Some topics, such as religion and politics, are sure to spark passionate conversation. In the world of childcare, topics might include head lice, toilet training, and of course, immunization! While few things in childcare are universal, one item that is addressed in every state’s regulations is immunization requirement.

Parents today are sometimes surprised by the number and complexity of early childhood vaccine requirements, and they are naturally concerned about the impact on their child. Add to that controversy over vaccine safety and the pandemic situations like the H1N1 influenza virus, and it seems everyone is ready to talk and share an opinion.

Vaccines are the greatest single public health achievement in history, saving millions of lives and nearly wiping out some diseases. As a childcare provider, you may need to help families with questions about immunizations, and those questions may cover everything from why immunizations are important, how many vaccines children need and the time frame (the “schedule”), and current topics that appear in the news, such as seasonal influenza.

Immunizations Prevent Serious Diseases

One reason families may resist immunization is the fear that several immunizations at one time may “overwhelm” a child’s immune system. In reality, any set of immunizations addresses very few of the thousands of germs that bombard a child’s body on any given day.

Vaccines are studied and tested intensely for safety before they are made available. Creating immunity against serious communicable illnesses is safe and actually improves children’s wellness.

Immunization has dramatically reduced illness and death rates among children, both in the U.S. and around the world. Because many staff and parents today have not experienced nor seen the devastating effects of those illnesses that vaccines prevent, they find themselves wondering if those germs still exist. It only takes a widespread case of measles spreading among children who are not vaccinated to show how well these immunizations reduce illness.

Current vaccines are made utilizing modern techniques that will stimulate immunity but cause the least amount of distress and fewest side effects. An example of an improved vaccine is the DTaP vaccine, which stimulates an immune response against diphtheria, tetanus, and pertussis. This new vaccine has fewer side effects and less pain for children.

In 1996, it was reformulated to contain no whole cell pertussis bacteria; since then, both mild and severe side effects have been greatly reduced. Also, even though the preservative thimerosal has not been shown to cause harm, it was removed from nearly every vaccine used to immunize children due to parent and provider concerns.

Recommended Immunizations

The Centers for Disease Control and Prevention (CDC) is the best source of information regarding recommended immunizations by age. The CDC works closely with medical groups to publish a complete schedule of vaccine recommendations at least annually if not twice each year.

In addition, many states have a list of mandated immunizations that are required for children attending childcare or school. These state requirements are generally established through legislation, sometimes years after a vaccine is recommended by medical groups, and may differ from the CDC’s recommendations.

Additionally, most mandated immunizations have a preferred time frame for administration, and a minimum amount of time that must pass between doses. Children in childcare settings are sometimes behind in their immunization schedules and childcare programs should support families in getting each child up-to-date.

Children today typically receive over 20 injections, based on the CDC schedule, before the age of two. These shots help prevent diseases, many of which can be life threatening.

The development of safe “combination” vaccines have made the vaccination process a bit easier because it means fewer doses to receive. Newer combination vaccines include Pediarix (diphtheria, tetanus, pertussis, hepatitis B virus, polio) and COMVAX (Haemophilus influenzae type b (Hib) and hepatitis B). Some vaccines can now be delivered intranasally (through the nose), which can be easier for patients afraid of needles.

The following vaccines are typically given between 2 months-6 years of age:

• DtaP (diphtheria, tetanus, and acellular pertussis) is given as a series of five shots.
• Polio requires a series of four shots.
• MMR (measles, mumps, and rubella) requires two doses.
• Hepatitis B requires a series of three shots.
• Hib vaccine (Haemophilus influenzae type b) may vary in number of doses, but typically requires 4 doses.
• Pneumococcal vaccine (PCV) is a series of four doses.
• Influenza (flu) vaccine is recommended each year because the vaccine changes yearly based on that year’s virus. Children 6 months-9 years of age receiving the influenza vaccine for the first time, receive series of two shots, separated by one month. Children who have already been properly vaccinated with influenza vaccine, or who are over 9 years of age, receive one shot. There is also a nasal mist version of this vaccine.
• Varicella (chickenpox) requires two doses of vaccine.
• Rotavirus vaccine is given by mouth; either two or three doses are given, depending upon the vaccine brand.

The H1N1 influenza vaccine targets the “new” flu bug that has caused illness and death worldwide and poses a serious threat to young children and adults. The CDC at first established “priority populations” given low vaccine supply and the need to protect the most vulnerable people first.

Those priority groups included, among others, caregivers and other household contacts of children under 6 months of age, as well as children aged 6 months-18 years. Once vaccine production was sufficient, the immunization was available to everyone. In the future, there may be other viruses such as H1N1 that require immunizations that are additional to the standard immunizations recommended for young children.

Helping families to track their children’s immunization process is a critical and visible way that childcare providers can make a vital difference in children’s lives. It is important to understand and communicate that vaccines are safe; to have a basic understanding of the number and type of diseases that today’s vaccines prevent; and to keep up with the headlines, for instance regarding seasonal or pandemic flu, so you can advise families and better understand what they are dealing with.

By Janie Sailors, RN, BSN, NCSN
Health Specialist TTAS, WKU Orlando, FL

Internet Resources

Childhood Immunization Schedule, Centers for Disease Control & Prevention, www.cdc.gov/vaccines/recs/schedules/child-schedule.htm

Immunization Schedule and Facts, American Academy of Pediatrics, www.aap.org/immunization

Kid’s Health, kidshealth.org/parent/infections/immunizations/vaccine.html