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Hepatitis A Vaccine is Safe and Effective
Hepatits A is a virus transmitted by contaminated food and is a common
cause of inflammation of the liver (hepatitis). This illness may be associated
with fever, yellowing of the skin and eyes (jaundice), loss of appetite,
nausea, vomiting, and tiredness. In many parts of the world, hepatitis
A is so common that almost every adult has been infected at some point
in his or her life. A vaccine to protect against hepatitis A infection
was licensed in the United States by the Food and Drug Administration
in 1995 for individuals 212 years of age.
A recent study published in the Journal of the American Medical Association showed
that the hepatitis A vaccine was highly effective in preventing hepatitis
A outbreaks among a large group of children who received it. The study
also found the vaccine to be quite safe. Out of the nearly 30,000 children
who received the vaccine, no serious side effects were reported. Mild
adverse reactions were reported in a small percentage of cases, including
injection site reactions, fever, and rash.
Should your child be immunized? In the United States, there actually
are certain areas of the country with higher than average rates of hepatitis
A. Speak with your child's pediatrician because the hepatitis A vaccine
is currently recommended for:
- Children living in areas with consistently higher rates of hepatitis
A. This includes 11 states where the prevalence of hepatitis A is
greater than twice the national average: Alaska, Arizona, California,
Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah,
and Washington. (Routine vaccination can also be considered in six
states where the prevalence of the disease is less than double but
greater than the national average: Arkansas, Colorado, Texas, Missouri,
Montana, and Wyoming.)
- Children traveling to countries where the disease is highly prevalent.
This includes all countries other than Canada, Japan, Australia, New
Zealand, Scandinavia, and those in Western Europe.
- Children with chronic liver disease or blood-clotting disorders.
April 2002 Update
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Immunizations for 2002
Vaccinations against childhood illnesses are arguably one of the most
significant medical achievements of the twentieth century. One hundred
years ago, approximately half of all children born in the United States
died before the age of 5, many of them from diseases that today can be
prevented by vaccines. With proper immunization, the number of cases
of these diseases has been reduced dramatically.
Although no new vaccines have been added to the 2002 recommended childhood
immunization schedule, this year's schedule highlights vaccines for pre-adolescents
and "catch-up" vaccines for children who have fallen behind
the currently recommended schedule.
In addition, due to unusual national shortages of the pneumococcal and
diphtheria/tetanus/pertussis vaccines, the 2002 immunization schedule
also includes a link to information from the Centers for Disease Control
(CDC), which explains the necessary modifications to the recommended
schedule for these vaccines. These vaccine shortages will hopefully only
Please discuss your child's immunization history with the doctor to
insure that his or her immunizations are up to date in accordance with
the current 2002 Recommended Childhood Immunization Schedule, approved
annually by the CDC, the American Academy of Pediatrics, and the American
Academy of Family Physicians. For additional reliable and up-to-date
information about vaccines and their importance, visit the National Immunization
Program website at http://www.cdc.gov/nip or
the American Academy of Pediatrics website at http://www.aap.org/.
April 2002 Update
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Vaccine safety: no link between thimerosal
and neurodevelopmental disorders
Parents should feel confident and safe when having their children immunized.
No evidence exists that proves a link between thimerosal-containing vaccines
and neurodevelopemental disorders, such as autism, attention deficit-hyperactivity
disorder, or speech and language delay. The Institute of Medicine recently
reported these findings, consistent with the recommendations of the American
Academy of Pediatrics.
Thimerosal, a mercury-containing preservative, was used for many years
in vaccines to prevent contamination. Taking in a high dose of mercury
is toxic to the human nervous system. But because of the increasing number
of vaccines routinely recommended for infants, concern was raised in
1999 by the Food and Drug Administration that the total amount of mercury
contained in the vaccinations could be exceeding the recommended mercury
levels for infants.
Although there's no data to suggest thimerosal caused any harm, the American
Academy of Pediatrics and the U.S. Public Health Service have requested
manufacturers remove thimerosal from vaccines. As a result, most, if
not all, childhood vaccines are now thimerosal-free.
The Institute of Medicine's recommendations emphasized the importance
and continued safety of childhood vaccination. Parents should definitely
be reassured that all routine childhood immunizations are in their children's
best interests, as they clearly have been shown to prevent potentially
November 2001 Update
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Breast-Feeding May Protect Against Childhood Asthma
Another vote in favor of breast-feeding! Researchers in Western Australia
found that babies who are fed breast milk exclusively for their first
four months are less likely to develop asthma by age 6. Asthma is the
leading cause of hospital admissions for Australian youth. In the United
States, it affects about 17 million Americans and about a quarter of
all children under 18.
To determine whether there was a connection between asthma and breast-feeding,
the researchers compared questionnaires completed by parents when their
children were a year old with questionnaires completed when the children
were 6. The surveys asked about breathing problems, feeding (length and
exclusivity of breast-feeding), smoking in the home, and daycare (to
evaluate exposure to respiratory infections).
The age at which a child was fed soy or cow's milk was more positively
associated with asthma and wheezing. Introduction of milk other than
breast milk before four months was a significant risk factor for the
development of asthma by age 6. According to the Food and Drug Administration,
babies who are breast-fed have lower rates of hospital admissions, ear
infections, diarrhea, rashes, allergies, and other medical problems than
bottle-fed babies. Because human milk contains cells that kill bacteria,
fungi, and viruses, breast-fed babies are protected from a number of
illnesses. To learn more about breast-feeding, see page 951 of the Family
Health Guide. If you are unable to breast-feed, see page 505 for more
information about other ways to prevent childhood asthma. Controllable
risk factors include the presence of house dust and tobacco smoke.
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New Pneumococcal Vaccine for Children Less Than
Two Years Old
A new vaccine called Prevnar is the first vaccine to protect children
less than two years old against the bacteria Streptococcus pneumoniae,
which is the leading cause of pneumonia, bacterial meningitis, bacteremia,
sinusitis, and acute otitis media, or middle-ear infections, in young
children. In addition to protecting children from pneumococcal infection,
vaccination with Prevnar also decreases transmission of pneumococci from
one child to another, an effect known as "herd immunity." Furthermore,
since middle-ear infections are the leading reason that children need
to take antibiotics, vaccination with Prevnar could reduce the need for
antibiotics in this age group. This, in turn, should slow or reverse
the trend of antimicrobial resistance. A different pneumococcal vaccine,
known generically as PPV23, has been available to adults for years, but
it has not been effective in children less than two years old.
The Centers for Disease Control and Prevention's (CDC's) Advisory Committee
on Immunization Practices (ACIP) recommends that all children less than
two years old should be vaccinated with Prevnar. Children aged two to
five years old should receive a two-shot series of Prevnar followed by
one dose of PPV23 if they are high-risk, a category that includes children
with HIV, immunocompromising conditions, chronic illness, or sickle cell
disease. Prevnar may also be considered for children between two to five
years with priority given to those who are between the ages of 24 and
35 months, of African-American, American Indian, or Alaska Native descent,
or who attend group day care centers.
Since Prevnar has not been studied sufficiently in children older than
five years who are at high risk for serious pneumococcal disease, ACIP
continues to recommend that children five and older receive PPV23.
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