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There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. This is Kid's Health Cast by Weill Cornell Medicine. I'm Melanie Cole. The diseases that vaccines prevent can be dangerous or even deadly, especially in infants and young children. Vaccination is one of the best ways parents can protect their children from life-threatening diseases. Joining me today is Dr. David Laufgraben. He's an Assistant Professor of Clinical Pediatrics at Weill Cornell Medicine and an Assistant Attending Pediatrician at New York Presbyterian Weill Cornell Medical Center.

Melanie: Dr. Laufgraben, it's a pleasure to have you with us. This is such a timely topic since we hear so much about vaccines in the media, and it's such an important topic as well. Please tell us first, a little history of vaccines. What are some vaccine preventable diseases?

Dr. Laufgraben: Absolutely. Thanks for having me. It's exciting to be here. And this is a great opportunity to talk about childhood vaccines. So the list of diseases that are preventable with vaccines is a long one and it's been growing and that's a great thing. It includes, conditions like chicken pox, diphtheria, H flu, hepatitis A and B, HPV, the regular flu, measles, meningococcal bacteria, mumps, whooping, cough, pneumococcus, polio, rotavirus, rubella, shingles, tetanus, yellow fever, and typhoid.

That is a mouthful. It is a growing list, and every one of them is important, to protect your kids against some of them only when they are traveling. But most of them, we routinely vaccinate kids for.

Melanie: So I think the big question on everyone's minds and parents, especially new parents, are immunizations safe. And how do we know that?

Dr. Laufgraben: Whether vaccines are safe is a great, important question. And it's one that I get a lot, it's important for parents to be asking questions like those. We want them to be advocates for their kids and to always be asking what is the safest practice for keeping their kids healthy. To answer it? Yes, vaccines are extremely safe. They are the products of years of research and strictly run clinical trials that establishes their safety and their efficacy. All of this is done under the eye of the Food and Drug Administration, which is a government agency that exists to protect public health.

Even after vaccines are approved, they continue to be closely monitored. There's a national system for reporting any unusual, serious, possible side effects among vaccinated kids, so that all of those cases can be carefully investigated. But the reason that our vaccines were approved in the first place for children and the reason that they're given out to millions of kids each year is because their more serious side effects are extremely rare. They are generally really well tolerated by both kids and infants. The more common side effects that we see are minor ones, fever or fussiness, redness at the site of the injection.

Those typically go away within one to two days. For a few vaccines, such as chicken pox, you can have a delayed reaction where kids get a rash and fever sometimes a few weeks later. And that kind of reaction just shows that your child's immune system is functioning the way we expect it to.

Melanie: So doctor, I'd love for you to address some myths and concerns that parents sometimes have about vaccines. One might be, the diseases like polio and mumps. We don't really see them very much anymore. They're rare. So why are vaccines for those still necessary?

Dr. Laufgraben: That's another great question. And it's one we do get, and I think it's a question that reflects the fact that vaccines have been really successful. So a lot of the serious illnesses vaccines prevent used to be a lot more common. Kids were paralyzed with polio. They filled up hospitals with brain infections from H flu and they developed whooping cough, a disease that was known as the hundred-day cough for its persistent respiratory symptoms that could even be fatal.

But, while all of the diseases that vaccines prevent are far less common today, they are not gone. Here in New York City, we were reminded of that recently, when a dip in vaccination rates led to an outbreak of measles in 2019 with over 600 cases to illustrate this, some pediatricians compare getting vaccinated to making sure that your child wears a seatbelt.

None of us expect to get in a car accident, just like nobody expects their child to catch measles or whooping cough, but accidents can still happen and vaccines like seatbelts help to protect your child from the unexpected. The other thing I want to point out is that when you vaccinate your child, you not only protect them, but you help protect all of the people around them as well, including kids and adults with cancer or rare immune disorders who may not even be allowed to get vaccinated.

Melanie: Well then doctor, another thing that I even felt as a new mother myself, 20 years ago, when they said, oh, they're going to get two today or three, will giving babies multiple vaccines at one time overload their immune system? What's the rationale behind multiple vaccines?

Dr. Laufgraben: So another great question and another common one. First, I want to say that getting multiple vaccines at one visit is absolutely safe. These vaccines, they boost the healthy immune system. They don't overwhelm it. The truth is that all of our immune systems encounter way more germs in our day-to-day lives than we are ever exposed to by vaccination. And our immune system can handle multiple vaccines given at the same time. And when we give them that way, it allows us to protect kids from more diseases at the earliest possible age.

Now, for your other question, why are multiple doses necessary? It's another great question and that gets back to all the research that goes into developing these vaccines in the first place. Our goal is to have a safe vaccine that is effective at preventing disease and is durable, that it provides protection that lasts. And when we do the vaccine research, we find out for each one of them, how many doses are necessary to achieve those things. So for some vaccines, we need multiple doses to get that efficacy rate high so it really does a great job protecting against the disease. Some vaccines, we have to give a booster, later on down the road because we noticed that the efficacy of that vaccine tends to dip over time. So we boost it up by giving another dose. So the story for each vaccine is a little different, but the goal is always the same. We want a safe vaccine that's effective and that lasts as long as possible.

Melanie:  And now let's clear up a few big ones. Tell us about the link between vaccines and autism. Clear this up once and for all. And then tell us if there's an association between a reduction in SIDS and vaccinations.

Dr. Laufgraben: So those are two hot button issues, and I'm glad we're addressing them. First, let's talk about autism. So, this question about any link between autism and vaccines is an important one for all of us in healthcare and for parents everywhere and accordingly, it has been exhaustively researched. The records of millions of kids from all over the world has been systematically studied, and there is no evidence of a link between autism and vaccines. The causes of autism and the best ways to support kids who are on the autistic spectrum will continue to be heavily researched questions. But all the information we do have, which is a huge amount, says that vaccines do not cause autism.

Now, when it comes to SIDS, and SIDS for your listeners is sudden infant death syndrome. It's the sudden death of a baby younger than one years old that doesn't have a known cause even after a complete investigation has been done. A number of studies have carefully looked at whether there is any relationship between early childhood vaccines and SIDS, and there is no evidence linking SIDS to vaccines. None that has ever been found. The other thing I like to point out is that the SIDS rate declined significantly in the 1990s, when we started telling parents that babies should sleep on their back in cribs, and then it stayed low into the two thousands. And the two thousands is when the childhood vaccine rate really increased. So even as we were vaccinating more and more infants and babies, the SIDS rate stayed nice and low, which is one more assurance that vaccination does not cause SIDS.

Melanie: Doctor, what do you say to parents that have questions about delaying some vaccines? They've heard about following an alternative schedule. Tell us about the risks of not vaccinating. They hear about herd immunity. And we've heard a lot about that recently. Tell us about what you say to parents that have concerns about this.

Dr. Laufgraben: So when a parent wants to delay or even skip certain vaccines, to me, that means they have questions or concerns about them that just have not yet been answered. And I think an important part of my job is to take those questions and concerns seriously and spend time addressing them to the best of my ability.

We really can only help kids, when we form a positive partnership with them and with their parents and trust and communication is the cornerstone of that relationship. Now the risk of not taking a vaccine is a real one. Vaccines prevent diseases that are not as common as they used to be because the vaccines are working, but they're still out there.

Kids can still catch whooping cough. They can become very sick or even worse than that from that disease or many others. And when vaccine rates in communities fall, we lose herd immunity. So just to talk about that for a minute. Herd immunity, thinks of us as a herd or a community of people in one area. And the logic behind it is that if the vast majority of that group has been vaccinated, then even if there are individuals in that group who get a disease, if the rest around them are vaccinated, then it's unlikely for that disease to spread. Now, the more people in a group who choose not to get vaccinated, then it becomes easier and easier for even rare diseases that are contagious to spread around because there are fewer people protected from them. So when that happens, we create opportunities for diseases to have larger outbreaks, which is what we saw with measles, recently in New York in 2019, as I mentioned.

Melanie: Let's talk about another biggie, Dr. Laufgraben, chickenpox. I mean, when I was younger, everybody you knew got it. And it was a thing. And now people are really concerned about the vaccine. It's such an important vaccination and now even some schools won't let kids in, unless they've had this one. Tell us about the chicken pox vaccine and why this is so important now.

Dr. Laufgraben: Absolutely. It's true that chicken pox is often a mild disease of childhood. But it is one that can have complications like bacterial skin infections, pneumonia, meningitis, even death can happen to healthy kids due to chickenpox infection. Now let's take a step back and look at it what the situation was like before the vaccine came around in the mid-nineties. Each year, thousands of kids were hospitalized with severe cases of chicken pox and around a hundred people died every year from complications in the United States alone.

If we had more kids getting un-vaccinated for chicken pox, it would mean that there would be more chicken pox in circulation. We would lose the herd immunity that we just discussed, and it would make it more likely that high-risk people who are at really high risk for complications from chicken pox, such as cancer patients, such as pregnant women, could become infected. Since the vaccine was introduced, chickenpox cases have fallen more than 95%, which is incredible progress, but that can be reversed if the vaccine rates fall.

Melanie:    What an important topic we're discussing today, Dr. Laufgraben, and now onto the flu, because right now we're concerned obviously about this pandemic in these historic times that we're living in. And I know a lot of physicians that I've interviewed are worried about this convergence, this perfect storm as it were, of the flu and COVID happening at the same time. Tell us about the flu vaccine and why it's almost more important now than it's ever been.

Dr. Laufgraben: So, as you mentioned, the flu vaccine is especially important this year. It's important every year, but it's never been more important because we are seeing a surge of COVID cases around the country. Unfortunately, the ERs are full of patients with COVID as are the hospital floors and the last thing we want is for people to get very sick from the flu. Most importantly, it's not going to be good for that person's health to have a bad flu infection. It's certainly not going to be good for them to have to seek care around many patients who have COVID and they could get exposed to COVID that way as well. Although we always remind patients to seek care when they need it, regardless of anything else, and it's also not good for our health care system, which is unfortunately on the verge of being overwhelmed with the coronavirus cases. At least, as of, now in December when we're having this conversation and hopefully that will improve, but we want to take as much of weight off of the hospitals and the clinics as possible. And we want to keep people healthy for all those reasons, it's so important to get your flu vaccine this year and I encourage all of our listeners to do so. There's a lot of myths about the flu. Since we've been talking about myths, some people ask can getting the flu vaccine, give you the flu and I always like to clear that up. The flu vaccine we give out is an inactivated vaccine that does not contain any live virus. Basically, we inject a small dead part of the virus so that the immune system can recognize what the virus looks like and learn how to fight it when the real thing comes along. The vaccine cannot give you the flu.

Melanie: Wow. Thank you so much for clearing all of this up doctor, what an important episode this is. As we wrap up, during this outbreak, can and should patients still come in for their vaccinations? Please wrap it up for us and let parents know what you would like them to know about the importance of vaccinations and now even more than ever just as important and what you're doing to keep them safe when they do come in for their well visits and their vaccines.

Dr. Laufgraben: Absolutely. So this is such an important question and maybe the most important question that we cover today. As we're all painfully aware, we're living through a scary time with the coronavirus pandemic and I support the position of the American Academy of Pediatrics, which is our national pediatrician organization, which is that kids should continue to see their pediatricians during this outbreak, on schedule to get their vaccines.

Now, as pediatricians, we need to do everything we can to make sure those visits remain as safe as possible for kids and for their parents. And we're certainly doing that here at Cornell. We are taking lots of precautions, including masking, hand-washing, which we always did before. We're very rigorous about. We are always prioritizing vaccine visits during the earlier part of the day and kids with symptoms, who may have some sort of disease at the end of the day. So they're not in the waiting room together. We're very careful about cleaning rooms. There are other precautions on top of that. To the parents listening, I encourage you to reach out to your pediatrician's office or wherever you may seek care for your child and have this conversation with them. Be reassured by all the precautions your doctor's office is taking. So you have the confidence to bring your child in, to get vaccinated and take all the precautions that you can as well in your own life because we do need to keep vaccinating our kids. The days when children's hospitals were packed with kids with all of these diseases that vaccines prevent, seems far off now, but those days can come back and I'm afraid they will if we don't continue to vaccinate our kids and vaccinate them on time. We should do everything we can to prevent the threat of Coronavirus from giving rise to years of increased illness in children due to under vaccination.

Melanie: I 100% agree. What great information you've given us today, doctor. Thank you so much for joining us and sharing this really vital message at this time. So thank you again. And Weill Cornell Medicine continues to see our patients in-person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

Thank you so much to our listeners. That concludes today's episode of Kids Health Cast. Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips like this and updates, follow us on your social channels. I'm Melanie Cole.