Illinois

See also: Biography and Related Resources

IELmoderator
Greetings, IEL Chat participants. Welcome to our IEL Chat on immunizations. To get started, let me introduce our guest speaker, Dr. Nanette Gilpin from Christie Clinic in Champaign, Illinois.

Dr. Gilpin
Good evening, and greetings to participants in the IEL Chat on the topic of childhood immunizations.

Immunization is a huge topic. Most parents are eager to get their children immunized and protected against diseases. However, they may still have concerns. I am prepared to address concerns about common reactions to various immunizations and why some immunizations have been taken off the market. Many parents are confused as to why Hepatitis B vaccine was off the market for a few months and is now back again. Others are concerned about the number of immunizations that children currently receive. One physician or clinic may use one set of immunizations, and another group may use what appears to be an entirely different set. I am happy to discuss all of these issues.

I would like to spend some time discussing what immunizations are currently available for children. Some physician groups may not educate parents about certain immunizations because of the cost of the immunization. I feel this is unfair to parents and children.

I will spend a little time talking about what is on the horizon for immunizations and immunization schedules.

IELmoderator
I'll begin with one question that we have for Dr. Gilpin.

"Dr. Gilpin, Babies get so many immunizations. Can this overwhelm or weaken their immune systems?"

Dr. Gilpin
No, immunizations do not weaken one's immune system. In fact, immunizations are believed to strengthen the immune system.

jpm
Thank you for being available to us, Dr. Gilpin. I have a question about immunizing children while their mother may be pregnant. Is it a good idea to wait on some immunizations till the baby is born? (We were told some years back that my stepson should wait on a rubella booster while I was pregnant.)

Dr. Gilpin
If it is toward the end of a pregnancy, it is best to wait on live virus vaccines. These include the flu vaccine, the MMR (measles, mumps, and rubella), and the Varicella (chicken pox vaccine).

IELmoderator
Chat participants may now send questions to be answered by Dr. Gilpin. Just a reminder: this is a moderated chat. Your questions will be received by the IEL moderator before being passed on to the chat as a whole.

Dianne
I was very interested to see that there is a new law requiring the chicken pox vaccination before young children can start school or child care. Why was this law implemented at this time?

Dr. Gilpin
Chicken pox is a disease that lasts several days. On average, children are unable to attend school or day care for 10 days once they develop chicken pox. This law is to help keep schoolchildren in attendance as much as possible. I am not certain of the reasoning behind including preschoolers in day care.

John & Diane
Hi, we, John and Diane, are caregivers, and the subjects of immunizations and related issues do come up with our parents and staff from time to time. Thank you for this session.

jpm
May I follow up on the question about waiting on boosters while the child's mother is pregnant -- could you address what the effects might be of the flu, MMR, or chicken pox vaccines that makes waiting a good idea, as you mentioned?

Dr. Gilpin
Since these vaccines contain live viruses, there is a small chance that the child can actually shed virus for several days. This would make it possible for the mother to contract the disease and then pass it on to her child. This is particularly dangerous with chicken pox, as the disease in newborns is frequently fatal. There have not been any cases of infants in this country developing chicken pox from immunizations given in this manner; our decision is based upon experience with children with wild chicken pox exposing their pregnant mother.

Dianne
How many children have severe reactions to vaccines, and does the percentage or number vary by the kind of vaccine?

Dr. Gilpin
The percentage does indeed vary from one immunization to another. For example, with the old DPT vaccine, the chance of developing seizures after the vaccine was 3 per 100,000. The new vaccine contains an acellular pertussis component. It has a much lower chance of post-vaccine seizure development.

itsthelud4u
Do you know if the children will need boosters later in life after they have had vaccines?

Dr. Gilpin
For some vaccines, a booster is necessary for the entire lifespan. This is true of the tetanus vaccine. All of us should be getting a booster every 10 years. Have you had yours?

John & Diane
We have just had a number of children come down with chicken pox who had been immunized. Three of the four had very light cases that were easier for the parents to manage, and they were not out of work as long.

Dr. Gilpin
This is because they were immunized. The Varicella, or chicken pox, vaccine is not 100% protective against chicken pox. It is believed to be about 85% protective. Children who contract chicken pox after immunization generally get a much milder case.

tes
In regards to the new law requiring Varicella vaccination of school children or proof of prior infection, can you tell us what will be considered acceptable proof of a child having had Varicella? (e.g., are scars acceptable, or must there have been MD documentation?).

Dr. Gilpin
I believe there needs to be MD documentation. Now, I don't know what they are going to require of physicians. Currently we sign off on a child's school physical form, which has both a place for the vaccination and a place to mark when the child had chicken pox disease. Theoretically, your physician should be marking one of the two.

John & Diane
What is the clinical reason for boosters?

Dr. Gilpin
Most immunizations require more than one dose to get your child's immune system up to full immunization. For DPaT, IPV, and Hib, this requires three separate immunization doses. Booster doses are given to make sure the immunity lasts longer.

JoAnn K
Dr. Gilpin, can you explain a little about the newer vaccination for preventing ear infections. How effective is it, and do you feel it is necessary? I am a day care provider, and the children who have had this immunization are still getting ear infections. Also my grandchild developed an upper respiratory infection soon after getting it -- probably just coincidence, but my other grandchild didn't have the immunization and hasn't been sick a day in her life. Thank you.

Dr. Gilpin
The vaccine is the Prevnar, or the new pneumococcal vaccine. Pneumococcus is a Strep bacteria. It is not the one that causes Strep throat, but is similar. It is responsible for 30-50% of ear infections and 30-50% of pneumonias. It is actually administered to protect children from pneumococcal meningitis. It has been nicknamed the ear infection vaccine, and the pneumonia vaccine. Both of these are poor names, as it obviously does not protect from all forms of pneumonia or all causes of ear infections. Upper respiratory symptoms within a few days of vaccination are not unusual.

itsthelud4u
Do you know if there is a vaccine for the Rotavirus? I heard that there may be one. I run a day care, and it seems every year the children come down with this.

IELmoderator
Dr. Gilpin is preparing an answer for itsthelud4u's question. Meanwhile, just a reminder. On the IEL Web site you, in the chat section, you can find a list of resources related to immunizations. This is available at: http://illinoisearlylearning.org/chat/gilpin/sup.htm.

Dr. Gilpin
Every year many children contract rotavirus. It is one of the more common causes of gastroenteritis (stomach flu) in infants and toddlers. There was a vaccine a few years ago. It was pulled off the market after a small number of children developed other intestinal problems shortly after receiving the vaccine. The actual number of children that developed this problem was small, but it was much more than we usually see with that particular problem. Manufacturers are working on a new vaccine. It is nowhere near ready for the market.

jpm
Dr. Gilpin, you mentioned in your intro that Hepatitis B was withdrawn from the market for awhile and then was brought back. I'm curious about that. What happened?

Dr. Gilpin
The CDC changed their guidelines on what they considered a safe level of mercury exposure for children under 6 months of age. The Hepatitis B vaccine did not have to be administered during the first 6 months, so the decision was made to pull that vaccine from the market and replace it with a Hepatitis B vaccine with little or no mercury. The new vaccine was on the market less than 6 months later. As stated, no child had an adverse reaction or problem. This was simply an administrative move to protect children from a potential problem.

IELmoderator
Dr. Gilpin, we have another question that a user has sent: Is there mercury used in vaccines for immunizations?

Dr. Gilpin
Many immunizations contain a preservative called Thiomerosal. Thiomerosal is there to prevent the growth of bacteria and funguses in the immunization prior to administration of the vaccine. Thiomerosal contains a small amount of mercury. No child has ever had an adverse reaction to the mercury in a vaccine. However, there has been a move in the medical community to reduce the amount of mercury to which children are exposed. This is why the Hepatitis B vaccine was temporarily removed from the market. There are currently two Hepatitis B vaccines available. One contains no mercury. The other contains only a very small amount of mercury. Manufacturers of other vaccines are looking at ways to produce their immunizations without mercury.

Nancy
Will the new chicken pox vaccine be available to meet the needs of the new requirement?

Dr. Gilpin
The chicken pox vaccine has been available for over 10 years. There is no shortage.

Dianne
I know immunizations are necessary, but they certainly aren't fun for the child! What can parents do to minimize their child's discomfort when they get a shot?

Dr. Gilpin
They aren't fun for us either. Giving Tylenol or Ibuprofen before the immunization does not minimize the discomfort of the administration of the shot. However, Tylenol or Ibuprofen can help with fevers and body aches experienced after the immunization. A warm compress or warm bath can help with the discomfort at the site of the shot.

Dianne
Maybe we just shouldn't tell the child ahead of time that he or she is going to get a shot from the doctor!

Dr. Gilpin
Research has shown that for most children it is best to tell them ahead of time. They don't like knowing, but this promotes trust between you and your child and lets your child know that their physician isn't going to do anything without telling them first. There are also books available to let your child know that immunizations are a normal part of visiting the doctor.

jpm
You mentioned that there were new vaccines on the horizon. I'm concerned about Lyme disease -- what's the status of the vaccine for that?

Dr. Gilpin
There is an effective vaccine available for Lyme disease. However, most insurances won't cover this vaccine unless you are getting it as a travel-related vaccine. Treatment to prevent Lyme disease is also available. If bitten by a tick that carries Lyme disease, one develops a characteristic rash at the site of the bite. Proceed to your doctor and get a prescription for Amoxicillin. This should be started within a couple of weeks of the bite. If allergic to Amoxicillin, other medications are available.

tes
Do you have any idea when the current shortage of tetanus vaccine might be relieved? Our health department has been advised to restrict use of Prevnar too. There have also been articles in the MMWR regarding possible shortages of MMR and Varicella. Any clue as to whether these shortages may ever be alleviated?

Dr. Gilpin
I wish I knew the answer to these. No one has been forthcoming with this information.

John & Diane
We strongly agree with the good doctor, trust is after all trust, and pain does after all come and go . . . .

Dianne
Where can I find a copy of the most up-to-date immunization schedule for children in Illinois? And maybe you answered this already, but do laws/regulations vary from state to state in terms of what is required?

IELmoderator
While Dr. Gilpin is preparing an answer to Dianne's question on immunization schedules, remember that IEL has a collection of Tip Sheets on topics related to early learning. They're available at: http://ecap.crc.uiuc.edu/cgi-bin/iel/searchiel.cgi?action=searchieltips;pl=sp (English)

Dr. Gilpin
Laws and regulations do indeed vary from state to state. This is partly because disease rates vary from state to state. For a current list for Illinois, contact your physician. Within a few days, this list will also be available on the Illinois Early Learning Web site.

John & Diane
And what about wasting disease and others on the 'horizon'?

IELmoderator
While Dr. Gilpin is preparing an answer to John & Dianne's question, let me note that recent Tip Sheets on the IEL Web site are the following:

• He's Teasing Me!
• Getting Ready to Read and Write in Child Care
• Is My Child OK? (on typical child development)

Dr. Gilpin
Nothing on the horizon for Wasting disease. Vaccines on the horizon include a newer, more effective vaccine for meningococcal meningitis. There are still plans to release a vaccine for RSV.

jpm
May I follow-up on the Lyme question? Is there any reason young children in an area with lots of the ticks should NOT be immunized?

Dr. Gilpin
No. Just don't expect your insurance to pay for it. Off hand, I do not know the cost of that immunization.

tes
In regards to discomfort during immunizations, do you think such preparations as EMLA cream have much effect?

Dr. Gilpin
I have tried EMLA cream (a topical anesthetic cream that is put on one hour before the immunization) and haven't seen any difference in children's reaction to the shots.

IELmoderator
Dr. Gilpin, here's another question that we received from an IEL user: Are immunizations linked to autism or learning disabilities?

Dr. Gilpin
No, immunizations are not causally linked to autism or learning disabilities. Autism is usually diagnosed at 15 months of age. This is because these children have to first obtain certain developmental abilities and then lose them to be able to make the diagnosis of autism. Certain vaccines are frequently given at 15 months of age, and some people believed they caused autism. By looking at different immunization schedules, we were able to show that the vaccines were not the cause of autism.

jpm
Could you say a little about smallpox vaccine -- no longer a thing of the past, or are they? Does its current form leave the same kind of round scar that mine did?

Dr. Gilpin
The current vaccine does leave the same scar. Smallpox vaccine does have some risks associated with it, including death. Because of this, we have not jumped into universally immunizing against smallpox. The current plan is to vaccine only those people in a community where a case has been confirmed.

IELmoderator
Dr. Gilpin, here is another question that we got at the IEL Web site: Can immunizations cause disease in the child or can others catch the disease from the child who's been immunized?

Dr. Gilpin
Immunizations can cause disease in children who have a reduced immune system or an immune system disease. Because of this, we do not give certain immunizations to children with HIV or who are on chemotherapy for cancer. Oral polio vaccine can become activated in a child who has received it. The child is unlikely to become ill, but caretakers exposed to the child's stools (changing diapers) can contract polio. This is one of the reasons that we do not use oral polio vaccine in this country anymore. For other immunization questions, consider checking http://www.nih.gov and looking under immunizations.

John & Diane
Which immunizations are live and which are dead?

Dr. Gilpin
Live vaccines are the flu vaccine, the MMR, and the Varicella vaccine. As far as I know, all others are not live.

jpm
Is the risk of death higher for smallpox vaccine than for other vaccines? (Sorry to be asking these questions piecemeal.) And thanks for your clear & concise responses!

Dr. Gilpin
It is believed that if we immunized everyone in the country for smallpox, we would have about 2,000 deaths. This is considerably higher than with other vaccines.

tes
I would like to go back to your earlier discussion of delaying vaccination of children with live vaccines when their mothers are pregnant until after the birth of their baby. You mentioned flu vaccines as one of these. Do they still use a live vaccine for influenza?

Dr. Gilpin
Yes, they still use live vaccine for flu.

IELmoderator
The IEL Chat session will end in a few minutes. We will not be taking further questions.

John & Diane
Thanks!

IELmoderator
However, please remember that If anyone has additional questions, you can send them by email to the IEL staff. The email address is iel@uiuc.edu or you can call IEL at (877) 275-3227 during normal business hours.

jpm
Your time is much appreciated, Dr. Gilpin

IELmoderator
Please join us for our next chat, which will be held on April 29 at 7 pm. The topic of the chat is "Supporting Children's Social Development: Strategies for Parents and Caregivers." The guest speaker is Dr. Lilian Katz from the University of Illinois.

Remember that this chat session has been transcribed. Check the IEL Web (visit the chat page) in a few days to find the transcript.

To all chat participants: Thank you for your participation in the IEL Chat session on immunizations. And thank you very much, Dr. Gilpin, for kindly joining us in this event, and for your very helpful answers to the good questions that we received.

tes
Thank you for the opportunity to take part in the chat session. I liked the format and opportunity to receive live responses to my questions.

IELmoderator
Thanks, all, and have a good evening.

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