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Vaccine Update April 1997

It's a new world of vaccines out there and parents need to know what changes have just occurred and what options they have for their babies. Most doctors are kept up to date by drug company representatives if they haven't kept up with the latest in research but parents need to be informed consumers so this is a summary of recent changes in immunization recommendations according to the Academy of Pediatrics (and my own opinions, of course).

DPT

The former topic of scary news tabloid reports and playground horror stories has mostly and long awaitedly bitten the dust. We are now using a vaccine that essentially takes the risk out of the pertussis portion by making it "acellular" hence the new acronym DaPT or acellular DPT and you might recognize this from your 18 month old's booster record because it isn't really new. It's been around for several years only now it's been approved for your 2, 4, and 6 month shots. You still need to look out for the uncommon but not rare tetanus reaction which is just a little local swelling and redness and pain at the site of the shot but that is nothing compared with the previous concerns of neurologic damage pertussis was implicated in causing in rare cases. For a while the old DPT was conveniently combined in one shot with HIB which is a vaccine against a type of meningitis but for the moment the new safer DaPT stands alone so your baby will get two shots on the same day in most doctor's offices but at least they are both safe. Ask your doctor whether she is using the new acellular DPT before you let her give the shot.

Polio

This vaccine has been a total success over the past 50 or so years and now they say polio just doesn't exist. Well that means that the oral vaccine (the one that is squeezed into your baby's mouth and is pink and seems to taste good) may not be needed anymore. The risk of the vaccine (which is live) giving polio to someone whose immunity is not so good may be greater than the risk of actually getting polio "in the wild". So a lot of debate lately has led to a return of the injected polio vaccine which is safer because it is partially inactivated and can't cause an accidental case of polio. The down side (aside from the injected part) is that there are still some researchers who say polio is not gone from the world altogether and without the oral vaccine we might be inviting an unwanted guest back into society. Most doctors are still using the oral vaccine but it is also OK to get a combo of 2 shots of IPV (the inactivated, injected kind) followed by 2 oral OPV types. You should discuss these options and inquire about your family's relative risk factors, if any, to the oral vaccine since it's an awful lot nicer to just 'drink' your shot than get 'stuck' with it.

Chicken Pox

This vaccine has been approved for prevention of chicken pox (varicella in medical lingo) for about 2 years and has been well tested for safety for about 15 years. Usually it's recommended for adults and children approaching adolescence (a questionable equivalent to adulthood) who have not had the pleasure of chicken pox. It's also a good idea for anyone living with someone who could be very endangered by getting chicken pox such as a person on chemotherapy or a person who is immune compromised (for instance a person with AIDS). The problem with the vaccine is that unlike getting the real thing (chicken pox for real, blisters, itching and all) the vaccine does not give you life long immunity. That's OK if we know when to give a booster shot but alas we do not yet know when and we won't until this group of children grow up and run out of immunity and get chicken pox. The problem I have here is that the vaccine has been approved for use in 1 year olds and since chicken pox is usually not a very dangerous disease except in adults I worry about this group of kids being the ones we learn from down the road when they get adult chicken pox because the vaccine's effect wore off. I suppose that's the way progress happens but my preference is that if you don't have a risk factor at home why not let your youngsters get the life long protection of the real thing and call it a day. Please don't think the vaccine is dangerous, it is not (although you can get a mild case of the pox from it at the site of the shot but this is unusual). Ask your doctor what he thinks about it before deciding. So much new information is coming in daily that you need to be on your toes. By the by, there is an antiviral medicine that some doctors recommend for your child on the first sign of chicken pox that makes the illness shorter and lighter and you might want to get it if your child breaks out before you've decided yes or no on the vaccine. It's called Zovirax and it's quite safe.

Hepatitis A

Not yet widely used but this vaccine is safe in young children and can be given to infants at risk for hepatitis A. This type of hepatitis is actually more common than hepatitis B which your newborns are already getting vaccinated against.

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