A Parent s Guide to Childhood Immunization Be informed.
Table of Contents Immunization: our best defense... 1 How vaccines work... 2 Vaccine-preventable diseases... 3 Effect of immunization on vaccine-preventable diseases in Canada... 4 Vaccine safety... 4 Vaccine information... 5 Frequently asked questions... 6 The New Brunswick Routine Immunization Schedule...8 Mandatory immunization in New Brunswick... 8 Caring for your child after immunization... 9 Useful immunization resources... 10 CNB 6329/January 2010 ISBN - 978-55471-236-6
Immunization: Our Best Defense Immunizing children is one of the most important ways to promote their health. Before many of today s vaccines were available, it was not uncommon for children to die or become disabled as a result of infections that are now preventable. Your Child s Best Shot, 3rd edition, Ronald Gold This booklet provides parents with facts about childhood immunization. On-time immunization is important for all ages but especially for infants and young children who may be at greater risk of vaccine preventable diseases and their complications. Children will have the greatest protection possible and the best chance to fight off disease when they are immunized according to the recommended immunization schedule. 1
How vaccines work To understand vaccines and how they work, you must know how the immune system works. When a germ enters the body, the immune system sees the germ as something unfamiliar or unusual and reacts by making antibodies to fight it. Antibodies are produced by having the disease or by being immunized. A vaccine is made from a tiny amount of the disease germ (virus or bacteria). For example, measles vaccine is made from the measles virus. The germ in the vaccine is killed or weakened to ensure the person will not get the disease from the vaccine. When the vaccine is given, the body starts to attack the small amount of the disease germ in the vaccine and builds up antibodies against that germ. These antibodies will fight off the disease when a person is exposed to the germ in the future. With immunization, a person does not have to get sick to be protected from diseases! 2
Vaccine-preventable diseases Disease Diphtheria Hepatitis B Haemophilus influenzae type b Spread by Contact with blood or body fluids Signs & symptoms Severe sore throat and weakness. Fever, headache, aches and pains, loss of appetite, nausea, vomiting, skin rash, and jaundice (yellow skin and eyes). Half of those infected may have no symptoms. Ear and sinus infection, eye infection, and/or pneumonia. Influenza Fever, headache, aches and pains, fatigue, sore throat, and/or cough. Measles Rash, fever, cough, runny nose, and/or pink eye. Mumps Pertussis Pneumococcal Fever and swollen salivary glands; however, in 50 per cent of cases there is no visible signs of illness. Runny nose and a cough that develops into severe coughing spasms, lasting six-to-12 weeks. Fever, chills, cough, and/or chest pain (related to pneumonia). Polio Rubella Person to person contact and contact with contaminated food, water, or objects Sore throat, fever, and/or nausea; however, in 90 to 95 per cent of cases there are no symptoms. Fever, swollen glands, and rash; however, in 50 per cent of cases there are no obvious symptoms. Tetanus Exposure through breaks in the skin Toxin affects spinal cord, leading to painful muscle spasms and seizures. Varicella Meningococcal Rash and fever. Fever, severe headache, stiff neck, vomiting, and/or rash. Human Papillomavirus Direct contact Warts on genitals, vagina, and/or anus; however, in many cases there are no symptoms. Adapted from Your Child s Best Shot, 3rd edition, Ron Gold, 2006 and Parents Guide to Childhood Immunizations, Center for Disease Control and Prevention, 2005. Complications Heart failure, paralysis, pneumonia, and death in one in 10 cases. Infants and children younger than five have a high risk of becoming chronic virus carriers. Chronic infection may lead to cirrhosis, liver failure, liver cancer, and death. Meningitis (an infection of the membranes and fluid that cover the brain and spinal cord), epiglottitis (an infection of the flap that covers the windpipe), pneumonia, arthritis, and death. Pneumonia, febrile seizures, severe inflammation of the muscles, especially the calf muscles, myocarditis (inflammation of the heart muscle), encephalitis (inflammation of the brain), and Reye s syndrome (a condition that causes damage to the brain and liver). Pneumonia, encephalitis (occurs in one in every 1000 cases), ear infections, seizures, and death in one in 3000 cases. Meningitis, encephalitis, deafness, as well as inflammation of the testicles or ovaries. Pneumonia, seizures, brain damage, and death in one in 400 infants. Meningitis, ear infections, pneumonia, bacteremia (when the bacteria grows in the bloodstream), and death. Paralysis in one in 100 cases, post-polio syndrome (muscle pain, weakness, and paralysis that occur 15-to-40 years after the first illness), and death in severe cases. Encephalitis, joint pain, chronic arthritis, decrease in platelets (particles in blood that help the blood to clot), and severe damage to the unborn baby if the mother was infected during the first three months of pregnancy. Choking spells, weight loss, bone fractures, pneumonia, suffocation, and death in 10 to 20 per cent of cases. Pneumonia, encephalitis, meningitis, and severe skin infections. Death in at least one in 10 cases, brain damage, deafness, amputations, and skin loss in 10 per cent of survivors. Cervical cancer, other genital cancers, and cancer of the mouth. 3
Effect of immunization on vaccine-preventable diseases in Canada Immunization has saved more lives in Canada in the last 50 years than any other health intervention. The table below shows how immunization has reduced vaccinepreventable diseases. Vaccine-preventable diseases Number of cases in Canada Number of cases in 2004 in peak year before routine immunization Diphtheria 9,000 1 Haemophilus influenzae type b (Hib) 2,000 68 Hepatitis B 3,000 829 Measles 300,000 7 Mumps 52,000 32 Pertussis (Whooping Cough) 25,000 2, 712 Polio 20,000 0 Rubella 69,000 9 Total number of cases 480,000 3,658 Canadian Coalition for Immunization Awareness & Promotion - January 2009 Vaccine safety Vaccines used in Canada are very safe. Before a vaccine is approved for use, it undergoes years of research and testing. The Public Health Agency of Canada continues to monitor all vaccines after they are approved. Serious reactions to vaccines are rare, but do occur. It is important that you report any unusual or serious side effects after immunization to the person who gave the vaccine to your child. Your immunization provider can discuss the benefits, risks, and side-effects before giving your child a vaccine. REMEMBER: The risks and consequences of vaccine-preventable diseases are much greater than vaccine side-effects. 4
Vaccine All vaccines Vaccine information Vaccine effectiveness Vaccine side-effects Injections can cause redness, swelling, and tenderness where the vaccine was given; this may last 24-to-48 hours. HB Hepatitis B DTaP-IPV-Hib Diphtheria, Tetanus, acellular Pertussis (whooping cough), Polio & Haemophilus influenzae type b (Hib) Pneu -C Pneumococcal Conjugate MMR Measles, Mumps & Rubella Varicella Chickenpox Men-C-C Meningococcal Conjugate C Inf Influenza DTaP - IPV Diphtheria, Tetanus, acellular pertussis and Polio HPV Human Papillomavirus Men-C-ACYW-135 Meningococcal conjugate A, C, Y, W-135 Tdap Tetanus, diphtheria, acellular pertussis Over 95 per cent of those who receive three doses of the vaccine develop antibodies. 99 per cent will be protected against polio, tetanus, and diphtheria. 90 per cent will be protected against Hib. 85 per cent will be protected against whooping cough. 97 per cent will be protected against invasive pneumococcal disease. Two doses provide almost 100 per cent protection against measles. One dose provides 95 per cent protection against mumps; two doses results in greater protection. One dose provides over 97 per cent protection against rubella. 85-90 per cent will be protected against chickenpox. 87 to 98 per cent effective against meningococcal C disease. With a good match to circulating flu viruses, 70 to 90 per cent effective in preventing illness in healthy children. 99 per cent of children will be protected against polio, tetanus, and diphtheria. 85 per cent of children will be protected against whooping cough. 99 per cent develop antibodies to HPV types 6, 11, 16, and 18. 98-99 per cent effective against four strains of meningococcal disease. 99 per cent will be protected against tetanus and diphtheria. 85 per cent will be protected against pertussis (whooping cough). Tiredness or a slight fever, lasting one to two days. Small, painless lump where the vaccine is given is rare but does occur. More serious side effects can include the following: - Abnormal crying for several hours. - High fever (39.4 C or higher for 24 hours). - Convulsions. - Collapse reaction (a shock-like reaction where the child is pale, unresponsive, and has less muscle tone than usual). Headache, chills, and fever higher than 38 C. Drowsiness, fussiness, diarrhea, and vomiting. Fever and malaise with or without rash lasting up to three days and occurring seven-to-12 days after immunization. One in one million may develop brain inflammation (encephalitis). Low platelets (blood clotting factor). Glands on the neck sometimes swell. Lymph nodes swell and a rash sometimes appears. Joint pain. A chickenpox-like rash at the injection site (in three to five per cent of those immunized). A chickenpox-like rash over the body occurring five to 26 days after immunization (in up to five per cent of those immunized). Note: Individuals who have a chickenpox-like rash after immunization rarely transmit the virus. Headache. Irritability or fussiness. Fever of 38 C or higher. Malaise (feeling unwell). Fever. Headache. Muscle aches. See the description in DTaP-IPV-Hib vaccine section above. Headache, fever, dizziness, and/or nausea. Headache, fatigue, irritability, and/or drowsiness. Headache. Feeling tired and unwell. Dizziness. Upset stomach (vomiting and diarrhea). 5
Frequently Asked Questions 1. Are there reasons not to immunize according to the recommended schedule? Yes: Vaccines should not be given to a child who has had a life-threatening allergy to any ingredient of the vaccine (e.g. an antibiotic), its container (e.g. latex), or to a previous dose. Live vaccines (MMR and Varicella) should not be given to a child who has a severe problem with their immune system. Live vaccines (MMR and Varicella) should not be given to anyone who is pregnant. 2. Are there reasons to postpone or wait to immunize? Yes: Immunization should be postponed if a child has a moderate or severe illness on the day any vaccine is to be given. Live vaccines (MMR and Varicella) should be postponed for anyone who has received a blood product or immune globulin within the past three-to-11 months. If your child requires two or more live vaccines, they must be given on the same day or one month apart. 3. Are there circumstances that require special consultation? Yes: If your child s immune system is affected by illness, steroid medication, or cancer treatments, protection from a vaccine may be reduced. The decision to immunize needs to be made in consultation with your child s doctor. If your child developed Guillain-Barré syndrome (a neurological condition) within eight weeks of receiving a vaccine, your physician needs to decide if future doses of the same vaccine should be given. 6
4. Does MMR vaccine cause autism? No: Scientific investigation does not support the claim that vaccines cause autism. The reason for an increase in autism is not known. One explanation might be that autism can include many more behaviours and learning disorders than it did in the past. 5. Will multiple injections overwhelm the immune system? No: Every day our bodies come in contact with millions of germs, causing our immune system to work continuously to protect us. The killed or weakened germs in each vaccine are very few when compared to the millions of germs fought every day by our immune system. 6. Should a parent be concerned about thimerosal in vaccines? No: Thimerosal is an effective and safe preservative used in vaccines. It is found in some multi-dose vials of vaccines. Thimerosal contains ethyl mercury which is broken down and quickly eliminated from the body. Another type of mercury is methyl mercury. This type of mercury is dangerous but it is not the same type of mercury that is in thimerosal. Since March 2001, all routine childhood vaccines in Canada are produced without thimerosal. Multi-dose vials of influenza vaccine do contain thimerosal. 7
New Brunswick Routine Immunization Schedule The New Brunswick Routine Immunization Schedule is set by the Chief Medical Officer of Health. It is based on recommendations from the National Advisory Committee on Immunization and the Canadian Immunization Committee. Vaccines recommended in this schedule are provided by Public Health and other health care professionals throughout New Brunswick. In addition to the Routine Immunization Schedule, there may be other campaigns; ask your immunization provider. Routine Childhood Immunization Schedule Age Vaccine Birth Hepatitis B 2 months Hepatitis B DTaP-IPV-Hib Pneumococcal conjugate 4 months DTaP-IPV-Hib Pneumococcal conjugate 6 months Hepatitis B DTaP-IPV-Hib Pneumococcal conjugate 12 months MMR (measles, mumps and rubella) Varicella (chicken pox) Meningococcal conjugate C 18 months DTaP-IPV-Hib Pneumococcal conjugate MMR 6-to-23 months Influenza (yearly) 4-to-6 years DTaP-IPV Grade 7 HPV (girls only) Grade 9 Tdap Meningococcal conjugate ACYW-135 Other school-based catch-up campaigns Please see your local public health office Influenza vaccine is recommended for all New Brunswickers, six months and older. It is provided free of charge to those at increased risk of complications from influenza, including all infants aged 6-to-23 months, their household contacts, and household contacts of infants under six months. Infants younger than six months are at increased risk of complications from influenza; however, the vaccine is not licensed for use in these young infants. Mandatory Immunization in New Brunswick Provincial legislation in New Brunswick requires that all children entering school for the first time and all children attending day care, show proof of immunization. The law allows you to refuse immunization because of medical reasons or personal objections. 8
Caring for your child after immunization Immediately after immunization, infants and young children may be comforted by cuddling and distractions. You will be asked to remain on site with your child for at least 15 minutes after the vaccine is given, so that any possible immediate reactions can be monitored and treated. Your infant or child may experience the following: Soreness, swelling, and redness in the area where the injection was given. Placing a cold cloth over the injection site may help reduce the soreness. Moving or using the limb may also help. Fever and pain can be treated with acetaminophen taken according to the directions on the package. Ibuprofen may also be used; however, you should consult with your doctor before using this medication if your baby is younger than six months. (ASA or aspirin is NOT recommended for infants and children under 18 years). If your child develops a high fever and/or seizures, you should seek medical advice immediately. Drowsiness, fussiness, and/or upset stomach. If your child has any serious reactions within four weeks of being immunized, it is important to inform your immunization-provider. New Brunswick winning poster in the 2008 National Immunization Poster Contest. Julie s message - Immunization protects you, your family and your community 9
Useful immunization resources To find more information, contact your local public heath office, your health care provider, or visit the following web sites: The New Brunswick Department of Health http://www.gnb.ca/0053/public_health/immunization-e.asp The Public Health Agency of Canada www.publichealth.gc.ca/immunization The Canadian Pediatric Society Caring for Kids http://www.caringforkids.cps.ca/immunization/index.htm Canadian Coalition for Immunization Awareness & Promotion (CCIAP) http://www.immunize.cpha.ca/en/default.aspx Canadian Immunization Guide, 7th edition, 2006 http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php Books Gold, R. (2006). Your Child s Best Shot, 3rd edition, 2006. Questions for your immunization provider: 10