by Warren P. Silberstein, M.D.
02/07/97
Revised: 10/07/00

Because of parents' concerns about the safety of the whole cell DTP vaccine we were all eagerly awaiting approval of the Acellular DTP Vaccine (DTaP) for use in infants as the primary immunization against Diphtheria, Tetanus, and Pertussis (Whooping Cough), and that approval has come. As of the January 1, 1997, the official recommendation is that all the injections for the DTP series be given with DTaP.

Another change starting January 1, 1997, is the recommendation that the primary series of Polio immunizations (2 months and 4 months) be given with the Inactivated Polio Vaccine (IPV) which is an injection. The IPV is similar to the Salk Vaccine that us older folks used to get as kids. The reason for this change is that Oral Polio Vaccine [OPV, also known as Sabin vaccine] is a live virus which, under rare circumstances can cause the actual disease with paralysis. This is so rare that I have never seen a case, but the amount of Polio in this country is so low that the risk isn't justified. The OPV was still recommended in 1997 for the boosters because there are some advantages to OPV. The OPV causes immunity in the intestines that actually blocks Polio from entering the body, and because it's a live vaccine, people who are exposed to a child who received OPV get a boost to their immunity. Giving IPV to infants gives them enough immunity that there is much less risk to giving them OPV for the booster; however there is still some risk. Therefore, as of January 1, 2000, the recommendations have been further changed: The recommended schedule for polio immunization is now all doses given as IPV. Notice that I said these are recommendations, not requirements. A parent may choose for their child to have all 4 doses as OPV or IPV. Either provides immunity and is acceptable for entry into school. If travelling to a country where there is a risk of polio, the recommended immunization for someone who is not fully immunized remains OPV.

The newest vaccine to join the heavy schedule of infant immunizations is the Pneumococcal Conjugate Vaccine (PCV-7) marketed under the brand name, Prevnar. PCV-7 protects against disease caused by the bacterium Streptococcus pneumoniae, also know as pneumococcus. Pneumococcus causes serious infections like meningitis, blood infections, and pneumonia. It is also one of the organisms which can cause ear infections. Because we are seeing some strains of pneumococcus which are resistant to multiple antibiotics, these infections are becoming harder to treat. That makes prevention by immunization an increasingly important approach to deal with this infection. The vaccine is well tolerated with common reactions including redness and soreness at the injection site, fever, irritability, and drowsiness. There are no known serious side effects from the vaccine.

The good news is that immunizations have gone a long way toward decreasing diseases in this country, and older children can benefit from the new vaccines as well. The bad news is that far too many children have not received all their shots. One reason, which should be easy to fix, is missed opportunities. Another reason is fear. Any parents who are worried about the vaccines need only check the information about the immunizations and the diseases which is available on the Center for Disease Control's Website. And for those who aren't immunized because they can't afford vaccines, the Federal Government has set up the VFC program. Participating physicians obtain vaccines from the government and charge only an administration fee of $17.85 per vaccine. This fee can be waived in cases of hardship. If your pediatrician hasn't signed up for the VFC program, ask him to join now.

Check the Immunization Action Coalition, National Network for Immunization Information, and the American Academy of Pediatrics Web sites for more immunization information.

Read Ask Dr. Warren Column