There are many questions that parents have about immunizations for their child. This article is designed to help you find answers to questions like:

Why should my child be vaccinated?

Immunization, also known as vaccination, is a medical technique that has been used for nearly 300 years to protect patients from illness and death by diseases caused by various bacteria and viruses. Modern medical advances have led to the development of more effective and even safer vaccines that protect millions of children around the world every year. The goal of vaccinations is to strengthen your child's immune system by teaching it how to fight off specific dangerous germs before your child is actually ever exposed to these diseases.

Essentially, vaccines "wake-up" your child's immune system, and prepare it for protecting the body against specific infections. Without the head start or "training camp" that vaccinations provide, your child would be at greater risk of serious illness and life-threatening complications when exposed to these aggressive infections. This is especially important when dealing with potentially lethal viral infections, since antibiotics are not effective against these kinds of organisms. Preventing your child from getting sick from these infections is essential, since treatment after the fact is far less effective, or may not be possible at all. As in most aspects of health, an ounce of prevention is better than a pound of cure.

Before the use of vaccinations, many thousands of children around the world, even here in North America, died annually from complications of common childhood infections like measles, rubella, whooping cough, diptheria and polio; many more suffered with life-long disabilities as a result of these infections.

When should my child be immunized?

The answer depends on how old your child is at present. Several new and important vaccines, notably ones for preventing meningitis, pneumonia and chicken pox, were introduced as part to the standard schedule of provincially covered vaccinations for children in Ontario in 2005. For several years before this, many children were already receiving these vaccines either through private insurance or payment methods, though at slightly different ages than is now covered by OHIP.

Below, you will find a table with the current recommended immunization schedule for newborns in Ontario. These are the basic and minimum kinds of vaccinations your child should receive. As you look at the table, you will see that when it comes to the vaccine for preventing meningitis caused by the bacteria N.meningiditis type C (one of the most deadly kinds of meningitis), the current provincial recommendation is for only one shot at 12 months of age. However, most pediatricians in Canada recommend, if cost is not an issue, that infants should instead receive earlier doses to protect them better during their first year of life; these earlier shots are not covered under OHIP, and would have to be paid for privately. As well, the vaccinations to prevent cervical, penile and anal cancer and HPV infection, although recommended by the National Advisory Committee on Immunization, are only provided as an optional vaccine by the Ontario provincial health plan when administered at school by Toronto Public Health to female students in grade 7.

If your child was born before 2005, the newer vaccines may have been missed. However, those children with access to private health insurance plans, or whose parents paid privately for the extra services, may have received these vaccines. If you're not sure if your child received these immunizations, check with your physician and you will be advised of an appropriate catch-up schedule for your child. Unfortunately, the manner in which provincial regulators designed the catch-up schedules may leave some older children ineligible for the extra vaccines. You can review your child's immunization record with your physician to clarify the situation, and determine the best course of action for your child.

recommended immunization schedule for children in Ontario (2010)
most vaccinations are provided at no cost under the Ontario Health Insurance Plan.
$
denotes recommended vaccines that are not covered by OHIP, but are covered by most private medical insurance plans.

age in months
vaccine to help prevent 2 3 4 5 6 7 12 15 18 2 years 4 to 6 years
DPTP diptheria
tetanus
pertussis
polio
Hib epiglottitis,
meningitis
(H.influenzae-b)
 
PneuC 13 pneumonia,
ear infection,
sepsis,
meningitis
(S.pneumoniae)
high
risk
high
risk
 
Rota severe
diarrhea
(Rotavirus)
 
MMR measles combined
as MMR-V
mumps
rubella
 
VZ chicken pox
(Varicella zoster)





combined
as MMR-V
 
Men meningitis
(N.meningiditis)
strain C
$


optional
$


optional
$








optional
strain A
strain W-135
strain Y
vaccine to help prevent   12 years  
(grade 7)
females
      (grade 8)      
9 to 26 years
males or females
HepB hepatitis B
(given at school)
 
Men-ACWY meningitis
(N.meningiditis
A,C,W-135,Y)
(given at school)
 
HPV 4 cervical cancer
and genital warts

given at school
(under OHIP)
optional optional optional
males (any age)
or females at
other ages

not covered
by OHIP
$




optional
$




optional
$




optional
vaccine to help prevent 14 to 16 years every 10 years every autumn
dTaP diptheria
tetanus
pertussis
 
Td diptheria after age 24 years
tetanus
 
influenza TIV flu,
pneumonia



if age > 6 months

Why does my child need more than one shot of a particular type of vaccine?

The number of doses your child needs in order to gain lasting immunity to a particular disease depends on both the age of your child, as well as the type of vaccine. During a child's first year of life, the immune system is still developing. They are more susceptible to infections in this period, and have a harder time fighting off many diseases if they are exposed.

Vaccinations during infancy are designed to boost their naive immune system's ability to fight off some of the most dangerous childhood illnesses. Although this bolstered immunity lasts for a while, the very fact that your child's immune system is still developing is what limits their bodies from "remembering" how to fight off these infections for very long. The booster doses of vaccines at specific intervals are designed to help their bodies reinforce the protective responsive against these infections.

By the time your child is 12 months old, their immune system has developed enough that fewer doses (or, in some cases, even just one dose) may be sufficient to provide lasting immunity to specific infections. This raises the question: why not wait until your child is a year old before starting the vaccines? After all, it would mean less shots. However, waiting that long would leave your children unprotected during the most vulnerable first months of life, when their immune system may not be strong enough to keep them safe from aggressive and life-threatening infections. Simply, the answer is to reduce their risk during what is already a high risk time in their life.

Nevertheless, scientists continue to work on creating more effective vaccines. New techniques have led to the creation of better carrier molecules which are designed to help the body develop a stronger memory in their ability to fight off an infection. Some of these new vaccines have already made their way into the regular childhood immunization schedule, and more are on the way. The goal is to have as few shots as possible, while having the best and most lasting protection. Though no parent relishes the thought of subjecting their child to an injection, it helps to remember that things have already come a long way, and the risks of not protecting your child with immunizations are just too high. It's important that your child does not miss any doses of their recommended vaccines.

What kinds of vaccines does my child need?

As listed in the schedule above, there are many different immunizations that your child will receive in their first year. A vaccine against a single bacteria or virus may help prevent multiple forms of infection or diseases. Conversely, some diseases, like meningitis, can be caused many different kinds of microbes, and a vaccine against each of these is needed to protect your child. Often times, vaccines against various germs may be combined into a single shot to minimize the discomfort to your child.

Vaccines produced by various manufacturers may be marketed under different trade names; however, the types of combinations have been standardized:

  • QuadracelTM and Adacel-PolioTM(DPTP)combine the immunizations against diptheria, pertussis, tetanus, polio.
  • PediacelTM (DPTP+Hib) consist of the combination of Quadracel with the vaccine to prevent diseases caused by H.influenzae type b. PediacelTM replaced the older PentacelTM vaccine for this purpose.
  • AdacelTM (dTap), is a modified combination intended as a booster, resulting in immunization against diptheria, tetanus and pertussis.
  • Tdis the regular shot adults receive every decade in order to boost immunity to tetanus and diptheria.
  • Prevnar-13TM (PneuC-13)provides immunization against different serotypes of S.pneumoniae. In November 2010, Prevnar-13, which promotes immunity against 13 serotypes, will have replaced Prevnar-7TM and SynflorixTM, which were designed to immunize your child against 7 and 10serotypes of the S.pneumoniae bacterium, respectively.
  • M-M-R IITM and PriorixTM (MMR)are forms of the combined immunization to prevent measles, mumps and rubella; it contains live attenuated (weakened) forms of these bacteria). In 2011, Priorix will be provided combined with the vaccine for chickenpox, in a form known as Priorix-TetraTM.
  • VarilrixTM (VZ), and previously Varivax IIITM, is a single vaccine used to prevent or reduce the severity of chicken pox infections; it contains a live attenuated strain of the virus. This is soon expected to be supplanted by the combination Priorix-TetraTM vaccine, to be given at a modified date.
  • HepBviral infection is immunized against with a specific vaccine type geared to adolescents in grade 7; it requires only two vaccinations, as opposed to the regular three shots required for vaccination at other ages.
  • flu shot TIVare made by multiple manufacturers, and provides immunity to the three specific strains of influenza predicted to invade your region for the oncoming flu season (october to april). This injectable TIV (triple inactivated vaccine) form contains killed viral particles, and is the only form currently provided under OHIP coverage in Ontario. (The nasal spray FluMistTM vaccine, which contains live virus, is not available under OHIP.)
  • GardasilTM (HPV 4)enhances immunity the four strains of human papilloma virus that lead to most cases of cervical cancer and anogenital warts (HPV types 6, 11, 16 and 18). It has also been associated with some forms of penile cancer.
  • Neisvac-CTM and MenjugateTM (Men) help immunize infants against meningitis caused by N.meningitis type C. At present these are the only forms of vaccination against N.meningitis available for children under 2 years of age. Until 2009, this was also the form of the vaccine given to 12-year-olds at school.
  • MenactraTM (Men) provides immunity against four strains (A,C,W-135,Y) that cause meningitis due to N.meningitis, and can be given to children who are at least 2 years of age. As of 2010, this is the form of meningitis vaccine given to adolelscents at school under OHIP.

What kinds of diseases do these vaccines prevent?

Diphtheria is a serious disease of the nose, throat and skin that can cause sore throat, fever and chills. The poison made by the diphtheria bacteria can lead to breathing problems, heart failure and nerve damage. Diphtheria can kill one out of every 10 people who get the disease. It is usually spread through coughing, sneezing and contact with objects, like tissues or pens, used by someone infected with diphtheria.

Pertussisor whooping cough can be a dangerous disease, especially in young children. Pertussis spreads very easily through coughing, sneezing or contact with the discharge of an infected person. It causes violent coughing fits, often resulting in vomiting, and can be severe enough to make very young children stop breathing. The cough can last for many weeks, and makes it hard to eat, drink or breathe. Pneumonia occurs in more than one out of five children with pertussis. It can also cause brain damage and, in rare cases, death. Children less than one year of age are most likely to have severe illness or die from pertussis, particularly if they have missed any of their vaccines.

Tetanus, also known as lock-jaw, is a lethal infection that can occur when tetanus bacteria get into a cut in the skin. This the bacteria that your mother was trying to warn you about when she told you not to step on a rusty nail. Despite the misconception, it's not the rust that's dangerous; it's the tetanus bacteria that can reside on dirty and sharp objects. Tetanus bacteria are found everywhere, including dust, soil and animal manure, and can survive for long periods in the soil as resilient spores. Tetanus causes severe cramping and painful spasms of the muscles in the neck, arms, legs and stomach, and can eventually prevent breathing. It kills up to two out of every 10 people who get the disease. Fortunately, tetanus is not generally spread between people.

Polio is a disease of the spinal cord that can lead to nerve damage, resulting in severe weakness or paralysis for life. It can pass from person to person through contaminated water, food or through direct contact with an infected individual. Thanks to vaccinations, polio is generally considered to have been eliminated in Canada; however, due to it's seriousness, and the fact that children may still be exposed here or abroad, it is felt to be important to continue immunize against this dangerous disease.

Haemophilus influenzae serotype b, not to be confused with the viral flu, is a bacteria that can infect the lining of the brain and spinal cord, leading to meningitis. It can also lead deafness and a severe throat infection known as epiglottitis that can make it difficult for your child to breathe; in serious cases, it can lead to brain damage and death, and children under five years of age are at the highest risk. Haemophilus can spread between children through coughing and sneezing, and can remain in the nose and throat of some people without causing any symptoms; this can lead to unintentional spread of the infection.

Measlesis a serious infection that begins with the common viral prodrome of fever, cough, red eyes and a runny nose. It spreads easily through droplets in the air from the sneezes of coughs of infected persons. This is followed by a red rash that starts on the face, and spreads to the rest of the body. Measles can lead to ear infections, pneumonia, as well as brain infection known as encephalitis, which can lead to brain damage and death. Measles is so infectious that over 98 per cent of people must be protected to prevent outbreaks in the community, and two full doses are required because measles to ensure protection.

Mumps is a viral infection that initiates with fever, headache and swelling of salivary glands in the cheeks and jaw. Its spreads through respiratory droplets when infected persons cough or sneeze. Mumps can also lead to encephalitis or meningitis (infections of the brain or lining of the spinal cord or brain), causing permanent brain damage. Other complications that can occur include deafness, painful swelling of the testicles in teenage boys and men or the ovaries in women and girls; this can lead to sterility in men. Mumps infection during the first three months of pregnancy may also increase the risk of miscarriage.

Rubellaor German Measles is a mild viral illness that typically presents with symptoms of a mild fever, enlarged lymph nodes and a rash that lasts about three days. Adults may experience headache, fatigue, runny nose, red eyes and, rarely, swelling of the joints. It is spread through coughing or sneezing, or direct contact with mucous or phlegm from an infected person. Rubella is included as an essential vaccine not only because of the illness that it causes to young children, but because of the extreme danger that it poses to your child's future reproductive potential: if a woman who has not previously been immunized against rubella gets pregnant, and is then exposed to rubella during the first few months of pregnancy, there is a high risk of severe birth defects such as cataracts, deafness, heart defects, and mental retardation, or the pregnancy can end in a miscarriage or stillbirth. Because of these serious complications, one of the goals of vaccination is reduce or eliminate the chance of chance of exposure to Rubella in the general population.

Chickenpox is caused by infection with the highly contagious herpes family virus, varicella zoster. Transmission between people can easily occur by direct contact with nose and throat discharges from an infected individual. It is also spread by contact with liquid from the blistering rash that occurs on the skin of infected individuals, or by objects that have been in recent contact with the rash. Chickenpox is usually a mild disease, with a low grade fever and a characteristic itchy rash that progresses from red bumps to blisters that burst, crust over and may cause permanent scarring. The illness is usually more severe in adolescents and adults. Complications from chickenpox can include secondary bacterial infection of the skin, ear infection, and less commonly, pneumonia, inflammation of the lining of the spinal corn or brain, and death.

Streptococcus pneumoniae is a bacteria which causes otitis media (middle ear infections), pneumonia (infection of the lung), and is the leading cause of sepsis (infection of the blood) and meningitis (infection of the lining of the brain and spinal cord) in children. It can be spread by sneezing, sharing eating utensils, kissing or when children put shared toys in their mouths; it can also be spread and retained in the nose and throat of many people without causing symptoms. Antibiotic treatment for it is not always effective, and it still leads to long-lasting injury or death in a small number of children with severe illness, particularly those with meningitis. Those at most risk of infection or severe illness include young children attending group day care, or children with asthma, heart disease or cancer. Children who are being breastfed have a lower risk of getting S.pneumoniae infections. Every year in Canada, 15 children under five years of age die from Streptococcus pneumoniae infections, 65 get meningitis and 700 get blood infections. Many more get pneumonia and middle ear infections. It is worth noting that although children vaccinated against S.pneumoniae may still get ear infections, they are less likely to have recurrent infections or require surgery to place tubes in their ears (myringotomy) as a consequence of ear infections.

Meningitis C is an infection of the lining of brain or spinal cord caused by the bacteria Neisseria meningiditis type C. It spreads through close contact with the saliva of infected individuals, for example by kissing, coughing, or sharing common items such as toys, drinking straws, eating utensils or cups; since one third of people your child is exposed to may be symptom-free carriers of this bacteria, the chance of exposure is high. It is most commonly seen in children under two years of age and adolescents between 15 and 19 years of age, and can lead to long lasting injury or death in ten per cent of infected children. About one in 20 children who survive meningitis will have brain damage. In addition, even with treatment, approximately half of all children with meningococcal septicemia (blood infection ) will die or have lasting disability.

Hepatitis Bis a virus that can cause either a short or life-long persistent infection that can lead to liver damage, liver cancer and death. There is no definitive cure for hepatitis B. It is transmitted through contact with bodily fluids (blood, breast milk, semen or vaginal secretions), either directly from person to person contact, or else through open wound exposure to a contaminated object. The hepatitis B virus can remain viable and infectious for more than three days on contaminated objects.

Influenza, also known as the Flu, is a viral infection of the nose, throat and lungs. It causes cough, high fever, headaches, muscle pains, and sometimes gastrointestinal upset. It can lead to middle ear infections, bronchiolitis, pneumonia, heart failure and death. Children who do not receive the flu shot are at significant risk of hospitalization if they catch the flu. The severity of disease varies annually depending on the prevalent strains of virus in different regions. The influenza virus can spread through droplets in the air from coughing or sneezing, or by handling contaminated toys and objects.

Human Papilloma Virus (HPV) infections can affect the skin and mucous membranes of the oral and anogenital regions. Certain types of HPV, in particular types 6, 11, 16 and 18, cause more than 70% of cervical cancer, as well as a significant proportion of penile, other anogenital and head and neck cancers. Most cases of HPV infection may be asymptomatic or undetectable; however, the presence of anogenital warts, even transiently, can be important indicator of infection. HPV can be transmitted through skin-to-skin contact with the infected area, through sexual contact, or from mother to child during the process of delivery.

Does getting the vaccine guarantee that my child will never get these diseases?

We know that getting vaccinating is definately more likely to save your child's life than simply relying the possibility of antibiotic or anti-viral treatment once they are infected. However, there is no treatment in medicine that can prevent disease one hundred per cent of the time. For example, Pentacel, when given according to the recommended schedule, protects 85 per cent of children against pertussis, more than 95 per cent against diphtheria, virtually 100 per cent against tetanus, 99 per cent against polio and 95 per cent against serious Haemophilus meningitis infections. Vaccination can also make these diseases, especialy pertussis, milder if they do occur. The measles-mumps-rubella vaccine protects almost everyone for life; it also makes the diseases milder for those who may still have been infected.

Are there any risks to vaccinating my child?

Whenever someone is to exposed to any foreign substances, whether foods, antibiotics or vaccinations, there is an extremely small chance that their body may react negatively to that exposure. As we know from experience, the incidence of such allergic reactions to a particular molecule is very low. After all, we are exposed to hundreds of new chemicals each day. Even if they do occur, the reactions are usually short-term and not life threatening; however, it is important to always take them seriously and see a doctor to assess your child. Certain vaccines, like MMR and VZ, contain weakened forms of live viruses in order to train your children's immune system effectively; individuals with impaired immune systems, such as HIV/AIDS or congential immune deficiencies, should not receive live vaccines such as these. Fortunately, science continues to deliver better tested and safer vaccines, and the ones on the market today have dramatically less reactions that those received by most of us in our childhood.

Understandably, most parents have concerns, especially given the amount of misinformation and pseudo-science that can circulate. Even the most discerning parent can get alarmed. After all, every one's highest goal is to keep your child safe. The important thing is to remember that the chance of such reactions is taken into account before a vaccine is even offered to your child, so unless your child has had a previous allergic reaction to the same vaccine or components of the vaccine, there is rarely any reason to avoid immunizing your child. It is simply a matter of making the choice that offers your child the most overall protection and safety. It's an easy decision.

    trademarks
  • QuadracelTM, PentacelTM, PediacelTM, AdacelTM, Adacel-PolioTM and MenactraTM are registered trademarks of Sanofi Pasteur Ltd.
  • SynflorixTM, VarilrixTM, PriorixTM and Priorix-TetraTM are registered trademarks of GlaxoSmithKline Inc.
  • PrevnarTM and Prevnar-13TM are registered trademarks of Wyeth.
  • GardasilTM, M-M-R IITM and Varivax IIITM are registered trademarks of Merck Frosst Canada Ltd.
  • MenjugateTM is a registered trademark of Chiron Corporation, used under license by Merk Frosst Canada Ltd.
  • Neisvac-CTM is a registered trademark of Baxter Ltd, used under license by GlaxoSmithKline Inc.
  • FluMistTM is a registered trademark of Medimmune LLC.
    references
  1. PentacelTM: fact sheet. Toronto Public Health, Mar 2006.
  2. MMR: fact sheet. Toronto Public Health, Mar 2006.
  3. Prevnar-13TM: fact sheet. Toronto Public Health, Nov 2010.
  4. PrevnarTM: fact sheet. Toronto Public Health, Jun 2005.
  5. RotateqTM: fact sheet. Toronto Public Health, 2010.
  6. Meningitis C: quick reference. Toronto Public Health, 2005.
  7. Publicly funded immunization schedules for Ontario. Ministry of Health and Longterm Care, Feb 2005.
  8. Communicable diseases in Toronto. Toronto Public Health, 2002.
  9. Canada Communicable Disease Report: Statement on Human Papilloma Virus. NACI, Health Canada. 15 Feb 2007.
  10. Influenza Fact Sheet. Toronto Public Health, October 2010.
  11. DTAP: fact sheet. Ontario Ministry of Health, Jun 2009.