Vaccinations For Children - A Decision Aid

Vaccinations for children - a decision aid

We come into contact with a large number of bacteria and viruses every day. Most of them affect us little, some not at all. But there are also pathogens that can cause serious infections. Diseases such as measles, polio, and tetanus can have serious complications and cause long-term effects or even be fatal. These risks can be avoided by vaccination.

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Vaccinations: Protection for Society

Vaccinations protect the vaccinated person (individual protection). In addition, many protective vaccinations, such as measles vaccination, also indirectly protect non-immune people because the spread of infections is prevented (community protection). Getting vaccinated is therefore not only an act of personal responsibility, but also a voluntary act of solidarity to protect susceptible members of our society who cannot be protected by a vaccination (e.g. infants or people with a weakened immune system).

Parents are confronted with the vaccination question by the child's third month at the latest. Some are unsure whether vaccination is really necessary. After all - this is often the objection that is concerned - vaccinations can also have side effects. Isn't it better to let them go through the supposedly "harmless" teething problems?

Because today's parents are no longer familiar with many of the vaccine-preventable diseases, respect for such diseases has decreased. Thanks to vaccinations, polio no longer exists in Austria, tetanus has become a rarity, and bacterial meningitis caused by Haemophilus influenzae type B practically no longer occurs in children in Austria. It must also be noted that so-called childhood diseases such as measles, mumps or whooping cough are by no means harmless and can affect people of all age groups. Vaccine-preventable diseases can be associated with serious complications (e.g., brain damage, paralysis, blindness, and deafness) and even death. Vaccinations can prevent these diseases and their consequential damage.

Individual vaccination advice

Vaccinations are an essential part of preventing many serious infectious diseases. Therefore, there are vaccination recommendations in Austria according to the Austrian vaccination plan, which are evaluated annually by the national vaccination committee according to the current state of knowledge and adapted if necessary. The most important contact person for any questions is the doctor. Her / his duty to inform is even regulated by law. Accordingly, before each vaccination he / she must inform the person being vaccinated or the parents / legal representative of the person being vaccinated about the disease to be prevented and the benefits or possible side effects or complications of the vaccination. In addition, the doctor should explain the type of vaccine, the duration of vaccination protection and follow-up and booster vaccinations. The individual decision for or against a vaccination ultimately rests with the person being vaccinated or with their parents / legal representative.

Vaccinate, yes or no?

The question “vaccinate, yes or no?” Is hotly debated in Austria, because there is no compulsory vaccination in this country. Anyone can refuse a vaccination for themselves or their child without giving a reason. It is up to the parents to have their children vaccinated in good time.

Note According to the UN Convention of November 20, 1989, children have the right to the best health care. This also includes protection against diseases that can be prevented by vaccination.

There is a lot of information and half-truths around when it comes to vaccination. Many parents are therefore quickly confused. Doesn't vaccination harm children more than it benefits them? Why should I have my child vaccinated against infectious diseases that have already been eradicated? Are Vaccinations Really Safe? The Robert Koch Institute, together with the Paul Ehrlich Institute, contrasted the most frequent objections to vaccination with hard facts. The answers should help to classify the claims and to get an idea of the benefits of vaccination. The most important points of discussion are summarized and supplemented here:

Thesis 1: Vaccinations do not protect in the long term

Whether a vaccination has to be repeated or not varies from vaccine to vaccine. The more intensely the immune system has to deal with a pathogen, the greater the probability that it will be recognized by the body's defense system when it penetrates later. Vaccinations with live vaccines in particular have a similarly strong impact on the immune system as a survived infection, but without exposing people to the risks of the disease. For example, if a child receives two measles-mumps-rubella (MMR) combined injections, it is assumed that the immune protection will last a lifetime. The situation is different with tetanus, diphtheria, polio or whooping cough. Vaccination against these infectious diseases only provides protection for a few years and should be refreshed regularly according to national recommendations.

However, due to the time-limited effect of a vaccine, it cannot be assumed to be less effective as long as one stays within the recommended intervals. Vaccinations should be boosted according to recommendations. If a booster vaccination is missed, each vaccination should be made up as soon as possible.

Note Even people who have already survived an infectious disease are - depending on the disease - sometimes not permanently immune to this disease! For example, you can get whooping cough several times in your life.

Thesis 2: We parents went through these diseases as children and got through them well

It is true that infectious diseases can heal without consequences. However, even supposedly “harmless” childhood diseases can be very dramatic in certain cases. The best examples are measles or mumps: about 1 in 1,000 children who develop measles will develop measles encephalitis

(Inflammation of the brain). This often leads to permanent brain damage and is even fatal in about every fourth case. In addition, as a rare long-term consequence (1 case per 5,000-10,000 infections) there is the always fatal subacute sclerosing panencephalitis (SSPE). If children fall ill by the age of five, the risk of developing SSPE later is greatly increased (17-fold). It is then 1: 1,700 to 1: 3,300 measles infections. Children who develop measles in the first year of life have the highest risk, around 1: 600. In addition, by weakening the immune system, measles causes an increased risk of dying from other infectious diseases that lasts for several years.

A complication of mumps in boys is inflammation of the testicles, which can lead to fertility problems. In five to ten percent of mumps illnesses, inflammation of the meninges / brain also occurs, which can cause permanent damage. In most cases, vaccination can prevent these complications.

In pregnant women who are not immune to this infectious disease, rubella can cause severe malformations in the unborn child; here too, vaccinations are effective in prevention.

Note A vaccination offers the opportunity to train the immune system on a harmless opponent. Infections, on the other hand, can cause health complications and even lead to death. Furthermore, it must also be taken into account that in the past there was no vaccination option for many infectious diseases.

Thesis 3: Breast-fed children do not have to be vaccinated because they get the antibodies with their mother's milk

In fact, antibodies are transferred to the unborn child via the bloodstream during pregnancy, which is why it makes sense to update your vaccination status before a pregnancy occurs ("prepare for pregnancy"). With the breast milk the baby receives further antibodies. One speaks of so-called nest protection, which is only a support for the child's immune system in the first months of life. However, it is not comprehensive enough to protect against certain infections.

In addition, the mother can only pass on those antibodies against diseases that she has either gone through herself or against which she has been vaccinated. In addition, vaccination of the mother against influenza during pregnancy is expressly recommended, as is current vaccination against pertussis.

Note Nest protection is poorly developed, especially in premature babies, so that these children particularly benefit from vaccinations.

Thesis 4: The child's immune system is overwhelmed by the many vaccinations and multiple vaccinations

Many parents fear that the child's immune system could be burdened by multiple vaccines (combination vaccines). In fact, children are confronted with significantly fewer vaccine antigens than they used to be. Vaccine antigens are components of the vaccines against which the protective antibodies are ultimately formed. In the 1980s, children were given a little more than 3,000 antigens with the vaccines used at the time, and in 2015 the average was just over 200 antigens in the vaccines used today. Assuming the average number of B cells in the blood, which play a key role in the immune response to vaccines, the immune system could effectively respond and protect against 10,000 vaccines at the same time.

Note A frequent criticism of the six-fold vaccination is that hepatitis B is mainly transmitted through sexual intercourse. However, it can also be transmitted indirectly through contaminated objects (e.g. in babies). The transmission can also take place through bloody contacts - for example in the context of small injuries and blood contact. Since hepatitis B almost always takes a chronic course in infants (with the high risk of developing liver cirrhosis and / or liver cancer later), children are particularly at risk.

Thesis 5: Children should only be vaccinated at a later age when their organism is more stable

Vaccinations can be carried out or made up at any age. Certain infections such as whooping cough hit babies harder than older children, which is why early protection is particularly important. If children are younger than six months with whooping cough infection, complications such as pneumonia or respiratory arrest occur in around 25 percent of cases. After that, the complication rate drops to around five percent. The number of bacterial meningitis is also highest in infants, which is why early protection against Haemophilus influenzae B, pneumococci and meningococci is important.

In addition, the establishment of the vaccination protection takes time. For example, a baby needs a certain amount of time after vaccinations, with some vaccinations even several doses, until comprehensive vaccination protection against the relevant disease is developed.

Thesis 6: You can get sick despite being vaccinated

That's right. A vaccination does not lead to an immune reaction 100 percent of the time. A small part of the population does not develop immunity after vaccination. These people can therefore get sick even though they are vaccinated. However, vaccinations can significantly reduce the likelihood of illness. However, if enough people are protected around such people, they benefit from community protection and do not fall ill. In addition, there are vaccinations that prevent particularly severe disease courses.

Thesis 7: Why should I vaccinate my child against diseases that no longer occur in our country

There are infectious diseases that have not occurred in Austria for many years, such as polio (short: polio). The European Union was declared polio-free by the WHO in 2002. However, this is already the result of vaccination programs. Nevertheless, as long as a disease has not been eradicated worldwide, it can be reintroduced. If not enough people are vaccinated against it, it can cause epidemics.

This became evident in 2010 in Tajikistan, where there was an outbreak of introduced polio wild viruses. In total, over 600 cases of acute paralysis were reported in 2010, and deaths have also been recorded. Despite safety precautions, the virus was spread to at least three other countries. In the course of such epidemics, infections can also be introduced to Austria through international travel.

Note In order to eradicate a pathogen, a very high vaccination rate in the population is necessary. Vaccination must continue until the pathogen is completely eradicated, as has been done with smallpox. Smallpox has been eradicated worldwide since 1980.

Thesis 8: Vaccinations cause diseases against which they are supposed to protect

It's true that certain vaccines can cause disease-like symptoms. However, a full-blown disease practically never develops. The best-known example are the so-called "vaccine measles": Since the measles vaccine is a live vaccine, a measles-like rash rarely occurs after the vaccination. A fully developed measles infection or known complications such as pneumonia or encephalitis are absolutely rare after a measles vaccination and occur in less than one case per million vaccinated. In true measles infection, encephalitis affects 1 in 1,000 children, and 6 out of 100 children have pneumonia.

After a vaccination, local and general reactions such as fever, nausea, tiredness, increased temperature, headache and body aches as well as swelling or redness at the injection site can occur. These are signs that the body is normally dealing with the vaccine. However, the absence of such reactions does not mean that the vaccination has no effect.

Note In order for a vaccination to be approved at all, the health benefits must be proven to be significantly higher than the vaccination-related risks. The risks of vaccination must be far lower than the risks associated with complications from illness. If vaccinations are available, national experts (National Vaccination Committee) assess the scientific data on the vaccine and the epidemiological situation, and ultimately evidence-based recommendations are made based on the current state of knowledge and regularly checked and updated.

Thesis 9: Vaccines contain dangerous chemicals

In addition to the killed or weakened pathogens, some vaccines contain other auxiliary substances such as formaldehyde, aluminum or antibiotics, but in extremely low concentrations (well below the specified toxicological limit values). The legal limit for formaldehyde, for example, is 0.2 mg / mL per dose. However, formaldehyde is a natural metabolic product that occurs constantly in blood (2.5 mg / L), cells and body fluids. Up to 14 mg are consumed daily with food, fruit and vegetables have a particularly high proportion. Formaldehyde is also produced by the body: 878 to 1310 mg per kilogram of body weight.

A few years ago, two American doctors suggested that the increase in autism cases registered in the USA was related to the mercury-containing preservative thiomersal in some vaccines. The WHO, the US “Institute of Medicine” and the European Medicines Agency (EMA) have come to the conclusion, independently of one another, that the available studies clearly speak against such a connection. Nonetheless, the pharmaceutical manufacturers have reacted to the heated debate: Mercury-free vaccines are now available for all generally recommended vaccinations. Thimerosal is no longer used in routine vaccines in Austria.

Aluminum salts strengthen the immune response in vaccines (max. 1.25 mg per dose). Here, too, there are clear statements from several authorities that the extremely low doses used in vaccines are in no way harmful to health.

You can find detailed information on the vaccination controversy on the website of the Robert Koch Institute (RKI). A detailed overview article on the subject of reactions and side effects after vaccinations is available on the website of the Federal Ministry for Social Affairs, Health, Care and Consumer Protection.