Myths, facts, ages and outbreaks
By Melissa Tucker
Hot on the heels of school supply lists, uniforms and packs of freshly sharpened pencils are often calls from the school nurse about immunizations.
Many schools require children to have routine vaccinations completed by a certain age. But even if your child is up-to-date on those, parents will soon see consent forms for immunizations like influenza, coming home in backpacks.
To determine which vaccines are required for enrollment, the Arkansas Board of Health looks to the immunization recommendations set by the Centers for Disease Control and Prevention, but doesn’t follow that schedule exactly, said Dr. Jennifer Dillaha, medical director for immunizations at the Department of Health.
“A lot of people don’t know how the immunization recommendations are made, and they are fearful because of misinformation that vaccines are not being properly studied or reviewed,” Dillaha said.
The organization in charge of that is the Advisory Committee on Immunization Practices or ACIP.
“ACIP makes recommendations to the CDC,” she said. “They take their recommendations, which the committee has voted on, and publish them in a journal called MMWR. When it’s published in MMWR, that’s when it becomes the official recommendations.”
She said ACIP reviews and updates recommendation each year as new studies come out and new vaccines become available. The committee reviews all information, including studies done by the manufacturer as well as independent studies.
The Arkansas Board of Health has the authority to make certain vaccinations required for daycare and school attendance in the state. Often, it’s based on what ACIP recommends, but it’s not everything.
“That’s an important distinction. Because for the most part, the requirements for school attendance have to do with vaccine-preventable diseases that are communicable in schools,” she said. “Some are not required, and a good example is the HPV vaccination. Another example, even though it’s transmissible in school, is the influenza vaccination. It’s also not required, but both of those vaccine-preventable disease can have dramatic long-term impacts on the health of a person.”
Dillaha says she frequently hears two concerns among parents when it comes to immunizations. First is the fear that vaccines cause autism, which she says is not accurate.
“There was a study that raised the concern in the late 1990s, and that study was found to have been falsified,” she said. “It was a fake study, so what it did was raise a lot of alarm, and so many other studies on hundreds of thousands of kids looked at whether there is an association between the MMR vaccines, and there’s no association. You would think if there was a link, when the vaccination rate for MMR goes down, then autism rates go down, but they don’t.”
She said if you compare the autism rates before the MMR vaccine was introduced, you would see an increase, but it doesn’t correlate.
“People fear it because there’s a time association. Autism is oftentimes diagnosed at about 2 to 3 years of age, and that’s about the time children are getting a number of recommended vaccines.”
She said doctors are able to diagnose autism earlier and could soon be able to see it at birth, which may help to further dispel the myth that autism and vaccines are linked.
“The other concern I hear is that children receive too many vaccines too soon,” she said. “We talked about the ACIP recommendations, and they review not only the vaccines but they also review the patterns of disease and make their recommendations based on what is the best timing to protect the children who are at highest risk for the disease the vaccine protects against.”
She said delaying vaccines doesn’t help the children avoid harm, but it increases their risk for harm.
“People don’t realize nowadays, with improvements in technology, what’s in the vaccines is very focused, so the number of antigens in vaccines is actually lower,” she said.
The antigen is the component of the vaccine that stimulates an immune response and provides protection from the disease.
“We have more vaccines, but the total number of antigens is a lot less than what they used to have 10 or 20 years ago,” she said.
Right now, there’s an outbreak of Hepatitis A in the northeastern part of the state, Dillaha said.
“It’s routinely recommended for children, but not required for school attendance after the first grade,” she said. “That’s an example of something recommended by ACIP; parents may wish to consider getting this vaccine for their children if they haven’t had it already.”
Another disease seeing a resurgence is pertussis, which is one of the four recommended vaccines at the 11-year-old well-child visit.
“That’s an important vaccine, especially for the pertussis which is also known as whooping cough,” she said. “People don’t develop lasting immunity to pertussis, and they may get it multiple times. They may have partial immunity, but the concern is it could be transmitted to a younger child under the age of 1 who can’t be fully immunized against pertussis. Children under 6 years of age are at much higher risk of having complications and dying from pertussis.”
Pregnant women and adolescents are also encouraged to get the vaccine to decrease the spread of pertussis in the community.
This year, the Health Department will once again provide influenza vaccines in schools in anticipation of flu season.
Parents must give permission for children to get the flu shot, and should be looking for consent forms in backpacks around the last week of September or the first of October, she said.
“This year there’s two kinds of vaccines: there’s the shot, and there’s the nasal spray that will be available in some locations,” she said. “The Health Department may have nasal spray later in the season, but we don’t have any right now. Unless we happen to get the nasal spray in time, the flu shot is recommended for everyone from ages 6 months through age 8.”
Any child younger than 9, if they have not had two doses of the vaccine before, this year they’ll need two doses about four weeks apart.
“We had five children last year in Arkansas who died of the flu,” she said. “There’s so many respiratory viruses out there that sometimes people think they’ve had the flu, and they get hit with the flu and there’s a big difference. We don’t often think of flu as being a serious disease, but it can be deadly.”