It has become a ritual for Pennsylvania parents preparing their children for the first day of kindergarten – school-required immunizations. Thanks to these required vaccinations, certain diseases have become very rare.
“Parents play a significant role in the long-term health of their children by making sure they are vaccinated,” said Bruce A. MacLeod, MD, 2014 president of the Pennsylvania Medical Society (PAMED). “By doing so, they’re also helping to protect the health of their community.”
Dr. MacLeod explains that parents used to be afraid that diseases such as measles, mumps, whooping cough or pertussis, diphtheria, and chicken pox would spread quickly in a classroom and school. Now, thanks to immunizations, outbreaks of these diseases are not common in schools with high immunization rates.
Allen Nussbaum, MD, president of the Pennsylvania Chapter of the American Academy of Pediatrics (PA AAP) and a pediatrician in York, says that Pennsylvania requires children to be vaccinated for eight diseases before starting school. In addition, a few additional vaccinations are required before 7th grade.
According to the Pennsylvania Department of Health, students must receive tetanus, diphtheria, polio, measles, mumps, rubella (German measles), hepatitis B, and varicella vaccinations before their first day of class. For 7th grade, they’ll also need to have the meningococcal conjugate and Tdap (tetanus, diphtheria, acellular pertussis) vaccines.
“These vaccinations have made a significant difference in improving our lives,” said G. Alan Yeasted, MD, FACP, a practicing internist in Pittsburgh and governor for the Western Region of the Pennsylvania Chapter of the American College of Physicians (PA-ACP), while also stating vaccinations are held to the highest standards for safety and effectiveness.
Margaret Hessen, MD, an infectious disease specialist from Bryn Mawr, adds, “Because we live in the era of modern medicine, and vaccines have been so successful in wiping out diseases that were often fatal in our grandparents’ childhood, people tend to forget the impact of the disease and worry more about side effects of the vaccines.”
“But we must keep potential side effects in perspective, and not lose sight of the importance of maintaining high rates of immunization to prevent infection from entering the community, taking hold, and spreading to those who are vulnerable to life-threatening complications,” adds Dr. Hessen, a Fellow of the American College of Physicians and member of PAMED.
Tetanus, also known as lockjaw, causes painful tightening of muscles throughout the body. In some cases, it can cause the jaws to lock so that the individual cannot open his mouth or swallow. Without treatment, tetanus is often fatal; even with aggressive critical care support, as many as 20 percent of cases die. The best solution is prevention through immunization.
“Typically, a person can get tetanus through a cut,” said Dr. MacLeod, an emergency medicine specialist in Pittsburgh. “Deep punctures created by nails and knives are of most concern, but a minor scratch can also be an avenue for this disease to find its way into your body as the bacteria are often found in dirt.”
Diphtheria affects the back of the nose or throat by building a thick coating that makes it difficult to breathe or swallow. The DTaP (younger children) and Tdap (older children and adults) vaccines protect individuals from this serious, sometimes deadly, disease.
Dr. Nussbaum of PA AAP says that the vaccine saves thousands of lives every year. “At one point in time, up to 15,000 people died every year and between 100,000 and 200,000 cases were diagnosed,” he said. “While there can be mild side effects from the diphtheria vaccines such as a fever or a sore arm, serious reactions are about one in a million. This is a very safe vaccine.”
Around age 11, the child should get a booster shot, Dr. Nussbaum explains. Adults also need to have a booster shot every 10 years.
Today, this disease has a historic connection to a well-known modern day sports event. An Alaskan outbreak in 1925 set the stage for the “Great Race of Mercy” that included 20 mushers and 150 dogs carrying diphtheria antitoxin over 674 miles in record time to save a community. Teams of mushers traveled day and night, enduring blizzards and temperatures of 50 degrees below zero, handing off the package of fresh diphtheria antitoxin to fresh musher dog teams. A trip that usually took 15 to 20 days was accomplished in a record 5 days, 7 hours, getting the lifesaving antitoxin to Nome, Alaska, to halt the diphtheria outbreak. Today, that mission’s effort is celebrated by the yearly Iditarod race.
Polio is a highly contagious viral infection that can lead to paralysis, breathing problems, and possibly death. During the first half of the 1900s, polio wreaked havoc on many American communities. At its peak, the most critically ill were robbed of their ability to breathe and confined to a mechanical ventilator known as an iron lung. Many others were crippled.
It was not until the 1950s when an initial breakthrough led by Pennsylvania Medical Society member Jonas Salk, MD, at the University of Pittsburgh, eventually led to the end of polio throughout most of the world.
Unfortunately, polio is again increasing due to political instability interfering with immunization efforts in Pakistan, Afghanistan, Syria, Iraq, Nigeria, and other part of Africa and the Middle East. The World Health Organization recently declared the resurgence of polio and spread internationally to be a “public health emergency of international concern.”
“We cannot be complacent about polio,” said Dr. MacLeod. “It is just a plane ride away.”
Dr. MacLeod, who practices in Pittsburgh, adds that Western Pennsylvania played an important role in the polio vaccine’s discovery, stating that many individuals from Allegheny County participated in clinical trials to help test the vaccine. Pennsylvania physicians later celebrated Dr. Salk’s work by honoring him with the Pennsylvania Medical Society’s first Distinguished Service Award.
Measles is a highly contagious virus that spreads through the air by breathing, coughing, or sneezing. It causes a rash all over the body as well as a fever, runny nose, and cough. It can lead to ear infections, pneumonia, and encephalitis. The open sores from the rash can get infected with hard-to-treat bacteria. Measles can lead to brain damage and even death.
In 2014, the U.S. is seeing the most measles cases since 1994 (including in Pennsylvania) due to a combination of importations from Europe and the Philippines and unvaccinated populations in the U.S.
As with any vaccine, says Dr. Yeasted of PA-ACP, there can be minor reactions that could include pain and redness at the injection site. Headaches and fatigue may also occur. Since the measles, mumps, rubella (MMR) vaccine is a live virus vaccine, there are medical reasons why some immune-suppressed people should not receive this vaccine. “Always check with your provider about MMR and all vaccines to make sure you get those recommended for your child,” added Dr. Yeasted.
The mumps virus is contagious and can be spread when a person coughs, sneezes, or talks. Touching contaminated surfaces can also help spread mumps. Complications from the disease may include viral meningitis and inflammation of testicles or ovaries. Mumps is not common in the United States thanks to vaccines, although outbreaks have occurred in recent history particularly in communities with high vaccine refusal rates. Immunization for this disease can be achieved through the MMR (measles, mumps, and rubella) vaccine. Its safety record is excellent.
Rubella is also known as “German measles” or “Three-day measles.” Rubella is a virus that can be spread from an infected person by coughing or sneezing. For the most part, rubella is mild, but there can be serious complications to the fetus if a pregnant woman contracts this disease. The rubella vaccine is contained in MMR vaccine and can prevent this dangerous and sometimes deadly disease. Side effects from rubella vaccine are usually mild – soreness around the injection site, fever, or rash.
Hepatitis B can cause serious damage to the liver. If an infection becomes chronic, it can lead to liver failure, liver cancer, or cirrhosis.
Unfortunately, there is no cure, but an effective vaccine series can help prevent hepatitis B. The hepatitis B vaccine series first became available in 1982. According to the CDC, no serious side effects have been reported since that time. Minor side effects may occur. Soreness at the injection site is the most common side effect.
Better known as “chickenpox,” varicella is a very contagious disease caused by the varicella-zoster virus. It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. It spreads easily from infected people to others who have never had chickenpox or received the chickenpox vaccine. Chickenpox spreads in the air through coughing or sneezing. It can also be spread by touching or breathing in the virus particles that come from chickenpox blisters.
Before the vaccine, about 4 million people would get chickenpox each year in the United States. Also, about 10,600 people were hospitalized and 100 to 150 people died each year as a result of chickenpox.
Fortunately, in 1995, the varicella vaccine became available. The chickenpox vaccine is very safe and effective at preventing the disease. Most people who get the vaccine will not get chickenpox. If a vaccinated person does get chickenpox, it is usually mild—with fewer blisters and mild or no fever. The chickenpox vaccine prevents almost all cases of severe disease.
Like many other vaccines, soreness around the injection site is not unusual.
Grade 7 – Don’t forget these
Once a child reaches the seventh grade, Pennsylvania has two additional vaccines required for school attendance. One is the meningococcal conjugate vaccine (MCV) and the other is a booster for tetanus, diphtheria, and acellular pertussis as Tdap vaccine.
Most people know meningococcal disease as meningitis, which causes the lining of the brain and spinal cord to become infected with bacteria. There are many strains of meningococcus and our current meningococcal vaccine prevents the most common types. This disease can kill quickly and vaccination is the best way to prevent it.
In addition to the vaccines required for school entry or attendance, the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommends the human papillomavirus (HPV) vaccine as one of the routine adolescent immunizations, most commonly started at ages 11 and 12 years. HPV vaccine prevents the most common types of cervical cancer for girls, genital warts for boys, and other types of cancer for both males and females. It is a three-dose series and has been found to be extremely safe.
What about Pertussis? Isn’t that also required?
Although pertussis vaccine isn’t listed among those required for school entry, it is recommended by the Centers for Disease Control and Prevention. Usually it is given in combination with tetanus and diphtheria vaccines as part of a multi-dose series beginning at two months of life.
Pertussis, or whooping cough, begins as an upper respiratory infection affecting the eyes and nose. It progresses over a few weeks to a deep protracted cough that occurs in long-lasting “paroxysms” or coughing fits that cannot be stopped voluntarily. These fits rob the sufferer of breath and oxygen. Patients may die of complications of the prolonged coughing fits, such as low oxygen levels and ruptured blood vessels. Outbreaks have been occurring with increased frequency in the US in recent years, and have claimed the lives of a number of children, particularly young infants.
This disease is largely preventable through immunization with DTaP vaccine in children and Tdap vaccine for teens and adults. Recent outbreaks of pertussis in the United States have brought increased attention to the importance of this vaccine. A booster dose is required for entry to 7th grade. Unfortunately, immunization does not provide lifelong immunity; booster doses with a combination vaccine that includes pertussis (Tdap) are necessary for older children and adults.
Adults also need vaccines
It is important to remember that vaccines are not just for kids. Adults need to be vaccinated as well, and some of those vaccines prevent infections in children by preventing spread from an infected adult.
Adult immunization is particularly important in preventing diseases in vulnerable children who are too young to be vaccinated against infections like pertussis and influenza. A vaccinated, protected adult will not spread infection to an infant child or grandchild in the household or community.