What to Know About Childhood Vaccines

One of the most important ways parents can protect a child’s health is with vaccination. Vaccines are safe and help the body’s immune system learn how to fight germs. But according to a recent study, not enough toddlers — only about 1 in 6 — are getting needed doses.

“Vaccines are life-saving and have been in place for a long time to prevent diseases,” says Dr. Melissa Stockwell, director of the Child and Adolescent Health Clinical Service at NewYork-Presbyterian/Columbia University Irving Medical Center and chief of the Division of Child and Adolescent Health at Columbia University Vagelos College of Physicians and Surgeons. “They are just one more tool in your toolbox to protect your children.”

Now is a good time to talk to the doctor to be sure your child is fully vaccinated. Many schools require children between 2 months and 18 years receive certain medications to attend. In addition, the Centers for Disease Control and Prevention (CDC) have now officially recommended a new RSV antibody shot to protect infants and some high-risk children against RSV — the leading cause of infant hospitalization in the country.

Every year, the CDC, American Academy of Pediatrics, and other leading health care organizations publish a recommended vaccination schedule for children ages 18 or younger after a rigorous review of scientific data.

Health Matters spoke with Dr. Stockwell, who is also an associate professor of Pediatrics at Columbia University Vagelos College of Physicians and Surgeons and of Population and Family Health at Columbia University Mailman School of Public Health, to answer questions about vaccine safety, the new RSV shot, which vaccines children need and when they need them.

Are vaccines safe?
Dr. Stockwell: Absolutely. Today’s vaccines go through many years of rigorous testing before they are ever given to humans. This is all done to ensure they are safe, effective and include only the necessary ingredients.

When do vaccines typically start for children?
Vaccines start at birth and continue with a regular cadence of immunizations throughout childhood and adolescence.

Are children required to get vaccinated before starting school?
All states follow mandatory vaccination guidelines for children going to child care facilities (including day cares) and schools. This is to keep every child safe and protected from preventable diseases. Check the school’s health forms to know which vaccines your child needs in order to attend.

What do parents need to know about the new RSV antibody shot?
The new RSV antibody injection, named nirsevimab, provides infants and toddlers with antibodies to protect against severe RSV illness. The CDC recommends one dose for all infants younger than 8 months, who were either born during or entering their first RSV season. That’s when a baby is most at risk for severe illness. For a small group of children between the ages of 8 and 19 months who are at increased risk of severe RSV disease, a dose is recommended in their second RSV season.

The ideal timing is in the first week of life for infants born shortly before and during the season, and shortly before the start of the RSV season for infants less than 8 months old and those 8 to 19 months who are at increased risk of severe RSV disease.

Nirsevimab is safe and effective. In studies, it reduced the risk of medically-attended illness (meaning when children have to visit a physician office, urgent care, or emergency room, or need hospitalization) for RSV in infants by about 70 to 75%. Nearly every child will get an RSV infection by the time they are 2 years old. While much of the time RSV can be a mild, cold-like illness, it can also cause severe illness which is what we are trying to protect children from. Nirsevimab is expected to be available this fall.

The bulk of vaccinations are given before a child turns 1 year old. Is it safe to give a young infant so many shots?
The number of shots a baby needs in their first year of life might seem overwhelming, but according to decades of scientific data, it’s completely safe to give many shots at one time. In fact, that is how these vaccines were studied. A baby’s immune system is more resilient than you might think. The ingredients in vaccines—for instance, inactivated strains of the virus — come in quantities that are significantly lower than what babies would come into contact with in their everyday environment.

How strictly do parents need to follow this schedule?
We definitely recommend that people follow this vaccine schedule as closely as possible because it protects children and adolescents against diseases that are still out there. There is a lot of thought put into the right timing of the vaccine schedule and is based on what experts think is the best way to get kids protected.

What are the possible side effects?
Common side effects include some mild swelling or redness where the shot was given, fussiness in infants, a low-grade fever, headache, and sleepiness. These are nothing to worry about. It means that the vaccine is working.

If, on the other hand, your child has a more severe reaction, such as a full body rash, difficulty breathing, or swelling of the face and throat, contact their doctor immediately.

Why do some vaccines need booster shots while others don’t?
There are some vaccines — for instance, the measles vaccine—where only one or two doses are needed, and then you don’t need it again for the rest of your life. But there are others — like the flu and COVID-19 vaccines — where the virus mutates just enough so that last year’s vaccine isn’t protective against this year’s variant. Those need to be given more frequently because we need to keep training the body to continue fighting off the virus.

Melissa S. Stockwell, M.D. M.P.H, is chief of the Division of Child and Adolescent Health and associate professor of Pediatrics at Columbia University Vagelos College of Physicians and Surgeons and of Population and Family Health at the Mailman School of Public Health. Her research, which concentrates on underserved children and adolescents, focuses on translational interventions to improve vaccinations with an emphasis on health technology and health literacy. Dr. Stockwell is the medical director of the NewYork-Presbyterian Immunization Registry (EzVac) and director of the Columbia University Primary Care Clinician Research Fellowship in Community Health. Additionally, she is a pediatrician at NewYork-Presbyterian Morgan Stanley Children’s Hospital and a NewYork-Presbyterian-affiliated community clinic. She also serves on the New York City Department of Health and Mental Hygiene’s Immunization Improvement Team.