Childhood Immunizations

A Parent’s Guide to the Top 12 Diseases Pediatricians Vaccinate for in the United States

1 of 3 from the Vaccine Series
Written by Dr. Rachel Culleton, naturopathic pediatrician

During this Covid-19 crisis, it is crucial to make an educated decision on vaccinations for your children. Every well-child exam you walk into you know you are going to be told what vaccines your child needs based on the CDC’s recommended vaccine schedule. For some that conversation is easy and for others it may be the reason you don’t want to schedule that exam.

When talking about vaccines with my own child’s pediatrician, I often felt overwhelmed and pressured by blanket recommendations, not fully understanding my child’s risks for getting the diseases.

So I took a step back and addressed my own apprehensions to “The Vaccine Talk” and how I could make it more individualized for the families in my practice.
I find that I have a more open discussion when I place a heavy emphasis on what the diseases are rather than what these vaccinations are preventing. The important aspect of this is that we are focusing on each child’s risks for contracting the disease.

If you hate the vaccine talks as much as I do as a mom, sit in that feeling of being uncomfortable, listen to what it brings up for you, and ask yourself:

“What are my hesitations?”

Most of us alive today have not experienced a worldwide infectious disease pandemic until now. We have seen the flu, measles, Zika, and Ebola but we have not seen anything on the scale of the Covid-19. Diseases like Covid-19 are why we have vaccinations and the devastation of Covid-19 is why we need to continue to talk about vaccinations. As a Naturopathic Pediatrician I will support your decisions around vaccines and will provide you with resources and education you need to make the decision that is right for your child.

Talking about vaccines is hard.
It sucks.
But it has to happen.

So let’s talk about it…

It is important, as parents, that you understand the diseases that your child is being vaccinated for, the risks of contracting the disease, and the potential complications that could arise. In this article, I will talk about the top 12 diseases that we immunize children for in the United States.
My hope is to provide you with the education and the clarity you need to make an informed decision on vaccines for your children.

Top 12 Children Vaccinations in the United States

This is not an all-inclusive list of diseases, but the 12 most common diseases that I spend time educating parents on in accordance with the new laws around vaccine exemptions.

Chickenpox

Chickenpox used to be very common in the United States. If you’re over the age of 30 you may remember and likely participated in “Chickenpox Parties”. I definitely did. In the early 1990s there were as many as 4 million cases, 13,000 hospitalizations, and 100-150 deaths per year from Chickenpox.

What are the risks of Chickenpox?
It is a highly contagious disease caused by the varicella-zoster virus. The classic rash starts on the trunk and quickly spreads over the entire body. On average a person will have 300-500 itchy blisters.
Chickenpox spreads very easily from person-to-person via respiratory droplets or direct contact with someone who has the disease. Severe complications of chickenpox include infected blisters, bleeding disorders, encephalitis (brain swelling), pneumonia (infection in the lungs). Those who are at the highest risk for severe complications include the babies, elderly, and immune-compromised individuals.

Why do we vaccinate Chickenpox?
There are no conventional treatments or preventative measures for Chickenpox. Immunization with the Varicella vaccine is the best way to prevent chickenpox. Since the vaccine was implemented in 1995 as many as 3.5 million cases, 9,000 hospitalizations and 100 deaths have been prevented each year.

Diphtheria

Diphtheria is a bacterial infection of the upper respiratory tract caused by the bacteria Corynebacterium diphtheriae. I first learned about diphtheria from playing the original Oregon Trail video game. The bacteria spread from person-to-person via respiratory droplets.

What are the risks of Diphtheria?
When the bacteria, C. diphtheriae, enters the airway of an individual it will attach to the lining of the respiratory system (lungs, trachea, throat, nose) and begin to produce a toxin. The toxin will lead to weakness, sore throat, fever, and swollen glands. As the healthy tissue in the respiratory system is destroyed by the toxin it will form a thick, fibrous, grey coating of dead tissue called a “pseudomembrane”. This “pseudomembrane” can cover tissues in the nose, tonsils, voice box, and throat, making it difficult to swallow and breath. Severe complications from diphtheria include blocking of the airway, damage to the heart and nerves from the toxin, paralysis from the toxin, and lung infection.

Why do we vaccinate Diphtheria?
Diphtheria was once a major cause of illness and death in children with a death rate of 20%. Cases of diphtheria have drastically decreased with the widespread use of the diphtheria vaccine in the 1920s. In 1921 the United States recorded 206,000 cases of diphtheria, resulting in 15,520 deaths. Between 2004 and 2008 no cases of diphtheria were recorded in the United States. So why do we still vaccinate for Diphtheria if the cases are decreasing in the United States? According to the WHO, in 2016 there were 7,100 cases reported globally. With increased globalization there is still the risk of getting diphtheria while traveling or from international travelers.

Hib (Haemophilus influenzae type b)

Haemophilus influenzae disease is the name of any infection caused by the bacteria H. influenzae. There are 6 identifiable types of this bacteria, type b (Hib) being the one most people are familiar with. Hib is spread from person-to-person through respiratory droplets.

What are the risks of Hib?
H. influenzae is an invasive disease, it causes a range of infections from ear infections, bronchitis, pneumonia, blood stream infection, meningitis, and epiglottitis (swelling of throat). Individuals can be carriers of Hib, meaning they have the bacteria in their noses or throats, are not showing signs of illness, but are able to transmit the bacteria to others.

Why do we vaccinate Hib?
The risk of death from different types of H. influenzae varies. For Hib meningitis (the most common form of invasive Hib disease), the fatality rate is 2-5%. Prior to vaccination 20,000 children younger than the age of five developed severe Hib disease in the United States each year, and about 1,000 died. Today, antibiotics are often used to treat Hib infections, but resistance to antibiotics is high and hospitalization is often required. Vaccination only prevents against Hib but not other Haemophilus influenzae diseases.

Hepatitis A

Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. The virus spreads when a person unknowingly ingests the virus from food, objects, or drink that are contaminated with undetectable amounts of fecal matter.

What are the risks of Hepatitis A?
Hepatitis is usually a short-term infection that does not become chronic. Most individuals will recover in a few weeks without lasting liver damage. Individuals at greatest risk for Hepatitis A are those who are homeless or traveling internationally to a country where Hepatitis A is endemic.

Why do we vaccinate Hepatitis A?
There are no specific treatments for acute Hepatitis A infections, only supportive care. Immunization with the Hepatitis A vaccine is the best way to prevent the disease.

Hepatitis B

Hepatitis B is a viral infection of the liver that ranges from mild illness to severe life-long disease known as chronic Hepatitis B. Hepatitis B is spread via blood, semen, or other bodily fluid infected with the virus. Individuals can be infected during birth, intercourse, sharing needles, sharing personal items (toothbrush, razors, infant/toddler toys, medical equipment with blood on it), and direct contact with infected individual’s blood.

What are the risks of Hepatitis B?
The risk of developing chronic Hepatitis B infection decreases with the child’s age. According to the CDC 90% of infants infected with Hepatitis B virus will develop a chronic infection whereas only 25-50% of children aged 1-5 years will develop a chronic infection. Adults will recover completely 95% of the time and not become chronically infected.1

Why do we vaccinate Hepatitis B?
The recommendation to vaccinate early for Hepatitis B is to prevent young children from developing chronic infections and serious complications later in life. Hepatitis B has a high rate of resistance to antiviral therapy and often needs to be treated with two to three antivirals drugs.

Measles

Measles can be very dangerous for babies, young children, adults over age 20, pregnant women, and individuals with compromised immune systems. Measles symptoms show 7-14 days after contact with the virus. These symptoms include fever, cough, rash, runny nose, and watery eyes. The rash will show 3-5 days after these initial symptoms.

What are the risks of Measles?
Severe complications of a measles virus infection include pneumonia and encephalitis. The most severe sequela of a measles virus infection is Subacute Sclerosing Panencephalitis (SPPE). SPPE is a fatal disease of the central nervous system that take 7-10 years to develop.2 According to the CDC as many as 1 out of 20 children who get measles will get pneumonia and 1 out of 1,000 children will develop encephalitis; which could leave the child deaf or with developmental disabilities.

Why do we vaccinate Measles?
As you can see, Measles has a very high rate of complications and about 1-3 out of every 1,000 children who become infected will die from complications of the infection.3
Measles is not a disease that has been eradicated. As recently as 2000, measles had an annual death rate of 1.1 million deaths globally among young children. There are no direct conventional treatments for Measles, only supportive care. Immunization with the MMR vaccine is the best way to prevent Measles.

Mumps

Mumps is a viral infection caused by a virus in the Rubulavirus genus. It can cause a low-grade fever, respiratory problems, and swelling of the salivary glands at the jawline under the ears. Mumps are transmitted from person-to-person by respiratory droplets that become airborne when an individual coughs, sneezes, and talks.

What are the risks of Mumps?
Mumps can be a mild disease or it can cause severe complications. These include meningitis and infertility.

Why do we vaccinate Mumps?
There are no direct conventional treatments for Mumps, only supportive care. Prior to the development of the mumps vaccine, the disease was a major cause of deafness in children.

Pertussis

Pertussis, commonly known as whooping cough, is a highly contagious respiratory disease caused by the bacteria Bordetella pertussis. Pertussis is transmitted from person-to-person by respiratory particles, coughing and sneezing.

What are the risks or Pertussis?
When the bacteria, B. pertussis, enters the airway it attaches to the cilia (small hair-like extensions of the cell) of the respiratory system and releases toxins that damage the cilia, leading to swelling of the airways. Many babies and young children are infected by older siblings or family members who do not know they have the disease. Severe complications of Pertussis include pneumonia, apnea, convulsions, encephalopathy, and 1% of babies under the age of 1 will die. It is very important to note that babies with pertussis might not cough. Instead they will stop breathing and turn blue.

Why do we vaccinate Pertussis?
The treatment for pertussis is generally limited to supportive care. Antibiotics are often used but rarely affect the course of illness unless they are administered very early on.
The best way to prevent Pertussis in your littles is to vaccinate them, yourself, their caregivers, and anyone who is going to come in contact with them. Pregnant women are vaccinated with Tdap during the 3rd trimester of pregnancy to reduce the risk of infection for both mom or her newborn baby.

Polio

Polio is a devastating disease caused by the poliovirus that struck in the warm summer months. The first major Polio epidemic in the United States was in Rutland County, Vermont. There were 132 cases of permanent paralysis and 18 deaths. The virus can spread from person to person and it is the infection of the spinal cord that leads to paralysis.

What are the risks of Polio?
Approximately 72% of those infected with poliovirus will be asymptomatic (show no visible symptoms) and 25% will experience flu-like symptoms, and a small portion will experience severe neurological symptoms. Between 2-5% of children and 15-30% of adults affected by paralytic polio will die.

Why do we vaccinate Polio?
Polio has no cure so prevention is the most effective way to prevent it. Thanks to a very successful vaccine program there has not been a case of polio in the United States since 1979.4 Vaccinating against the poliovirus is still critical in the United States because there are still reported cases of Polio worldwide and with the globalization of the world we can see diseases that were essentially eradicated start to make a come back.

Pneumococcal

Pneumococcal disease is the name of any infection caused by Streptococcus pneumoniae bacteria or pneumococcus. Transmission of pneumococcus is from person-to-person via respiratory secretions when an infected individual coughs or sneezes.

What are the risks of Pneumococcal?
Pneumococcal disease is one of the most common causes of severe pneumonia (infection of the lung). It can also cause infections of the blood, meningitis, and ear infections. Pneumococcus is what we would call an invasive disease, the bacteria gets in the body and grows where we are normally free of germs. The symptoms and complications of pneumococcal disease depend on the area of the body that is infected. Severe complications include meningitis, bacteremia, and pneumonia. Approximately 5% of individuals with non-invasive infection will die from it and that rate is much higher among the elderly and infants. 5

Why do we vaccinate Pneumococcal?
Antibiotics are used to treat Pneumococcal disease but resistance is common. Drug resistance can complicate the disease and lengthen hospital stays. S. pneumoniae causes more than 4,800 cases of invasive pneumococcal disease in children under the age of 5. In this age group the death rate is about 5% and those who survive will be left with permanent injury.

Rubella

Rubella, commonly known as “German Measles”, is a highly contagious disease caused by the rubella virus. Symptoms of Rubella are typically mild in children with a rash starting on the face and then progressing to the whole body. The virus is transmitted from person-to-person by respiratory droplets when the infected individual coughs or sneezes. Infected individuals may be contagious as early as a week before the appearance of the rash.

What are the risks of Rubella?
Rubella is not a high risk disease in children, often the symptoms are mild. Rubella is a high risk disease in pregnancy, it can cause fetal death and severe birth defects.

Why do we vaccinate Rubella?
Thanks to the very successful vaccine program Rubella has been eradicated from the United States since 2004. Prior to eradication the CDC reports that the Rubella Epidemic of 1964-1965 estimated 12.5 million people got rubella, 11,000 pregnant women lost their babies, 2,100 newborns died, and 20,000 babies were born with congenital rubella syndrome (CRS).6 To maintain eradication of Rubella in the United states it is important that all children and women of childbearing ages are fully immunized.

Tetanus

Tetanus is a potentially fatal disease caused by an exotoxin from Clostridium tetani, a bacteria which is found in the soil, dust, and manure.

What are the risks of Tetanus?
Complications of tetanus can be severe. It can present in the children as locked jaw, complaints of a headache, involuntary muscle spasms (typically abdomen), trouble swallowing, and fever. It could also present only as an acute abdomen so it’s important to always look at what is occurring before onset. 7

Why do we vaccinate Tetanus?
For patients suffering from spasms supportive treatment often includes procedures to maintain an open airway. Treatment of the underlying disease involves globulin therapy which removes the tetanus toxin from the body. Thankfully due to vaccination efforts reported cases of tetanus have declined more than 95% since 1947 and deaths have declined almost 99% in the same period.8 It is almost entirely preventable through the use of vaccinations. It should also be noted that surviving tetanus infection does not confer lifelong immunity and tetanus immunization is recommended for all survivors.

Need some support from a naturopathic pediatrician?
You can schedule an in-person or video consultation with me here.
In the face of the covid-19, it is even more important to make proactive decisions for your child’s health.

Stay tuned for my next article…

Early Childhood VaccinesI will go over each individual vaccine that is offered in most pediatric and family medicine practices. My final article of the vaccine series will discuss the CDC’s recommended vaccine schedule, alternative schedules, identifying risk for adverse reactions, and how to support your child through vaccinations.

List of reputable references :

CDC. Hepatitis B Questions and Answers for the Public.
https://www.cdc.gov/hepatitis/hbv/bfaq.htm. Published 2020.
CDC. Subacute Sclerosing Panencephalitis Surveillance. 31(43). https://www.cdc.gov/mmwr/preview/mmwrhtml/00001185.htm. Published 1982.
CDC. Measles (Rubeola): Complications of Measles. https://www.cdc.gov/measles/symptoms/complications.html. Published 2019.
CDC. Polio Elimination in the United States. https://www.cdc.gov/polio/what-is-polio/polio-us.html. Published 2019.
CDC. Pneumococcal Disease Symptoms and Complications. https://www.cdc.gov/pneumococcal/about/symptoms-complications.html. Published 2017.
CDC. Rubella (German Measles, Three-Day Measles). https://www.cdc.gov/rubella/about/in-the-us.html. Published 2017.
Aydin-Teke T, Bayhan GI, Afsarlar CE, Oz FN, Akansel AR, Tanir G. A report of two pediatric tetanus cases. Turk J Pediatr. 2011;53:437-440.
CDC. Tetanus Surveillance. https://www.cdc.gov/tetanus/surveillance.html. Published 2013.