child-vaccines-parent-guide

What’s in Your Child’s Vaccines? A Guide for Parents

2 of 3 from the Vaccine Series

Written by Dr. Rachel Culleton, naturopathic pediatrician

When my child was born I spent an exceptional amount of time researching vaccines. Did I remember ANY of what I had learned by the time I got to his well-child visit? No. I was a new parent, I was exhausted, but luckily I found a provider I trusted. They helped me navigate the CDC’s recommended vaccine schedule and create a plan that fit my child’s needs.

Vaccinating our children is a personal choice. As parents, we lean very heavily on medical recommendations made by our children’s providers to make that choice.

It is your medical provider’s job to educate you on the...
  • Risks associated with the disease
  • Pros and cons of each vaccine
  • Alternative immunization schedules
  • Exemption options if you choose to forgo immunizations

I advise you as parents to do your own research. Focus on the diseases and what vaccine schedule you are comfortable with for your child. 

As parents, it is important that you understand the...
  • Vaccines you are immunizing your child with
  • Components of those vaccines
  • Potential risks or side effects of the vaccine

Here is a guide of the most common U.S. vaccines, their ingredients and side effects. Vaccine ingredients are a major topic of concern when it comes to discussing side effects and childhood development. I hope this list provides you with the education and the clarity you need to make an informed decision on vaccines for your children.

The Most Common Child Vaccines: Ingredients & Side Effects

DTaP

What is the DTaP vaccine?
The DTaP vaccine prevents the spread of diphtheria, tetanus, and pertussis from person-to-person. DTaP may be given as a stand-alone vaccine, or as part of a combination vaccine (a vaccine that combines more than one vaccine together into one shot). The two standalone vaccines licensed in the US for Children under the age of 7 years are:

The combination vaccines licensed in the US for children under the age of 7 are: 

  • Kinrix® (GlaxoSmithKline) DTaP and Polio
  • Pediarix® (GlaxoSmithKline) DTaP, Polio, and Hepatitis B
  • Pentacel® (Sanofi Pasteur) DTaP, Polio, and Hib 

The CDC recommends that children receive 5 doses of DTaP: 2 months, 4 months, 6 months, 15-18 months, and 4-6 years.

What is actually in the DTaP vaccine?
The standalone DTaP vaccine contains diphtheria toxoid, tetanus toxoid, and a combination of acellular pertussis antigens. Other vaccine ingredients include aluminum phosphate or hydroxide as the adjuvant, residual formaldehyde, residual glutaraldehyde, polysorbate 80, and 2-phenoxyethanol. Ingredients included in the manufacturing of the vaccine include but are not limited to Stainer-Scholte medium, modified Mueller’s growth medium, modified Mueller-Miller casamino acid medium, Fenton medium (containing bovine extract), modified Latham medium (derived from bovine casein), modified Stainer-Scholte liquid medium.

Which DTaP vaccine contains the least amount of aluminum per dose?

Are there risks associated with the DTaP vaccine?
The most common adverse reactions to the DTap vaccine:

  • Soreness and swelling at the site of injection
  • Fever
  • Fussiness
  • Feeling tired
  • Decreased appetite
  • Vomiting

Rare and more serious side effects include febrile seizures, non-stop crying for 3 or more hours, Guillain-Barré Syndrome, or high fever over 105°F. Rarely the vaccine leads to swelling of the entire arm or leg.

Hib

What is the Hib vaccine?
The Hib vaccine prevents the person-to-person spread of Haemophilus influenzae type b. Hib may be given as a stand-alone vaccine, or as part of a combination vaccine. The three standalone vaccines licensed in the US for Children: 

The CDC recommends that children receive 4 doses of the Hib vaccine: 2 months, 4 months, 6 months, and 12-15 months.

What is actually in the Hib vaccine?
ActHIB® and Hiberix® use a tetanus toxoid as the protein carrier for the Haemophilus influenzae type b polysaccharide capsule. PedvaxHib® uses a Meningococcal group B outer membrane protein as the protein carrier. Other vaccine ingredients may include (depending on the brand) ammonium sulfate, formalin and sucrose. Ingredients included in the manufacturing of the vaccine include but are not limited to Modified Mueller Medium, Modified Miller Medium, formaldehyde, lactose, semi-synthetic medium, aluminum hydroxyphosphate, sulfate, ethanol, enzymes, phenol, detergent, complex fermentation medium.

Are there risks associated with the Hib vaccine?
The most common adverse reactions to the Hib vaccine: 

  • Infants 2-16 months: fussiness (75%), inconsolable crying (58%), and decreased activity (51%)
  • Children 15-20 months: swelling, redness, and/or pain was experienced in 5-30% 

Serious adverse reactions of the Hib vaccine are rare but include Guillain-Barre syndrome, seizures, and renal failure.

Pneumococcal conjugate Vaccine (PCV)

What is the PCV vaccine?
The only PCV vaccine licensed in the USA to prevent the person-to-person spread of Pneumococcal disease in children is Prevnar13® (Wyeth), also known as PCV13. The CDC recommends that children receive 4 doses of the PCV13 vaccine: 2 months, 4 months, 6 months, and 12-15 months.

What is actually in the PCV vaccine?
Prevnar13® includes purified capsular polysaccharide of 13 serotypes of Streptococcus pneumoniae conjugated to a nontoxic variant of diphtheria toxin (CRM197). PCV13 contains approximately 2.2 micrograms (µg) of polysaccharide from each of 12 serotypes and approximately 4.4 µg of polysaccharide from serotype 6B; the total concentration of CRM197 is approximately 34 μg. The vaccine contains 0.02% polysorbate 80, 125µg of aluminum as aluminum phosphate adjuvant, and succinate buffer. Ingredients included in the manufacturing of the vaccine include but are not limited to casamino acids, yeast, and soy peptone broth.

Are there risks associated with the PCV vaccine?
The most common adverse reactions to the PCV13 vaccine:

  • Irritability
  • Pain and tenderness at the injection site
  • Decreased appetite
  • Changes in sleep patterns
  • Fever

Severe adverse reactions with the PCV13 vaccine are rare. Two large clinical trials showed a correlation between an increase in hospitalizations for reactive airway disease and PCV13 recipients1.

Polio

What is the Polio vaccine?
The Polio vaccine licensed and approved for use in the US is an inactivated form of polio that contains all 3 serotypes of the virus. The vaccine can be given as a standalone, IPOL® (Aventis Pasteur), or combination. The combination vaccines licensed in the US are combined with DTaP and only approved for children under the age of 7 are: 

  • Kinrixl® (GlaxoSmithKline) DTaP and Polio
  • Pediarix® (GlaxoSmithKline) DTaP, Polio, and Hepatitis B
  • Pentacel® (Sanofi Pasteur) DTaP, Polio, and Hib 

The CDC recommends children get 4 doses of polio vaccine: 2 months, 4 months, 6-18 months, and 4-6 years.

What is actually in the Polio vaccine?
The viruses grown for the IPOL® vaccine are grown in a type of monkey kidney tissue culture (vero cells) and are inactivated with formaldehyde. Other vaccine ingredients include 2-phenoxyethanol, and trace amounts of neomycin, streptomycin, and polymyxin B. 

Are there risks associated with the Polio vaccine?
Even though the purification process of the vaccine removes all measurable amounts of neomycin, streptomycin, and polymyxin B, allergic reactions may occur in individuals sensitive to these substances.
The most common adverse reactions to the polio vaccine:

  • Redness and pain at the site of injection
  • Fussiness/irritability
  • Fever over 102°F

MMR

What is the MMR vaccine?
There are two vaccines licensed to reduce the spread of measles, mumps, and rubella in the US. The two  MMR vaccines licensed for use in the US are:

The CDC recommends two doses of MMR: 12-15 months and 5-6 years.

What is actually in the MMR vaccine?
The MMRII® vaccine contains all three live attenuated (weakened) viruses (measles, mumps, and rubella). Other vaccine ingredients include sodium phosphate, sodium bicarbonate, Medium 199, minimum essential medium, neomycin, phenol red, sorbitol, potassium phosphate, gelatin, sucrose, and MSG.

Are there risks associated with the MMR vaccine?
Common adverse reactions of the MMRII® vaccine: 

  • Pain at the site of injection
  • Fever over 102°F
  • Rash
  • Temporary joint stiffness.

The MMR vaccine has also been associated with an increase in febrile seizures. With the potential presence of neomycin after purification there is a small risk of allergic reaction in individuals who are sensitive to that substance.

Varicella

What is the varicella vaccine?
The varicella vaccine prevents the person-to-person spread of the varicella zoster virus which results in what is commonly known as Chickenpox. There is one standalone vaccine licensed in the US and one combination vaccine.

What is actually in the varicella vaccine?
Varivax contains live attenuated varicella zoster virus, processed porcine gelatin, MSG, trace quantities of MRC-5 cells (human lung fibroblasts), EDTA, neomycin, and fetal bovine serum.

What are the risks associated with the varicella vaccine?
Common adverse reactions of the Varivax vaccine:

  • Pain and soreness at the site of injection
  • Fever over 102°F
  • Chickenpox-like rash at the injection site.

Can my child get chickenpox from the vaccine?
There is a small chance (<4%) chance of developing a generalized rash (head-to-toe) from the vaccine. Transmission of the vaccine virus is not common but the risk of transmission increases if a rash pesents. Risks from the vaccine virus are less than that of the wild-type virus in adults.
Rare but serious adverse reactions of the vaccine include severe allergic reactions to vaccine components.

If my child is vaccinated for chickenpox does it mean they won’t get shingles?
No, shingles is the reactivation of the chickenpox virus. The vaccine is a live attenuated virus and has the potential to reactivate later in life as shingles.

Hepatitis A

What is the Hepatitis A vaccine?
The Hepatitis A vaccine prevents the person-to-person spread of the Hepatitis A virus. The two standalone and one combination vaccine licensed for use in the US are: 

The CDC recommends that children receive 2 doses of the Hepatitis A vaccine: 12 and 18 months. 

What is actually in the Hepatitis A vaccine?
The Hepatitis A vaccine contains live attenuated Hepatitis A virus. Other ingredients include aluminum (225µg in Vaqta and 250µg in Harvix), saline solution, and 2-phenoxyethanol. Ingredients included in the manufacturing of the vaccine include but are not limited to residual proteins and DNA, amino acids, polysorbate 20, formaldehyde, formalin, sodium borate, and Neomycin.  

What are the risks associated with the Hepatitis A vaccine?
The most common adverse reactions to the Hepatitis A vaccine:

  • Pain and soreness at site of injection
  • Irritability
  • Fatigue/malaise
  • Low grade fever, 102°F (2-3 days)
  • Diarrhea
  • Nausea
  • Jaundice (yellowing of skin)

Severe reactions to the Hepatitis A vaccine include enlarged liver, liver damage, and acute liver failure.

Hepatitis B

What is the Hepatitis B vaccine?
The Hepatitis B vaccine prevents the person-to-person spread of the Hepatitis B virus. The standalone vaccines approved for use in the US are: 

The combination vaccines licensed for use in the US are: 

The CDC recommends that children receive 3 doses of Hepatitis B vaccine: Birth, 1 month, and 6-18 months. 

Important to Note: The hepatitis B vaccine at birth is necessary only in those born to mothers infected with the hepatitis B virus. You can refuse this dose and choose to vaccinate your child at a later date. 

What is actually in the Hepatitis B vaccine?
The Hepatitis B vaccine contains the hepatitis B virus surface antigen. Other ingredients include aluminum, saline solution, and phosphate buffers. Ingredients included in the manufacturing of the vaccine include but are not limited to yeast proteins and formaldehyde. 

Which Hepatitis B vaccine contains the least amount of aluminum per dose?

What are the risks associated with the Hepatitis B vaccine?
The most common adverse reactions to the Hepatitis B vaccine:

  • Pain and soreness at site of injection
  • Fatigue
  • Headache
  • Fever and malaise
  • Nausea and vomiting

Rare adverse reactions reported during postmarketing surveillance include but are not limited to:

  • Immune System Disorders: Hypersensitivity reactions, arthralgias/arthritis, systemic lupus erythematosus (SLE), lupus-like syndrome, vasculitis, and polyarteritis nodosa
  • Gastrointestinal Disorders: Elevation of liver enzymes
  • Nervous System Disorders: Guillain-Barré syndrome, multiple sclerosis, Bell’s Palsy.
  • Skin and Subcutaneous Disorders: Stevens-Johnson syndrome; alopecia; petechiae; eczema
  • Blood and Lymphatic System Disorders: Increased erythrocyte sedimentation rate; thrombocytopenia
  • Eye Disorders: Optic neuritis

Anybody can report adverse vaccine events online using the Vaccine Adverse Event Reporting System.

What are the “Other Ingredients” that I am seeing in the vaccines?
Vaccines contain not only the bacterial and viral antigens, but other ingredients that are used for sterilizing, preserving, enhancing, and aiding in the growth of the active substance; as well as, inactivation and stabilizing of the product. These ingredients are vital in making the vaccine effective but can cause reactions in individuals who have sensitivities to these components.

What is the manufacturing process of a vaccine?
In the manufacturing process of the vaccine, the viruses and bacteria are grown in different growth mediums. These growth mediums are typically derived from bovine (cow) for bacteria and cells from human, chicken, or monkey for viruses. The sterilization and inactivation process can include formaldehyde and antibiotics to kill any potential bacteria in viral vaccines.

I keep hearing about adjuvants, what are they?
Adjuvants are immunological agents added to vaccines to boost the immune response. This boost gives a higher concentration of antibodies and therefore longer lasting protection. Nearly all vaccines, except live attenuated vaccines, contain adjuvants. Aluminum being the most commonly used. You will find aluminum in the following standalone or combination vaccines: PCV, Hepatitis B, and DTaP. 

There is little understanding of what aluminum does to children when injected and it is unknown whether the aluminum accumulates in the body or is eliminated through pathways of detox.

What about preservatives and thimerosal?
Preservatives are compounds that prevent growth of microorganisms in vaccines. Thimerosal was the most commonly used preservative until it was removed from childhood vaccines in 2001. You can still find thimerosal in multi-dose flu vaccines, but all other commonly used childhood vaccines do not contain measurable amounts. 

If we aren’t using thimerosal, what are we using?
Most often preservatives are not needed because single dose vials are used instead of multi-dose vials. 

What about stabilizers? Are those the same as preservatives?
Stabilizers help maintain effectiveness during transport and storage. Stabilizers commonly used are 2-phenoxyethanol, MSG, sugars, and gelatins. 

Need support in navigating the CDC’s recommended vaccine schedule?
In the face of the covid-19, it is even more important to make proactive decisions for your child’s health. As a naturopathic pediatrician I will help you navigate the recommendations and create a plan that fits your child’s needs.
Schedule a Vaccine Consultation or Well Child Visit with me today!

Stay tuned for my next article: Immunization Schedules
I will discuss the CDC’s recommended vaccine schedule, alternative schedules, identifying risk for adverse reactions, and how to support your child through vaccinations.

  1.   Black S, Shinefield H, Fireman B, Lewis E, Ray P, Hansen JR, Elvin L, Ensor KM, Hackell J, Siber G, Malinoski F, Madore D, Chang I, Kohberger R, Watson W, Austrian R EK. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. Pediatr Infect Dis J. 2000;19(3):187-195.

 

 

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