Vaccinations
Children should be vaccinated to protect them against infectious diseases. Vaccination has eliminated smallpox and nearly eliminated other infections, such as polio and measles, that were once common childhood scourges in the United States. Despite this success, it is important for health care professionals to continue to vaccinate children. Many of the diseases prevented by vaccination are still present in the United States and remain common in other parts of the world. These diseases can spread rapidly among unvaccinated children, who will also be at particular risk when traveling to other countries.
No vaccine is 100% effective and 100% safe. A few vaccinated children fail to become immune, and a few develop side effects. Most often, the side effects are minor, such as pain at the injection site, an itchy rash, or a mild fever. Very rarely, there are more serious problems. The oral polio vaccine, which is made of a live, weakened virus, can cause polio if the weakened virus mutates, which happens once in every 2.4 million children. Although this is an extremely small chance, it led doctors in the United States to recommend completely switching to an inactivated, injectable polio vaccine. Also, the pertussis component of the older whole-cell diphtheria, tetanus, and pertussis vaccine (DTP) occasionally led to febrile seizures (see Section 6, Chapter 85) in about 1 in 10,000 children, and more rarely confusion and fainting. Although these episodes do not leave any lasting damage, they are distressing to parents. Doctors now recommend a newer version of the vaccine using acellular pertussis (DTaP), which has a much lower chance of these reactions. Similarly, febrile seizures have occurred in about 3 in 10,000 children following the measles, mumps, rubella (MMR) vaccine. Although the public press has reported concerns that the MMR vaccine may produce autism, scientific evidence shows that this does not happen.
To help people evaluate the risks of vaccination, the federal government requires doctors to give parents a Vaccine Information Statement each time a child is vaccinated. Also, a federal Vaccine Injury Compensation Program was established to compensate anyone suffering permanent consequences of vaccination. This program was established because doctors and health authorities want as many children as possible to be protected from life-threatening diseases. When considering the risks of vaccination, parents must remember that their child is at much greater risk from the diseases that vaccinations prevent.
 See the figure Vaccination Schedule for Infants and Children.
Most doctors follow the vaccination schedule recommended by the American Academy of Pediatrics, which begins during the first week after birth with the hepatitis B vaccine. The recommended ages for vaccinations should not be construed as absolute. For example, 2 months can mean 6 to 10 weeks. Although parents should try to have their children vaccinated according to the schedule, a slight delay does not interfere with the final immunity achieved nor does it entail restarting the series of injections from the beginning. Vaccination need not be delayed, however, if the infant has a slight fever from a mild infection such as an ordinary cold. Some vaccines are recommended only under special circumstances.
More than one vaccine may be given during a visit to the doctor's office, but several vaccines are often combined into one injection, for example, pertussis, diphtheria, tetanus, and Haemophilus influenzae type b vaccines. A combination vaccine reduces the number of injections needed but does not reduce the safety or effectiveness of the vaccines.
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