The "most essential" infant vaccines

[mommy2caroline]

Hi everyone,

I just got back from the LLLI conference in Chicago, and I attended Dr. Robert Sears's talk on vaccines. In his talk, he discussed the four "most essential" infant vaccines - basically, that if you choose to delay or skip anything, then these four are the most pressing to get before age 2 - as young as possible, actually, since the diseases are most harmful to infants less than a year old. The shots were: Hib, Pc (which he clarified is Prevnar, for pnemococcal), Rotavirus, and DTaP (just because of pertussis - he said the others could wait, but you can't get the pertussis vax separately). He basically said that if you had these vaxes before 2, then you really didn't need anything else until you were much older - like 12 or so. And also, if you skipped all vaxes before 2 and were fine, well, you still didn't really need to get any until closer to the teen years. I was just wondering what other people's thoughts were on all this.

Here are my questions:
- Are the incidences of these diseases much lower in exclusively breastfed babies? Most likely yes - so how much lower? Anyone know of a link to any stats?

- The pertussis vax doesn't seem too effective... it seems like everyone knows a kid who got whooping cough despite getting the DTaP vax. anywhere to find actual statistics of babies who got it after one, two, three, or a full four doses? I wonder how many babies who got it and were "vaxed" had only had one or two doses... and how many were fully vaxed? And if you can't get them fully vaxed until 15-18 months, then what's the point if it doesn't give a high degree of immunity?

- My ped didn't even suggest rotavirus or prevnar for my dd, who is now 2 years old. She said that wrt prevnar, they didn't need it until they were two unless they were in daycare. But Dr. Sears claims that the really important time to get it is before age 2... so why get it after age 2 if the baby was fine before without it?

Thanks, everyone... I had dd vaxed w/ Hib and DTaP at 2, 4, and 6 months before stopping altogether, but no rotavirus or prevnar... and now I'm trying to decide what to do w/ this baby.

Another thread to follow on what I learned from him about the rubella vax...

[mamakay]

Here are my questions:
- Are the incidences of these diseases much lower in exclusively breastfed babies? Most likely yes - so how much lower? Anyone know of a link to any stats?

Well...stuff like Hib and Prevnar...what you're really wanting to avoid is bacterial meningitis from the bacteria in particular, and the vaxes aren't doing a great job of that because of a phenomenon called "serotype replacement". Bf'ing does work ok to prevent bacterial meningitis, but the actual risk reduction is hard to figure out, and I've never seen it actually calculated. The other big risk factors are being in daycare and being around smoke, so my "intuitive" guess would be that the risk is reduced by about 75% by avoiding all the risk factors.
With pertussis, bm does contain antibodies, but how well they work is totally unknown. Whatever they do, it probably isn't totally preventing the disease so much as it is helping the baby have a milder case. Similar kind of deal with rotavirus.
It sucks, but the exact effectiveness of breastfeeding protection just isn't totally known. We know it's there, but not exactly how well it works.

- The pertussis vax doesn't seem too effective... it seems like everyone knows a kid who got whooping cough despite getting the DTaP vax. anywhere to find actual statistics of babies who got it after one, two, three, or a full four doses? I wonder how many babies who got it and were "vaxed" had only had one or two doses... and how many were fully vaxed? And if you can't get them fully vaxed until 15-18 months, then what's the point if it doesn't give a high degree of immunity?

No one really knows what's going on with pertussis. The effectiveness of the first 2 doses are totally unknown, and it looks like the vax never actually prevents the disease...it just helps people have milder cases.
Of course, pertussis can suck so bad, I can see why people might want to do the vax even then. Even a 20% reduction in severity can mean the difference between toughing a cough out at home for a few weeks vs. ending up at the ER on oxygen for a week.

- My ped didn't even suggest rotavirus or prevnar for my dd, who is now 2 years old. She said that wrt prevnar, they didn't need it until they were two unless they were in daycare. But Dr. Sears claims that the really important time to get it is before age 2... so why get it after age 2 if the baby was fine before without it?

I don't really agree with your ped or Dr. Sears, but what Sears is saying at least makes sense. I have no idea what your ped could be talking about. The risk of dying from pneumococcal bacteria basically goes away after age 2 and doesn't come back until you're "elderly".
I guess what your ped is talking about is this:
In daycare, there are a lot of little cold viruses floating around, and getting a viral cold can predispose a kid to getting a secondary bacterial infection after the cold, like a lingering ear infection or an upper respiratory tract infection? So she's thinking Prevnar will stave off the secondary bacterial infections???
Something like that, maybe?

Either way, read up on Prevnar and serotype replacement and decide for yourself.

[mommy2caroline]

Originally Posted by mamakay

Similar kind of deal with rotavirus.
It sucks, but the exact effectiveness of breastfeeding protection just isn't totally known. We know it's there, but not exactly how well it works.

I think the good thing about bfing and rotavirus would be that a puking baby will be able to keep breastmilk down better than anything else - I saw that with my dd a few months ago when she had her only (so far) stomach bug. so at least if they do get it, hopefully it'd be a milder case, and hopefully the breastmilk would keep them hydrated enough... has anyone here had a baby get rotavirus while nursing and have a really bad case and not keep any breastmilk down?

Originally Posted by mamakay

No one really knows what's going on with pertussis. The effectiveness of the first 2 doses are totally unknown, and it looks like the vax never actually prevents the disease...it just helps people have milder cases.
Of course, pertussis can suck so bad, I can see why people might want to do the vax even then. Even a 20% reduction in severity can mean the difference between toughing a cough out at home for a few weeks vs. ending up at the ER on oxygen for a week.

I wish there was a pertussis-only vax - at least that would make it easier to decide. Dr. Sears explained it as though pertussis were serious enough in infants that getting the vax outweighed any risks that might be posed by the DT part of the shot... still, it'd be nice to have the option of splitting that one up for infants.

Originally Posted by mamakay

I don't really agree with your ped or Dr. Sears, but what Sears is saying at least makes sense. I have no idea what your ped could be talking about. The risk of dying from pneumococcal bacteria basically goes away after age 2 and doesn't come back until you're "elderly".
I guess what your ped is talking about is this:
In daycare, there are a lot of little cold viruses floating around, and getting a viral cold can predispose a kid to getting a secondary bacterial infection after the cold, like a lingering ear infection or an upper respiratory tract infection? So she's thinking Prevnar will stave off the secondary bacterial infections???
Something like that, maybe?

That's what I was thinking - why recommend prevnar to kids after age 2 if they are past the serious stage? I guess not everyone goes on the "seriousness" factor... if a school requires prevnar, then they would make a kid get it at age five in kindergarten, even though the risk is basically gone.

I'll look in to the serotype replacement - hadn't heard of that before. Thanks!

[BethanyB]

That's interesting that Dr.Sears suggested the rotavirus vax, b/c my ped didn't. When we told her we were still on the fence re: vaxes, she said the three main ones she'd suggest were the dtap, hib and prevnar. I, too, wish there was more data out there regarding babies who are EBF and the rates/severity of certain diseases.

[mommy2caroline]

My ped has never mentioned rotavirus either... maybe it is because it is such a relatively new vax? That's all I can think of... Somebody asked Dr. Sears about concern about its track record as a new vax, and he said that he waited for almost a year before beginning to recommend it... I don't know when that was, but my dd is over 2 now, so maybe not many drs. were recommending it at that point?

He also stated that rotavirus, Hib, and Prevnar have virtually no chemicals in them (DTaP does), as compared to other vaxes... and he said that DTaP, Hib, and Prevnar use no animal/human tissues (rotavirus uses animal tissue)... so he was suggesting that in addition to recommending them because they were the most serious things to prevent in infants, they were also lower risk as far as putting weird stuff into the body.

[anewmama]

Did he have his new book there?

ETA: DId he have anything to say about adverse reactions to shots?

[mamakay]

Live vaxes are "pure" when it comes to chemicals. But other animal viruses (specifically cow viruses) sneak in there sometimes, too. That's my only issue with any of the live vaxes, really.

[anewmama]

Originally Posted by mommy2caroline

I wish there was a pertussis-only vax - at least that would make it easier to decide. Dr. Sears explained it as though pertussis were serious enough in infants that getting the vax outweighed any risks that might be posed by the DT part of the shot... still, it'd be nice to have the option of splitting that one up for infants.

I was always under the impression that the DT part is the least of one's worries overall and that it is the P part that is most worrisome?

[AMJ]

"has anyone here had a baby get rotavirus while nursing and have a really bad case and not keep any breastmilk down?"


Hi...just starting to lurk around this board since I have a new baby arriving in a couple of months and I'm planning to take a different approach to vaccinating than I did with DD, but I did want to say that my DD had a HORRIBLE case of rotavirus when she was 5.5 months old. She was sick for over a week and had to be hospitalized twice. She definitely couldn't keep breastmilk down. The first signs of the rotavirus was when I was nursing her in bed on a Sunday morning and she proceeded to projectile vomit all over me as she finished nursing.

I am so hesitant about the new rotavirus vaccine (especially after the problems with the rotavirus vax they had a few years ago), but then I think of my tiny DD being hooked up to an IV at the hospital or her sad, exhausted little eyes looking up at me helplessly the third or fourth day of being sick. I really don't want to risk put my second child through that.

[mommy2caroline]

Originally Posted by anewmama

Did he have his new book there?

ETA: DId he have anything to say about adverse reactions to shots?

No, but he sure pushed it a lot! It comes out in October. The talk was a brush-over of the info in the book.

He talked about reactions some - he said that he likes to split up all shots, only giving two at a time - no combo vaxes like Pediarix. He especially likes to avoid mercury (which he said is really not as prevalent now, that any shots with it now contain only 1% of the mercury they used to have)... he said to look for brands that have no traces. He was most concerned with only giving shots that contained different preservatives together - especially aluminum. So, if he was giving one vax with aluminum in it, if he gave another at the same visit it would not contain aluminum. His theory seemed to be to hit the body with as little foreign items at a time to minimize any reactions that may occur.

He also said that 1 in 100,000 doses (meaning all vaxes combined) would cause a severe reaction. He broke that down to show that kids are put at this risk 39 times if they get the full schedule of vaxes, meaning 1 in 2,600 children will have a severe reaction. This sounds too high for my comfort, but he compared it to the risk of getting a severe disease as being 1 in 600 children. But then he reminded us that you had to break that down by the vax and the age groups, etc. So that's where it is important to look at each disease and the risk of getting it and then compare it to risks from the shot itself. It'd be good to look at a breakdown of yearly severe reactions to each vax... anyone have a link for that?

[mommy2caroline]

Originally Posted by anewmama

I was always under the impression that the DT part is the least of one's worries overall and that it is the P part that is most worrisome?

That's right. Makes you wonder why there is no pertussis-only shot.

[sophiekat]

i'm *really* interested to know how he "calculated" his numbers wrt adverse reactions & complications of disease :
overall i find his recommendations pretty interesting -- i think most paeds would recommend DTaP but the HiB, prevnar, and rotavirus seem to be the trendy vaxxes to have as favourites :

[EVC]

has anyone here had a baby get rotavirus while nursing and have a really bad case and not keep any breastmilk down?

Yes. Well, actually not my dd, but a girl in her daycare group (there was a huge epidemic at our daycare last fall--about 80-85% of the kids ending up getting it). Anyway, the girl was about 11 months old, breastfed, and ended up hospitalized for dehydration. She could not keep breasmilk down.

(I am NOT at all advocating the vax--we're nonvaxer's--but just pointing out the reality that it CAN and DOES happen.)

[ldsmom06]

Originally Posted by AMJ

"has anyone here had a baby get rotavirus while nursing and have a really bad case and not keep any breastmilk down?"


Hi...just starting to lurk around this board since I have a new baby arriving in a couple of months and I'm planning to take a different approach to vaccinating than I did with DD, but I did want to say that my DD had a HORRIBLE case of rotavirus when she was 5.5 months old. She was sick for over a week and had to be hospitalized twice. She definitely couldn't keep breastmilk down. The first signs of the rotavirus was when I was nursing her in bed on a Sunday morning and she proceeded to projectile vomit all over me as she finished nursing.

I am so hesitant about the new rotavirus vaccine (especially after the problems with the rotavirus vax they had a few years ago), but then I think of my tiny DD being hooked up to an IV at the hospital or her sad, exhausted little eyes looking up at me helplessly the third or fourth day of being sick. I really don't want to risk put my second child through that.

My ds got rotavirus while breastfeeding. He had a milder case of it. His fellow rotavirus babies had it much worse!! He had the rotavirus vax. His ped said he would of been hospitalized if he hadn't had the vax.

[EVC]

He had the rotavirus vax. His ped said he would of been hospitalized if he hadn't had the vax.

Hmm.....And how exactly does he know that???? : The vast majority of kids who get rotavirus do NOT end up hospitalized and that was true well before the vax was even introduced!

[mamakay]

Psychic pediatricians, huh?

[nonibradshaw]

They only recommend the rotavirus vax for dc 18 mos and younger. When
ds1 was 2 he had a really severe case of rotavirus that lasted 14 days (he was not ebf at that time). So at 6 mo well child my ped suggested vax for
ds2 i jumped..so sorry i did. He was miserable colicky, diarriaha, rash. If I had to do it all over again I would not do it! In retrospec the vax is way too new and since they withdrew the first vax after administering it a year I should have known better.

[mommy2caroline]

Originally Posted by EVC

Hmm.....And how exactly does he know that???? : The vast majority of kids who get rotavirus do NOT end up hospitalized and that was true well before the vax was even introduced!

Yeah - Sears's numbers on this were 1 in 100 babies are hospitalized with rotavirus - which means a lot more than 1 in 100 get a milder case.

So, has anyone here had a baby who was breastfed exclusively at least six months, not in daycare, and still had a really bad case of rotavirus (requiring hospitalization/IV fluids)? Just curious, since there are no stats on how likely breastfed, non-daycare babies are to get it... just that we know their risks are reduced.

[mamakay]

Originally Posted by mommy2caroline

Yeah - Sears's numbers on this were 1 in 100 babies are hospitalized with rotavirus - which means a lot more than 1 in 100 get a milder case.

So, has anyone here had a baby who was breastfed exclusively at least six months, not in daycare, and still had a really bad case of rotavirus (requiring hospitalization/IV fluids)? Just curious, since there are no stats on how likely breastfed, non-daycare babies are to get it... just that we know their risks are reduced.

My son came close to us going to the ER. And he was 2 when he got it.
I *think* knowing the "tricks" to keeping a pukey kid hydrated will reduce your chances of actually ending up at her ER.
If you're not in daycare, your baby will be older when they catch rotavirus, too, probably. That seems to be the way it works from what I've seen, at least.
And I bet the one in 100 number is an overestimations that takes into account those parents who just run to the ER over everything, too. If you don't expect rotavirus to be "bad" and don't know the symptoms, and the signs of actual dehydration, I can see a lot of people just going to the ER thinking their kid has some fatal disease after a few days of it.

My wild guess would be that a bf'ed kid not in daycare has a one in 300 chance of actually needing IV fluids because of rotavirus.

[lyttlewon]

Originally Posted by AMJ

I am so hesitant about the new rotavirus vaccine (especially after the problems with the rotavirus vax they had a few years ago), but then I think of my tiny DD being hooked up to an IV at the hospital or her sad, exhausted little eyes looking up at me helplessly the third or fourth day of being sick. I really don't want to risk put my second child through that.

Seriously consider the side effects of the vaccine. The most common reaction is vomiting and diarrhea which is exactly what you are trying to avoid.