We will be discussing... Vaccines a balanced discussion of what you need to know to make an informed decision. Vaccines.

Transcription

1 Vaccines a balanced discussion of what you need to know to make an informed decision Koren Barrett ND We will be discussing... Vaccines what it is and what they do Traditional vaccine schedule Detailed information on each vaccine and the diseases it protects against Alternate schedules How to vaccinate safely What next?... Vaccines Vaccine Benefits A small dose of an attenuated bacteria or virus Stimulates the immune system to react thereby creating memory primes the pump Large decrease in pertussis infections Polio eradicated from western hemisphere Small pox eradicated Measles at all time low Diptheria is rare Death from tetanus is rare Drop in infant mortality Vaccines and What is all the controversy? Street and roads cleaned Water supply improved Cemeteries opened Sewage control Antibiotics (1940s) Concerns with safety. Testing Ingredients Immune system shift 1

2 Testing Mercury in vaccines? Vaccine studies are conducted to ensure they raise titer levels, the studies are too small to detect many potentially dangerous events All clinical trials only enroll healthy infants no studies where they are administered to sick kids Thimerosal was a preservative added to vaccines to inhibit the growth of bacteria Thimerosal contains; Ethyl Mercury 2001 Thimerosal was eliminated from most vaccines (flu vaccines, Meningococcal and Rhogam may still contain the preservative) Thimerosal Thimerosal Safe level of organic (methyl) mercury EPA 0.1 mcg/kg per day ASTDR 0.3 mcg/kg per day FDA 0.1 mcg/kg per day WHO 3.3 mcg/kg per week DTaP + Hib + Hep B was a total of 62.5 mcg This exceeds all safe levels for a 10 lb infant 1999, the maximum cumulative exposure to mercury from vaccines in the recommended childhood immunization schedule was within acceptable limits for the methylmercury exposure guidelines set by FDA, Agency for Toxic Substances and Disease Registry (ATSDR), and the World Health Organization (WHO). However, depending on the vaccine formulations used and the weight of the infant, some infants could have been exposed to cumulative levels of mercury during the first six months of life that exceeded EPA recommended guidelines for safe intake of methylmercury. As a precautionary measure, the Public Health Service (including FDA, National Institutes of Health [NIH], Centers for Disease Control and Prevention [CDC] and Health Resources and Services Administration [HRSA]) and the American Academy of Pediatrics issued a Joint Statement, urging vaccine manufacturers to reduce or eliminate thimerosal in vaccines as soon as possible. Accessed Mercury Other ingredients. Induces DNA break Membrane damage Death of neurons Websites to determine content Aluminum Known neurotoxin, linked to autoimmune disease When several vaccines are given in combination exceeds safe dosage Preservatives (must be in multi dose vials) Formaldehyde Use of human or animal tissues Possible viral and mycoplasma contaminant Antibiotic residue 2

3 Immature immune system? Too Many?? Vaccines depend on creation of memory in the immune system to be effective Most immunological memory doesn t happen the first year of life Immune activation different for an infant vs. a toddler (1 yo) TH1 vs TH2 Early immunization many alter the immune system creating more allergies/ asthma/ eczema/ autoimmunity Vaccine schedules are recommended by the CDC (center for disease control) and AAP (American academy of pediatrics) 1970 s Recommended children receive 23 doses of 7 vaccines by age 6 starting at 2 months old 2012 Recommend children receive 48 doses of 15 vaccines by age 6 starting at 12 hours old Too much??? Today s Schedule At 2 months babies receive as many as 8 vaccines in one visit At months babies receive up to 13 in a single visit Birth - Hep B 1 month - Hep B 2 months - HIB, Pc, DTaP, arotavirus, Polio 4 months - HIB, Pc, DTaP, arotavirus, Polio 6 months HIB, Pc, DTaP, Rotavirus, Hep B, Flu Today s Schedule One size fits all approach 1 year MMR, chickenpox, Hep A, Flu 15 months HIB, Pc 18 months DtaP, Polio, Hep A, Flu 2 years - Flu 3 years - Flu 4 years - Flu 5 years DTaP, Polio, MMR, Flu, Chickenpox 12 years Tdap, Meningococcal, HPV (3x) The focus of the immunization schedule is based on herd immunity Little allowance for individual immune status Preemie age adjusting is not taken into consideration Reason for giving vaccines at a young age Linked to pediatric wellness visits greatest chance to immunize the greatest portion of the population 3

4 A better way? Evaluating individual risk Determining which vaccine is appropriate Proper timing of vaccines Prevention and treatment of the diseases What do I need to know about Hepatitis B? Virus Majority of hepatitis infections occur in people ages yo ½ of the people never develop symptoms Only 20% develop severe symptoms Can become chronic 10% risk Causes liver damage 25% of people eventually develop liver failure Hepatitis B risk factors Hepatitis B frequency Babies born to infected mothers (70-90% risk of transmission) Vaccine should be considered later in life as Hepatitis B is primarily an adult disease transmitted through infected body fluids Drug addicts Sexual promiscuity Health care workers exposed to blood Persons who require repeat blood transfusions 200,000 new cases yearly in all age groups Only 360 cases reported yearly in infants prior to vaccine Less than 1% of cases occur in persons less than 15 yo Hepatitis B vaccines Hep B Protection by age & dose Vaccine options; Recombivax HB 250 mcg aluminum, yeast, formaldehyde Engerix B 250 mcg aluminum, yeast, 0.5 mcg mercury Comvax 225 mcg aluminum (this is less than the 475 mcg if you give hep b and HIB separately) Pediarix DTaP + Enerix + polio, many preservatives and additional ingredients!! Twinrix hep A + hep B for persons age 18 yo or older Dose 1 Infants 16-40% Teens/adults 20-30% Dose 2 Infants 80-90% Teens/adults 75-80% Dose 3 Infants % Teens/adults 90-95% Preterm infants have less efficacy when <2 kg 4

5 Hep B vaccine Adverse reactions reported to CDC Hep B vaccine Who should get it? Pain at site of injection 0-20% of children - fatigue, headache, irritable.4-6.4% had a low grade fever Alleged to cause exacerbation / causative factor of multiple sclerosis New Zealand study found 60% increase of diabetes following a massive hepatitis B immunization campaign Not for children unless born to mother who is hepatitis B positive Consider in adolescents age 9-11 before they become sexually active Adults who are in a high risk group What do I need to know about HIB Haemophilus Influenzae Type B Bacteria Humans are the only known host Transmitted by respiratory droplet Usually causes mild cold Severe cases cause meningitis Hib meningitis has a 5% fatality rate 25% cause some brain damage Difficult to recognize in the early stages It is a treatable condition by IV antibiotics, will prevent fatalities but not all damage Hib risk factors Smoker in the house at most risk for being an asymptomatic carrier Highest risk ages 6-12 months Rare prior to age 6 m and never seen after 5 yo Not breast fed protection in infants from moms antibodies in breast milk for 6 months Daycare or school age siblings Greater than 4 in a household Chronic disease ill children at greater risk Hib frequency Hib Vaccines No 25 cases yearly mostly in children under the age of 5 yo, rare beyond 3 yo Prior to vaccines in the 80s 20,000 cases yearly PedVaxHIB (2 doses in primary series) contains 225 mcg aluminum Pentacel (in combo with DTaP and polio) contains 1500 mcg aluminum (more than the sum of its components separately 330 mcg) Comvax (in combo with Hep B) contains 225 mcg aluminum (this is less than the 475 mcg if you give hep b and HIB separately) ActHIB (3 doses in primary series) HibTITER (3 doses in primary series) TriHIBit (combined with DTaP for 18 m only) 5

6 Hib vaccine protection by age and dose Hib vaccine Adverse reactions Do not give prior to 6 weeks old may make future vaccines ineffective Most do not show a proper immune response before age 6 months Requires less dosages if given later Any previously unvaccinated child months only needs a single dose of the vaccine No need to vaccinate children older than 59 months Local inflammation 5-30% Seizures, renal failure, guillain barre Recent research has linked an association with type 1 diabetes, the more vaccine doses the higher the risk Hib Who should get it? What do I need to know about Pc Pneumoccoccal Conjugate Not effective less than 6 months of age Major risk factors (second hand smoke, daycare, large family, poverty, not breast fed) Not needed after 5 yo Bacteria Spread by respiratory droplet Very common and virtually every child is a carrier the first year of life Causes URI, pneumonia May cause meningitis 30% fatality It is a treatable condition by IV antibiotics for severe infection, oral antibiotics for mild infection Pc Risk Factors Pc - frequency Second hand smoke exposure Lack of breast feeding Daycare African American, Native American or Alaskan Poor nutrition and vitamin A deficiency Yes in its mild form Most common cause of infant meningitis 10,000 cases yearly of severe infection in children under 5 yo in US and 20,000 in adults cases yearly in all age groups of severe infection resistant to antibiotics 60,000 yearly before introduction of the vaccine 6

7 Pc vaccines Pc protection by age and dose Prevnar 125 mcg of aluminum Protects against 7 strains but strain #3 (the worst) is not one of them Pneumovax 23 for adults only Age 6 wks to 7 months requires 4 doses Age 7-11 months requires 3 doses Age months requires 2 doses Age 24 + months requires 1 dose Pc vaccine Adverse reactions Pc vaccine Who should get it? Seizures Fever Tenderness at site of injection Not effective prior to 6 months of age Any child with major risk factors Consider waiting until 2 yo for health children with no risk factors What do I need to know about Diptheria The D of DTaP What is it? Bacteria Causes severe throat infection Infection through respiratory droplet What is the concern? Can cause closing of throat, difficulty breathing 5-10% fatality It is a treatable condition with an antitoxin and IV antibiotics Diphtheria risk factors People who live in crowded areas with poor sanitation Alcohol addiction and drug use have higher rates of diphtheria 7

8 Diphtheria frequency Diphtheria Vaccines No Maximum 5 cases yearly There was only 1 case in 2002 Daptacel Tripedia Infanrix Pentacel (in combo with Hib and polio) Pediarix (in combo with hep B and polio) TriHIBit (combined with Hib for 18 m only) Vaccine can be given separately from DTaP Diptheria vaccine Adverse reactions What do I need to know about tetanus - T of DTaP Site tenderness Rare severe reactions Anaphylaxis Urticaria Neurological complications What is it? Bacteria that lives in the soil Can cause paralysis Enters body through contaminated wound Not contagious Treated with immunoglobulin What is the concern? Causes paralysis through out the body 15% fatality rate Tetanus risk factors Tetanus frequency Puncture wounds NO CASES YEARLY virtually all in older adults who have not received a booster shot 15 cases in children from

9 Tetanus Vaccines Tetanus vaccine Protection by age and dose Daptacel 330 mcg aluminum, 100 mcg formaldehyde Tripedia 170 mcg aluminum, 100 mcg formaldehyde, 0.3 mcg mercury Infanrix 625 mcg aluminum Pentacel contains 1500 mcg aluminum (more than the sum of its components separately 330 mcg) Studies show that less doses are needed if a child is vaccinated after 12 months old Tetanus vaccine Adverse reactions Tetanus vaccine Who should get it? Mild soreness at site of injection Rare allergic reaction or kidney problems Fatigue Consider in children older than 1 year What do I need to know about Pertussis? - P of DTaP Pertussis risk factors Bacteria - WHOOPING COUGH Coughing fits that last 30 sec to 2 min so severe the person has trouble breathing Toxin released irritates the lungs Illness can last 3 months Most serious in 1 st 6 months of life 1% fatality 2000 cases yearly 75% hospitalized 20 die yearly (most before 2 months of age) Possible brain damage due to prolonged coughing Daycare Sibling between ages 4-10 (Kids of this age group who were previously vaccinated are common vectors) Exposure to second hand smoke Parents who are health care workers or teachers are the most common vectors 9

10 Pertussis frequency Pertussis vaccines cases reported each year in US In the US 5-10 children die every year most deaths occur in unvaccinated children or children too young to be vaccinated Daptacel 330 mcg aluminum, 100 mcg formaldehyde Tripedia 170 mcg aluminum, 100 mcg formaldehyde, 0.3 mcg mercury Infanrix 625 mcg aluminum Pentacel contains 1500 mcg aluminum (more than the sum of its components separately 330 mcg) After 6 months fatality VERY rare but we vaccinate older children and adults to protect infants Immunity only lasts 4-8 years There are no pertussis only vaccines Pertussis vaccine Protection by age and dose Pertussis vaccine Adverse reactions If you start later children will develop a titer from the 1 st dose Redness, swelling. Pain and vomiting No appetite Breast milk does not provide much protection (unlike Hib or Pc) Pertussis vaccine Who should get it? Highest rates in inner cities Note: lowest vaccination rate in Ashland OR yet not the highest incidence of the disease What do I need to know about Rotavirus? Virus Settles in the intestines Severe vomiting and diarrhea children die yearly due to dehydration Most severe in the first year of life There is no medication to treat the illness give fluids (IV if necessary) 10

11 Rotavirus risk factors Rotavirus Frequency Daycare!!! Easily spread in daycares due to resistance to antibacterial soaps 2 million people are hospitalized yearly for the disease ½ million Dr visits yearly for the disease Worst in late fall and winter By age 3 yo most kids will have had the virus once Rotavirus vaccines Rotavirus vaccine Adverse reactions RotaTeq 5 strains Rotarix 1 strain (not yet available) Vaccine concerns; Viruses are whole and live, intended to create a small infection, live viruses are coming out of the diaper for 15 days after the first dose (10-50%) Concern with intussusception (concern with older version of vaccine) Rotavirus vaccine Who should get it? High risk kids Daycare Older siblings Poor health What do I need to know about Polio? What is it? Virus Most cases do not show any symptoms What is the concern? 1 in 250 cases muscle paralysis Maybe temporary but 2/3 have permanent muscle weakness Most often not fatal 11

12 Polio risk factors Polio frequency Breast feeding gives passive immunity A healthy GI tract is most likely protective If a child is traveling to a country where Polio is endemic then consider vaccinating. No No cases since 1985 Polio vaccines Polio protection by age and dose Ipol inactivated whole virus Pediarix (in combo with hep B and DTaP) Pentacel (in combo with DTaP and HIB) No longer using live oral vaccine (can contaminate others or cause the disease in the recipient) Highly effective in producing immunity >90% immune after 2 doses >99% immune after 3 doses Duration of immunity not know with certainty Ipol vaccine grown on monkey kidney tissue Breast feeding diminishes the child's immune response to the vaccine that s why 3 shots are given Polio vaccine adverse reactions Polio vaccine who should get it? Previous live vaccine could cause polio or infect others (lots of problems!!) Pentacel contains 1500 mcg aluminum (more than the sum of its components separately 330 mcg) Minor local reaction redness and swelling SV40 and cancer SV40 is a virus found in the rhesus monkey kidney cells (how the virus was grown) that is a human carcinogen (causes cancer) Removed in 1990 s Traveling out of the country Keep up healthy gut flora Breast feeding gives immunity Start vaccine after breastfeeding has stopped 12

13 What do I need to know about Flu Influenza? What is it? Virus many strains Common cold symptoms Treatable with antiviral mediations if started in the first 48 hours What is the concern? Not usually serious 100,000 hospitalizations yearly usu in elderly 100 deaths yearly in children and young adults combined 1500 deaths yearly 90% in elderly May want to vaccinate family to protect those at risk Flu frequency VERY Millions of cases yearly Flu Vaccines Flu vaccine who should get it? Vaccine concerns; Flumist live virus for ages 5+ years can cause a flu infection Fluzone ages 6m and older. 25 mcg mercury in multi dose vials (0 mcg in single dose vial these were made in limited supply and difficult to find) FluLaval ages 18 yo and older 25 mcg mercury Fluarix ages 18 years and older 1 microgram mercury Fluvirin ages 4 years and older trace amount mercury Package insert not known whether when given to pregnant women if it will cause fetal harm The influenza virus vaccine is an FDA pregnancy risk category C drug. The ability of Fluarix, Fluvirin, FluLaval, Afluria, or Fluzone to cause fetal harm or to affect reproductive capacity is unknown. Immuno-compromised people that need protection from other family members Consider carefully is you are pregnant Flu - Pregnancy category C "Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus." What do I need to know about Measles? M of MMR What is it? Virus Causes a fever, rash, runny nose and cough What is the concern? Not usually serious 1 in 1000 cases is fatal by infecting internal organs 13

14 Measles risk factors Measles frequency Measles has an antibody that is transferred though the placenta and breast milk. - When a child stops breast feeding they are at increased risk Mothers have less antibody if they received the vaccine vs. having the disease Vitamin A deficiency and international travel are increased risk factors. NO cases yearly 1980s The majority of outbreaks occurred among middle, high, school and college student population As many as 95% of persons infected during these outbreaks had received one dose of the measles vaccine A second dose is now recommended for school age children Measles vaccines Live virus Vaccines produce a mild non communicable infection Vaccine types MMR II measles, mumps and rubella Attenuvax (measles alone no longer produced) Proquad MMR with chickenpox (insert states do not use tylenol at time of vaccination) Measles protection by age and dose Antibodies develop in ~95% of children vaccinated at 12 months of age In ~98% of children vaccinated at 15 months of age Vaccine induced immunity appears to be long term but a booster seems to be needed Measles vaccine adverse reactions Fever Rashes Thrombocytopenia (low platelet) within 2 months of the vaccine 1 in 30,000 Link to autism? Increased expression of IgE Possible link to rise in allergy and asthma What should I know about Mumps? M #2 of MMR What is it? Virus Causes fever rash and swelling of the saliva glands in the cheeks What is the concern? Rarely infects the internal organs In adults rarely causes sterility No specific treatment is available 14

15 Mumps frequency Mumps vaccines No 250 cases yearly in the US Vaccine types (live virus) Mumpsvax (mumps alone no longer produced) MMR II measles, mumps and rubella Proquad MMR with chickenpox The vaccine produces a mild non communicable infection Mumps protection by age and dose Mumps vaccine adverse reactions The first dose provides long-term protection (97%) Second doses of MMR are given because of the measles component (not because of the mumps or rubella components) Vaccine most effective when given after 16 months No effectiveness prior to 12 months of age Life long immunity Very safe vaccine Most problems are due to the measles or rubella components What do I need to know about Rubella? R of MMR Rubella risk factors What is it? Virus usually a mild childhood disease Fever rash and aching joints No specific treatment runs its course What is the concern? In pregnancy can infect the fetus and cause birth defects 4 babies born between with congenital rubella syndrome A fetus is at risk of a pregnant woman who is not immune and contracts rubella 15

16 Rubella frequency Rubella vaccines No Used to be 100,000 cases yearly 2005 CDC announced rubella eradicated in US Vaccine types live virus Meruvax II (rubella alone no longer produced) MMR II measles, mumps and rubella Proquad MMR with chickenpox Rubella vaccine protection by age and dose Rubella vaccine adverse reactions 1st dosage provides long term immunity at least 15 years Second dose of MMR is given for the measles component (>95% immune after 1 st dose) Most effective when given after the age of 16 months Do not vaccinate a breast feeding woman the infant may become infected Vaccine concerns; rare Do not give to people /infants with gelatin or egg allergies What do I need to know about Chickenpox varicella? Chickenpox frequency Herpes virus - Causes fever and spots Not usually serious 1 in 65,000 cases is fatal More serious in those with compromised immune systems can cause birth defects if a pregnant woman contracts the disease in the first half of her pregnancy. Can be treated with acyclovir (antiviral medication if started within 72 hours of the rash appearance) In adults - reactivate to cause shingles (zoster) Prior to 1990 and initiation of vaccine 3.5 million cases yearly 75-85% decrease since the vaccination began 16

17 Chickenpox vaccines Chickenpox vaccine adverse reactions Vaccine types Varivax live virus ProQuad (combined with MMR) I don t recommend, increased rates of high fever and febrile seizures better to give separately Zostavax (for adults only to prevent shingles) Do not give within 30 days of receiving MMR, increased risk of breakthrough chickenpox Vaccine concerns; Unnecessary vaccine? Possible link to increased incidence of shingles in children? May make shingles in adults more likely Short lived immunity ~7 years, increased risk of dangers of adult chickenpox Chickenpox vaccine who should get it? What do I need to know about Hepatitis A? Adults and children 15 yo who did not get the disease Much more severe disease Immuno-compromised children Genetic disorder Disease Medical treatment 2 nd highest rate of death from chickenpox What is it? Virus Attacks the liver Most children do not have any symptoms What is the concern? Several weeks of illness Rarely will come and go for up to 6 months If underlying liver disease can suffer severe liver damage No specific treatment is available Hepatitis A vaccines Hepatitis A frequency Vaccine types Vaqta mcg aluminum Havrix mcg aluminum Twinrix (combined with hep B for 18+years old) 10,000 cases yearly mostly kids age 5-14 yo 17

18 Hepatitis A adverse reactions Hepatitis A vaccine who should get it? Vaccine concerns; Recent addition to vaccine schedule (2006) Usually harmless disease in children Travel What do I need to know about Meningococcal? Meningococcal frequency Bacteria - Can cause meningitis What is the concern? Very serious illness - 10% are fatal 20% are fatal among teens and college age students (50 fatalities in 250 students contracting the disease) 15% of survivors have some permanent disability nerve damage or heating loss It is a treatable condition by IV antibiotics, but disease progresses VERY rapidly 3000 cases yearly Most cases occur in infants 2 m to 2 years old, some in college freshman in dorms or men's military barracks Meningococcal vaccines Meningococcal vaccine adverse reactions Vaccine types menactra Vaccine concerns; Rare condition Guillian Barre Syndrome 19 cases reported in 2007 among adolescents 18

19 What do I need to know about HPV Human Papillo Virus? HPV frequency What is it? Virus Causes genital warts and cervical cancer Transmitted sexually What is the concern? Several strains can progress to cervical cancer If undiscovered can be fatal Very 80% of sexually active adults carry 1 or more strains of the virus Most common sexually transmitted infection 20 million people become infected with HPV yearly HPV vaccine HPV adverse reactions Vaccine types Gardasil Vaccine concerns; Only protects against the most common strains not ALL the strains. This protects for the stains causing 70% of cancers 225 mcg aluminum New vaccine may be slight increased risk of autoimmune disease Unsure how long it lasts at least 4 years Travel considerations Alternate schedule Dr Cave Yellow fever vaccine S America, sub Saharan Africa Typhoid vaccine Asia, Africa, C/S America Japanese encephalitis vaccine SE Asia, China, India, E Russia Birth Hep B only if the mother if positive 4 month Hib Polio 5 months DTaP 6 months - HIB, Polio 7 months DTaP 8 months Hib 9 months DTap 19

20 Alternate schedule Dr Cave Alternate schedule Dr Cave 15 month measles 17 months Hib Polio 18 months - DTaP 24 months Pneumovax 27 months - rubella 30 months - mumps 4-5 years varicella (if not immune already) 4-5 years Hep B only if required by state 4-5 years - DTaP and Polio booster 4-5 years test for MMR titers Alternate schedule Dr Sears Alternate schedule Dr Sears 2 month DTaP Rotavirus 3 months Pc, Hib 4 months DTaP, Rotavirus 5 months Pc, Hib 6 months DTap, Rotavirus 7 months Pc, Hib 9 month Polio, Flu (x2) 12 months Mumps Polio 15 months Pc Hib 18 months DTaP, chickenpox 21 months - Flu 2 years Rubella, Polio 2 ½ years Hep B, Hep A Alternate schedule Dr Sears Select schedule Dr Sears 3 years Hep B, Measles, Flu 3 1/2 years Hep B, Hep A 4 years DTaP, Polio, Flu 5 years MMR, Flu 6 years - Chickenpox 12 years Tdap, HPV 12 years 2 months - HPV 13 years HPV, Meningococcal 2 month DTaP Rotavirus 3 months Pc, Hib 4 months DTaP, Rotavirus 5 months Pc, Hib 6 months DTap, Rotavirus 7 months Pc, Hib 20

21 Select schedule Dr Sears Another option Children with No risk factors 15 months Pc Hib 5 years tetanus booster 10 years Titers for MMR, chickenpox, hep A. Consider vaccination if not immune. Also consider 3 dose polio If travel to Africa or Asia is a possibility 11 years HPV (3 doses) 12 years Hep B (3 doses) 2 years DTaP 3 years Inactivated polio virus 4 years MMR 5 years DTaP 18 years - MMR Risk factors Another option children with risk factors Selected risk factors Not breastfeeding Smoker in the house Daycare Vector (someone from whom they may catch an infection) Another child age 4-10 yo Health care worker Teacher/educator Alaskan or Native American 6 months Hib 7 months DTaP (do not give at same time as Hib) 8 months PCV(exposure to 2nd hand smoke) 12 months Hib 13 months DTaP 2 ½ years IPV 3 & 18 years MMR 5 years - DTaP Titers What about pre-medicating? Consider having your child s titers checked Many children will become immune even if they have not received the full course of vaccinations. Parents often administer a pain reliever prior to the vaccination May mask symptoms May make vaccines more harmful (tylenol) 21

22 How to safely immunize your child How to Safely Vaccinate Your Child Separate vaccines in time Use thimerosal free vaccines Separate MMR when available (if your pediatrician still has this available) Breast feed Avoid immunizing your child when they are sick, have diarrhea or on antibiotics. Keep children on nutrient rich diets Minimize sugar and junk foods How to Safely Vaccinate Your Child Exemptions Minimize other chemical exposures Probiotics Omega 3 fish oils Vitamin A give before vaccination California allows; Medical Religious Philosophical Vitamin C give before vaccination Vaccines Koren Barrett ND Research vaccines and make informed choices Discuss concerns with your doctor Do not be intimidated by medical personal (you are the parent and you call the shots!) Newport Integrative Health 1831 Orange Ave Ste A Costa Mesa CA (949) Website; 22