Common Parental ConcernsChoose a common concern for a description of the concern, sample responses, and resources for parents. Too Many/ Too SoonParents worry that giving too many vaccines too soon may overwhelm a baby’s immune system. Consider discussing the following:Babies are exposed to many more antigens every day than what they will get in the vaccines. Antigen exposure happens every time they eat, play on the floor or put a toy in their mouth. Although infants do receive a lot of shots, they are given at the time babies are most at risk of illness and serious complications from the disease.The diseases that vaccines prevent are very serious and can cause, liver damage, heart disease, or hearing loss, all of which can last a lifetime, or even death.Vaccines are well-studied to make sure that it is safe to give them all at once.Even though children get more vaccines today than they did in the past, the number of antigens is fewer. Resources: AAP HealthyChildren: Multiple Vaccines in One Visit CHOP: Too Many Vaccines! Non-Standard SchedulesSome parents would prefer to spread out vaccines and believe an "alternative" or nonstandard schedule is safer. Consider discussing the following:The recommended schedule is designed to protect children when they are most vulnerable to the diseases vaccines prevent.Non-standard schedules that spread out vaccines or start when a child is older do not provide protection against serious illnesses when infants and young children are most at risk for the diseases. If a parent maintains they do not want a vaccine, document the request for a nonstandard schedule and that the risks of not vaccinating were discussed.Consider a tracking system to remind families to return for needed vaccines. Resources: AAP: The Problem With Dr Bob’s Alternative Vaccine Schedule” AAP Healthy Children: Why is the Schedule Like That Vaccine IngredientsWhen parents ask about the ingredients in vaccines, ask what concerns them specifically. AntigensAntigens stimulate the body’s immune response to make antibodies, cells that protect against infection. Antigens in vaccines cause the immune system to make antibodies that will protect the body if it comes into contact with a bacteria or virus that can cause illnesses. Some of the antigens are killed, and some are live. Live virus vaccines include MMR and chickenpox. Adjuvants and AluminumAdjuvants help increase the body’s immune response to the antigen in the vaccine.These adjuvants make it possible to use smaller amounts of antigens and decrease the number of doses needed.Aluminum salts or gels are used in some vaccines in the United States. Aluminum salts have been used safely for more than 70 years. Aluminum is in our food, air, and water. Formula and breast milk include aluminum. The amount of aluminum in vaccines is similar to that found in 33-oz of infant formula.Vaccines that contain aluminum are those that prevent diphtheria, tetanus, and pertussis; hepatitis A; hepatitis B; H influenzae type b; HPV; and pneumococcus infection. Thimerosal Thimerosal is a mercury-based preservative that has been used to prevent contamination of vaccines with bacteria and fungi. Some parents worried that thimerosal used in vaccines may lead to autism. Many scientific studies have shown that there is no link between thimerosal and autismRates of autism have actually increased since thimerosal was removed from vaccines in 2001. Today, most childhood vaccines do not contain thimerosal, with two exceptions:It is still often used during the manufacturing process but then removed, leaving only a very small (trace) amount. It is also used in vials that contain more than one dose of vaccine. For example, influenza vaccine is prepared in multidose vials that contain thimerosal and is also available in single syringes without thimerosal. Resources: AAP HealthyChildren - Vaccine Ingredients: FAQs CHOP - Vaccines and Thimerosal CHOP - Vaccine Ingredients: What You Should Know Autism In 1998, Dr Andrew Wakefield published a paper about 8 children who reportedly developed autism after receiving the MMR vaccine. Over the past decade, 10 of the 13 authors have retracted the findings. In 2010, The Lancet retracted the study, citing ethical misconduct on the part of Wakefield.Since then, scientific studies comparing thousands of children who received the vaccine with thousands of children who have not have been completed, and have not found a relationship between the vaccine and autism.Scientific studies about a link between thimerosal and autism have been completed as well. These studies have reported that there is no link between thimerosal and autism. (MMR vaccine has never contained thimerosal.)During the past decade, with thimerosal removed from most childhood vaccines, the rate of autism has continued to rise. Resources AAP HealthyChildren: Vaccine Studies: Examine the Evidence CHOP: Vaccines and Side Effects: The Facts CHOP: Vaccines and Autism: What You Should Know CHOP: Do Vaccines Cause Autism – video My Child Will not Be Exposed to Sexually Transmitted InfectionsSome parents think their children will not be exposed to diseases like hepatitis B (Hep B) and HPV. The parents do not understand why Hep B vaccine is recommended for their infant, who is not participating in sexual activity or intravenous drug use. Other parents don’t know why HPV vaccine is needed if their adolescent is not sexually active. Hepatitis B The Hep B vaccine is the best protection a child can have against a dangerous and lifelong disease. Before the vaccine was introduced, 20,000 children under the age of 10 became infected each year in the US.Vaccinating early against Hep B assures children's immunity when they are the most vulnerable to the worst complications of the disease and before they enter the high-risk adolescent years.Because of common scrapes, falls, and lack of personal hygiene, children (particularly in child care settings) are more exposed to bodily fluids than some adults.Infants who catch Hep B from their mothers at birth are at a greater risk of suffering a premature death from liver cancer or liver failure later in life.Even if the mother and the baby are both negative for Hep B at birth, it is important to get the vaccine. Since individuals that are infected with hepatitis B often do not feel sick or show symptoms of the disease, they can pass the virus on unknowingly. In two-thirds of the cases of childhood transmission of the virus, the mother was HBsAg (Hep B surface antigen) negative but the unvaccinated infant was exposed from a family member or caregiver. HPVThe AAP recommends HPV vaccination at 11 to 12 years of age for several reasons:The immune system of an 11- to 12-year-old responds better to the vaccine than that of an older teen. A teen needs all r doses of the vaccine before ever coming into contact with the virus in order to be fully protected.The uptake for HPV vaccine is lower than other adolescent vaccines given at the same age. Please remember to recommend this as a routine vaccine along with your recommendations for Tdap, Meningococcal, and flu (if during flu season). One way to do this is to say:“Today your child is due for 4 vaccines, influenza, HPV, Meningococcal, and Tdap. Do you have any questions?”Receiving HPV Vaccine Will Lead My Child to Engage in Sexual Activity Studies show that children who receive HPV vaccine do not have sex any earlier than those who received only the other vaccines typically administered to teens. This tells us that children do not see the vaccine as a license to have sex. Sexual Activity–Related Outcomes After Human Papillomavirus Vaccination of 11- to 12-Year-Olds Bednarczyk, et al. 2012. Pediatrics, 130, 5, 798-805. Effect of Human Papillomavirus (HPV) Vaccination on Clinical Indicators of Sexual Behavior Among Adolescent Girls: the Ontario Grade 8 HPV Vaccine Cohort Study Smith, et al. 2014. Canadian Medical Association Journal. Published online December 8, 2014 My Child Does Not Want to Receive an Additional ShotEven though a shot may hurt, it is very quick and much easier than suffering from a serious disease, such as meningitis or cancer. There are no benefits to waiting, but doing so can put your child at risk for these diseases, as they will be unprotected for longer.There are ways to reduce pain during vaccination. Stroking the skin or applying pressure to the skin before the shot can help. I can also provide a medication to numb your child's skin. Does My Son Really Need HPV Vaccine If It Prevents Cervical Cancer?Even though only females can get cervical cancer, HPV vaccine can protect both males and females from genital warts and cancers of the mouth, throat, anus, and genitals. A preteen boy who receives HPV vaccine can also protect his future partner. Men and women infected with HPV often have no symptoms. Women can get cervical cancer screenings, but there is no such test for men. Men who are infected and don't know it can spread HPV to a partner.Why Is More Than One Dose Needed?For some vaccines, more than one dose is needed for the body to build up enough immunity to protect against infection. For others, one is enough to protect a person, but immunity may wane over time. When this happens, an additional dose can "boost" the immunity back up so that children and teens are still fully protected. Resources: AAP HealthyChildren - Are Your Kids Protected From Cancer Caused by HPV CDC - HPV Vaccines Influenza Vaccine Is Not ImportantSome parents question the need for a yearly dose of the flu vaccine. They believe that influenza is a relatively mild disease (one that they have had and have survived) and that the risk of vaccination outweighs the risk of the disease. Parents also may have concerns about thimerosal in the flu vaccine (see above).Influenza is a serious disease, and people of any age can get it. In an average year, the flu causes 49,000 deaths and 200,000 hospitalizations in the US. The “flu season” is usually from November-April each year. An annual flu vaccine is the best way to reduce circulation of the flu. Annual shots are necessary because flu viruses change from year to year. This means that a person can get the flu more than once during their lifetime. The immunity that is built up from having the flu caused by one virus strain doesn’t always provide protection when a new strain is circulating. In other words, a vaccine made against flu viruses circulating last year may not protect against the newer viruses. Further, immunity to the disease declines over time and may be too low to provide protection after one year. Resources: CDC - Questions & Answers: Thimerosal-Containing Influenza Vaccine CDC - Influenza Web siteAAP - Influenza Implementation Guidance (PDF 246KB) Resources The Immunization ScheduleNew for 2017! Click here for the current schedule recommended by the AAP, AAPF, AGPC and CDC.Information for ParentsVisit HealthyChildren.org, the AAP parenting website, for information for families about immunizations. The Latest on Immunizations Updated Immunization PoliciesThe AAP recently released 2 clinical reports on adolescent immunization.Immunization Initiatives NewsletterCheck out our newsletter for the latest on immunizations.