The vaccination does make the baby cry, so why do it?

ResearchBlogging.orgIt seems like every time I take Huxley (now 18 months old) to the doctor, the following things happen: 1) Somebody says "Well, he won't need to get stuck with any needles for a long while now .... his next scheduled immunization is [insert phrase indicating 'a long time into the future']"; and 2) Huxley gets stuck with some needles.

The last time, a few days ago, was especially bad.

We hung around in the exam room for a while, and Huxley was in a very happy mood. He learned to say "Elmo" and how to point to the "Otoscope" when asked. The doctor, having recently had a baby of her own, had not seen him in a long time, and they were happy to see each other and got along just fine. The examination showed no problems. The doctor left happy with Huxley's progress.

Then, the inoculations nurse walked in.

"You hold his arms and I'll get his feet."

Huxley was shocked and surprised when the first needle went in.

His eyes belied an expression of betrayal and fear when the second needle when in.

He turned red and his lower lip started to quiver when the third needle went in.

The redness deepened considerably and tears started to stream down his cheeks when the fourth needle went in.

He started to wail when the fifth needle went in.

He gave me a distinctly dirty look when the sixth needle went in.

And then he did something he's done every time he's gotten a vaccination: He did not die.

I've seen babys die. Have you? Babies tend to die quietly. They are not red-faced and teared-up and lip-quivering and crying loudly. Rather, they are quite, lethargic, limp, droopy-eyed, and then, just lifeless. Or at least, that is what I've seen. That's what a baby looks like after days or weeks of being ravaged by an infectious disease that finally kills it. Typically, the mother looks only a little bit better, and is almost as silent.

Huxley was pretty brave through his first four vaccines, but the last two got to him. Normally, there would have been only four shots, but the state health authorities decided to move an MMR shot he would have gotten later (and thus, another shot that goes nicely with MMR) to an earlier time to help stem an outbreak of measles going on in Minnesota right now.

Situation Update (4/27/11)
There have been 23 confirmed cases of measles reported in Minnesota, ranging in age from 4 months to 51 years old.
Infection acquired:

Twenty of the cases have been linked to a case that acquired infection in Kenya (21 total)
One case acquired infection in Florida
One case acquired infection in India

Vaccination status:

Seven of the cases were too young to receive vaccine
Nine were of age but were not vaccinated
One was vaccinated
One was vaccinated prior to the recommended age
Five have unknown vaccine status

There have been fourteen hospitalizations and no deaths.


Most children in the US who have not been vaccinated are the victims of parents who refused the vaccine out of ignorance. As you know, there is a strong anti-vax movement in the US. They think vaccinations cause all sorts of problems, including autism. Or, perhaps they just think that vaccinations are just unnatural.

But I'm pretty sure some anti-vaxers ... not the activists but just some of the parents who quietly chose to not have their children stuck ... do so because they can't stand the needle, the pain, and (in some cases) the subsequent though generally very minor suffering or discomfort of a needle-wound or side effects of the vaccination. And I can understand that. When you see the infant you love being so brave in the face of the atrocities of the doctor's office, turning red, trying not to cry, lip quivering, finally breaking down, and that look ... that look of betrayal ... Yeah, I can see not wanting to do this too often.

But I do get Huxley vaccinated because 1) I'm not some kind of selfish moron who wants to avoid personal discomfort or self-blame for an infant's short-lived pain and b) I've seen the babies die, quietly at the end though often after days or weeks of very obvious pain and suffering, of infectious diseases. So when I watched Huxley take his shots like the man-infant he is, I simply reminded myself that this was better than an untimely burial, but I did let myself get a little mad at the Anti-Vaxers who, through their ignorance and hatred of other people's children, caused the MMR schedule to change and Huxley to endure two more shots in one sitting than usual.

We don't know where the current Minnesota outbreak is going, but there was an outbreak of measles in 2008 that has been studied in a recent paper called "Health Care-Associated Measles Outbreak in the United States After an Importation: Challenges and Economic Impact" by Sanny Chen et. al.

From the abstract:

On 12 February 2008, an infected Swiss traveler visited hospital A in Tucson, Arizona, and initiated a predominantly health care-associated measles outbreak involving 14 cases. ... Of 14 patients with confirmed cases, 7 (50%) were aged ≥18 years, 4 (29%) were hospitalized, 7 (50%) acquired measles in health care settings, and all (100%) were unvaccinated or had unknown vaccination status. Of the 11 patients (79%) who had accessed health care services while infectious, 1 (9%) was masked and isolated promptly after rash onset. HCP (Health care personnel) measles immunity data from 2 hospitals confirmed that 1776 (25%) of 7195 HCP lacked evidence of measles immunity. Among these HCPs, 139 (9%) of 1583 tested seronegative for measles immunoglobulin G, including 1 person who acquired measles. The 2 hospitals spent $799,136 responding to and containing 7 cases in these facilities.

Suspecting measles as a diagnosis, instituting immediate airborne isolation, and ensuring rapidly retrievable measles immunity records for HCPs are paramount in preventing health care-associated spread and in minimizing hospital outbreak-response costs.

Measles infected between 3 and 4 million Americans a year before vaccines stemmed the disease in the early 1960s. Between 2000 and 2008, between 37 and 140 cases were reported annually in the US. The typical pattern is for an imported case of measles to cause a local outbreak among unvaccinated people. Those unvaccinated people are almost always of two kinds: Those who are not vaccinated because of the Anti-vax movement, or those who were too young to be vaccinated (or who are unvaccinated for some other equally valid reason) and are thus victims of the anti-vaxers.

The study points out that because measles is such a nasty disease, those infected often end up in a health care facility. For this reason, health care professionals have a higher risk of acquiring the disease. The other group at higher risk for getting measles is, of course, patients in the health care facility. Take Patient 4 from the Tucson outbreak:

Patient 4 was an unvaccinated 11-month-old boy who had spent 45 min in an ED room across the hall from patient 2 at hospital A on 24 February. Fever (temperature, 38.9°C) developed on 4 March, and a maculopapular rash developed on 10 March.

And some of those at risk are at risk because their parents chose to put their children at risk:

Patients 5 and 6 were siblings aged 3 and 5 years, respectively, who had not been vaccinated because of parental opposition to vaccination. Both children were exposed to patient 2 while visiting their mother at hospital A on 24 and 25 February. Their fever onsets occurred on 5 March (temperature, 39.5°C) and 6 March (38.9°C), respectively.

And, these accidental accomplices can then put others at risk in a kind of vicious cycle. Consider, for example, Patient 8:

Patient 8 was an unvaccinated 1-year-old girl who was exposed to patient 4 in the pediatrician's office on 10 March while waiting to receive MMR vaccine. Fever (temperature, 38.5°C) developed on 19 March, a generalized maculopapular rash developed on 20 March, and earache developed on 20 March.

It turns out that in Minnesota, the current outbreak is facilitated in part by misinformation being spread among certain fairly recent immigrants. After arrival in the US, they were indoctrinated into the anti-vax ideology by someone. I'm not sure how this happened exactly, but apparently members of the Somali community are concerned that anti-vax misinformation has been circulated and is causing many individuals to avoid vaccinations. This is being addressed.

In the mean time, get your vaccination and get your children vaccinated.

Chen, S., Anderson, S., Kutty, P., Lugo, F., McDonald, M., Rota, P., Ortega-Sanchez, I., Komatsu, K., Armstrong, G., Sunenshine, R., & Seward, J. (2011). Health Care-Associated Measles Outbreak in the United States After an Importation: Challenges and Economic Impact Journal of Infectious Diseases DOI: 10.1093/infdis/jir115

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yup....we can't protect our children from all pain...childbirth was painful too, but few people would say it wasn't worth it...vaccinate children to prevent worse than tears...Thanks for writing, and I love your child's name! Brave New World fan?

Our oldest once smiled at nurse immediately after a vaccination, no lie...I think he understood what we were doing.

How dare you make your child cry like that with a safe and effective vaccine? Wouldn't you rather blame the crying on me or any other member of the vaccine-preventable pathogen posse? As one anti-vaxer put it, "At least you know what you're getting into with the infection. You can't tell what's in the goddamn vaccine."

Gotta love anti-vaxers. They're the reason I'm still around.

Some childhood trauma involving needles created in me a phobia of injections and blood draw. It's still an emotionally uncomfortable event for me. I always tell them I'm needle-phobic and that I want to lie down. This does help. How to prevent this phobia from developing in a kid? Hugs and deep breathing and relaxation exercises? (Next, I need to find a sedation dentist. That scene is even worse.)

By Timberwoof (not verified) on 02 May 2011 #permalink

Greg, I'm so sorry your pediatrician has only one "inoculation nurse". Mine has two that work in tandem. Two vaccines at one time, one in each leg. They are very good and it's over much more quickly.

But Huxley's at about the age that my daughter figured out what would happen at the office. It got harder then. But I held her down and nuzzled her and it helped. The problem became worse when she got older and needed flu shots. At or 6 her screams were loud. She was even afraid of the nasal vaccine--until she actually had it, now she's fine.

By the way, I spoke to someone recently that said she only gave her kids the "necessary" vaccines. No flu, chicken pox, what a fool. It's so bad her children may have to suffer for her foolishness.

By Lynn Wilhelm (not verified) on 02 May 2011 #permalink

I doubt anti-vaxers will read these comments, but my nephew caught measles when he was 19 (wasn't vaccinated) and was in a coma for three days before recovering.
We gave our children vaccinations cause we love them. Ignorance can kill.

Great post! I've written a couple of posts about vaccination myself since my little Monkey (almost 6 months) started getting shots. As a microbiologist and biomedical researcher, I never understood the anti-vax movement, or the intense need for honest communication about vaccinations, until watching him suffer through those first few shots. It was awful, but I continue to do it for exactly the reasons you outline. Besides, I'm pretty sure it's a lot harder on me than it is on him.

Huxley may have had to suffer through a series of injections each worse than the one before, but it could be worse. My parents stopped taking me in for inoculations when I was 5 or 6 (in the mid-1970s) because one doctor (or nurse, I forget) was an idiot who jabbed the bone, causing an infection or other problem that lasted a month. I was in so much pain that my parents never took me back for another shot.

I wish they had. A decade ago, I started travelling and living outside of Canada and had to suffer a panoply of inoculations and booster shots before I left, plus numerous others over several years since then, all because I never had them as a kid.

Oh - and anti-vaccination types are uneducated morons.


We really should have Star Trek style injections by now.

By Charles Sullivan (not verified) on 02 May 2011 #permalink

Charles, I think we do. I'm not sure why one vaccination requires one type of injection and a different one another kind, but there are some of those star-trek ones out there.

According to testimony given last Thursday at a hearing by the Committee on Health and Human Services Reform on vaccinations, 60% of the kids who have come down with measles during the recent outbreak required hospitalization.
It's not just another disease that you can shuck off easily.
At that hearing it became very evident that autism is being used as a facade to terrorize parents from vaccinating their kids with vaccines that contain barely detectable (by the most sensitive assays available) amounts of "human fetal DNA".
The following was introduced today

H.F. No. 1636, as introduced - 87th Legislative Session (2011-2012) Posted on May 02, 2011
1.1A bill for an act
1.2relating to public health; requiring labeling of certain vaccines containing human
1.3DNA;proposing coding for new law in Minnesota Statutes, chapter 145.

1.5 Section 1. [145.669] HUMAN DNA VACCINES.
1.6Vaccines manufactured using human fetal or embryonic cell lines, proteins,
1.7deoxyribonucleic acid (DNA), recombinant DNA, monoclonal antibodies, or any other
1.8components derived from human tissue must be clearly labeled as being derived from or
1.9manufactured using such human fetal or embryonic tissue and containing such human
1.10fetal or embryonic DNA components in particular vaccines.

Although it won't pass this year, it probably will be brought up with more support next year.

By perry hackett (not verified) on 02 May 2011 #permalink

Hah. My brother bit the doctor who was cleaning and stitching some cuts on his face (he'd been running on dirty gravel with his coat turned down over his elbows so he couldn't catch himself). Thankfully, she was enough of a trouper that she just asked for him to be given more anaesthetic spray and for my father to hold his jaw shut. She realised that even though he was throwing a good oldfashioned tantrum, the adults in the room had a duty of care to ensure the wounds didn't get infected and the scarring was minimised. Same with vaccinations: toddlers are allowed to act out because they're unhappy with present suffering or risk for future benefits; grown-ups are not.

By stripey_cat (not verified) on 02 May 2011 #permalink

I'm surprised by the number of vaccinations you get in the USA, more specifically the number of needles stuck into the little ones.
The most needles mine ever got were two and that was against:
Tetanus, Diphteria, Pertusis, Polio, Hib, Hepatitis B and Pneumonia.
Another 4 in 1 is MMR and Chicken Pox.

On a general note, I heavily bribe my kids for trips to the pediatrician. Unless they're so sick they really need to be in bed, I take them for cake afterwards and then to the toy store for a small toy. I'm really trying to condition them. The pediatrician is something to look forward to, not to be dreaded and the memory of a toy seems to last longer than that of a needle.

Greg: How does that relate to my surprise at the number of needles? Are you vaccinating against MORE diseases than we do, or are you simply using single vaccines vs. combined vaccines? Is it more effective to do so?
I'm not arguing about who has the most idiots not vaccinating their kids (but please, you know, Europe isn't a country, it's a continent). I'm even pro mandatrory vaccination (with medical excemptions) and consider not vaccinating to be child abuse.
I do my best to counter the anti-vaxxers wherever I find them. Still, what does that do to answer my question?

Charles, one day in elementary school (in the late '60s or early '70s) we all lined up for an immunization. It was done with some kind of pressurized injection, very "Star Trek". But the whole damn rest of the process was the same as before, so between the anxiety of waiting for who knows what and the smell of the alcoholâ

/me faints. (Smelling salts and a glass of water for Mister Woof!) The adults running the show seemed more annoyed than anything else, and made sure that no kid who fainted ever got to see any other kids who fainted.

Stripey_cat, I get what you say about adults not being allowed to act it out. Nevertheless, I permit myself a grumpy face and perhaps to explore why I feel as I do ⦠and perhaps some day get over it. The biggest things for me are 1) let me lie down and 2) tell me when it's done. So I got my MMR last summer out of social responsibility. (Can I have a cookie?)

By Timberwoof (not verified) on 02 May 2011 #permalink

At the mass swine flu vaccinations at the local university, they did hand out cookies. I encourage this.

Seriously, Timberwoof, you do deserve recognition for doing this despite it being difficult--and for talking about it so others know it can be done. I have a friend who passes out from that weird vaccination reflex. He just tells them he's going to do it, so go ahead but be prepared. And he tells people that it happens. Makes it much harder for them to complain about inconvenience or mild arm soreness.

Thanks, Stephanie. I used to pass out, too, and I probably would if I had to stand or sit.

Give your friend my sympathies and tell him to lie down and think on Buddha or something. You can't faint if you're lying down. Also, I wiggle my foot opposite the one from where I will get stuck. That way I can relaaaaax that arm yet express my nervousness in a harmless way. One of the nurses at the doctor's knows me now and knows what to do.

Also, this may squick your friend, but needle technology has gotten better lately. They are smaller and sharper than they used to be, and thus hurt less. It's not the pain that bothers me, but all the other stuff: preparation, the smell of alcohol, and my own nervousness and being upset because I am upset.

Writing this has raised my BP a bit. I'll practice relaxing and breathing slowly now. Where's my teddy-woof? ;-)

Get your immunizations, and don't whine more than I do.

By Timberwoof (not verified) on 02 May 2011 #permalink

Timberwoof... Do you remember if the pressurized injector was less painful?

The one anecdote I have is that it is actually more painful than a properly administered needle. After all, it is forcing a liquid under the outer layer of the skin using pressure. The recipient was military, and the military used it because it was quick and easy to inject a bunch of people without having to change needles between each one... not because it was somehow "nicer".

Travc, no I don't recall whether the pneumatic thing was painful.

But once the initial phobia was set up, I don't think it was the pain so much as the anxiety surrounding the whole procedure. About twenty years ago I got a Prince Albert. That hurt like a ⦠like a very painful thing! Yes, scared-of-needles-me got a Prince Albert. Go figure. A few months later I had to get two injections for an unrelated allergy attack. I was so itchy from the anaphylactic shock that I could not feel the needles ⦠and my doctor was good at giving injections. I was okay with shots for a while after that. I had a dentist who would schedule me for the first appointment in the morning so I could walk to the office and still be half asleep. So it's easy to set up the phobia but it takes practice to overcome.

But think of the children! So how would I model to a child in my care how to get an injection? Not being a parent, I'd give this a try: Holding, humming, breathing, talking softly, saying, "All done" when it was done, and holding and rocking some more.

Greg, Huxley has my sympathies.

By Timberwoof (not verified) on 02 May 2011 #permalink

Are you vaccinating against MORE diseases than we do, or are you simply using single vaccines vs. combined vaccines?

I believe the US vaccinates for more things that most European countries.

I had to look up "Prince Albert." If you want a bit of a shock, look it up in Wikpedia.


depending on where you work.

But this part was funny: "Sexual partners of those with piercings may present with complications such as chipped teeth..."

Warning: pedant alert.

"I've seen baby's die." --> "I've seen babies die."

"Or, perhaps they just think that vaccinations are just natural." Perhaps "vaccinations are unnatural," or "infections are just natural."

My daughter goes to a school where a lot of parents don't vaccinate their kids. When one of their kids gets mumps or whatever, they send out an email inviting parents to send their children over to get immunity "the natural way."

Most people have only a superficial understanding of science but 50 years ago there was widespread trust that by and large science was providing the best available answers. Science continues on as it always has, but that trust has been lost, and I place most of the blame on the popular press. Always looking for a titillating story, one researcher in some outpost will make a contrarian claim, and the press trumpets it, usually stripping any nuance that might have been in the initial study. Later they have fun making science look fickle by running a follow up story how "scientists" have now concluded exactly the opposite.

Of course it is impossible to talk rationally with anti-vax parents, even ones I have an otherwise good regard for, as telling them they have a flawed understanding of immunization is tantamount to claiming they are bad parents. And nobody wants to hear that about themselves.

Everybody here, ask yourself this question and answer it honestly:

When was the last time you heard a mom say something that indicated that since she is a mom, she has some kind of mommy instinct? And, (here's the actual question): What did you say? Did you tell her that there is no such thing?

I've done it twice in the last 10 days. (Patting myself on the back.) Not easy, and I have certainly NOT done it at various times in the past.

I always took vaccinations and eye drops like a champ.
Novocaine, on the other hand, was a bit tough for me, but they did a bad job of numbing my mouth before the shot.

Greg, as someone who loves kids & won't have any of his own and as someone who filled out his vaccine dance card before going on immunosuppressants for arthritis: thank you. Give Huxley a big hug for me.

Got a lot of shots early.

My conclusion is that needle insertion is traumatic but a majority of the actual pain, and trauma afterward, comes from how fast the stuff in injected. Smaller needles help on both counts as they go in with less damage being done and the constriction of the smaller needle forces even the most hyper nurses to slow down the rate of insertion of the liquid.

I figured this out when getting regular shots it was always less painful with a nurse who took her time pushing on the plunger. It took the better part of six or seven seconds to empty the syringe and it didn't sting. It also seemed the shot site was less painful afterward.

Next time you get a shot ask for the smallest bore needle allowed and have them slow down pushing the plunger.

So, I've given you the German vaccine schedule, what other vaccinations do you give your kids? I know we don't routinely imunize against the flu and Rotavirus (only "high risk kids"). In areas where the ticks are carrying FSME you get that, too.
Even if I add those it hardly explains 5 injections at a time to me.
What IS a problem here is that we are not only huge fans of woo, but also that we started the vaccination game late. I was born in 1979 and all I got was DPT. Later the girls would get Rubella as well. The rest were childhood diseases and you were a child to get them. Which means I had to make it through measles (locking my self up in a cupboard because I was so f... light sensitive), whomping cough, mumps and chicken pox (locking myself up crying in the bathroom on my 21st birthday). It also means that you have huge groups of unvaccinated and "unimunized" people who are therefore at risk if there's an outbreak.

"When was the last time you heard a mom say something that indicated that since she is a mom, she has some kind of mommy instinct? And, (here's the actual question): What did you say? Did you tell her that there is no such thing?"
Well, I usually tell them that yeah, during my first pregnancy, my mummy instinct told me that everything was fine. Just until the moment it wasn't. Shuts people up quickly. And then I'll try to reason with them that, even though there is no "instinct", there's experience. I know my kids well, I know when they're just "cough potion and Winnie the Poo movie on the couch" sick and when they need a doctor.
And that yes, there are things like lucky coincidences. A friend of mine's daughter would have bled to death if she hadn't been to her room in just the right moment.

Completely anecdotal, but I had the experience of the needle-less shot while in boot camp in the early 80's. I don't recall any particular pain...but would have to be pretty extraordinary to stand out against the other pains of basic training. Anyhow, the word was that if you happened to flinch, the jet would make a nice gash. And several of the guys did leave with nicks and tears bloody enough to require bandaging.

Timberwoof, is there a really close aunt/uncle/family friend who can take the kids in to see the doctor during vaccinations? I think your tension about needles could scare the kids more than the injections themselves. Children are very sensitive to parental moods. Presenting it to them as both not a big deal, and something they get praise/treats for coping with are helpful.

By Samantha Vimes (not verified) on 02 May 2011 #permalink

Baby had her first two shots yesterday. The shots themselves were pretty un-traumatic, but she was feeling rather poorly in the evening, crying and being rather pitiful. Fortunately the healing power of nursing is almost magical, and today she's back to her usual sunny self.

It is awful as a parent to listen to painful cries of a baby, but I imagine it to be more awful still to witness serious disease in your child. Give me one evening of discomfort over coughing that cracks ribs or worse any day!

Giliell: Great mom answer.

Infants and children up through sixyears get vaccinated for ...

Hepatitis A and Hepatitis B (two shots each?)
measles, mumps and rubella (MMR) (pattern is changing, one shot as child one later?)
Influenza (annually)
Polio (three shots over five years)
Haemophilus influenzae menengitis (three shots)
Rotovirus (may be only in some areas now, three shots)
Diphtheria, pertussis and and tetanus (combined vaccine, four shots over six years, plus/minus)
Pneumococcal conjugate (three shots)

Most of this is required, some not. That's a total of 14 infectious diseases.

For older kids there is a number of boosters, etc. plus Human Pap and Meningococcal conjugate.

Jealous of modern kids. They have so many fewer days seriously ill, it's great.

Being a child of the 70's, I got vaccination for measles, rubella, polio, diphtheria, pertussis and tetanus. I've also had vaccinations for yellow fever and typhoid (living in the tropics will do that for you) and got one for TB just before I started college (now that I was sore about, but having seen what the TB infection rate is doing nowadays, I've made my peace with it!). I get the flu jab whenever it's on offer.

At some point I'll have to go see the GP about what vaccinations I can still usefully get. Hepatitis A and B happen to be high on that list.

By Bystander (not verified) on 03 May 2011 #permalink

Being a child from the early 50's, the vaccinations available today were not available waay back then. I did get the following miserable dieases: measles, mumps and yes, the dreaded polio. I would never, EVER not vaccinate a child for these horrible diseases. never EVER.

@Carol, as a child of the early 50s myself, you'd be surprised to learn which vaccinations have been around for a long time. As a Military Brat Abroad, we used to have to repeat the entire series every 6 months. Cholera, Yellow fever, tetanus, typhoid fever, Small Pox, Polio, Diphtheria, Typhus, Pertussis,..and I am still missing a couple, I remember that there were 12...
@ Greg, there are 3 Hep B vaccinations. When we/I inject small children (Huxley's age) in the thigh I have them sit on the parent's lap, facing the parent. This gives me better access and more control of the legs. I have the parent hold and comfort the child while I give the injections. I ALWAYS tell the child when I am giving an injection, and I tell them when I am through. I also praise them. When they are older, I tell them what I am going to do, that it may be uncomfortable, and I am going to give them a job. This job is to hold as still as possible, and when I count to three, I have them yell as loud as they can, them I vaccinate them. They tend to do very well, and after a few times, no longer need to yell to distract themselves. Also, they tend not to tense their arm as much if I have them concentrate on yelling.

Samantha, I don't have kids of my own, but having been a kid, I think about these things. And if I had kids, I feel I ought to be there for those events even if it squicked me.

gwen: Good on you! Heh. Did you see the Mythbusters episode on the effects of swearing on pain tolerance?

When I got sedated for having my wisdom teeth extracted, my oral surgeon lied to me, an ethical lie. He said he'd just use a child's IV, and when he put it in, it would feel like a pinch, like thisâand I thought he pinched me, but it was the actual needle. Oh. Oh, it feels fuzzy, kind of ⦠whump. (Wow. I'm sure dumping here. I think it's helping me process stuff, and I hope it helps caregivers and others like me.)

By timberwoof (not verified) on 03 May 2011 #permalink

A crying baby's certainly preferable to a dying one. Unfortunately the irresponsible parents out there also put a significant number of vaccinated people at risk since vaccines are not 100% effective. The ongoing outbreaks of measles already demonstrates this (a significant number of the reported infections are of folks who did have their vaccines). The Hep B vaccine never worked on me; I was tested and simply had no antibodies, so I know I have to rely on mass immunization to give me some added protection against Hep B (not that I engage in activities that put me at higher risk).

By MadScientist (not verified) on 03 May 2011 #permalink

Comparing your schedule to ours, we have a lot more combined vaccines.
Tetanus, Diphteria, Polio, Hip, Pertusis and Pneumococcal conjugate are one vaccine and there are 3 shots within the first year and I think a fourth one at age 3 or so.
MMR and Varicella is also one vaccine, 1 shot at 11 months, one supposedly 1 month later (we're actually 6 months behind that, every time we have an appointment the little one is sick, go figure).

You have my sympathy. I was traumatised by needles as a kid. Before kids start school they get a medical scan and are also tested for tuberculosis. For some reason or other, I reacted positively to that. Which meant regular X-rays and blood testing. I couldn't understand. I wasn't feeling sick and they were hurting me. What was even worse, it was my own mum and her nice colleagues who were hurting me (my mum is a laboratory assistant in a children's hospital). I kicked, I screamed, I bite and I would run from needles for years.
Thankfully, I'm also very stubborn, so one day I decided to not let it pass and started my own "I'm not afraid of needles" programm and went to donate plasma. Thankfully it worked.

MMR and Varicella are going to be combine in the near future, probably. These things do change. Although my info is very current, there may well be plans to change this pattern by the next time shots are due. Or, perhaps we are leading the way and the Europeans will follow. Or both.

yes, those things change a lot. My kids are only 2 years apart and there are already some differences between their schedules.

Greg -- you can already get MMRV in the US, even here in Minnesota. I know because my daughter did. ;-)

How many actual injections the kid gets isn't decided by the CDC. Your doctor's office has more to do with it. The CDC just gives windows of when various vaccinations should be done; your doctor can work out the actual implementation details within those windows, which can mean picking various combined shots over others. Mine makes a point of never giving more than 4 at a time if it can be avoided.

Right now is a special case, though, because of the measles epidemic. There's more urgency to getting measles vaccine right now, which may warrant an extra shot just for that. And again, it depends on which specific products your clinic uses.

By Calli Arcale (not verified) on 03 May 2011 #permalink

Oh, and Greg, we use 25g needles for kids, the smallest it is safe to use, 27g bend if you even twitch. for adults we use 23g needles, just slightly larger. The only reason to use a 21g needle is if the med is especially viscous..and there are only a few I can think of.

Greg -- you can already get MMRV in the US, even here in Minnesota. I know because my daughter did. ;-)

As you say, it's not a national standard: Huxley got an MMR and a V, two needles, last week, unfortunately! That may be because of the relationship between available doses, appropriate needles size, etc. because it was unusual for him to get it at all at that age.

"That may be because of the relationship between available doses, appropriate needles size, etc. because it was unusual for him to get it at all at that age. "

I would be interested to know whether those things are REALLY down to some science or rather to politics. IIRC your Huxley is the same age as my youngest (18m) and she was supposed to have completed her two shots of the MMRV by the age of 1.
The information I got was that the first shot imunizes about 90-92% of kids, while the second one gets that number up to 95-97%, which always leaves an unfortunate number of people who simply don't get imunized.
So, why would it be unusual for an American kid but just the state of art for a German one?

Or the third possibility: Multifinality. If there are guesses along the way, the results from the application of the same science in two different system will likely result in different outcomes from the same premises.

Most likely, though, there is some logic to all of this that we don't understand because it has to do with production and marketing requirements where the juice is made. That translates into recommendations with medical verisimilitude fed to physicians.

I wonder how many vaccines, if any, are made by German and US based companies? I.e., Bayer AG vs not? All these different outcomes are probably being made in one small room by some guy with a cigar.

Giliell -- it's not a difference between what's the state of the art but what's the current epidemiological advice. And that does vary from country to country, for good reasons. It's not that one country's schedule is better than the other; it's that one country's schedule is better *for them*. Measles has historically been more of a problem in Europe than the US, so epidemiologically, it's probably more urgent to get the vaccination series completed, whereas in the US, it's historically been safe to spread it out more. Upshot of spreading it out more -- the immunity lasts a smidge longer if the last shot is later, and with some vaccines, older patients may develop the desired immunity with fewer shots (because of their more mature immune system). One factor is the average age of patients with a particular vaccine-preventable disease in a given country; if 90% of the patients are, say, 2 years old, you want to make sure your vaccinating people completely as early as possible. If 90% of them are 15, however, you might want to aim a little older.

By Calli Arcale (not verified) on 04 May 2011 #permalink

A quick check says that they're all made by GlaxoSmithCline
A lot of those decissions are made by the fact of who makes the best offer in a country, seems like GSK has a pretty monopoly on childhood-vaccination in Germany.

There IS a standard recommended vaccine schedule put out by the CDC. All of our medical manuals have it in the index. It occasionally gets updated when new information becomes available, or new vaccines are added. I have a feeling that a lot of the variability has to do with doctor preference and vaccine availability.

Thanx, that makes sense.
As I said, those things ARE a bigger issue here, partly due to history and culture, partly due to the way our healtcare is organized, partly due to bad information.

One problem is that "childhood diseases" are not taken seriously. The very word is a synonym for "minor problems" recently developed things have. So you might say "I'm not going to buy a 3D TV until they've gotten over their childhood diseases"
I don't know, is that ever used in that way in English?
My BIL, who is a trained virologist, until recently, was of the opinion that you really don't have to vaccinate against everything. Until he caught rubella...

The problem with the healthcare system is that the way it's organized you just cannot have some sort of mass-vaccination. When I studied in Ireland, they started vaccinating against Meningitis C. It was done on campus and even I, an exchange student could just go there and get it. That's avery low threshold model that makes it easy for people just going there, getting it, not much planning or commitment needed. In Germany you always have to make an appointment and so on.

The bad information is on the one hand about the dangers of those diseases, since they're still considered a harmless nuissance, and also on how they're transmitted. Hep B is portraied as a STD, which means that people see no reason to vaccinate a newborn.

As a parent and public health scientist I can't thank you enough for this eloquent, compelling post. There was also a small outbreak of measles in my (Canadian) city last year, originating from a family that were anti-vacc and where the children were infected by a visitor from another country. My son is also 18 months and it makes me terrified to send him to school in a few years if this trend continues.

What the anti-vacc protest also miss is that people likely DIED in the clincial trials (as happens, in very small numbers) for these drugs years ago when they were orginally introduced. Don't let that be in vain and reverse years of progress...

I only wish as scientists AND as a concerned parents we could become more organized and speak out together as you do here.

You all are nuts! Vaccinations have been PROVEN to contain MERCURY, LEAD, PRESERVATIVES, DYES, and cause AUTISM! If you are still Pro're an idiot.