As frequent readers may have noticed, this blog has been silent in recent months as I have been busy adjusting to life with a little human. A cute, but demanding little human. The tiny man turned four months recently and we had our second set of vaccinations. We ended up having them late as the baby had bronchitis at eight weeks old and with the holidays we got delayed for four weeks. Not ideal but not avoidable in our case.
Talking to other new moms I discovered a trend. Delaying vaccinations on purpose.
Because it wasn’t clear to them WHY they should vaccinate at 8 weeks?
People seem to think that a month or two later won’t hurt or even be beneficial (spoiler: it is not!!). And when you think doctors would be able to advise worried parents – think again. One friend told me she delayed the shots for her son because the doc couldn’t tell her why she should vaccinate at eight weeks.
So for all those out there wondering why we vaccinate for the first time at eight weeks, here are a few facts:
The first set of shots protects your kid from eight pretty bad diseases/pathogens at once (see list below). And yes babies are small at that age, but just imaging them catching any of these diseases? Wouldn’t that be worse than a little jab and some mild discomfort (e.g. maybe a fever and some unhappiness)? Especially as some of these pathogens are far more dangerous for the youngest. The earlier you vaccinate the earlier your kids are protected.
- Diphtheria toxin, produced by the bacterium Corynebacterium diphtheriae, can lead to a thick coating of the nose, throat, or airway causing trouble breathing, hearth failure or even death.*
- Tetanus is caused by Clostridium tetani. Spores of this bacterium can be found in soil or dirt. Once it enters via a cut or bite wound, the bacteria produce a toxin called tetanospasmin, which affects motor neurons controlling the muscles causing the disease-typical muscle spasms.*
- Pertussis or whooping cough. Caused by Bordetella pertussis, this disease looks like the common cold in its early stages. The bacteria attach in your upper respiratory system and cause a typical cough accompanied with difficulties to breath. It’s particularly dangerous for babies, as their breathing can simply pause which can cause complications like brain damage.*
- Haemophilus influenzae type b (Hib). While the name is misleading, Hib is a bacterium and has nothing to do with the flu. It is much worse. Hib can cause meningitis, bloodstream infections (sepsis), pneumonia and arthritis. Infections are most prevalent in children under 5.*
- Polio or Poliomyelitis is an infections disease caused by the poliovirus. It can lead to paralysis, which if the airways are affected can be deadly. While polio is nearly eradicated, the risk of infections is still very much present and to fully eradicate the disease, all children need to be vaccinated.*
- Hepatitis B (Hep B). This viral liver infection is much more likely to become chronic, if the infection occurs early in life. Chronic disease can lead to sever damage of the liver, including cancer. *
- Pneumococcus. Caused by bacteria called Streptococcus pneumoniae, this infection is a leading cause for pneumonia, meningitis, sepsis and ear infections in kids.
- Rotavirus. Leading cause for diarrhoea in babies and toddlers. The disease progression often leads to sever dehydration, which can be life threatening. Roughly one child a day dies of Rotavirus infections in the EU.*These six are normally given in one shot.
So why not vaccinate at birth?
Babies are not born with a fully developed immune system. Compared to adults, immune responses in newborns are dampened and less inflammatory – maybe to avoid an overreaction. Out of the sterile womb, babies are suddenly exposed to thousands of particles (antigens), most of which are harmless and should be ignored by the immune system. To ensure this, a careful balance is key in the newborn phase of life.
The initial immunosuppressive environment needs to be taken into account when devising vaccination strategies. One example demonstrating the importance of vaccination time is the pertussis vaccine. It induces little immune activation when given within 24 hours of birth, but when given three weeks after birth it mounts strong immune responses. After clinical trials on all eight vaccines given in the first set of shots, eight weeks is considered the best time point to vaccinate. All vaccines are tested for both safety and efficacy – vaccinations at eight weeks are therefore not only safe but also provide good immune responses! There are exceptions, the Hep B vaccine for example mounts good responses from birth and is given to newborns right away if their mother is HepB positive.
While the immune system of babies keeps maturing over the first few years of life, vaccinating later than eight weeks is not beneficial. It is rather a misinterpretation of what maturation means for the immune system past those initial eight weeks.
The immune system matures by exposure to pathogens. Each time your immune system comes in contact with a certain pathogen, it produces specific immunological molecules called antibodies and memory cells. These allow a quicker response to the same pathogen the next time you encounter it. The repertoire of antibodies and cells grows over the months and years. To counteract the initial lack of antibodies, mothers transfer their antibodies onto their babies, both via the placenta during pregnancy and via breast milk. However, and this is key, more exposure does not mean better response to seeing a new antigen (regardless of in form of a vaccine or pathogen). So while waiting for the initial suppressive eight weeks to pass improves the babies immune response to vaccines, waiting even longer won’t further improve the immune response. Your child won’t be safe. It will be not protected while you wait.
One more note regarding the Rotavirus vaccination:
I know quite a few people who optioned out of this one. But 80% of cases of diarrhoea in kids under two are caused by this virus, and half of the kids infected need a hospital stay due to dehydration. However, it is not a lethal disease, meaning people are less likely to vaccinate if they feel the side effects are too big. The thing is, in my opinion, the side effects aren’t that big – there is the notion that kids could suffer from intussusception (a condition in which the gut folds into itself). The first vaccine used against Rotavirus, which is not used anymore, had a largely increased risk of intussusception. Currently used vaccines are much safer. In fact the risk of this particular side effect increases over time, so if your kid is vaccinated at 12 weeks it is safer than if he/she catches the disease later in life. Overall, I believe the benefits outweigh the risks as most kids catch rotavirus before they are five.