Selected Podcast
What Every Parent Should Know About Pediatric Immunizations
Some parents have concerns about the safety of vaccines. Dr. René Bravo addresses the importance of pediatric immunizations and concerns about them.
Featuring:
Rene’ Bravo, MD
Rene’ Bravo, MD was born in South Florida and raised in Southern California. He grew up in Bell, California and attended Point Loma Nazarene University. Dr. Bravoattended medical school at UC San Francisco and completed hisinternship and residency in general pediatrics at Stanford University Medical Center. In 1986, he decided to start his own practice in SLO county right out of residency. At that time,he hadtwosmall sons. His familygrew to fivesons, and now includes twodaughters in law. Healso hasfourgrandkids, with more in the future. He has been married for almost 38 years. He enjoys being a grandparent. Transcription:
Prakash Chandran (Host): This program is community service and is not intended to be a substitute for medical advice. Listeners having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the programs are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.
Watching your child get a shot isn’t easy, and it’s even harder when you have concerns about the safety of the vaccine. Millions of parents immunize their children each year without concern. Yet some parents have heard rumors that vaccines can cause serious health problems. So how can parents actually get the facts about which vaccines are safe. Here with us to discuss is Dr. Rene Bravo, a pediatrician at Sierra Vista Regional Medical Center. Dr. Bravo, thanks so much for being here today.
Rene’ Bravo, MD (Guest): Oh, it’s very nice to be here.
Host: So I wanted to start off by asking what types of vaccines are currently recommended for children.
Dr. Bravo: In the United States, the standards are pretty uniform. We require vaccines against whooping cough, polio, hepatitis B, tetanus, meningitis, measles, mumps, rubella, hepatitis A, and the rotavirus as well as chicken box.
Host: Mkay. It’s interesting that you mentioned things like the polio and the mumps. I've heard from my friends who are new parents that these diseases are pretty rare. So I'm kind of curious as to why vaccines are still needed for them.
Dr. Bravo: Well in order to keep them from reoccurring, a population needs to be protected against them. These diseases, occasionally they’ll rear their heads. You want to be able to have a population that does not allow these diseases to go through it. So that’s why the whole theory of vaccination exists. It exists to protect a large group of people from a disease which can cause significant harm to them or death.
Host: Yeah, that makes a lot of sense. So kind of going into what I mentioned at the top of the episode. I know a lot of parents are hesitant to give their children vaccines for a number of different reasons. So maybe you can maybe help dispel some myths that we hear often about vaccines and talk to us a little bit about if vaccines are safe.
Dr. Bravo: Absolutely. I can say this unequivocally: vaccines are safe. They work, and they prevent significant disease. It’s probably, I would consider vaccinations one of the great advances of modern history. A century ago, child mortality was very high because of many of the diseases that we vaccinate against now. But I've seen a disturbing trend over the last 20 years or so where there’s increasing amounts of misinformation and fear that are evolving against vaccines. But vaccinations are probably one of the safest things that we can do to keep our children healthy.
I would tell you that the second part of this is the absence of vaccines in a population can really lead to resurgences of diseases that we’re seeing again: whooping cough, measles for example. These things were almost eradicated 20 years ago, and now we’re seeing these things come back. That’s because, in my opinion, there’s a lot of disinformation out there about vaccines. Let me talk about whether they're safe or not because that’s become the biggest issue.
Host: Yeah, please do.
Dr. Bravo: There’s nothing that’s completely safe in our culture, in society. But vaccines, we accept vaccinations because for the benefit gotten, the risk is minimal. We are able to quantitate that.
Host: Yeah. It’s really interesting that you talk about some of these things are almost completely eradicated. But then you have a few people that hear that disinformation that you're talking about and decide not to do it. You mentioned something about vaccines are the best way to keep our children protected, but it’s also the best way to keep the children around us protected, right. I know in doing some research for this--
Dr. Bravo: Correct, absolutely.
Host: There’s this herd immunity, right?
Dr. Bravo: Yes. You hit right on an important point. There will be children in the population that are not able to receive vaccines because their immune systems may be compromised or they're unable to get them for other medical indications. And, they are protected by the children and the people around them who are already immune to these diseases. That’s why, another very important. Not only is it a good, personal thing to do for your child, but it is a good, societal thing to do for the population of children around you who can't get vaccines.
Host: Okay, yeah. I think that is really good advice. It kind of goes into detail as to why it is so important to get your children vaccinated. I want to talk a little bit about the disinformation that some parents hear. I've heard some parents say that there's a link between vaccines and Sudden Infant Death Syndrome, or SIDS. Can you talk a little bit about that?
Dr. Bravo: Yes. I mean there really hasn’t been anything that’s been definitive that’s shown that there's a causal relationship between that or, for example, autism. Yet, even when things like this are scientifically evaluated and talked about and looked at and researched, it seems that with the advent of social media and the cyber information world, often times misinformation is out there a lot longer than it needs to be. I would tell you this. I mean the greatest example we have is the MMR. People were for years fearing measles, mumps, rubella vaccine saying that it was causing autism, et cetera. I mean hundreds of millions of dollars were spent to evaluate that, and they found no, again, that it was absolute there was no causality between the MMR vaccine and autism. Yet that still persists out there. In fact, I just saw a study recently which showed that the rate of autism is the same in unvaccinated as it is in vaccinated children. So we need to do a better job of getting this information out to help parents make good decisions for their children.
Host: Yeah. I think that’s the tough things about the internet and social media is that things do live on. I was doing some research and I saw that that study had been disproven, but wow has it persisted. It’s one of these things when if you're searching for what are the problems for vaccines, then those things are going to come up. It really perpetuates this disinformation that you're talking about.
Dr. Bravo: Yeah. I deal with this on a daily basis. I have parents that come into my office. They say, “Doc. Tell me about the vaccines. I'm really worried about getting them for my child.” And I do. I tell them just frankly what 35 years of doing this on a daily basis has taught me. I mean you can react to vaccines. I don’t want to sugar coat that. Anything you put into the human body can cause a reaction. But a severe reaction that would be damaging to a human being, we know that there’s about 1 in 900,000 kids that really will react to it, but we’re willing to accept that risk because the benefit is far greater.
I tell parents too that your doctor when you vaccinate your child will take it very seriously. One of the thought processes that pediatricians go through when they're examining babies in their well checkups is, they ask themselves the question is this child going to be okay to get his or her vaccines? So we take it really seriously. That’s why when we give these vaccines, we are not glib or dismissive of the questions. But we also realize that we feel, and I can speak for all the pediatricians practically in this community, we feel that we’re doing a lot of good to help prevent illness from these children in the future.
Host: Yeah, you certainly are. So I actually want to talk a little bit about the vaccine plan, or the number of vaccines you should get after a child is born. Because my wife and I are actually expecting our first in July, which is awesome.
Dr. Bravo: Congratulations.
Host: Thank you. Thank you. I do think about this though. What vaccines should I get started with? When should I have them administered? Who should administer them? So maybe talk a little bit about that.
Dr. Bravo: Yes. Currently, we start vaccinating children at birth actually. You'll be offered the hepatitis B vaccine in the hospital. Then in the United States, from six to eight weeks is when the first set of vaccines is given. Usually it’s three injections followed by an oral liquid: the dTap, polio, hepatitis B, and then the Hb, the Prevnar, and the rotavirus. Now, it sounds like a lot, but it really isn’t. Because in each vaccine is a small protein, an antigen they call it, that’s designed to stimulate the immune system to provide protection. A lot of people say, “Well, gosh. That’s a lot.” The reality is the human body is dealing with thousands of these types of proteins every day. The immune system is always dealing with this. So these small antigens that are put in there are just a small minority of everything else that your infant is facing in terms of vaccination.
The vaccinations then are given at two months, four months, and six months. At nine months, there’s a little fudge in there. You can do one, but usually it moves on to a year, 15, and 18 months. By 18 months, you should be completely vaccinated. There’re different ones. Every time that you interact with your pediatrician, you should ask about what vaccines they're getting and what potential reactions you can expect. Because sometimes children will develop low grade fevers or muscle aches or redness where the injection goes in. These things are fairly expected frankly. So I don’t want my patients to be surprised by any of this.
Host: Yeah. It’s really good that you mentioned that because I was just going to ask you about the side effects. It sounds like it’s completely normal, but in the long run it’s going to really help them avoid something more serious. I want to ask a little bit more on the whole vaccine schedule. Is that something that your pediatrician will just schedule out for you? Do you have to be proactive about it?
Dr. Bravo: Well, most of the time it’s scheduled out for you. I mean we follow the American Academy of Pediatrics schedule. Sometimes parents will want to tweak it a little bit based on—And I'm open to talking about that. But we really advise that you follow the schedule because it’s designed to give shots at an interval that most benefits the baby and helps the baby’s immune system deal with it very well.
Host: What is the best way to keep track of your child’s vaccine history? Is there like an online form with the doctor? Or is there an app that you recommend? What would you say about that?
Dr. Bravo: That’s a great question. Back in the day when you were small, we used to give out a yellow vaccine card, but the state of California has decided to go all paperless. So now there’s a state registry called a CAIR—California Immunization Registry. Most pediatricians’ offices log into that. So parents can download it themselves even from their home. Or you can request a vaccine record be given to you at each visit, which a lot of doctor’s offices will do. So it’s fairly easy to keep a track of that.
Host: Yeah. That’s fantastic that it’s all paperless, it’s all in one place, and it’s all documented for you to know. You know Dr. Bravo, I really appreciate you educating us on these vaccines, these pediatric vaccines today. Is there anything else you’d like to share with our audience before we wrap up?
Dr. Bravo: Yes. Please feel free, and it’s very important that you're comfortable in making the decision about vaccines with your pediatrician or healthcare provider. Talk to them, come prepared, ask questions. They welcome your questions because we understand, and we advocate very strongly for things that help our children. Vaccines are a very important part of keeping our children healthy.
Host: Well, I really appreciate your time. This has been a very comforting conversation for me, especially as I'm expecting. So thank you, again. For everyone else, for referral to a board certified physician, please call the Sierra Vista Regional Medical Center and Twin Cities Community Hospital physician referral line at 866-966-3680. My guest today has been Dr. Rene Bravo. I'm Prakash Chandran and thank you so much for listening.
Prakash Chandran (Host): This program is community service and is not intended to be a substitute for medical advice. Listeners having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the programs are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.
Watching your child get a shot isn’t easy, and it’s even harder when you have concerns about the safety of the vaccine. Millions of parents immunize their children each year without concern. Yet some parents have heard rumors that vaccines can cause serious health problems. So how can parents actually get the facts about which vaccines are safe. Here with us to discuss is Dr. Rene Bravo, a pediatrician at Sierra Vista Regional Medical Center. Dr. Bravo, thanks so much for being here today.
Rene’ Bravo, MD (Guest): Oh, it’s very nice to be here.
Host: So I wanted to start off by asking what types of vaccines are currently recommended for children.
Dr. Bravo: In the United States, the standards are pretty uniform. We require vaccines against whooping cough, polio, hepatitis B, tetanus, meningitis, measles, mumps, rubella, hepatitis A, and the rotavirus as well as chicken box.
Host: Mkay. It’s interesting that you mentioned things like the polio and the mumps. I've heard from my friends who are new parents that these diseases are pretty rare. So I'm kind of curious as to why vaccines are still needed for them.
Dr. Bravo: Well in order to keep them from reoccurring, a population needs to be protected against them. These diseases, occasionally they’ll rear their heads. You want to be able to have a population that does not allow these diseases to go through it. So that’s why the whole theory of vaccination exists. It exists to protect a large group of people from a disease which can cause significant harm to them or death.
Host: Yeah, that makes a lot of sense. So kind of going into what I mentioned at the top of the episode. I know a lot of parents are hesitant to give their children vaccines for a number of different reasons. So maybe you can maybe help dispel some myths that we hear often about vaccines and talk to us a little bit about if vaccines are safe.
Dr. Bravo: Absolutely. I can say this unequivocally: vaccines are safe. They work, and they prevent significant disease. It’s probably, I would consider vaccinations one of the great advances of modern history. A century ago, child mortality was very high because of many of the diseases that we vaccinate against now. But I've seen a disturbing trend over the last 20 years or so where there’s increasing amounts of misinformation and fear that are evolving against vaccines. But vaccinations are probably one of the safest things that we can do to keep our children healthy.
I would tell you that the second part of this is the absence of vaccines in a population can really lead to resurgences of diseases that we’re seeing again: whooping cough, measles for example. These things were almost eradicated 20 years ago, and now we’re seeing these things come back. That’s because, in my opinion, there’s a lot of disinformation out there about vaccines. Let me talk about whether they're safe or not because that’s become the biggest issue.
Host: Yeah, please do.
Dr. Bravo: There’s nothing that’s completely safe in our culture, in society. But vaccines, we accept vaccinations because for the benefit gotten, the risk is minimal. We are able to quantitate that.
Host: Yeah. It’s really interesting that you talk about some of these things are almost completely eradicated. But then you have a few people that hear that disinformation that you're talking about and decide not to do it. You mentioned something about vaccines are the best way to keep our children protected, but it’s also the best way to keep the children around us protected, right. I know in doing some research for this--
Dr. Bravo: Correct, absolutely.
Host: There’s this herd immunity, right?
Dr. Bravo: Yes. You hit right on an important point. There will be children in the population that are not able to receive vaccines because their immune systems may be compromised or they're unable to get them for other medical indications. And, they are protected by the children and the people around them who are already immune to these diseases. That’s why, another very important. Not only is it a good, personal thing to do for your child, but it is a good, societal thing to do for the population of children around you who can't get vaccines.
Host: Okay, yeah. I think that is really good advice. It kind of goes into detail as to why it is so important to get your children vaccinated. I want to talk a little bit about the disinformation that some parents hear. I've heard some parents say that there's a link between vaccines and Sudden Infant Death Syndrome, or SIDS. Can you talk a little bit about that?
Dr. Bravo: Yes. I mean there really hasn’t been anything that’s been definitive that’s shown that there's a causal relationship between that or, for example, autism. Yet, even when things like this are scientifically evaluated and talked about and looked at and researched, it seems that with the advent of social media and the cyber information world, often times misinformation is out there a lot longer than it needs to be. I would tell you this. I mean the greatest example we have is the MMR. People were for years fearing measles, mumps, rubella vaccine saying that it was causing autism, et cetera. I mean hundreds of millions of dollars were spent to evaluate that, and they found no, again, that it was absolute there was no causality between the MMR vaccine and autism. Yet that still persists out there. In fact, I just saw a study recently which showed that the rate of autism is the same in unvaccinated as it is in vaccinated children. So we need to do a better job of getting this information out to help parents make good decisions for their children.
Host: Yeah. I think that’s the tough things about the internet and social media is that things do live on. I was doing some research and I saw that that study had been disproven, but wow has it persisted. It’s one of these things when if you're searching for what are the problems for vaccines, then those things are going to come up. It really perpetuates this disinformation that you're talking about.
Dr. Bravo: Yeah. I deal with this on a daily basis. I have parents that come into my office. They say, “Doc. Tell me about the vaccines. I'm really worried about getting them for my child.” And I do. I tell them just frankly what 35 years of doing this on a daily basis has taught me. I mean you can react to vaccines. I don’t want to sugar coat that. Anything you put into the human body can cause a reaction. But a severe reaction that would be damaging to a human being, we know that there’s about 1 in 900,000 kids that really will react to it, but we’re willing to accept that risk because the benefit is far greater.
I tell parents too that your doctor when you vaccinate your child will take it very seriously. One of the thought processes that pediatricians go through when they're examining babies in their well checkups is, they ask themselves the question is this child going to be okay to get his or her vaccines? So we take it really seriously. That’s why when we give these vaccines, we are not glib or dismissive of the questions. But we also realize that we feel, and I can speak for all the pediatricians practically in this community, we feel that we’re doing a lot of good to help prevent illness from these children in the future.
Host: Yeah, you certainly are. So I actually want to talk a little bit about the vaccine plan, or the number of vaccines you should get after a child is born. Because my wife and I are actually expecting our first in July, which is awesome.
Dr. Bravo: Congratulations.
Host: Thank you. Thank you. I do think about this though. What vaccines should I get started with? When should I have them administered? Who should administer them? So maybe talk a little bit about that.
Dr. Bravo: Yes. Currently, we start vaccinating children at birth actually. You'll be offered the hepatitis B vaccine in the hospital. Then in the United States, from six to eight weeks is when the first set of vaccines is given. Usually it’s three injections followed by an oral liquid: the dTap, polio, hepatitis B, and then the Hb, the Prevnar, and the rotavirus. Now, it sounds like a lot, but it really isn’t. Because in each vaccine is a small protein, an antigen they call it, that’s designed to stimulate the immune system to provide protection. A lot of people say, “Well, gosh. That’s a lot.” The reality is the human body is dealing with thousands of these types of proteins every day. The immune system is always dealing with this. So these small antigens that are put in there are just a small minority of everything else that your infant is facing in terms of vaccination.
The vaccinations then are given at two months, four months, and six months. At nine months, there’s a little fudge in there. You can do one, but usually it moves on to a year, 15, and 18 months. By 18 months, you should be completely vaccinated. There’re different ones. Every time that you interact with your pediatrician, you should ask about what vaccines they're getting and what potential reactions you can expect. Because sometimes children will develop low grade fevers or muscle aches or redness where the injection goes in. These things are fairly expected frankly. So I don’t want my patients to be surprised by any of this.
Host: Yeah. It’s really good that you mentioned that because I was just going to ask you about the side effects. It sounds like it’s completely normal, but in the long run it’s going to really help them avoid something more serious. I want to ask a little bit more on the whole vaccine schedule. Is that something that your pediatrician will just schedule out for you? Do you have to be proactive about it?
Dr. Bravo: Well, most of the time it’s scheduled out for you. I mean we follow the American Academy of Pediatrics schedule. Sometimes parents will want to tweak it a little bit based on—And I'm open to talking about that. But we really advise that you follow the schedule because it’s designed to give shots at an interval that most benefits the baby and helps the baby’s immune system deal with it very well.
Host: What is the best way to keep track of your child’s vaccine history? Is there like an online form with the doctor? Or is there an app that you recommend? What would you say about that?
Dr. Bravo: That’s a great question. Back in the day when you were small, we used to give out a yellow vaccine card, but the state of California has decided to go all paperless. So now there’s a state registry called a CAIR—California Immunization Registry. Most pediatricians’ offices log into that. So parents can download it themselves even from their home. Or you can request a vaccine record be given to you at each visit, which a lot of doctor’s offices will do. So it’s fairly easy to keep a track of that.
Host: Yeah. That’s fantastic that it’s all paperless, it’s all in one place, and it’s all documented for you to know. You know Dr. Bravo, I really appreciate you educating us on these vaccines, these pediatric vaccines today. Is there anything else you’d like to share with our audience before we wrap up?
Dr. Bravo: Yes. Please feel free, and it’s very important that you're comfortable in making the decision about vaccines with your pediatrician or healthcare provider. Talk to them, come prepared, ask questions. They welcome your questions because we understand, and we advocate very strongly for things that help our children. Vaccines are a very important part of keeping our children healthy.
Host: Well, I really appreciate your time. This has been a very comforting conversation for me, especially as I'm expecting. So thank you, again. For everyone else, for referral to a board certified physician, please call the Sierra Vista Regional Medical Center and Twin Cities Community Hospital physician referral line at 866-966-3680. My guest today has been Dr. Rene Bravo. I'm Prakash Chandran and thank you so much for listening.