Nolan Alexander (Host): This is UAMS Health Talk. I'm Nolan Alexander, here with Dr. Robert Hopkins, Professor of Internal Medicine and pediatrics at the University of Arkansas for Medical Sciences. And he's the Medical Director for the National Foundation for Infectious Diseases.

Today, let's learn more about the ABCs of common vaccinations and what families need to know heading into the new school year. Dr. Hopkins, how are you today?

Robert Hopkins, MD: I'm doing great, Nolan. Glad to be on with you.

Host: It's certainly our pleasure. So, let's get to it. Which vaccinations are most commonly recommended for children and teens at the start of the school year, and how do those differ from age groups? So for instance, from preschool to elementary all the way up through college.

Robert Hopkins, MD: We start off with routine vaccinations in our small children actually starting at birth. We have a couple of vaccines that we recommend before babies leave the newborn nursery. One is a vaccination for a virus called hepatitis B. That's the first in a series of vaccines to protect babies against that virus, that if you acquire it at any age, it can cause severe liver disease. But particularly if babies get it, it can be a real problem and can cause early liver disease leading even to liver cancer. And in babies that are born during the wintertime, we also recommend a vaccine against a virus called RSV. RSV is a virus that causes pneumonia and severe lung disease in infants.

And then, starting at two months of age, we have a big series of vaccines that we do. We protect against diphtheria, against whooping cough, against tetanus, against polio. We protect our children against a virus that causes severe diarrhea called rotavirus, a bacteria called pneumococcus, a bacteria called Haemophilus influenza type B. Now, that's a mouthful for you.

We also protect our children against measles, mumps, rubella, and chickenpox. So, lots of vaccines. The good thing for parents to know is many of those vaccines are in combinations. So, it doesn't mean a separate injection for each of them, and they're all safe. They're very effective for our children. We've been using them for years and years. My kids all got them. So, I want all of my patients and their family to have those same levels of protection.

Host: You spoke a good bit about vaccines for the youth, right? For those that are just born, two years old, toddlers, beyond the infant stage, up through preschool. Anything else here as we get set for school related to elementary school students onto middle school, high school, and then college?

Robert Hopkins, MD: For our kids that are going into school, depending on where you live you know, in Arkansas we have set vaccine requirements. You should have a set number of booster shots for your kids to be up to date. There's a little different recommendation for daycare than there is for school because our kids don't need quite as many doses.

For college, particularly important for folks to be protected against measles, mumps, and rubella because there are some or some young adults that didn't get those vaccines as children. And we don't often think about our winter respiratory viruses at the beginning of school, but it's coming up very soon, thinking about flu vaccination, COVID vaccination and RSV if you're not already protected.

Host: What are the current CDC and WHO guideline updates for this year regarding back-to-school vaccines? And have there been any notable changes from the previous years?

Robert Hopkins, MD: Well, as many may know, there have been some ups and downs and challenges with the current CDC recommendations. The advisory committee had some changes that were made that were, shall we say, less than ideal. But a lot of our medical specialty societies, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, the American College of Obstetrics and Gynecology, have stepped in and are giving us good updated evidence-based recommendations.

No big changes for this year other than we've seen a decline in immunization rates for our children starting school. So, it's really important for us to get those vaccination rates back up, because along with that decline in vaccination rates, we've also seen an increase in measles and in whooping cough. We don't want to see that affecting our families.

Host: So Doctor, I'm not trying to take us down a wormhole here. But as a parent, I'm looking to understand, you listed a lot of groups, and then we're probably more so familiar with the CDC acronym. So how do those groups communicate and work together?

Robert Hopkins, MD: They're all collaborating very closely with an organization called the Vaccine Integrity Project. They're helping serve the role, they and the American Medical Association, kind of, shall we say, herding all the cats together. So while assuring that we're coordinating our responses, we're looking at the same set of evidence, and we're making sure that our recommendations are developed the same.

If I look at the schedule for the American Academy of Pediatrics and that for the American Academy of Family Physicians for Children, the schedules are exactly the same. They look a little different just because of the way they're produced for those different organizations, but they've got the same content.

Host: How do routine school entry vaccines, like some of the ones you mentioned, MMR, DTaP, Tdap, polio, varicella, how do those work in the body to provide long-term protection? And why are the booster doses that you also touched on necessary?

Robert Hopkins, MD: What the vaccines do is you introduce a product that your body recognizes as foreign, "This is not part of me." Your body builds antibodies. They build an immune response so that, when it sees that product again, it responds very rapidly and can stop you developing an infection that you would get if you hadn't had that immune protection.

The reason we have to give booster doses of vaccines are that sometimes takes a number of doses, a number of exposures for the body to recognize that foreign product and to be able to maintain immunity for a long period of time. For a vaccine like measles, mumps, and rubella vaccine or chickenpox vaccine, two doses is enough to give you lifelong immunity after those two doses of vaccine.

For other vaccines, they aren't quite as potent. So for the diphtheria, tetanus, acellular pertussis or DTaP vaccine, we need more doses, and we need to give another type of vaccine called Tdap in adulthood to maintain immunity going forward. So, different vaccines have different levels of potency for providing long-term immunity, and booster doses are there to help stimulate that immunity so that you maintain that protection.

Host: Again, with families coming back to school at this time of year, how safe are the common back-to-school vaccines? And what are the most frequent side effects? And which warning signs should prompt parents to seek medical evaluation?

Robert Hopkins, MD: All our vaccines that we use for routine schedules in children are very safe. They've been tested in thorough clinical trials. We've been monitoring the safety of those vaccines going forward as we continue to use them. The vaccines that we use are commonly going to cause a sore arm, kind of makes sense. You inject a vaccine into the muscle, you've stuck a needle in the arm. That's going to be a little sore. So, sore arm, sometimes you'll get a little bit of fever, sometimes achiness, sometimes a little redness around that injection site. And even sometimes people will have a little headache or even a little low-grade fever. Those are not uncommon at all.

Now, if somebody after a vaccination, has a very high-grade fever, so 102, 103 degrees, or they're really feeling terrible, or if they feel short of breath, or other symptoms that are really out of the ordinary, contact your healthcare professional right away. None of those are common, but those are things to pay attention to.

Host: What guidance should general practitioners give on the influenza vaccination timing for the school year, including whether an early vaccination like late summer versus later in the fall matters?

Robert Hopkins, MD: The influenza vaccination's recommended for everybody six months of age and older. And in our young children, particularly those that have not gotten flu vaccine before, getting that vaccine early, even right now, late August, early September is fine because young children need two doses of influenza vaccine the first year that they're vaccinated, separated by about a month. After that first prime to the pump, so to speak, you only need one dose of influenza vaccine a year. For children, there's nothing wrong with giving the vaccine earlier in the season because they're going to maintain that immunity for a longer period of time than folks who get a little gray hair like I do, or folks who've got chronic health conditions.

In people like me, older adults and those who've got chronic health conditions, we generally wait on that flu vaccine till September or October. It's more important to get vaccinated early than it would be to not get vaccinated.

Host: Along a similar lines, how has the COVID-19 vaccination guidance for school-aged children evolved over the past few years? And what's the latest when it comes to evidence on its safety, its effectiveness, and the need for updated doses?

Robert Hopkins, MD: So, COVID-19 vaccine is available for anybody six months of age and older who wants to be vaccinated. The people that are at highest risk of COVID-19 infections include our older adults and our youngest children. Children six months to two years of age are the second most likely group to be hospitalized or to have severe outcomes, only secondary to our older adults.

And so, it's recommended that everybody 65 and older get a COVID-19 vaccine every year. All of our children six months of age through two years of age should get a COVID vaccine every year. Now, children that have not previously received COVID vaccine do need two doses. Older adults can get more than one dose, and people who've got a weakened immune system, like somebody who may have had a kidney transplant or have cancer on chemotherapy, may need more than one dose a year, and they need to talk with their healthcare professional about that.

But anybody six months of age and older can get that COVID vaccine if they want it. I've gotten mine multiple times. I'm going to get mine here shortly this fall when the new vaccine's available. I would encourage others to do the same.

Host: Dr. Hopkins, can you explain the role of meningococcal vaccines for teenagers and college students and why first-year students living in dorms are considered a higher-risk group?

Robert Hopkins, MD: So, meningococcal vaccine is a vaccine that protects us against a bacteria that can cause severe infections like meningitis, bloodstream infections, or what we call sepsis. Sepsis means the body basically having a drop in blood pressure collapse in ability to take care of their necessary bodily functions that can happen with an overwhelming infection.

Meningococcal infections are very uncommon, but the highest risk groups are adolescents and young adults. And so, that's the reason we recommend meningococcal vaccination in preteens and teenagers. They also can easily be transmitted in people who've got close household contact. So, young adults that are going to be living in a dormitory in a college, that's a high-risk situation. Young adults that may be enrolling in the military, living in a barracks, that's another high-risk situation. And so in those situations, we want to make sure that we protect those people. It's not common for them to get those meningococcal infections, but we don't want you to have a devastating infection that may result in severe outcomes that it could affect you for the rest of your life.

Host: Thank you, Doctor. And just one more question. How should clinicians counsel vaccine-hesitant families about back-to-school immunizations, including addressing myths about fertility, autism, immune overload, or too many shots at once?

Robert Hopkins, MD: Well, unfortunately, there's a lot of information out there for people to sort through. And there's a lot of bad information, unfortunately, out there also. The vaccines that we use for children and adults in this country today, when they're used as they're recommended, are safe and highly effective.

Parents, patients come to me all the time with questions. The most important thing for me to do is to see that they have questions, to answer those questions thoughtfully, and to tell them the truth. There is misinformation out there. The vaccines do not contain cells from aborted babies. These vaccines do not contain chips. These vaccines do not have any common adverse events other than potentially that sore arm or the redness or maybe have a little achiness after a vaccine. We wouldn't be using these vaccines, which are tested more thoroughly than essentially every other product that we can prescribe, every other medication.

They're tested far better than the supplements or the vitamins that you get on the shelf in the pharmacy or the grocery store. So, these vaccines are safe. We wouldn't recommend them if they weren't important to protect our children and our other family members.

Host: Dr. Hopkins, this has been so helpful today. Thank you so much for your time and insight with us.

Robert Hopkins, MD: It's been my absolute pleasure, Nolan.

Host: That was Dr. Robert Hopkins from the University of Arkansas for Medical Sciences. For more information, visit uams.edu. And this is UAMS Health Talk. Thanks for listening.