10 Vaccines Your Young Child Needs

They say that time favors the patient. For the past few years, I've been patiently plugging the importance of vaccinations in my writings and risking the ire of the antivaxxers everywhere. Every healthcare professional and medical journalist whom I encounter supports the importance of encouraging others to vaccinate and spreading the message. The CDC, WHO, and health-care agencies around the world (think Pulse Polio Programmes in India) have made vaccination a top priority. 

Finally, the tide on vaccination has seemingly turned, and more people are cognizant of what happens when we refuse to vaccinate (see measles in paradise AKA Disneyland). So in the "let's get vaccinated" spirit, I want to share you the 10 vaccinations that the CDC recommends initiating in children aged 24 months or fewer.


Vaccination #1: Hepatitis B

Unlike any other vaccination, the hepatitis B vaccination is actually given at birth.  On the CDC schedule, 3 doses are given through 18 months of age.  This prevention strategy started in 1991, so if you or a loved one were born before 1991, please still get vaccinated!

Hepatitis B is the number one cause of viral liver failure, and liver failure kills. 'Nuff said.


Vaccination #2: Rotavirus

The rotavirus vaccination comes in 2 flavors: Rotarix and RotaTeq.  Rotarix is given in 2 doses at 2 or 4 months.  RotaTeq is given in 3 doses at 2, 4 and 6 months.  Even with vaccination, a child might still catch rotavirus.

Rotavirus causes severe watery diarrhea, abdominal pain, fever, loss of appetite and dehydration.  Although it affects adults, too, it hits kids particularly hard.  To make matters worse, once you catch rotavirus once, you could catch it again. 

Want to know how medicine (and nursing) students remember that ROTAvirus causes diarrhea?  "Right Out The Anus" virus.  Show me a medical student, and I'll show you walking mnemonic dictionary.


Vaccination #3: Diphteria, Tetanus, and acellular Pertussis (DTaP)

The DTaP vaccination is given in 5 doses to children aged 2 months to 6 years. 

DTaP is a triple threat and vaccinates against Diphtheria, Tetanus, and acellular Pertussis.  Interestingly, DTaP can be further combined to vaccinate against Haemophilus influenza Type b (Hib), inactivated polio and Hepatitis B.

Diphtheria is a very serious bacterial infection that can be caught from another person who sneezes or coughs or from a fomite (fomite is medical jargon for an inanimate object like a toy, soap or towel).  Diphtheria causes a sore throat, fever, weakness and swollen lymph nodes in the neck.

Tetanus is caused by Clostridium bacteria and painfully locks up all of your muscles including your jaw ("lockjaw").  The Clostridium bacteria enters the body through a deep cut and lives in soil (think stepping on an old rusty nail).

Pertussis or whooping cough is a bacterial infection which is highly contagious.  Although once rare, whooping cough is becoming more prevalent in the United States.  Whooping cough causes uncontrollable (paroxysmal) fits of coughing.  These coughing fits make it difficult to take a breathe.  When a person finally does take a breath, a pathognomonic or disease-specific "whoop" is sounded.   Interestingly, pertussis is derived from the Latin per- meaning "extremely" and -tussis meaning "cough" hence "extreme cough."


Vaccination #4: Haemophilus influenza type b (Hib)

Dosing for the Haemophilus influenza type b (Hib) vaccine is a bit complicated.  First, there are a few iterations of the vaccine that can require up to 4 doses starting as early as 6 weeks and ending at 15 months.  Second, if a child has a weakened immune system for whatever reason (HIV infection, chemotherapy or so forth), more doses may be necessary.

Although Hib is the most relevant strain from a clinical perspective, Haemophilus comes in 6 strains: a, b, c, d, e and f.  For all you trivia nuts out there, Haemophilus was the first living organism to have its genome sequenced.

Despite its name, Haemophilus influenza doesn't cause the flu.  Hib can cause encephalitis pneumonia, cellulitis (skin infection) and epiglottitis (an infected epiglottis that closes off the airway).  Hib hits kids particularly hard.


Vaccination #5: Pneumococcal Conjugate

The CDC recommends 2 types of pneumococcal vaccinations: PCV13 and PPSV23.  The PCV13 vaccination is given to all children, and PPSV23 is recommended for certain high-risk groups and adults aged 65 and older.  Moreover, PPSV23 is given after 2 years of age; whereas, PCV13 is given in 4 doses which begin at 2 months and end at 15 months.

Pneumococcal vaccines protect against pneumococcus, an organism that can cause potentially deadly infection. Specifically, pneumococcus can cause:

  • severe pneumonia
  • ear infections
  • sinus infections
  • meningitis
  • bacteremia (infection of the blood)

Vaccination #6: Inactivated Poliovirus

The polio vaccine is administered in 4 doses from age 2 months up to 6 years.

Although rare in most Western countries, poliomyelitis or infection caused by the polio virus is still common in developing nations where fewer people are vaccinated.


Vaccination #7: Influenza

For children aged between 6 months and 8 years, the influenza vaccine is given annually in one or two doses (separated by at least 4 weeks).  For those older than 7 years, the vaccine is given once annually.

Influenza vaccine protects us against the flu.  Influenza is highly contagious and spreads quickly in the air of crowded environments like day-care centers.  Often, kids will bring the virus home and infect other siblings and parents.  Flu can sometimes result in hospitalization or, more rarely, death.


Vaccination #8: Measles, Mumps and Rubella (MMR)

The measles, mumps and rubella (MMR) vaccine is typically given in 2 doses: one dose at 12 to 15 months and one dose at 4 to 6 years.

Measles is a highly contagious disease that wreaks havoc in very public places like amusement parks and concerts.  Infection with measles causes fever, runny nose, sore throat, rash and more.  In some, later complications like pneumonia and encephalitis (brain infection) can be deadly.

The mumps virus causes various acute symptoms including fever, headache, fatigue and inflammation or swelling of the salivary glands.  Mumps can also infect the testicles and cause inflammation (orchitis) or inflammation.  If the prospect of such swelling isn't enough to convince you to vaccinate, consider that orchitis can sometimes result in sterility.

Infection with the rubella virus is relatively mild and short-lived.  In about half of those infected, rubella causes a low-grade rash, which starts on the face and spreads to the rest of the body.  Inflammation of the glands toward the back of the neck and head (posterior auricular and suboccipital) accompany the rash.   In babies born to infected mothers, rubella infection is much more serious and causes congenital cataracts which need to be surgically removed.

Interestingly, from a historical perspective, rubella was first viewed as a variant of measles (German measles) or scarlet fever.  (To make matters confusing, measles is sometimes referred to as rubeola.) It wasn't until the mid-1900s that the rubella virus was discovered and recognized as a viral agent of its own. 


Vaccination #9: Varicella

Varicella vaccine is typically administered in 2 doses: one dose at 12 to 15 months and a second dose at 4 to 6 years.

The varicella zoster virus causes chickenpox and shingles (herpes zoster), a painful and localized skin infection. 


Vaccination #10: Hepatitis A

The hepatitis A vaccine is a two-dose series given between 12 and 24 months. The two doses must be separated by 6 to 18 months.

Fortunately, unlike hepatitis B and C, hepatitis A fails to cause chronic liver disease and is rarely fatal. It is typically found in developing countries with poor sanitary conditions where, according to the WHO, 90 percent of children are infected before the age of 10.

Symptoms of hepatitis A infection can range from mild to severe fever, diarrhea, abdominal discomfort, loss of appetite, darkened urine and jaundice or yellowing of the skin and eyes.


Vaccines: The Upshot (Pun Totally Intended)

Except in rare cases where vaccination is contraindicated (think severe allergic reaction), we all need to get vaccinated not only to protect ourselves but also to protect others. If you or your child has yet to be vaccinated, consult with your physician because catch-up vaccination is recommended and available. Even if you don't have health insurance, the federal government funds vaccination at little or no cost.

Vaccination is somewhat analogous to voting. Sure, we can depend on others to vote our favorite candidate into office just like, for some but not all of these diseases, we can depend on others getting vaccinated to keep us safe (a phenomenon known as herd immunity). However, whereas the consequences of inaction in political terms are ideological and fiscal, the consequences of failure to vaccinate can be deadly.

Outbreaks directly attributable to antivaccination movements in the United States and other Western countries with advanced systems of health care is definitely a #firstworldproblem(As so aptly pointed out by Melinda Gates on HuffPost Live, mothers in developing nations walk 10 kilometers, in the heat and child in tow, to receive vaccination, because they know what death looks like.) Sadly, a statistically significant number of people, based on the unfounded medical advice of celebrities (like Playboy playmate Jenny McCarthy who was booted from The View after just one season), refuse to vaccinate their children for fear of autism or some other fabricated association. (Don't get me wrong, I loooove Playboy as much as the next teenager.) In the end, which advice are you going to heed: "advice" from an ignorant talking head or advice representing the collective medical intelligence of the CDC and every other health-care institution the world over?  

Selected Sources

Bonfante G, Rosenau AM. Chapter 134. Rashes in Infants and Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011. Accessed January 29, 2015.

Daley MF, O'Leary ST, Nyquist A. Immunization. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. CURRENT Diagnosis & Treatment: Pediatrics, 22e. New York, NY: McGraw-Hill; 2013. Accessed January 28, 2015.

Kumar S, Qamar AA. Chapter 38. Acute Liver Failure. In: Greenberger NJ, Blumberg RS, Burakoff R. eds. CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 2e. New York, NY: McGraw-Hill; 2012. Accessed January 28, 2015.

Murphy TF. Chapter 145. Haemophilus and Moraxella Infections. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012. Accessed January 29, 2015.

Pringle E, Graham EM. Chapter 15. Ocular Disorders Associated with Systemic Diseases. In: Riordan-Eva P, Cunningham ET, Jr. eds. Vaughan & Asbury's General Ophthalmology, 18e. New York, NY: McGraw-Hill; 2011. Accessed January 29, 2015.

Zimmerman LA, Reef SE. Chapter 193. Rubella (German Measles). In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012. Accessed January 29, 2015.

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