Preventive Services Covered by Private Health Plans under the Affordable Care Act

Spacing Out Child Vaccines

Should I space out my child's immunizations?

Tanya Altman, MD, FAAP

There isn't any evidence 'that spacing out vaccines is better than giving them according to the schedule that has been studied and tested for many years by the CDC. In fact, by spacing out your child's vaccines, what you are doing is leaving them vulnerable to these diseases at a time when they can get really sick when they are so young. There is a reason that we vaccinate babies at two months, at four months, at six months of age. It's because that's when if they were to catch these illnesses, they can get very seriously ill and even die.

Narrator

Tell me more about the two, four, and six, why was that chosen?

Tanya Altman, MD, FAAP

That's a good question. Scientists have been studying vaccines for quite some time, and they are always improving them and making them better. And initially, they came up with this vaccination schedule, as to when the best time is to give vaccines to infants. And if you look at the schedule, you'll notice that there are several booster doses. So for example, babies will get their first whooping cough vaccine. It's a combination of DTaP Diphtheria, Tetanus, and Pertussis, which is whooping cough at two months. And then at four months, when they get that booster vaccine, it protects them a little more. And then at six months, they get another booster, and they're protected even a little more. And then at 15 or 18 months, they will get that final booster to get them the best protection that we have until they need another dose before kindergarten. And all of these booster doses are important, because over time, immunity to certain diseases can wane, and so with each booster dose that you get, your body is generating more protection.

","publisher":"WebMD Video"} ]]>

Hide Video Transcript

Narrator

Should I space out my child's immunizations?

Tanya Altman, MD, FAAP

There isn't any evidence 'that spacing out vaccines is better than giving them according to the schedule that has been studied and tested for many years by the CDC. In fact, by spacing out your child's vaccines, what you are doing is leaving them vulnerable to these diseases at a time when they can get really sick when they are so young. There is a reason that we vaccinate babies at two months, at four months, at six months of age. It's because that's when if they were to catch these illnesses, they can get very seriously ill and even die.

Narrator

Tell me more about the two, four, and six, why was that chosen?

Tanya Altman, MD, FAAP

That's a good question. Scientists have been studying vaccines for quite some time, and they are always improving them and making them better. And initially, they came up with this vaccination schedule, as to when the best time is to give vaccines to infants. And if you look at the schedule, you'll notice that there are several booster doses. So for example, babies will get their first whooping cough vaccine. It's a combination of DTaP Diphtheria, Tetanus, and Pertussis, which is whooping cough at two months. And then at four months, when they get that booster vaccine, it protects them a little more. And then at six months, they get another booster, and they're protected even a little more. And then at 15 or 18 months, they will get that final booster to get them the best protection that we have until they need another dose before kindergarten. And all of these booster doses are important, because over time, immunity to certain diseases can wane, and so with each booster dose that you get, your body is generating more protection.

Does Your Child Really Need The Rotavirus Vaccine?

The rotavirus vaccine provides a safe and effective defense against rotavirus disease and its complications.

The vaccine is mostly given to infants and young children since the disease affects this age group most often. The Centers for Disease Control and Prevention (CDC) advises that infants receive their first dose of this vaccine at 2 months and complete the vaccine series before 8 months of age.

It is easy for the rotavirus to spread. The disease causes severe, watery diarrhea. Fever and vomiting can also occur, which raises the risk of dehydration (loss of fluids). Severe cases can be life-threatening.

4 Reasons Your Child Should Get the Rotavirus Vaccine 1. It Works The rotavirus vaccine is the best way to protect your baby from this disease. The disease has become less common since the vaccine was introduced in 2006. The vaccine has also prevented about 40,000 to 50,000 hospitalizations of young children every year since its introduction. 2. There Is No Treatment for Rotavirus There are no specific medications to treat rotavirus infection. Children infected with rotavirus must be encouraged to drink fluids to prevent dehydration and the need for hospitalization. Symptoms of the rotavirus can last from three to eight days. 3. Rotavirus Is Highly Contagious Rotavirus is one of the most common causes of severe diarrhea in the United States. It is a highly contagious virus. Rotavirus infects nearly all young children at least once before they turn 5 years old. 4. The Disease Can Be Life-Threatening While most children recover from rotavirus without problems, it can lead to dehydration. When this occurs in infants under 12 months old, they may need intravenous (IV) hydration to replenish their liquids and prevent life-threatening complications. When severe cases progress, the disease can cause convulsions or shock. Dehydration is the most common cause of rotavirus-related deaths. How the Virus Spreads The rotavirus is mostly spread by fecal-oral contact, usually from direct contact with infected stool. Since the virus remains stable outside the body, it can also spread through contact with contaminated objects, food, or water. It is common for the virus to spread when a healthy person comes in contact with small amounts of infected stool during a diaper change and then touches their mouth. This doesn't have to happen immediately since the rotavirus can live on your hands for a few hours and on hard, dry objects for several days. You can also become infected when you put your hands in or near your mouth after you touch infected areas such as toys, changing tables, or doorknobs that have a small amount of infected stool on them. While handwashing and cleaning with a disinfectant can lower the risk of rotavirus spread, this hardy virus is hard to control using only these measures. Babies and young children have the highest risk of getting rotavirus disease. Children who attend childcare settings have the highest risk for infection. The virus also spreads easily in families and hospitals. Getting Vaccinated: What to Expect The rotavirus vaccine has a low risk of side effects and can help reduce the risk of hospitalization due to the disease. Experts agree that the benefits of getting the rotavirus vaccine outweigh the risks. Here is what you can expect when your baby receives the vaccine: Vaccine Schedule The CDC recommends that infants receive their first dose of the rotavirus at 2 months old. The remaining vaccination schedule varies based on the type of vaccine used. The schedule includes: RotaTeq (RV5): Administered as a series of three oral doses given at 2 months, 4 months, and 6 months of age Rotarix (RV1): Administered as a series of two oral doses given at 2 months and 4 months of age Guidelines for the administration of the rotavirus vaccine indicate that the vaccine should be administered before a child is 15 weeks old. Infants should receive all doses of the rotavirus vaccine before they are 8 months old. If your infant missed receiving their first dose at 2 months of age, they may still be eligible to receive the vaccine on a modified schedule supervised by your healthcare provider. It is considered safe for your infant to receive a rotavirus vaccine during the same visit that they receive the following vaccines: When administered at the same time, the rotavirus vaccine does not affect your infant's immune response to these other vaccines. Available Vaccines Two rotavirus vaccines are approved by the Food and Drug Administration (FDA) for use in the United States, They are:  RotaTeq (RV5): Approved in 2006 Rotarix (RV1): Approved in 2008 Both RotaTeq and Rotarix are live-attenuated viruses, which are manufactured using a live but very weak form of the rotavirus. Because these vaccines are so close to the rotavirus, they prompt a strong and long-lasting immune response that protects against the virus. The American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP) support the use of rotavirus vaccinations and do not state a preference for either RotaTeq or Rotarix. However, both organizations recommend completing the vaccine course using the same product. If it is unknown which type of rotavirus vaccine the child received first, the AAP and ACIP support prioritizing the completion of the series with the vaccine formulation that is available. Oral Route of Administration Both RotaTeq and Rotarix are given orally instead of as an injection. The vaccine is given by putting drops into the infant's mouth toward the inner cheek so they can swallow it. There is a small risk of acquiring the rotavirus by coming into contact with your baby's stool while changing their diaper shortly after they are vaccinated. This can occur because the vaccine passes through the gastrointestinal (GI) system. Though rare, it's important to take precautions to avoid this if you or someone else in your household is immunocompromised (having a weakened immune system). To reduce the risk of this type of transmission, clean your hands thoroughly after every diaper change for up to two weeks after your baby is vaccinated. In addition, it is theoretically possible for you to be exposed to the weakened rotavirus by kissing your infant on the mouth after they receive the rotavirus vaccine. However, no studies have investigated the transmission of the virus via this route. Potential Side Effects Potential side effects that can occur with either rotavirus vaccination include: Rarely, intussusception (a type of obstructed bowel syndrome) can occur within a week after the first or second rotavirus immunization. The condition is considered a medical emergency and requires immediate emergency medical treatment. Symptoms usually begin suddenly. Get immediate emergency medical treatment if you notice the following signs of intussusception in your infant after they receive a rotavirus vaccine: Crying very loudly, which may occur in waves that come and go Drawing the knees up toward their chest Grunting due to pain Passing currant jelly stools (stools missed with blood and mucus) Swollen baby Vomiting Vomiting bile, a bitter-tasting yellowish-green fluid How Effective Is the Vaccine? The Rotarix and RotaTeq rotavirus vaccines are both considered safe and effective for protecting against severe rotavirus disease. Research from a large study of rotavirus vaccine performance in the United States. Indicates that both vaccines are effective in preventing rotavirus-related inpatient hospital visits, emergency room visits, and severe infection among younger children. According to the CDC, research indicates that both vaccines provide comparable effectiveness in the following ways: RotaTeq (RV5) In large clinical trials, RotaTeq demonstrated the following range of effectiveness through the first rotavirus season (December through June) after vaccination: 98% protection against severe rotavirus gastroenteritis, defined as fever, vomiting, and changes in behavior 74% protection against gastroenteritis of any severity, defined as inflammation of the stomach and intestine In addition, during the first two years after vaccination, infants who received the RotaTeq vaccine had a 94% reduced chance of visiting an emergency room and a 96% reduced chance of being hospitalized. Rotarix (RV1) Research indicates that Rotarix demonstrated a comparable range of effectiveness: 85% to 96% protection against severe rotavirus gastroenteritis through two rotavirus seasons (December through June), based on two clinical trials 96% effectiveness in reducing hospitalizations during two rotavirus seasons, based on one clinical trial Is It Safe? Both rotavirus vaccines are considered safe. The primary safety concern is that the vaccines cause a small increased risk of intussusception. In this rare but serious condition, a segment of the intestine folds, or "telescopes" onto itself. The condition can occur naturally in infants younger than 24 months. Research indicates that the rate of intussusception in vaccinated infants ranges from about 1 in 20,000 to 1 in every 100,000 infants. Data from large surveillance studies of intussusception indicate that for every intussusception hospitalization caused by rotavirus vaccination, the vaccine prevents hundreds to more than 1,000 hospitalizations. Based on these statistics, the rotavirus's benefits outweigh the small intussusception risk. Rotavirus Vaccine Recall in 1999 The first rotavirus vaccine was approved in 1998. Called RotaShield, this vaccine was removed from the market the following year. Despite clinical data from before it was was licensed indicating its safety, RotaShield caused a high rate of intussusception in some babies under 12 months old. In its first year of use, the vaccine was linked to 15 cases of intussusception. RotaSheld was promptly removed from the recommended vaccine schedule and is no longer available in the United States. Should Some Children Avoid It? While the rotavirus vaccine is considered safe for most infants, your healthcare provider can help you determine whether your child should receive the rotavirus vaccine. According to the CDC, infants with the following characteristics should not receive a rotavirus vaccine: A severe or life-threatening allergic reaction to a previous dose of rotavirus vaccine A severe or life-threatening allergy to any substance used in the rotavirus vaccine including latex Severe combined immunodeficiency, a rare condition in which your infant's immune system can't fight infections A previous episode of intussusception, a severe type of bowel blockage A moderate or severe illness A weakened immune system as a result of human immunodeficiency virus (HIV) or any other condition that affects your immune system, cancer or cancer therapy with X-rays or drugs, treatments that involve drugs such as steroids Infants should not be vaccinated when they have a moderate or severe illness, including moderate or severe diarrhea or vomiting. They can be vaccinated when they recover if they do not have any other contraindications for vaccination. Allergic Reactions While it's very rare for children to have an allergic reaction to the rotavirus vaccine, it can occur. Like all vaccines, the rotavirus vaccine carries the potential risk of anaphylaxis (a life-threatening allergic reaction). An allergic reaction can also occur hours or days after vaccination. Call 911 or seek emergency medical treatment if your child has any of the following signs of an allergic reaction after receiving a rotavirus vaccine: Summary The rotavirus vaccine is advised for all healthy infants, starting at 2 months of age. The vaccine is the best way to protect your child from the rotavirus and its severe complications. Your infant can receive comparable defense from either of two FDA-approved oral rotavirus vaccines. Side effects of the rotavirus vaccine are mild for most infants. The vaccine also carries a very small risk of intussusception. However, the benefits of being vaccinated outweigh the slight risk of getting this side effect. Knowing the symptoms of intussusception and other adverse side effects can help you recognize when these problems occur.

Why Is The Tdap Vaccine Important For Pregnant Women?

Have a medical-related question you've always wanted answered? The doctors at the Pediatric Center are here to help! Email your 'Ask the Doctor' questions to news@eastidahonews.Com and they might end up in our weekly column.

Question

Why is the Tdap vaccine important for pregnant women?

Answer

Vaccination during pregnancy is a crucial measure to protect both the mother and the newborn from potentially serious diseases. One of the most important vaccines recommended for pregnant women is the Tdap vaccine, which protects against tetanus, diphtheria, and pertussis (whooping cough).

Whooping cough, or pertussis, is a highly contagious bacterial infection that can cause severe respiratory issues, especially in infants who are too young to be fully vaccinated. Babies are most vulnerable during the first few months of life, when they have not yet completed their primary series of vaccines. Whooping cough can lead to complications such as pneumonia, seizures, brain damage, or even death in infants under two months old.

Beyond pertussis, the Tdap vaccine also provides protection against tetanus and diphtheria, although these diseases are rare in many developed countries due to widespread vaccination. However, the risk of tetanus, especially during childbirth, still exists in areas with low vaccination coverage, and ensuring maternal protection further reduces this risk.

Both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists strongly recommend the Tdap vaccine during pregnancy. Their recommendations include pregnant women receiving Tdap between 27 and 36 weeks gestation. Mothers can pass on protective antibodies to their babies, giving them immediate defense against whooping cough until they can receive their own vaccinations (at 2 months of age). This passive immunity provides crucial protection during the early weeks of life, when babies are most at risk.

It is also recommended the Tdap vaccine be administered during each pregnancy, regardless of prior vaccination history. Protection from the vaccine diminishes over time, so a booster is necessary to ensure that each newborn receives optimal protection.

Pertussis outbreaks continue to occur, even in countries with high vaccination rates. One of the reasons is that immunity from childhood vaccines and previous Tdap vaccinations wanes over time, making adults and teenagers susceptible to infection again. While pertussis may only cause mild symptoms in adults, it can be life-threatening for newborns.

Vaccinating pregnant women significantly reduces the risk of whooping cough in newborns. According to the Centers for Disease Control and Prevention (CDC), studies show that Tdap vaccination during pregnancy prevents more than 90% of pertussis cases in infants younger than 2 months old. This high level of protection underscores why widespread maternal vaccination is essential.

Some expectant mothers may worry about the safety of receiving a vaccine during pregnancy. However, the Tdap vaccine has a strong safety record. Research consistently shows no increased risk of complications such as preterm birth, stillbirth, or birth defects due to Tdap vaccination. Health experts, including the AAP and ACOG, emphasize that the benefits of vaccination far outweigh the risks, as it helps prevent a deadly infection in newborns.

The Tdap vaccine is a safe and essential tool for protecting both pregnant women and their babies from serious diseases, particularly whooping cough. Expectant mothers should consult with their healthcare providers to ensure timely vaccination, safeguarding the health of their babies from the moment they are born.

This column does not establish a provider/patient relationship and is for general informational purposes only. This column is not a substitute for consulting with a physician or other health care provider.

---