Category: 1. Immunizations

From the moment we become parents, we work to keep our children’s environment safe. We child-proof our homes and make sure poisons and dangerous objects are secured wherever our kids spend time. But we aren’t always as diligent about making sure the community spaces where our children learn and play are protected from threats we can’t see, like infectious diseases.

Just this fall there was a vaccine-preventable disease reported in my son’s 2nd grade class. When he started kindergarten a couple years ago we were told the class was 100% up-to-date on immunizations, so I got done worrying about things like exposures to chicken pox, measles, and mumps from his classmates. We know vaccines aren’t 100% protective, of course, but I took stock in knowing that his class of children was protected as best they could be.

So, when I heard about the case of chicken pox, it reminded me I needed to check back in.

Because he’s fully immunized, I wasn’t worried when I heard the news about this case of chicken pox (varicella vaccine has a high vaccine effectiveness, with 98% of children protected after two doses). But it got me thinking that I needed to contact the school and see how we’re doing. Not just on the state-mandated vaccines, where we scored 100% a couple years ago, but on the  flu shot, too. Often we (as parents) have no idea the percentage of a class that is protected on this essential, every-year vaccine.

How Healthy is Your State?

Every parent should know if their child resides, learns, and plays in a safe environment. Knowing their child’s “world” is up-to-date on vaccines is an important data point, and knowing where your community stands just got a little easier!

The new AAP interactive infographic is a great, high-level view into knowing how your state fairs with status on vaccines and protections from outbreaks of infections like measles and pertussis, as well as influenza.

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Knowing how your community is doing on vaccines and speaking up about what you believe matters. More than ever before, clearly articulating that you vaccinate your child and that you want your child to be surrounded by people that do the same is essential.

Check out your state’s data in the AAP infographic. Get even deeper into the data with online resources like School Digger that allows you to look at vaccine data at the school level.

Pediatricians and parents can partner unlike ever before and with tools unlike we’ve ever had to make sure the spaces where our children spend their days are as safe as possible. Speak up, ask about rates at your schools, and tell other parents how much you value vaccines that protect your children and their friends.

Q. What ingredients are in vaccines?

All vaccines contain antigens. Antigens make vaccines work. They prompt the body to create the immune response needed to protect against infection. Antigens come in several forms. The form used in a vaccine is chosen because studies show it is the best way to protect against a particular infection.

Antigen forms include:

• Weakened live viruses. They are too weak to cause disease but can still prompt an immune response. Measles, mumps, rubella, rotavirus, chickenpox, and one type of influenza vaccine contain weakened live viruses.
• Inactivated (or killed) viruses. These viruses cannot cause even a mild form of the disease, but the body still recognizes the virus and creates an immune response to protect itself. The polio, hepatitis A, influenza and rabies vaccines contain inactivated viruses.
• Partial viruses. These are made up of the specific part of the dead virus that will prompt a protective immune response. Some vaccines are made this way including the hepatitis B and HPV vaccine.
• Partial bacteria. are made up of the specific part of the dead bacteria that will prompt a protective immune response. Some vaccines are made this way including the Hib, pneumococcal, meningococcal, diphtheria, tetanus and pertussis (whooping cough) vaccines. 

Vaccines also contain other ingredients, which help make them safer and more effective. They include:

• Preservatives. They keep the vials from getting contaminated with germs.
• Adjuvants. They help the body create a better immune response. These are aluminum salts.
• Additives. They help the vaccine stay effective while being stored. Additives include gelatin, albumin, sucrose, lactose, MSG and glycine.
• Residuals of the vaccine production process. Some ingredients are needed to make the vaccine. Although these ingredients are removed, tiny (residual) amounts are left in the final product. Depending on how the vaccine is made, it may include tiny amounts of antibiotics (neomycin), egg protein or yeast protein.

Q. Are these other ingredients in vaccines safe?

A. Yes.

Q. Why are these other ingredients in vaccines? 

A. Each ingredient has a specific function in a vaccine. These ingredients have been studied and are safe for humans in the amount used in vaccines. This amount is much less than children encounter in their environment, food and water.

• Aluminum salts. Aluminum salts help your body create a better immune response to vaccines. Aluminum salts are necessary to make some of the vaccines we use more effective. Without an adjuvant like aluminum, people could need more doses of shots to be protected. Everyone is exposed to aluminum because there is much aluminum in the earth’s crust. It’s present in our food, air and water, including breast milk and formula. The amount of aluminum in vaccines is similar to that found in 33 ounces of infant formula. Aluminum has been used and studied in vaccines for 75 years and is safe.
• Formaldehyde. Formaldehyde is used to detoxify diphtheria and tetanus toxins or to inactivate a virus. The tiny amount which may be left in these vaccines is safe. Vaccines are not the only source of formaldehyde your baby is exposed to. Formaldehyde is also in products like paper towels, mascara and carpeting. Our bodies normally have formaldehyde in the blood stream and at levels higher than in vaccines.
• Antibiotics. Antibiotics, such as neomycin, are present in some vaccines to prevent bacterial contamination when the vaccine is made. Trace amounts of antibiotics in vaccines rarely, if ever, cause allergic reactions.
• Egg protein. Influenza and yellow fever vaccines are produced in eggs, so egg proteins are present in the final product and can cause allergic reaction. Measles and mumps vaccines are made in chick embryo cells in culture, not in eggs. The much smaller amount of remaining egg proteins found in the MMR (measles, mumps, rubella) vaccine does not usually cause a reaction in egg allergic children.
• Gelatin. Some vaccines contain gelatin to protect them against freeze-drying or heat. People with severe allergies to gelatin should avoid getting gelatin-containing vaccines.

Q. Do vaccines contain antifreeze?

A: No. Antifreeze is typically made of ethylene glycol, which is unsafe. Confusion has arisen, because polyethylene glycol (a chemical used in antifreeze and personal care products like skin creams and toothpaste) is used in vaccines and is safe. It is used to inactivate the influenza virus in some influenza vaccines. It is also used to purify other vaccines.

Q. Do vaccines contain mercury?

A: Almost all childhood vaccines do NOT contain any mercury. Methylmercury, which is found in fish and other animals (including humans) can be toxic and lead to adverse effects in humans. Thimerosal, a mercury-based preservative, was removed from most childhood vaccines in 2001. Thimerosal contains a different form of mercury called ethylmercury, which is processed by the body very differently than methylmercury, and is not associated with the same adverse effects. It is still present in some influenza vaccines. Thimerosal is still used in the manufacture of some vaccines to prevent contamination. The thimerosal is removed at the end of the manufacturing process. In some cases, a tiny amount of thimerosal remains. The remaining amount is so small, that it is not possible for it to have any effect. Valid scientific studies have shown there is no link between thimerosal and autism. In fact, autism rates have actually increased since thimerosal was removed from childhood vaccines. The American Academy of Pediatrics (AAP), the American Medical Association (AMA), the CDC, and the Institute of Medicine (IOM) agree that science does not support a link between thimerosal in vaccines and autism.

Q. Do vaccines contain fetal tissue?

A. No. A few vaccines involve growing the viruses in human cell culture. Two cell lines provide the cultures needed for producing vaccines. These lines were developed from two fetuses in the 1960s. The fetuses were aborted for medical reasons, not for the purpose of producing vaccines. These cell lines have an indefinite life span, meaning that no new aborted fetuses are ever used. No fetal tissue is included in the vaccines, either, so children are not injected with any part of an aborted fetus.

Q. Should vaccines be “greener”?

A. The amount of each additive used in vaccines is very small. In fact, we are exposed to much higher levels of these chemicals in our everyday lives. In vaccines, these ingredients are used to make the vaccine safer and more effective. Each vaccine is tested many times to make sure it is safe and works. Taking ingredients out might affect the ability of the vaccine to protect a child. Research is always being done to make sure that ingredients in vaccines continue to be the safest and best available for children.

As a parent, you may have questions about vaccines for your preteen. Below are frequently asked questions and answers you need from the American Academy of Pediatrics (AAP) to be confident about your decision to vaccinate.

HPV Vaccine Parent FAQs

Why is the HPV vaccine recommended at such a young age?

• The HPV vaccine is more effective if given sooner rather than later. This is partly because pre-teens produce more antibody after HPV vaccination than older teens do.  This is why younger adolescents need fewer HPV vaccine doses than older teens need to get the same protection.
  • For teens who start the series before their 15th birthday, the HPV vaccine is now approved as a 2-dose series. The doses should be given 6 to 12 months apart.
  • If the vaccine is started at age 15 or later, a 3-dose series of HPV vaccine is given (over a six-month period) for adequate protection.

Why does my son need HPV vaccine if it protects against cervical cancer?

• The most common cancer caused by HPV is cancer of the mouth and throat. This HPV cancer is more common in males than females.
  • HPV vaccine can prevent other HPV-caused problems such as cancers of the penis and anus, and genital warts.
  • HPV vaccine does prevent cervical pre-cancer and cancer in females. A preteen boy who receives HPV vaccine can protect his future spouse. When grown, a man who is infected and doesn’t know it (there are usually no symptoms) can spread HPV to his partner.

If my child is not sexually active, why is the HPV vaccine needed?

• If we wait to vaccinate until someone is sexually active, the vaccine won’t work as well.  Vaccines only work if given before someone is exposed to a virus. People may be infected with HPV without having sex outside marriage. They may be exposed to the virus during intimate touching or from intercourse during marriage. The HPV vaccine seems to last a lifetime—so it can never be too early to vaccinate, only too late. In short, the vaccine is recommended when it is most effective. Why wait?

Is HPV common enough to warrant vaccination of all young people?

• Studies show that 50-80% of people test positive for HPV within 2-3 years of the first time they engaged in sexual activity, making it important that preteens receive the full series before first sexual activity. The Centers for Disease Control and Prevention (CDC) reports that as many as 64% of teen or preteen girls may be infected with HPV, and 75% of new cases of HPV are found in persons age 15-24 years. Even if your child waits until he is married and or only has one partner in the future, your child could still be exposed to HPV by that partner.

Will receiving HPV vaccine give my child permission to engage in sexual activity?

• As pediatricians, we understand this concern—we want teens to be mature before sexual activity. Studies show that children who receive HPV vaccine do not have sex any earlier than those who only received other teen vaccines. This tells us that children do not see this vaccine as a license to have sex.

FAQs About All Preteen Vaccines 

Do adolescent vaccines have serious side effects?

• Pain: Pediatricians do not like to cause discomfort to children of any age. Even though shots may hurt, getting a vaccine is not as bad as suffering from a serious disease such as meningitis or cancer. Talk with your pediatrician about ways to reduce pain during vaccination. Stroking the skin or applying pressure to the skin before the shot reduces the pain. In some offices, medication to numb the skin may be available.
• Fainting: Your pediatrician may ask your child to sit for 15 minutes after getting any shot in case your child faints (syncope). Staying seated for 15 minutes reduces the main risk from fainting — getting hurt from falling.
• Vaccination at sick visits: Many families are busy, and it is hard to find time to visit the pediatrician’s office to get a shot. It is smart to get any vaccines that are due when your child is in the pediatrician’s office. This will reduce the chance that your child has to miss school, work, or other activities to receive vaccines.
• Safety: All vaccines routinely recommended for preteens have been licensed by the Food and Drug Administration and found to be safe. The safety of each vaccine continues to be checked after it is licensed. Your pediatrician can provide you with a Vaccine Information Statement that explains the mild side effects that can occur after receiving shots.

Why is more than one dose of vaccine needed?

• HPV vaccine: It is recommended that your child receives 2 doses of HPV vaccine between the ages of 9 and 12 for full and lasting protection. Both doses of the HPV vaccine are needed for the body to build up enough immunity to protect against infection. This is also true of many of the vaccines that babies get.
• Meningococcal vaccine: One dose of meningococcal vaccine protects a person, but immunity may decrease over time. A booster dose can “boost” immunity so that your child is still fully protected. Children should receive meningococcal vaccine as preteens to be fully protected for a few years and another dose at age 16 to boost immunity levels.
• Tdap: Recently, there have been several outbreaks of pertussis (whooping cough) throughout the United States. One study has shown that this is due, in part, to decreasing immunity. It is possible that booster doses of pertussis vaccine (in Tdap) will be recommended in the future. Studies are still underway to determine exactly when they will be needed.

What is the cost of these vaccines? I’m not sure if I can afford them or if my insurance will cover them.

• Pediatricians realize that healthcare can be costly for families. The Affordable Care Act (ACA) requires insurance companies to cover the cost of all recommended vaccines, which include those for teens and preteens. (If your insurance plan has been unchanged since March 23, 2010, it may not have to follow these new rules. If this is the case, your insurance plan may require you to pay part of the vaccination cost or meet your deductible before it will pay for vaccinations. Talk with your pediatrician about options for paying this.)
• The Vaccines for Children (VFC) Program vaccines at no cost to children.
  • A child qualifies for VFC vaccine if she/he:
  • Does not have health insurance,
  • Has Medicaid insurance
  • Has insurance that does not cover vaccines
  • Is American Indian or Alaskan Native

My child has a cold and fever.  Can she receive any vaccinations while she’s sick?

Yes. If an otherwise healthy child only has a mild illness such as a runny nose, a low-grade fever, an ear infection, a cough, or mild diarrhea, she can safely be vaccinated.

Many parents put off check-ups because they dread how their child might act when they need a shot. If your child—or you—are afraid of pain from getting a vaccine, you are not alone. At least two-thirds of children and one-fourth of adults have a fear of needles.

Help your child feel more in control

It is natural to want to wait until the last minute on the way to the clinic to tell your child they are getting a shot. While you may think you are helping avoid stress, it makes more stress for you and for them. Being prepared sets the stage for a better experience.

• Use words that create a positive story about their experience. Words matter. Try more neutral words like “pressure,” “pinch,” “poke” and “immunization” instead of “pain” and “shot.” For example: “We get to go to the doctor and get medicine that helps keep you healthy” feels different than “We have to go to the doctor and get a shot.”
• Let them know you understand their worries. This is even more important if they already feel nervous or anxious. Telling kids that it is “not a big deal” or “don’t worry” can make them feel like you do not understand their feelings, and actually make anxiety worse.
• You can make your child feel heard but still help them cope at the same time. Say something like, “I know! It’s not much fun. You’re not looking forward to it, are you? I get it. That’s why we’re going to make a plan so you can feel more comfortable and in control.” This can help your child feel like you are listening, and you are there for them. You are letting them know that their concerns are reasonable and there is something to do about them. These actions help all of us better manage our anxiety.
• And don’t apologize. We say we are sorry when we do something wrong. Taking care of your child’s health is not wrong.
• Provide a good reason why they need the vaccine. Knowing why can motivate your child. You can explain, “We get vaccines because it protects you from getting sick and keeps you healthy.” For older kids, you can say, “Because it helps your body build immunity to fight off harmful infections.” Pointing out that they are doing good for the community can be powerful, too.

Make a plan

Before you go, make a clear plan with your child and be ready to share it with your medical provider. Sometimes people think that having a medical procedure means giving up control. But feeling empowered with plan is an option, and it makes for a much better experience. When people know how to face a challenge, it is easier to feel in control.

There are even child-friendly guides to help you plan what your child wants to do to be more comfortable and how to avoid feeling pain from the poke. Here are a few ideas.

• Comfort: If your child likes the idea of being held there are many ways you and your child can sit that keep them safe, still and comforted by your touch and closeness. Your touch and the comfort positioning change how the body processes pain signals. It can work for older kids, too.
  
  Note:Kids should never be held down against their will for medical procedures.
• Numbing creams and sprays: Ask your doctor about choices for over the counter or prescription topical anesthetic cream, patches or cooling sprays. Follow the directions to know when to apply it. Some take about 30 minutes to work.
• Vibration: Most people don’t realize that pain is actually “in our head.” When our body feels a possible threat, it sends a warning signal along our nerves to the brain. But there are ways to stop the signal from reaching our brain. One way is to use vibration on the skin to create a traffic jam in the nervous system. When we place a vibration tool on the arm (or leg for younger kids) just above where the shot is given, it stops the signal, changes the sensation and prevents the pain.
• Distraction: You know how hard it can be to get your child’s attention when they are deeply focused on a video or playing a game on their smartphone. Use that same tool to direct their attention away from anxiety and pain. Let them choose what they want to do to distract themselves before and during the immunization. A few ideas include telling a story, reading a book, singing a song and watching funny videos.
• Take deep breaths: Have your child practice taking easy, slow breaths in and out. It calms them down and lowers their body’s reaction to pain. You can help them by breathing along with them. Blowing bubbles or pinwheels also can help slow their breathing and distract them from the immunization.

Be sure to let the doctor know that you and your child have talked about choices and share your plan.

When the anxiety is too much to handle

For most kids and adults, these strategies are enough to find the sense of control they need to feel calm and confident during medical procedures. However, for some children and adults, the anxiety can be too overwhelming. They may need more help overcoming their past negative experience. If so, seek support from a mental health professional or child life specialist.

Keep in mind that how you are feeling has a big impact on how your child will react during a medical procedure. Stress is contagious, but so is calm.

You know your child best

Some parents don’t speak up because they feel intimidated, or the doctor or nurse doesn’t ask. They may worry that they will upset someone. It’s okay to speak up when you know what works for your child. Your pediatrician needs and wants your input! We all want the same thing—to have the best experience possible. It makes things better now and sets your child up for a lifetime of feeling good about their health care.

Many children and parents associate a trip to the pediatrician with shots. There are actually a couple of vaccines that we don’t give as an injection, specifically the oral rotavirus vaccine. It would be great if we could give them all by mouth, but vaccines contain proteins and complex sugars that are digested quickly in the stomach, so the only way to get most of them into contact with the immune system is to inject them into the skin or muscle.

Combination Vaccines

The good news is that pediatricians have gotten better at minimizing or even eliminating the pain of vaccination. For one thing, we can often administer multiple vaccines in a single injection.

Thanks to combination vaccines, the greatest number of injections many children receive at any given wellness examination is 3. We usually give these vaccines in the thighs during the first few years of life and in the shoulder muscles after that. When staff are available, they can use both legs at the same time to minimize the duration of discomfort. Because what pain there is tends to be experienced as a single event, it is discouraged for parents to spread vaccines out over multiple visits. There is no medical reason to do so, and it tends to prolong the discomfort for everyone.

Pain-Control Techniques

A number of pain control techniques are currently available and can make shots much less stressful. For toddlers and school-aged children, the combination of distraction techniques, like blowing bubbles or playing games and numbing creams or sprays can be very effective for all shots and needle procedures.

Numbing agents include:

• A cooling spray which can be applied just before shots are given so there is no poking sensation.
• Topical anesthetic creams that can also be applied ahead of time to make the skin numb when the shot is given.
• A plastic plate covered with small points and a buzzing sensation that blocks pain signals.

For babies who are nursing, breastfeeding during a vaccination can provide significant pain relief.  Sucking on a pacifier can also be comforting.

Even without using any of these techniques, most babies calm down very quickly after their shots with being held. The calm in your voice and the firm reassurance of your embrace tell your baby that everything is fine. Remember, the shots may hurt for a moment, but the protection they’re giving your baby is good for a lifetime.

Adverse Reactions

By far the most common adverse reactions following vaccination are fever and fussiness, and sometimes there may be a little redness or swelling at the injection site. Many parents ask if they should give acetaminophen (eg, Tylenol, PediaCare Fever Reducer) or ibuprofen (eg, Motrin, Advil) prior to the vaccine visit. In the past we have encouraged using these medications to reduce any discomfort or potential fever from vaccines. Some newer studies have questioned whether giving acetaminophen might make the vaccines slightly less effective, so some pediatricians are no longer recommending it.

Any medication or vaccine has the potential to cause an allergic reaction, sometimes a severe one. Rates of severe allergic reactions with vaccines run in the 1 per million range, making them quite rare.

When to Call the Doctor

No symptoms after receiving vaccines should be dramatic. If your child has a temperature above 102°F or a fever that lasts more than a few days, or if she is unusually fussy, you should still consult her doctor and not just assume her symptoms are from vaccines.

If you notice your child getting hives, wheezing, or seeming unusually ill shortly after she gets vaccines, alert office staff if you’re still there or call emergency medical services (911) if you’re not.

​Why get vaccinated?

Tdap vaccine can prevent tetanus, diphtheria, and pertussis.

Diphtheria and pertussis spread from person to person. Tetanus enters the body through cuts or wounds.

• TETANUS (T), causes painful stiffening of the muscles. Tetanus can lead to serious health problems, including being unable to open the mouth, having trouble swallowing and breathing, or death.
• DIPHTHERIA (D) can lead to difficulty breathing, heart failure, paralysis, or death.
• PERTUSSIS (aP), also known as “whooping cough,” can cause uncontrollable, violent coughing which makes it hard to breathe, eat, or drink. Pertussis can be extremely serious in babies and young children, causing pneumonia, convulsions, brain damage, or death. In teens and adults, it can cause weight loss, loss of bladder control, passing out, and rib fractures from severe coughing.

Before vaccines, the United States saw as many as 200,000 cases a year of diphtheria and pertussis, and hundreds of cases of tetanus.

Tdap vaccine

Tdap is only for children 7 years and older, adolescents, and adults.

Adolescents should receive a single dose of Tdap, preferably at age 11 or 12 years.

Pregnant women should get a dose of Tdap during every pregnancy, to protect the newborn from pertussis. Infants are most at risk for severe, life-threatening complications from pertussis.

Adults who have never received Tdap should get a dose of Tdap.

Also, adults should receive a booster dose every 10 years, or earlier in the case of a severe and dirty wound or burn. Booster doses can be either Tdap or Td (a different vaccine that protects against tetanus and diphtheria but not pertussis).

Tdap may be given at the same time as other vaccines.

Talk with your health care provider

Tell your vaccine provider if the person getting the vaccine:

• Has had an allergic reaction after a previous dose of any vaccine that protects against tetanus, diphtheria, or pertussis, or has any severe, life-threatening allergies.
• Has had a coma, decreased level of consciousness, or prolonged seizures within 7 days after a previous dose of any pertussis vaccine (DTP, DTaP, or Tdap).
• Has seizures or another nervous system problem.
• Has ever had Guillain-Barré Syndrome (also called GBS).
• Has had severe pain or swelling after a previous dose of any vaccine that protects against tetanus or diphtheria.

In some cases, your health care provider may decide to postpone Tdap vaccination to a future visit.

People with minor illnesses, such as a cold, may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting Tdap vaccine.

Your health care provider can give you more information.

Risks of a vaccine reaction

• Pain, redness, or swelling where the shot was given, mild fever, headache, feeling tired, and nausea, vomiting, diarrhea, or stomachache sometimes happen after Tdap vaccine.
• People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears.
• As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death.

What if there is a serious problem?

An allergic reaction could occur after the vaccinated person leaves the clinic. If you see signs of a severe allergic reaction (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness), call 9-1-1 and get the person to the nearest hospital.

For other signs that concern you, call your health care provider.

​Why get vaccinated?

Td vaccine can prevent tetanus and diphtheria. Tetanus enters the body through cuts or wounds. Diphtheria spreads from person to person.

TETANUS (T) causes painful stiffening of the muscles. Tetanus can lead to serious health problems, including being unable to open the mouth, having trouble swallowing and breathing, or death.

DIPHTHERIA (D) can lead to difficulty breathing, heart failure, paralysis, or death.

Td vaccine

Td is only for children 7 years and older, adolescents, and adults.

Td is usually given as a booster dose every 10 years, but it can also be given earlier after a severe and dirty wound or burn.

Another vaccine, called Tdap, that protects against pertussis, also known as “whooping cough,” in addition to tetanus and diphtheria, may be used instead of Td.

Td may be given at the same time as other vaccines.

Talk with your health care provider

Tell your vaccine provider if the person getting the vaccine:

• Has had an allergic reaction after a previous dose of any vaccine that protects against tetanus or diphtheria, or has any severe, life-threatening allergies.
• Has ever had Guillain-Barré Syndrome (also called GBS).
• Has had severe pain or swelling after a previous dose of any vaccine that protects against tetanus or diphtheria.

In some cases, your health care provider may decide to postpone Td vaccination to a future visit.

People with minor illnesses, such as a cold, may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting Td vaccine.

Your health care provider can give you more information.

Risks of a vaccine reaction

Pain, redness, or swelling where the shot was given, mild fever, headache, feeling tired, and nausea, vomiting, diarrhea, or stomachache sometimes happen after Td vaccine.

People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears.

As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death.

What if there is a serious problem?

An allergic reaction could occur after the vaccinated person leaves the clinic. If you see signs of a severe allergic reaction (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness), call 9-1-1 and get the person to the nearest hospital.

Many parents put off check-ups because they dread how their child might act when they need a shot. If your child—or you—are afraid of pain from getting a vaccine, you are not alone. At least two-thirds of children and one-fourth of adults have a fear of needles.

Help your child feel more in control

It is natural to want to wait until the last minute on the way to the clinic to tell your child they are getting a shot. While you may think you are helping avoid stress, it makes more stress for you and for them. Being prepared sets the stage for a better experience.

• Use words that create a positive story about their experience. Words matter. Try more neutral words like “pressure,” “pinch,” “poke” and “immunization” instead of “pain” and “shot.” For example: “We get to go to the doctor and get medicine that helps keep you healthy” feels different than “We have to go to the doctor and get a shot.”
• Let them know you understand their worries. This is even more important if they already feel nervous or anxious. Telling kids that it is “not a big deal” or “don’t worry” can make them feel like you do not understand their feelings, and actually make anxiety worse.
• You can make your child feel heard but still help them cope at the same time. Say something like, “I know! It’s not much fun. You’re not looking forward to it, are you? I get it. That’s why we’re going to make a plan so you can feel more comfortable and in control.” This can help your child feel like you are listening, and you are there for them. You are letting them know that their concerns are reasonable and there is something to do about them. These actions help all of us better manage our anxiety.
• And don’t apologize. We say we are sorry when we do something wrong. Taking care of your child’s health is not wrong.
• Provide a good reason why they need the vaccine. Knowing why can motivate your child. You can explain, “We get vaccines because it protects you from getting sick and keeps you healthy.” For older kids, you can say, “Because it helps your body build immunity to fight off harmful infections.” Pointing out that they are doing good for the community can be powerful, too.

Make a plan

Before you go, make a clear plan with your child and be ready to share it with your medical provider. Sometimes people think that having a medical procedure means giving up control. But feeling empowered with plan is an option, and it makes for a much better experience. When people know how to face a challenge, it is easier to feel in control.

There are even child-friendly guides to help you plan what your child wants to do to be more comfortable and how to avoid feeling pain from the poke. Here are a few ideas.

• Comfort: If your child likes the idea of being held there are many ways you and your child can sit that keep them safe, still and comforted by your touch and closeness. Your touch and the comfort positioning change how the body processes pain signals. It can work for older kids, too.
  
  Note:Kids should never be held down against their will for medical procedures.
• Numbing creams and sprays: Ask your doctor about choices for over the counter or prescription topical anesthetic cream, patches or cooling sprays. Follow the directions to know when to apply it. Some take about 30 minutes to work.
• Vibration: Most people don’t realize that pain is actually “in our head.” When our body feels a possible threat, it sends a warning signal along our nerves to the brain. But there are ways to stop the signal from reaching our brain. One way is to use vibration on the skin to create a traffic jam in the nervous system. When we place a vibration tool on the arm (or leg for younger kids) just above where the shot is given, it stops the signal, changes the sensation and prevents the pain.
• Distraction: You know how hard it can be to get your child’s attention when they are deeply focused on a video or playing a game on their smartphone. Use that same tool to direct their attention away from anxiety and pain. Let them choose what they want to do to distract themselves before and during the immunization. A few ideas include telling a story, reading a book, singing a song and watching funny videos.
• Take deep breaths: Have your child practice taking easy, slow breaths in and out. It calms them down and lowers their body’s reaction to pain. You can help them by breathing along with them. Blowing bubbles or pinwheels also can help slow their breathing and distract them from the immunization.

Be sure to let the doctor know that you and your child have talked about choices and share your plan.

When the anxiety is too much to handle

For most kids and adults, these strategies are enough to find the sense of control they need to feel calm and confident during medical procedures. However, for some children and adults, the anxiety can be too overwhelming. They may need more help overcoming their past negative experience. If so, seek support from a mental health professional or child life specialist.

Keep in mind that how you are feeling has a big impact on how your child will react during a medical procedure. Stress is contagious, but so is calm.

You know your child best

Some parents don’t speak up because they feel intimidated, or the doctor or nurse doesn’t ask. They may worry that they will upset someone. It’s okay to speak up when you know what works for your child. Your pediatrician needs and wants your input! We all want the same thing—to have the best experience possible. It makes things better now and sets your child up for a lifetime of feeling good about their health care.

Why get vaccinated?Meningococcal B vaccine can help protect against meningococcal disease caused by serogroup B. A different meningococcal vaccine is available that can help protect against serogroups A, C, W, and Y.

Meningococcal disease can cause meningitis (infection of the lining of the brain and spinal cord) and infections of the blood. Even when it is treated, meningococcal disease kills 10 to 15 infected people out of 100. And of those who survive, about 10 to 20 out of every 100 will suffer disabilities such as hearing loss, brain damage, kidney damage, loss of limbs, nervous system problems, or severe scars from skin grafts.

• Anyone can get meningococcal disease but certain people are at increased risk, including:
• Infants younger than one year old
• Adolescents and young adults 16 through 23 years old
• People with certain medical conditions that affect the immune system
• Microbiologists who routinely work with isolates of N. meningitidis, the bacteria that cause meningococcal disease
• People at risk because of an outbreak in their community

Meningococcal B vaccine

For best protection, more than 1 dose of a meningococcal B vaccine is needed. There are two meningococcal B vaccines available. The same vaccine must be used for all doses.

Meningococcal B vaccines are recommended for people 10 years or older who are at increased risk for serogroup B meningococcal disease, including:

• People at risk because of a serogroup B meningococcal disease outbreak
• Anyone whose spleen is damaged or has been removed, including people with sickle cell disease
• Anyone with a rare immune system condition called “persistent complement component deficiency”
• Anyone taking a type of drug called a complement inhibitor, such as eculizumab (also called Soliris®) or ravulizumab (also called Ultomiris®)
• Microbiologists who routinely work with isolates of N. meningitidis

These vaccines may also be given to anyone 16 through 23 years old to provide short-term protection against most strains of serogroup B meningococcal disease; 16 through 18 years are the preferred ages for vaccination.

Talk with your health care provider

Tell your vaccine provider if the person getting the vaccine:

• Has had an allergic reaction after a previous dose of meningococcal B vaccine, or has any severe, life-threatening allergies.
• Is pregnant or breastfeeding.

In some cases, your health care provider may decide to postpone meningococcal B vaccination to a future visit.

People with minor illnesses, such as a cold, may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting meningococcal B vaccine.

Your health care provider can give you more information.

Risks of a vaccine reaction

Soreness, redness, or swelling where the shot is given, tiredness, fatigue, headache, muscle or joint pain, fever, chills, nausea, or diarrhea can happen after meningococcal B vaccine. Some of these reactions occur in more than half of the people who receive the vaccine.

People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears.

As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death.

What if there is a serious problem?

An allergic reaction could occur after the vaccinated person leaves the clinic. If you see signs of a severe allergic reaction (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness), call 9-1-1 and get the person to the nearest hospital.

For other signs that concern you, call your health care provider.

Adverse reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your health care provider will usually file this report, or you can do it yourself. Visit the VAERS website or call 1-800-822-7967. VAERS is only for reporting reactions, and VAERS staff do not give medical advice.