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Prakash Chandran (Host): Did you know that vaccines are considered to be one of the most important life saving medical innovations of the 20^th century? There’s a reason we never hear of children contracting diseases like diphtheria, polio or rubella anymore. I’m Prakash Chandran and today we will be discussing the importance of vaccinating your children. And here with us to discuss is Dr. Ben Flannery, a pediatrician at the Northfield Clinic of Northfield Hospital and Clinics. Pleasure to have you here Dr. Flannery. So, let’s start with the basics. Why should children get vaccines in the first place?

Ben Flannery, MD, FAAP (Guest): Yeah, thank you for having me. So, children should really get vaccines in order to protect them from possibly life-threatening illnesses. And that’s one of the reasons that we choose to vaccinate kids for so many different things because we are trying to protect them from getting these illnesses, which some can cause death and others can cause lifelong disability and so, there’s a lot of problems with these diseases and preventing them is the best way to not have to treat them.

Host: Yeah, that makes a lot of sense. I’m curious as to why we give so many vaccines at such an early age. Like can you give us an example of when children start getting vaccines and why getting them early is so important?

Dr. Flannery: Yeah, so, there is one immunization we will do in the newborn period and it is the hepatitis B vaccine. But the majority of our vaccines all start at two months of age for babies. And so, we start at that time because those are the kids – babies are the most vulnerable to these diseases and we have done studies to prove that it’s safe to start them at these ages. The entire CDC recommended schedule has been studied and found to be safe and so even though babies are small, and young; their immune systems are generally very healthy and can easily handle the vaccine administration and again, this is the time that they are most vulnerable. If a two-month-old were to contract something like haemophilus influenza type B and get meningitis, which is a spinal infection, they are much more likely to die than if an older kid were to get it. So, we try to vaccinate the ones that are most at risk and so, the first time we start it is at two months of age to try to protect those youngest that are most at risk.

Host: And is this something that parents need to generally be aware of and go to their doctor for or is this something that’s just done after a child is born, they are scheduled for an appointment for the vaccination? How does that work?

Dr. Flannery: Yeah, so, after babies are born, usually we like parents to have picked out a pediatric or family practice provider for them as a physician for them to see their child and be their primary doctor and assist the family in their growth and development and preventative medicine. And so, usually, once you meet with your child’s provider, then they kind of help set up these well-child visits where we will see children on a scheduled basis to make sure that they are growing well, they are developing well and then staying healthy and so usually, we start that at two months. And so, most parents once you have a baby in a hospital, if you don’t already have a pediatric provider picked out; usually the nursery can help you find that and give suggestions and then the clinic will help guide you once you get set up with an appointment in the clinic on when to follow up. And then at those visits, for instance at the two-month visit, we will talk about all the immunizations and go through why we get them and what they are and some of the common side effects and things like that.

Host: I’m glad you touched on that. So, let’s get into the specifics a little bit. You talked about the immunizations and I’m just curious about what are the vaccines that are given during let’s say the first year of a child’s life?

Dr. Flannery: Okay, so the vaccines that are given at the two-month visit, the first big series of vaccines that you get are the same ones that are generally given at the four-month visit when they are seen next as well as the next visit after that which is the six-month visit. So, those are three visits where we will give a series of the same shots. Those shots include – they are all in different kinds of formulations depending on the clinic that you are at, the state you are in, depending sometimes even on your insurance of what formulation it is whether it’s from one pharmaceutical company or another.

But generally, what we want to give is the hepatitis B vaccine which is a liver infection that once you get it, you generally have it for your lifetime and there is no cure for it and it often leads to liver failure, the hepatitis B disease. So, we give three hepatitis B shots in that series which protects you for life. The next one we give is a vaccine called Prevnar and it protects against a bacteria called pneumococcus. And pneumococcus is the most common cause of pneumonia and blood infection in infants and children. Most kids that are admitted for severe pneumonia often in an ICU setting very often those kids are found to have a pneumococcus bacteria present in their lungs. So, we give a series of those three and then that again is repeated after a year of age as your fourth and last one which then helps protect you for life from several strains of the pneumococcus bacteria.

The third immunization we give in that series of three is polio which polio has been eradicated in the Americas, but it is still present in many third world countries around the world and those are always just a flight away from being in the United States. So, we still vaccinate for polio even though luckily, we have not had any reported cases that have started in the United States.

The next disease that we protect from is one called haemophilus influenza type B. haemophilus influenza is a family of bacteria that very often cause meningitis which is a spinal infection. Haemophilus influenza type B back twenty years ago, before we had the vaccine would sicken thousands of kids every year, many of them with meningitis and it probably would kill over 1000 kids a year from meningitis. So, we protect against that one which is really important.

The next one is a group of three diseases that all come in the same immunization regardless of what combination vaccine you use. And these are the diphtheria, tetanus and pertussis. Diphtheria is an infection often in the throat where it can close your throat. Tetanus is a disease that the bacteria is able to enclose itself in almost like a cocoon and sit in the soil for years and resist heat and cold. And so that’s why we worry about getting an infected would or getting scratched by a dirty nail, we worry that there are some of those tetanus toxins that are on that dirty nail from being in the soil and being around and then once you get tetanus it can infect your wound and it usually causes severe nerve damage that’s irreparable. And the last one in that is called pertussis which is also known as whopping cough. Whooping cough is also known as the hundred-day cough and essentially even if you treat whooping cough you often will cough for several more weeks or months possibly. And pertussis, the other big concern is that in babies, especially less than six months; when they often get pertussis, it doesn’t really cause coughing it actually just shuts off the breathing center in the brain. And so, they often will just stop breathing for periods of time which is very serious and can be life-threatening.

So, those are kind of the string of the immunizations that are given as injected into the body. Then there is one other one that’s orally given against a virus called rotavirus. This oral vaccine tastes essentially like sugar and sweet and usually goes down pretty well. And rotavirus is a virus that causes severe diarrhea and vomiting. In the United States generally it hospitalizes thousands of infants a year but in the developing world, it does kill several kids due to dehydration. And so, it helps protect against that virus which usually is an outbreak at a daycare or a school.

And so those are the series that you get under the first year. And then after a year, at twelve months, is when we start three new vaccines including the measles, mumps, rubella, the chickenpox and then hepatitis A. Hepatitis A is an acute liver infection in the same family as hepatitis B, but it is usually acute and you do get over it, but you can have liver failure. The chickenpox is a viral infection that causes the very typical chickenpox oozing rash, but can make kids very sick with high fevers, can cause even brain infection and pneumonia and hospitalization.

And then the measles, mumps, rubella. Measles is a viral infection with a very typical red rash. It usually starts with a cough and a runny nose but can progress to incredibly high fevers, and worldwide we still are having kind of sporadic outbreaks of measles including one of the largest ones in the United States was here in Minnesota where I work. But it is one of the leading causes of death among young children globally still in developing countries. I think years ago, it was 150-200,000 kids die every year of measles still. So, we protect against that.

Mumps is an infection that starts in the salivary glands. It’s another viral infection but actually can make men sterile because it can affect the testicles. And then rubella is another type of virus that’s also called German measles. It’s kind of a milder version of measles, but rubella has been found to cause problems in a growing fetus that are very serious. So, if moms were to get infected with that or have that, it can cause a lot of birth defects and so, that’s why that shot is always given together.

So, those are roughly the shots that we give in a year.

Host: That’s quite a comprehensive answer. It just seems like there are so many different vaccines and I think one important thing to takeaway is something you said earlier that at a young age; especially within a couple of months, children are very susceptible to a lot of these things because their immune system has not fully developed. So, I still know with everything that you just said and all of the different vaccines; there are still people who are hesitant to get their children vaccinated. Some people argue that there could be a link between vaccines and autism. So, maybe speak a little bit about that and maybe alleviating some of these concerns.

Dr. Flannery: Sure. So, yeah, I mean an infectious disease physician at Northwestern in Chicago kind of had stated one time, kind of why vaccines are questioned so often, and this is Dr. Shulman, Stanford Shulman at Northwestern in Chicago and he said most controversies are because when vaccines are successful, nothing happens. As this occurs more and more, the public eventually has little or no memory of the morbidity or mortality that was caused by the serious diseases like smallpox, measles, chickenpox and other vaccine preventable diseases. So, essentially, when vaccines work; we forget about what life was like before them. Back in the 1930s and 40s, there would be polio outbreaks where the whole city would be almost quarantined, and thousands of people would become handicapped and debilitated from polio or even die. And so there was time where there was a Chicago outbreak of polio and everybody drove around Chicago. And so, we kind of forget because vaccines have been so successful; we forget the dangers of these diseases and so, the vaccines because they are so successful are victim of that success because people then forget how scary these things can be.

I think Dr. Paul Offit at the Pediatric Infectious Disease at Children’s Hospital in Philadelphia also said it can be argued that the intervention of vaccines has saved more lives over the course of the human history than every other medical intervention combined. And that’s kind of a bold statement; but you can see on these charts when we vaccinate the number of these diseases that occur drops dramatically. And so, that’s why more vaccines that can be created to save children’s lives is something that pediatricians and researchers are always pushing to find.

It seems like it’s a lot. And every year we- especially compared to even when I was a child, there’s a lot more vaccines and that’s just because as we create more, and we find out from studies that they are safe; we want to get children protected as soon as possible. It is a lot of pokes. That is one thing that I tell parents that you can’t takeaway very easily the pain of a poke and so if we could put all the immunizations in one shot or give it in different way that didn’t have to poke them; we would love to. But, that’s very difficult to do safely and effectively. So, often at the two-month visit, the combination of immunizations that you get are often three shots and then the oral rotavirus one. So, that’s three pokes usually two shots in one thigh and one in the other is generally the recommended schedule.

Host: I really like the answer that you gave, and I love that you’ve also said the biggest thing right now or the biggest concern is the number of pokes that children have to get. But you know what, that is nothing in comparison to contracting one of these diseases. For more information please visit www.northfieldhospital.org/pediatrics. My guest today has been Dr. Ben Flannery. I’m Prakash Chandran. Thank you so much for listening.