Vaccines Seek to Offer Cradle-to-Grave Protection

While the shots still save young lives, advances look to protect older folks, too

FRIDAY, Aug. 29, 2008 (HealthDay News) -- Immunization shots used to be the realm of the young.

Babies would go through series after series of vaccinations. And toddlers would take their shots before entering preschool.

And they still do. But vaccines are now expanding to include all age ranges, in an attempt to ward off disease from the cradle to the grave.

What's more, immunization rates continue to gradually improve in the United States, although not as quickly as public health officials would like.

About 77 percent of children 19 months to 35 months had received all their recommended vaccinations in 2007, according to the U.S. Centers for Disease Control and Prevention. It falls short of the federal goal of 80 percent but is a small improvement over the 76 percent rate found in 2005.

"We may have a little way to go, but that's not bad," said Dr. Thomas Weida, professor of family and community medicine at Penn State's Hershey Medical Center. The government's next goal is 90 percent of kids in that age range immunized by 2010.

Public health officials see these regular vaccinations as a wall holding back terrible diseases that have plagued mankind for centuries: measles, whooping cough, rubella, diphtheria, tetanus and mumps, among others.

"Vaccines are probably one of the top two or three public health interventions of all time," said Dr. Doug Campos-Outcalt, associate chairman of the Department of Family and Community Medicine at the University of Arizona College of Medicine, Phoenix Campus. "They now have been so successful, they suffer from their success, because people don't see the diseases and the horrors associated with them."

The immunization goals are part of an effort to ensure that even those who don't receive vaccinations will be protected from disease by those who do, Weida said.

"You get something called herd immunity, although I wish there were a better name for it," he said. "If you get enough people vaccinated, even people who aren't vaccinated are protected, because the disease can't transmit. The virus can't get past the wall of vaccinated people we've created."

Most of the biggest changes in the immunization schedule have targeted preteens ages 11 to 12, Campos-Outcalt said.

There are new immunizations available for meningitis, human papillomavirus (HPV), and tetanus/diphtheria/pertussis in that age range, he said.

"It's kind of a coincidence," Campos-Outcalt said. "Several vaccines for that age group just kind of came up."

The HPV immunization is unique in that it is the first vaccine that can prevent a form of cancer. Girls are provided the vaccine to prevent the spread of HPV, a sexually transmitted disease that can result in cervical cancer.

The HPV vaccine has been somewhat controversial, with some religious and conservative groups arguing that it promotes promiscuity.

"The issue is explaining the vaccine at a time when neither the child nor the parent want to think about this, when the girl is still preteen," Weida said. "I say, 'This is to prevent cervical cancer, and you have to receive it before you're infected.' "

Unfortunately, some vaccinations have been lagging in teenagers. Researchers have found that immunization goals for children 13 to 17 have fallen short in all the recommended vaccines.

The problem is that most children enter public elementary schools, where there are strict immunization requirements, Weida said. Not as many go on to college, however, where they would face the same requirements.

"There's not the same push if you're not going to college, so they don't think about it," Weida said.

Influenza is another disease receiving a huge immunization push from public health officials. The flu vaccine soon will be recommended for children through age 18, Campos-Outcalt said.

"I think eventually it will be universally recommended for everyone, every year," Campos-Outcalt said. "This is just an incremental step in that direction."

Weida agreed. "We need to do a better job at immunizing people against flu," he said. "Everyone over 50 should get one, and so should kids, because we're discovering they're the reservoir for flu. They're in a closed container called school, so they transmit it easily between themselves, and then they bring that little present home."

New vaccines also have been springing up for the elderly, specifically immunization that provides protection against pneumonia and shingles.

To keep track of all these changes, Weida recommends that families choose a doctor and stick with him or her.

"If my patients come in for a routine visit or a sick visit, I'll look at their immunization record," he said. "You're not going to get that so much if you're bouncing around from provider to provider, because they're not going to have the record."

A more promising means of making vaccination easier is the movement toward creating nasal or oral vaccines, Campos-Outcalt said. A nasal flu vaccine already has been produced, and others are on the way.

A widespread belief that some childhood vaccines are linked to autism has hampered improvement of the vaccination rate, despite numerous studies that have disproved the claim.

It has become a great source of frustration among public health experts, Campos-Outcalt said.

"To me, it's kind of puzzling," he said. "The evidence is becoming clearer every day that vaccines do not cause autism. But there are some very stubborn groups out there who still make that claim."

More information

To learn more about vaccines, visit the CDC.

SOURCES: Thomas Weida, M.D., professor, family and community medicine, Milton S. Hershey Medical Center, Penn State Univerity, Hershey, Pa.; Doug Campos-Outcalt, M.D., associate chairman, Department of Family and Community Medicine, University of Arizona College of Medicine, Phoenix Campus; U.S. Centers for Disease Control and Prevention
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