Children currently receive 22-23 shots before they enter school, including:
- 3 doses of Hepatitis B
- 5 doses of DTaP
- 3-4 doses of Hib
- 4 doses of IPV (polio)
- 4 doses of Prevnar
- 2 doses of MMR
- 1 dose of Varivax (chickenpox)
And they may also get a yearly flu shot and the hepatitis A series of shots.
Every parent (and Pediatrician) would like for kids to get less shots. However, there are only a few ways for this to happen:
- You could choose to not vaccinate your kids and put them at risk of vaccine preventable illnesses.
- You could hope that these vaccine preventable illnesses will be totally eliminated worldwide so that the vaccine isn't needed anymore. The first candidate for this will likely be polio, and although cases continue to drop, the target date for eradication is not until 2005. The eradication of other infections, such as measles, is so far off, I don't think there are real target dates for it to happen.
- You could ask for combination vaccines to decrease the number of shots your child gets. The ACIP, AAP, and AAFP 'recommend that combination vaccines may be used whenever any components of the combination are indicated and its other components are not contraindicated.'
Your child likely already gets a number of combination vaccines. The DTaP vaccine combines the diphtheria, tetanus, and acellular pertussis immunizations into one shot. Similarly, the MMR vaccines combines measles, mumps, and rubella.
And other vaccines are also technically combinations, including Prevnar, which protects against 7 subtypes of the Strep. pneumo bacteria, the inactivated polio vaccine (IPV), which protects against three types of the poliovirus, and the flu vaccine, which covers three types of flu.
Decreasing the Number of Shots
Other combination vaccines which your children may not be offered can also help to decrease the number of shots they get. These combination shots include:
- New! Pediarix - combines the immunizations for Diphtheria, Tetanus and acellular Pertussis (DTaP), Hepatitis B and inactivated Polio (IPV), which used to require three separate shots. It can be given at age 2, 4, and 6 months.
- Comvax - combines the hepatitis B and Hib vaccine into one shot. It is given as a three dose series and if your child completes the series, he will get 4 fewer shots than a child who got the shots separately (3 hepatitis B shots and 4 Hib shots).
- TriHIBit - combines Hib and DTaP. Unfortunately, this vaccine is only licensed for use as the fourth dose of the vaccination series at age 15-18 months. So at most, it will save you one shot and you wouldn't use it if you had completed the Comvax series of shots.
- Twinrix - combines hepatitis A and hepatitis B into one shot and is given as a 3 dose series. Unfortunately, it is only approved for use in people aged 18 years or older.
Other combination vaccines will hopefully be available soon, including shots that combine:
- MMR and Varivax
- DTaP and IPV
- DTaP and hepatitis B
- DTaP, IPV, and Hib (Pentavac)
- DTaP, hepatitis B, and Hib
- DTaP, IPV, Hib and hepatitis B (Hexavac)
- DTaP, Hib, IPV, hepatitis A, and hepatitis B
I don't know when these new combination shots will be available or if they will ever be approved, but the combination DTaP, hepatitis B, and IPV vaccine has already been tested. A study in the Pediatric Infectious Disease Journal concluded that giving the 'DTaP-HBV-IPV vaccine with Hib vaccine is at least as safe as administering individual DTPa, Hib, and OPV vaccines.'1 So hopefully FDA approval isn't too far off.
A combination of DTaP and hepatitis B has also been tested and found to be 'safe and immunogenic when given to infants at 2, 4 and 6 months of age.'2
And combination vaccines are already in use outside of the United States. A combination of DTaP-IPV/Hib, which is called Pentavac, is used in Europe and has been available since 1997. A recent study, Antibody persistence in five-year-old children who received a pentavalent combination vaccine in infancy,3 confirmed the vaccine's effectiveness.
Hexavac (DTaP, IPV, Hib and hepatitis B) has also been tested and found to be 'generally well-tolerated and provided immune responses adequate to be protective against six infectious diseases with a single injection, given at 2, 4 and 6 months of age.' 4 Hexavac is already approved for use in Europe.
Combination vaccines with DTaP and hepatitis B and another with DTaP and IPV are also licensed outside the US.
Hopefully, more testing is being done to get these combination vaccines FDA approved for use in the United States.
These new combination vaccines will greatly decrease the number of individual shots that kids need. Using just the Pentavac vaccine would decrease to 16 the number of shots children get before they start school.
Even with Pentavac, younger children will still get a lot of shots at each visit. Currently, at two months, most kids get the DTaP, IPV, Hib, hepatitis B and Prevnar vaccines. So, with Pentavac, that would still be 3 shots at one time. With Hexavac it would just be 2 shots.
Decreasing the Pain from Shots
If the idea of 2 or 3 shots is still too much for you to think about, until they come out with a super vaccine that combines everything into a single shot, or edible vaccines, you might consider using EMLA cream when your child gets his vaccines.
EMLA is an anesthetic that can be applied to your child's skin so that he doesn't feel the injection. Studies have shown that the 'EMLA patch has no adverse effect on the antibody response to MMR vaccine and significantly reduces the pain associated with the subcutaneous administration of the vaccine.'5
The downside is that you have to apply the cream 60 minutes before the shot, you have to know where to apply it, and there is the added cost of buying the EMLA cream. And other studies that show that EMLA is safe when used with other vaccines have not been completed yet.
EMLA is now available as an EMLA Anesthetic Disc (also called a patch or pad) that makes its application even easier. A box with two discs costs about $10-$15.
Combination Vaccines Drawbacks
The biggest one right now is that the Vaccines For Children program, which provides vaccines to children without insurance coverage for vaccines, doesn't always provide or pay for combination vaccines. If your doctor's office is a VFC provider, they would have to maintain two vaccine schedules for those children with and without insurance, which can be confusing.
Pediarix is currently covered by the VFC program though.
And combination vaccines may not work as well as getting the immunizations individually. That is why you just can't mix the shots together. A lot of research has to go into making sure combination shots are safe and that the work well.
References:
1 Safety and immunogenicity of a pentavalent diphtheria, tetanus, pertussis, hepatitis B and polio combination vaccine in infants. Yeh SH - Pediatr Infect Dis J - 01-Oct-2001; 20(10): 973-80
2Safety and immunogenicity of a combination diphtheria-tetanus toxoids-acellular pertussis-hepatitis B vaccine administered at two, four and six months of age compared with monovalent hepatitis B vaccine administered at birth, one month and six months of age. Greenberg DP - Pediatr Infect Dis J - 01-Aug-2002; 21(8): 769-77
3Antibody persistence in five-year-old children who received a pentavalent combination vaccine in infancy. Carlsson R - Pediatr Infect Dis J - 2002 Jun; 21(6); 535
4Immunogenicity and safety of a new liquid hexavalent combined vaccine compared with separate administration of reference licensed vaccines in infants. Mallet E - Pediatr Infect Dis J - 01-Dec-2000; 19(12): 1119-27
5Lidocaine-prilocaine patch decreases the pain associated with the subcutaneous administration of measles-mumps-rubella vaccine but does not adversely affect the antibody response. Halperin SA - J Pediatr - 01-Jun-2000; 136(6): 789-94
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