Common Immunization Questions from Parents

Parents 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.
• Infants are given vaccines at the time babies are most at risk of illness and serious complications from disease.
• The diseases that vaccines prevent are very serious and can cause illness, disability, 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.

Some 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. 

Antigens

• Antigens 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 Aluminum

• Adjuvants 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 autism
• Rates 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.

• 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 didn’t receive the vaccine 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.

Some 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 scrapes, falls, and sub-optimal personal hygiene are common, children (particularly those in child care settings) have more exposure 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 unvaccinated infected infants, the mother was Hep B surface antigen negative and the infant was exposed from a family member or caregiver.

HPV

• The AAP recommends HPV vaccination at 9 to 12 years of age for several reasons:
• The immune system of a 9- to 12-year-old responds better to the vaccine than that of an older teen.
• A teen needs all recommended 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.

My Child Does Not Want to Receive an Additional Shot

• Even 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. Medication can also be provided 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.

• ​A flu vaccine is more important than ever! A flu vaccine can also help reduce the burden on our healthcare systems responding to the COVID-19 pandemic and save medical resources for care of COVID-19 patients.
• The flu can lead to serious health problems and hospital stays, including for children with special health care needs. The good news is it's quick and easy to protect your child from the flu. Your child can get the flu vaccine at the doctor's office, pharmacy, or local health centers. Some hospitals and schools offer flu vaccines, too.
• Getting the flu is much riskier than getting the flu vaccine.
• When it comes to your child's health, it's okay to ask questions! Remember, you and your child’s doctor are working together to keep your child healthy and safe.

• Yes, your child and your family should receive a flu vaccine to protect the health of your family. Pediatrician's offices are open and taking extra steps to make sure you and your children are safe when you come in.

• Avoiding the influenza in the past is not a predictor of who will get the flu in the future. Getting vaccinated is the single most important thing you can do to prevent influenza. Influenza kills up to 79,000 people in the US each year and makes many more very sick. Many of these deaths occur in healthy individuals. Even one unnecessary death is too many.
• Getting a flu shot is always important. During the COVID-19 pandemic, it is even more important, as severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) and influenza virus will likely be circulating at the same time and have similar symptoms.

• It’s important to distinguish influenza from what many parents call “the flu.” It’s important for parents to understand that the flu shot only prevents influenza, not the hundreds of other types of viruses that children and adults can get that cause things like colds or vomiting and diarrhea. 
• Consider framing influenza as one of the most severe viruses that children can get – yes, other viruses can cause similar symptoms, but influenza is really the worst of the viruses commonly encountered by children, and it can be prevented.
• Flu shots given with a needle are made with either killed viruses or with only a single protein from the flu virus. The nasal spray vaccine contains live viruses that are weakened so that they will not cause illness. If someone gets a flu shot in the middle of flu season, they may already have been exposed to influenza and be coming down with it or another virus (colds are very common during influenza season and can vary in severity). Because the shot and getting sick happened at the same time, they think the flu shot gave them influenza. Many times, parents attribute any illness around vaccination as caused by the flu shot, but almost always, these illnesses are simply coincidental, and are not actually influenza.
• It also takes about 2 weeks for the body to build protection after the shot, so some people get sick just before or during that time period and blame the shot.
• The most common side effects of an influenza vaccine are soreness at the injection site and sometimes a low-grade fever. Sometimes people who experience side effects seem to think "they got the flu."

• While the flu vaccine is not 100% effective, we do know that those who are vaccinated and who later get an influenza virus are less likely to have severe illness, to be hospitalized or to have serious complications.
• Each year scientists determine the 3 or 4 most common strains of influenza virus circulating and that's what's included in the upcoming year's flu vaccine. Most of the time when parents say that they or their child got “the flu,” it was a virus other than influenza that made them sick. While it’s still possible to get influenza after getting the flu shot, it tends to be less severe.

• Although it is sometimes challenging to tell the difference between a cold and influenza, influenza can have serious implications and even lead to death, especially for the very young, very sick, or very old. It tends to last for several days, keeping you out of work and your child out of school. Getting vaccinated not only protects you, but those closest to you as well.