Pediatric Health Topics

Childhood Immunizations

There are few things that have had as much impact on improvement in world health as routine immunizations. Drs. Womble, Outlaw, Capps, and Ms. Sarno believe that following recommended guidelines for immunization of your children is the most important thing you can do to protect their health. Routine immunization has made a major impact on child mortality but unfortunately this has left few modern day parents with any real exposure to and very little knowledge about any of the diseases that we currently vaccinate for.

The following is a brief description of vaccine preventable diseases. If you would like to learn more about this very important subject we recommend the following book:

Vaccines: What You Should Know by Paul A. Offit, MD and Louis M. Bell, MD.

Hepatitis & Rotavirus

Hepatitis B infection is an infection of the liver that may result in chronic liver disease including cirrhosis of the liver or liver cancer. Spread of disease is either through transmission from mother to child or through some other blood contact. Recommendation for universal vaccination was made in 1991. Previous vaccination campaigns focused on vaccinating the highest risk groups but were ineffective since 30-40% of new infections were occurring among those who would not have been identified as being at high risk. Each year in the United States, an estimated 40,000-50,000 persons are newly infected with hepatitis B virus and 5,000 remain chronically infected. Overall, an estimated 1 million people in the United States have chronic hepatitis B virus infection, and 2,000-4,000 people die each year from liver disease or liver cancer related to hepatitis B.
Rotavirus can make your baby or young child very sick. This virus is the most common cause of severe diarrhea in infants and young children in the U.S., and it also often leads to vomiting, fever, and dehydration. Rotavirus is very contagious; it spreads when infants or young children come into contact with an infected person or objects contaminated by the feces of an infected person. Before a rotavirus vaccine was introduced in 2006, as many as 270,000 infants and young children were taken to the emergency room each year because of the disease, and as many as 70,000 were hospitalized.

Diptheria, Tetanus and Pertussis Combination Vaccine (DTaP)

There are only 0.001 cases of diptheria per 100,000 population in the U.S. since 1980; before the introduction of vaccine in the 1920s incidence was 100-200 cases per 100,000 population. Death occurs in 5%-10% of respiratory cases. Respiratory diphtheria presents as a sore throat with low-grade fever and an adherent membrane of the tonsils, pharynx, or nose. Neck swelling is usually present in severe disease. Respiratory diphtheria has become a rare disease in the U.S. (0-5 cases per year.) The current rarity of disease is not a reason for eliminating vaccination however since disease continues to spread worldwide and circulates even in populations with greater than 80% childhood vaccination rates. Based on pre-vaccine incidence of 100-200 cases per 100,000 and an approximate 7.5% mortality rate we would expect over 30,000 annual deaths from diphtheria if vaccination was not continued.
Tetanus (lockjaw) is a serious disease that causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw so the victim cannot open his mouth or swallow. Tetanus leads to death in about 1 in 10 cases. Almost all reported cases of tetanus are in persons who have either never been vaccinated, or who completed a primary series but have not had a booster in the preceding 10 years. In the late 1940s, tetanus toxoid was introduced into routine childhood immunization. At that time, 500–600 cases (approximately 0.4 cases per 100,000 population) were reported per year. From 2000 through 2007 an average of 31 cases were reported per year.
Pertussis is a highly communicable, vaccine-preventable disease that lasts for many weeks and is typically manifested in children with intermittent spasms of severe coughing, whooping, and gagging/vomiting after coughing. In the United States, 5000-7000 cases are reported each year. Incidence of pertussis has increased steadily since the 1980s. The incidence in 2007 was 3.6/100,000 when 10,454, cases of pertussis were reported. This is one vaccine preventable illness that is on the rise which has led to recommendations for booster doses of pertussis vaccine for adults (see routine health maintenance guidelines on immunization practices for adults on this website). Young children can die from pertussis. Most deaths occur among unvaccinated children or children too young to be vaccinated.
Haemophilus influenzae type b vaccine prevents meningitis (an infection of the covering of the brain and spinal cord), pneumonia (lung infection), epiglottitis (a severe throat infection), and other serious infections caused by a type of bacteria called Haemophilus influenzae type b. Hib meningitis results in death in one out of 20 children, and permanent brain damage in 10% - 30% of the survivors. Before the introduction of a Hib vaccine, H. influenzae type b (Hib) was the leading cause of bacterial meningitis among children younger than age five years in the United States. Every year about 20,000 children younger than age five years got severe Hib disease and about 1,000 children died. By 2006, this number had dropped to just 29 cases per year.
Prevnar vaccine protects against a common bacteria, the pneumococcus, which can attack different parts of the body. When bacteria invade the lungs, they cause the most common form of community-acquired bacterial pneumonia; when bacteria invade the bloodstream, they cause bacteremia; and when they invade the covering of the brain, they cause meningitis. Before pneumococcal conjugate vaccine became available for children, pneumococcus caused 63,000 cases of invasive pneumococcal disease and 6,100 deaths in the U.S. each year. Many children who developed pneumococcal meningitis also developed long-term complications such as deafness or seizures. Since the vaccine was introduced, the incidence of invasive pneumococcal disease in children has been reduced by 75%.
Polio virus causes acute paralysis that can lead to permanent physical disability and even death. Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States. To date polio has been eliminated from the Western hemisphere, and the European and Western Pacific regions. Stopping vaccination before eradication is achieved would result in a resurgence of the disease in the United States and worldwide.

We recognize that some parents have questions about autism and mmr vaccination or other vaccines.

We believe that there is no causal relationship between any vaccination and the development of autism spectrum disorders.

For more information please refer to the following web site from the CDC. Autism Spectrum Disorders (ASDs)


Measles, Mumps, and Rubella Combination Vaccine (MMR)

Measles causes fever, runny nose, cough and a rash all over the body. About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. For every 1,000 children who get measles, one or two will die. While measles is almost gone from the United States, it still kills nearly 200,000 people each year around the world. During 2008, more measles cases in the US were reported than in any other year since 1997. More than 90% of those infected had not been vaccinated, or their vaccination status was unknown.
Mumps is best known for the swelling of the cheeks and jaw that it causes, a result of inflammation of the salivary glands. Mumps also causes a fever and headache. It is usually a mild disease, but it leads to meningitis in about 1 child in 10 who get the disease. It can occasionally cause encephalitis, deafness (about 1 in 20,000 cases), or even death (about 1 in 10,000 cases). An estimated 212,000 cases of mumps occurred in the U.S. in 1964. After vaccine licensure in 1967, reports of mumps decreased rapidly. There were only 266 reported cases of Mumps in 2001. We can not let our guard down against mumps, however. A 2006 outbreak among college students, most of whom had received two doses of vaccine, led to over 5500 cases in 15 states. Mumps is highly communicable and it only takes a few unvaccinated to initiate transmission.
While rubella is usually mild in children and adults, up to 90 percent of infants born to mothers infected with rubella during the first trimester of pregnancy will develop congenital rubella syndrome (CRS), resulting in heart defects, cataracts, mental retardation, and deafness. In 1964-1965, before rubella immunization was used routinely in the U.S., there was an epidemic of rubella that resulted in an estimated 20,000 infants born with CRS (11,600 were deaf, 3,580 were blind, and 1,800 were mentally retarded). Since 1999, there have been only 40 pregnant women infected with rubella. If we stopped rubella immunization, immunity to rubella would decline and rubella would once again return, resulting in pregnant women becoming infected with rubella and then giving birth to infants with CRS.
Prior to the licensing of the chickenpox vaccine in 1995, almost all persons in the United States had suffered from chickenpox by adulthood. Each year, the virus caused an estimated 4 million cases of chickenpox, 11,000 hospitalizations, and 100-150 deaths.
In the United States, there were an estimated 25,000 new hepatitis A virus infections in 2007. Hepatitis A is usually spread when the hepatitis A virus is taken in by mouth from contact with objects, food, or drinks contaminated by the feces (or stool) of an infected person. Symptoms (including fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, and yellowing of the skin or eyes) usually last less than 2 months, although some people can be ill for as long as 6 months. 2006 recommendations for universal vaccination for all children starting at age one are based on observations of safety and efficacy of regional vaccination programs instituted earlier in the southwestern United States.

Age at Exam Vaccinations Screening Tests
Birth Hepatitis B Support for new parents and breast feeding
2 or 3 Days   Support for new parents and breast feeding
2 Weeks Catch up Hepatitis B
2 Months DTaP, Polio, HIB, Pneumococcus, Hepatitis B, Rotavirus  
4 Months DTaP, Polio, HIB, Pneumococcus, (Hepatitis B), Rotavirus
6 Months DTaP, (Polio), HIB, Pneumococcus, Hepatitis B, Rotavirus, Influenza Developmental Screening
9 Months Catch up vaccines, Influenza
12 Months Hepatitis A, MMR, Chicken pox, Influenza Developmental Screening, Blood Count, Lead
15 Months DTaP, (Polio), HIB, Pneumococcus, Influenza, Influenza
18 Months Hepatitis A, Influenza Developmental Screening, Autism Screening
24 months Catch up vaccines, Influenza Developmental Screening, Autism Screening
30 months Catch up vaccines, Influenza Developmental Screening, Autism Screening
3 Years Catch up vaccines, Influenza Developmental Screening, Vision Screening
4-5 Years DTaP, Polio, MMR, Chicken pox, Influenza Developmental Screening; Vision Screening, Hearing Screening
6-10 Years Catch up vaccines, Influenza Vision Screening, Hearing Screening
11-12 Years Tdap, Meningitis, HPV, Influenza Vision Screening, Hearing Screening as needed; blood counts as needed
13-21 Years Catch up vaccines, Influenza Vision Screening, Hearing Screening as needed; blood counts as needed
  • Combination vaccines are available to reduce the number of shots for infants and toddlers.
  • Vaccines in (…) may be given at different times depending upon the brand of the vaccine used.
  • NC state law requires that immunizations that are due at 12 months and 4 years be given after the child’s birthday.
  • Influenza vaccine is given starting at age 6 months and is needed every year.

This Information compiled from