Why do kids get so many shots?

Cream colored teddy bear sitting on a medical exam table with sterile bandages and other medical supplies, with a bandaid on its chest and wearing a paper mask.
Teddy Bear Hospital by Christiaan Triebert via Flickr.

I’m an ardent believer in the relative safety and efficacy of vaccines, but that doesn’t mean I enjoy having to take my kid to the doctor for shots. I’m relieved that my child is now in school and the bulk of vaccinations are behind us. When he was an infant, we carefully timed his feedings so that he’d nurse right after a shot, as the easiest means of soothing him. When he was a toddler, we resorted to ice cream. Needless to say, none of us particularly enjoyed these experiences.

Other than an annual flu shot and the occasional booster, there aren’t many more shots that he’ll be getting. But for a while, it seemed like every doctor’s visit was accompanied by a shot. So it makes sense that parents would be asking themselves “are all these shots necessary?”

It’s normal to have questions about vaccines, because the vaccine schedule is different than the one that existed when we were kids. So, why do our kids get so many shots these days? Do they actually get more shots than we did when we were kids? And are there any that can be skipped, particularly if you’re the parent that faints at the sight of a needle, or has a kid that will cry for hours on end after a jab?

Are there more shots today than there were a few decades ago?

Yes. Children today receive more vaccinations than they did in the past. But there’s good reason for this:

  • Children get more shots today simply because there are more vaccines. Shots for Hepatitis B didn’t exist when I was born (I’m dating myself here…). Neither did vaccinations for chickenpox. So the fact that children get more shots today also means they are protected against even more diseases. Just imagine: there’s now a shot that can help prevent a type of cancer. That’s pretty awesome.
  • The annual flu shot has to be given at the beginning of each flu season. Because the flu virus is constantly changing, the vaccine has to change accordingly. That’s also why the efficacy of the vaccine fluctuates year to year. Some years, the vaccine matches the flu virus pretty well. Other years, it doesn’t.

The good news is that scientists are constantly working on creating combination vaccines. As you may know, the famous MMR vaccine prevents measles, mumps, and rubella. These were given as separate vaccines until 1971. Combination vaccines help doctors, parents, and patients: parents need to make fewer visits to the doctor’s office, and kids face the needle far fewer times. Plus, the odds of missing a shot decreases.

Won’t my child’s system get overwhelmed from so many shots?

Infographic showing Vaccines Today Work Better Than Ever. Since 1980: More protection, fewer antigens.
Image from iVaccinate.

No. In addition to targeting more diseases scientists have also improved the composition of shots over the years. So, even though kids receive more vaccinations, the amount of antigens (the proteins that help us acquire immunity) they receive is actually significantly less. In the 1980s, the total amount of proteins that children would receive from all their vaccinations was approximately 3000. Today, it’s less than 200.

It’s also important to remember that getting the disease that the vaccine prevents exposes us to far more antigens than what is present in a vaccine. The number of antigens for some vaccines (tetanus, as an example) is as low as 1.

Can I spread out my kid’s shots?

The CDC’s vaccine schedule is reviewed three times a year to determine if any changes need to be made based on the latest data available. The final schedule considers the child’s health as well as the risk of exposure to disease. For example, growing up in Venezuela, I received shots for yellow fever, but in the United States the risk of exposure to this disease is very low so it is not included in the CDC’s vaccination schedule. However, if there was a yellow fever outbreak, the CDC may consider updating the vaccination schedule to include this shot.

Ignoring the CDC’s recommended schedule to spread out shots is risky because:

  • The schedule you pick will not have been tested. You are giving up a schedule that has been trialed and tested for a schedule that has little data to support it.
  • By delaying vaccinations and spreading them out, you increase the risk that your child will encounter the virus without having built up sufficient immunity.
  • There’s data suggesting that delaying vaccinations increases the risk of febrile seizures after vaccination.

In short, there’s no real benefit in delaying vaccinations, only added risk.

Are there any shots that I can skip?

Instead of asking “is there a shot that I can skip”, ask yourself “is there a disease that I’m willing to risk exposing my child to”? It makes a difference, doesn’t it? Because every parent will always say “I don’t want my child to get sick”.

Parents today seem especially skeptical of the value of the chickenpox and flu shots, since many of them got both of these without any long term health impact. This is a type of “survivorship bias”: a selection bias that can lead us to incorrect and optimistic conclusions  because some of the data is missing (in this case, we don’t hear from individuals who suffered the worst consequences of chickenpox, because they didn’t survive).

The Chickenpox Vaccine

I got the chickenpox, also known as varicella, as a child. I have a few scars on my head from it, but otherwise I’m unscathed. My mom stayed home with me and my two siblings for a week or so while we were sick, which could not have been easy. Had she been working outside of the home, it would have been a financial stress, too.

What’s worse is the risk of shingles, a side effect of getting the chickenpox. My mom got shingles several times later in life, as did my aunt and my grandma, who got shingles while in the hospital in the last month of her life. Once you get chickenpox, the virus lays dormant in your body for years, ultimately presenting itself as shingles, especially when you’re weak and your immune system is fighting off something else. My mom has told me that it’s a very painful experience that can last a long time. Thinking of my grandma, who couldn’t speak at the time, having to deal with shingles on top of everything else fills me with immense sadness. So it came as no surprise to me that my mom got the vaccine for shingles as soon as it was available. I will too, as soon as I qualify for it.

Chickenpox itself carries risk, as its complications are quite severe. So given the choice between a) the low-risk vaccine for chickenpox or b) the risk of chickenpox that could have complications and would require a vaccine later in life to avoid shingles, it was a pretty easy choice to vaccinate my son.

Infographic of Varicella aka Chickenpox cause (varicella zoster virus), symptoms, prevention (vaccination), complications, and epidemiology.
Image from Dawn’s Brain.

The flu shot

The most common argument I hear against the flu shot is “well, it doesn’t work”. That’s not true. It may not prevent everyone from getting the flu, but it does work, because it saves lives. I look back to this last flu season which was particularly deadly: even though we were all vaccinated, I was still worried that my kid would get the flu and would require hospitalization, similar to dozens of children in our area. But since he was vaccinated, I knew that he had the best shot of remaining healthy and that if he did get the flu his symptoms would be less severe.

When we hear that “the flu shot only worked in 48% of cases”, that’s STILL 48% of cases that it prevented, which is better than 0 cases that are prevented when no one is vaccinated. And make no mistake about it: the flu can be deadly. In my home state of California, over 150 people died from the flu this last season, including young children. And since you cannot get the flu from the flu shot (because the flu virus in the shot is inactive), the risk associated with the shot is quite low.

Vaccines are one of the best disease prevention tools we have

Children today receive more shots than their parents did, but it’s for good reason. Today we can protect against more diseases than ever before. The current vaccine schedule actually protects again more diseases, with far fewer antigens. Though you might think of the chickenpox and the flu as ‘not that bad,’ these diseases can be painful, can have serious complications, even death. These vaccinations are important for our health, so parents should adhere to the schedules recommended by their pediatricians.