Childhood vaccination schedules are in the news, with a key regulatory committee at the U.S. Centers for Disease Control reconsidering long-established practices.
The news can be confusing for parents, who may wonder what the proposed changes mean when it comes to vaccinating their children.
Pediatric clinicians have a key role to play in shedding light on the issue. It starts with listening carefully to parents’ questions and input, according to Seth Hoffman, MD, an infectious disease specialist at Stanford Medicine and a member of the Stanford Maternal and Child Health Research Institute.
It’s normal for parents to worry or feel outside their comfort zone when they’re making health decisions for their infants and young children.
“They think, ‘This is my kid!’” Hoffman said. “It’s absolutely fair that parents are concerned about anything we are giving their children. I’m a parent, too, so I understand that feeling.”
Hoffman and colleagues recently published a review article in Pediatrics about one vaccine component that has been questioned by political appointees, the aluminum salts included in vaccines to help activate the immune system. He spoke with Insights about five things physicians and families should know about childhood vaccines.
1. Two-way dialogue between pediatricians and parents works best
The first step for pediatricians in their conversations with parents — on vaccines or any other topic — should always be to listen.
“Parents deserve respect,” Hoffman said. “Their concerns are real.”
Parents should know that experts like Hoffman recommend clinicians engage in open dialogue with families, taking their concerns into account.
Empathetic communication is key, he said, and it works better than just listing facts about vaccines. As he has shared this approach with his colleagues, “They really appreciate that we give them this framework, and that there’s data to support approaching families in this manner.”
With parents’ concerns as their starting point, physicians can share context about specific vaccines and their components; discuss the evidence supporting vaccination; and talk about the risks to children who miss out on protection from severe, potentially fatal infectious diseases.
“For aluminum salts, for example, we have nearly 100 years of experience, with billions of doses administered and large studies involving millions of children around the world that show no links to the conditions that parents are most often worried about,” Hoffman said.
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2. Childhood vaccines have improved with rigorous testing
Over the last 100 years, scientists have invented and tested many vaccine improvements. Compared with their predecessors, modern vaccines elicit better immune responses from fewer doses. They also produce fewer side effects.
One key change that enabled these improvements was giving patients smaller, more purified pieces of each infectious bacteria or virus, aka antigens, rather than whole viruses or bacteria. This reduces vaccination side effects. While modern vaccines still produce some swelling and soreness at the injection site, they are much less likely than older vaccines to cause fevers or other whole-body responses.
Because a small, purified antigen doesn’t put the immune system on alert in the same way as a whole pathogen, a second component, adjuvants, are added to vaccines. Adjuvants “wake up” the immune system, getting it to pay attention to the purified antigen. They help boost the effectiveness of vaccination for babies and young children, whose immune responses are less developed.
Aluminum salts are the most common adjuvant; they have been widely used in childhood vaccines since the 1930s. Vaccination deposits a small amount of aluminum salt in the muscle where the dose is injected, and from there it is gradually absorbed into the bloodstream. The amount of vaccine aluminum in the bloodstream remains so small it doesn’t produce a measurable change in blood aluminum levels. It is cleared by the kidneys and is safe even for vulnerable patients such as premature babies. But it’s enough to tickle the immune system into a robust response.
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3. Vaccination concerns are not borne out in rigorous trials
Science always involves some back and forth, Hoffman said. Ideas that first arise from smaller studies are later subjected to more rigorous testing and may be disproven.
Small studies have raised concerns about possible links between some vaccine components and several conditions, such as autism, allergies, and autoimmune and neurodevelopmental diseases. But large, rigorous trials — including one that closely tracked more than a million children in Denmark — have not supported any connection between these conditions and aluminum salts or other components of childhood vaccines.
Information from other sources also supports the safety of aluminum salts. Aluminum is the third most common element on Earth, and everyone is routinely exposed to aluminum from varied sources, including our food and drink.
Aluminum salts are used elsewhere in medicine. They are injected as part of subcutaneous immunotherapy that is used mostly in Europe to treat allergies, for instance.
“In this subcutaneous immunotherapy, kids are getting substantially more aluminum in one year than they receive from the vaccines given over the first 18 years of a child’s life,” Hoffman said, adding that this treatment has been widely shown to be safe.
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4. What works elsewhere may not work in the U.S.
One change recently recommended by the Advisory Committee on Immunization Practices, which is part of the U.S. Centers for Disease Control, is to discontinue routinely giving the hepatitis B vaccine to all newborns.
“The hepatitis B vaccine has decades of safety data behind it, and there is a clear rationale for why we give the birth dose, especially in the United States,” Hoffman said.
Some European countries do not administer a standard birth dose of the hepatitis B vaccine, relying instead on universal health insurance and near-universal prenatal screening as the first lines of defense for preventing hepatitis B transmission from infected mothers to their infants at birth.
But in the United States — where pregnant patients do not have equal access to prenatal hepatitis screening and care — giving the vaccine to every infant at birth offers important protection against a lifelong infection.
“The birth dose of hepatitis B can prevent the development of a chronic infection that we cannot cure,” Hoffman said. The infection puts people at an increased risk for long-term liver disease, cirrhosis and liver cancer, he said.
“Weakening the universal birth dose recommendation means we’re making a decision that we’re OK with kids slipping through the cracks of our prevention strategies,” he said. “And unfortunately, they are likely to develop a lifelong chronic disease.”
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5. Scaling back vaccination has consequences
Long-held vaccination practices — such as including aluminum salts to help activate the immune system and giving a dose of the hepatitis B vaccine to every newborn — have been rigorously studied for generations, Hoffman noted. And widespread vaccine uptake has drastically lowered the rates of infectious diseases that used to cause millions of childhood illnesses and deaths.
It’s important for pediatric clinicians to help parents understand the potential consequences of contracting vaccine-preventable diseases, he said.
“All the data on vaccination have been carefully examined, over decades by people with the relevant expertise, and clinicians and parents can feel confident about the safety profile and effectiveness of pediatric vaccines,” Hoffman said. “With vaccination, your children are avoiding disease that can have lifelong side effects or even be fatal.”
The first step for pediatricians in their conversations with parents — on vaccines or any other topic — should always be to listen.
“Parents deserve respect,” Hoffman said. “Their concerns are real.”
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